Factors affecting mortality and resource use for hospitalized patients with cirrhosis

PubMed Central

Charatcharoenwitthaya, Phunchai; Soonthornworasiri, Ngamphol; Karaketklang, Khemajira; Poovorawan, Kittiyod; Pan-ngum, Wirichada; Chotiyaputta, Watcharasak; Tanwandee, Tawesak; Phaosawasdi, Kamthorn

2017-01-01

Abstract Hospitalizations for advanced liver disease are costly and associated with significant mortality. This population-based study aimed to evaluate factors associated with in-hospital mortality and resource use for the management of hospitalized patients with cirrhosis. Mortality records and resource utilization for 52,027 patients hospitalized with cirrhosis and/or complications of portal hypertension (ascites, hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis, or hepatorenal syndrome) were extracted from a nationally representative sample of Thai inpatients covered by Universal Coverage Scheme during 2009 to 2013. The rate of dying in the hospital increased steadily by 12% from 9.6% in 2009 to 10.8% in 2013 (P < .001). Complications of portal hypertension were independently associated with increased in-hospital mortality except for ascites. The highest independent risk for hospital death was seen with hepatorenal syndrome (odds ratio [OR], 5.04; 95% confidence interval [CI], 4.38–5.79). Mortality rate remained high in patients with infection, particularly septicemia (OR, 4.26; 95% CI, 4.0–4.54) and pneumonia (OR, 2.44; 95% CI, 2.18–2.73). Receiving upper endoscopy (OR, 0.29; 95% CI, 0.27–0.32) and paracentesis (OR, 0.93; 95% CI, 0.87–1.00) were associated with improved patient survival. The inflation-adjusted national annual costs (P = .06) and total hospital days (P = .07) for cirrhosis showed a trend toward increasing during the 5-year period. Renal dysfunction, infection, and sequelae of portal hypertension except for ascites were independently associated with increased resource utilization. Renal dysfunction, infection, and portal hypertension-related complications are the main factors affecting in-hospital mortality and resource utilization for hospitalized patients with cirrhosis. The early intervention for modifiable factors is an important step toward improving hospital outcomes. PMID:28796076

Occupational social class and mortality in a population of men economically active: the contribution of education and employment situation.

PubMed

Regidor, Enrique; Ronda, Elena; Martínez, David; Calle, M Elisa; Navarro, Pedro; Domínguez, Vicente

2005-01-01

This study examines how education and employment situation contribute to the association between a classification of occupational class based on skill assets and mortality from different causes of death. Data were obtained by linking records from the 1996 population census for Spanish men aged 35-64 residing in Madrid with 1996 and 1997 mortality records. The risk of mortality was higher in skilled, semi-skilled and unskilled workers than in higher and lower managerial and professional workers. Adjusting for educational level substantially decreased the magnitude of the gradient. The decrease in the gradient after adjusting for employment situation was much smaller. Except in the case of mortality from respiratory diseases, the mortality gradient disappeared after adjusting for both variables. These results show that education and, to a much lesser degree, employment situation explain part of the social gradient observed in mortality from all causes and from broad causes of death, except from respiratory diseases.

Country level economic disparities in child injury mortality.

PubMed

Khan, Uzma Rahim; Sengoelge, Mathilde; Zia, Nukhba; Razzak, Junaid Abdul; Hasselberg, Marie; Laflamme, Lucie

2015-02-01

Injuries are a neglected cause of child mortality globally and the burden is unequally distributed in resource poor settings. The aim of this study is to explore the share and distribution of child injury mortality across country economic levels and the correlation between country economic level and injuries. All-cause and injury mortality rates per 100,000 were extracted for 187 countries for the 1-4 age group and under 5s from the Global Burden of Disease Study 2010. Countries were grouped into four economic levels. Gross domestic product (GDP) per capita was used to determine correlation with injury mortality. For all regions and country economic levels, the share of injuries in all-cause mortality was greater when considering the 1-4 age group than under 5s, ranging from 36.6% in Organization for Economic Cooperation and Development countries to 10.6% in Sub-Saharan Africa. Except for Sub-Saharan Africa, there is a graded association between country economic level and 1-4 injury mortality across regions, with all low-income countries having the highest rates. Except for the two regions with the highest overall injury mortality rates, there is a significant negative correlation between GDP and injury mortality in Latin America and the Caribbean, Eastern Europe/Central Asia, Asia East/South-East and Pacific and North Africa/ Middle East. Child injury mortality is unevenly distributed across regions and country economic level to the detriment of poorer countries. A significant negative correlation exists between GDP and injury in all regions, exception for the most resource poor where the burden of injuries is highest. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Observed effects of an exceptional drought on tree mortality in a tropical dry forest

NASA Astrophysics Data System (ADS)

Medvigy, D.; Vargas, G.; Xu, X.; Smith, C. M.; Becknell, J.; Brodribb, T.; Powers, J. S.

2016-12-01

Climate models predict that the coming century will bring reduced rainfall to Neotropical dry forests. It is unknown how tropical dry forest trees will respond to such rainfall reductions. Will there be increased mortality? If so, what will be the dominant mechanism of mortality? Will certain functional groups or size classes be more susceptible to unusually dry conditions and do functional traits underlie these patterns? With these questions in mind, we analyzed the response of trees from 18 Costa Rican tropical dry forest inventory plots and from additional transects to the exceptional 2015 drought that coincided with a strong ENSO event. We compared stand-level mortality rates observed during pre-drought years (2008-2014) and during the drought year of 2015 in the inventory plots. For both inventory plots and transects, we analyzed whether particular functional groups or size classes experienced exceptional mortality after the drought. We found that mortality rates were two to three times higher during the drought than before the drought. In contrast to observations at moist tropical forests, tree size had little influence on mortality. In terms of functional groups, mortality rates of evergreen oaks growing on nutrient-poor soils particularly increased during drought. Legumes seemed less affected by the drought than non-legumes. However, elevated mortality rates were not clearly correlated with commonly-measured traits like wood density or specific leaf area. Instead, hydraulic traits like P50 or turgor loss point may be better predictors of drought-driven mortality. In addition, trees that died during the drought tended to have smaller relative growth rate prior to the drought than trees that survived the drought.

[Epidemiological transition in Latin America: a comparison of four countries].

PubMed

Albala, C; Vio, F; Yáñez, M

1997-06-01

In the last decade, Latin America has experienced important transformations in its health conditions, due to demographic changes and a rapid urbanization process. To analyze socioeconomic, demographic and epidemiological changes in Chile, Guatemala, Mexico and Uruguay and relate them to the different stages in the demographic and epidemiological transition of these countries. Data was obtained from official information of local and international organizations such as Pan-American Health Organization, United Nations, Latin American Center for Demography (CELADE) and World Bank. Guatemala is in a pre-transition stage with a high proportion of communicable diseases as causes of death (61%) as compared with Mexico (22%), Chile (13%) and Uruguay (7%). Mexico is in a prolonged transition situation and Chile is close to Uruguay in a post-transitional stage. Despite decreasing rates of mortality, the proportion of deaths represented by chronic diseases and injuries has increased to over 30% in all countries, except Uruguay. Adjusted mortality rates for cardiovascular diseases are lower in Latin American countries, as compared to Canada. However, excepting Guatemala, there are differences in the pattern of cardiovascular disease, with a higher mortality due to cerebrovascular and a lower mortality due to coronary artery diseases. An increment in non communicable diseases is expected for the next decades in Latin America. Analysis of demographic and epidemiological transition is crucial to define health policies and to adequate health systems to the new situations.

Adaptation of the Long-Lived Monocarpic Perennial Saxifraga longifolia to High Altitude1[OPEN

PubMed Central

Morales, Melanie; Fleta-Soriano, Eva; Garcia, Maria B.

2016-01-01

Global change is exerting a major effect on plant communities, altering their potential capacity for adaptation. Here, we aimed at unveiling mechanisms of adaptation to high altitude in an endemic long-lived monocarpic, Saxifraga longifolia, by combining demographic and physiological approaches. Plants from three altitudes (570, 1100, and 2100 m above sea level [a.s.l.]) were investigated in terms of leaf water and pigment contents, and activation of stress defense mechanisms. The influence of plant size on physiological performance and mortality was also investigated. Levels of photoprotective molecules (α-tocopherol, carotenoids, and anthocyanins) increased in response to high altitude (1100 relative to 570 m a.s.l.), which was paralleled by reduced soil and leaf water contents and increased ABA levels. The more demanding effect of high altitude on photoprotection was, however, partly abolished at very high altitudes (2100 m a.s.l.) due to improved soil water contents, with the exception of α-tocopherol accumulation. α-Tocopherol levels increased progressively at increasing altitudes, which paralleled with reductions in lipid peroxidation, thus suggesting plants from the highest altitude effectively withstood high light stress. Furthermore, mortality of juveniles was highest at the intermediate population, suggesting that drought stress was the main environmental driver of mortality of juveniles in this rocky plant species. Population structure and vital rates in the high population evidenced lower recruitment and mortality in juveniles, activation of clonal growth, and absence of plant size-dependent mortality. We conclude that, despite S. longifolia has evolved complex mechanisms of adaptation to altitude at the cellular, whole-plant and population levels, drought events may drive increased mortality in the framework of global change. PMID:27440756

Adaptation of the Long-Lived Monocarpic Perennial Saxifraga longifolia to High Altitude.

PubMed

Munné-Bosch, Sergi; Cotado, Alba; Morales, Melanie; Fleta-Soriano, Eva; Villellas, Jesús; Garcia, Maria B

2016-10-01

Global change is exerting a major effect on plant communities, altering their potential capacity for adaptation. Here, we aimed at unveiling mechanisms of adaptation to high altitude in an endemic long-lived monocarpic, Saxifraga longifolia, by combining demographic and physiological approaches. Plants from three altitudes (570, 1100, and 2100 m above sea level [a.s.l.]) were investigated in terms of leaf water and pigment contents, and activation of stress defense mechanisms. The influence of plant size on physiological performance and mortality was also investigated. Levels of photoprotective molecules (α-tocopherol, carotenoids, and anthocyanins) increased in response to high altitude (1100 relative to 570 m a.s.l.), which was paralleled by reduced soil and leaf water contents and increased ABA levels. The more demanding effect of high altitude on photoprotection was, however, partly abolished at very high altitudes (2100 m a.s.l.) due to improved soil water contents, with the exception of α-tocopherol accumulation. α-Tocopherol levels increased progressively at increasing altitudes, which paralleled with reductions in lipid peroxidation, thus suggesting plants from the highest altitude effectively withstood high light stress. Furthermore, mortality of juveniles was highest at the intermediate population, suggesting that drought stress was the main environmental driver of mortality of juveniles in this rocky plant species. Population structure and vital rates in the high population evidenced lower recruitment and mortality in juveniles, activation of clonal growth, and absence of plant size-dependent mortality. We conclude that, despite S. longifolia has evolved complex mechanisms of adaptation to altitude at the cellular, whole-plant and population levels, drought events may drive increased mortality in the framework of global change. © 2016 American Society of Plant Biologists. All Rights Reserved.

Women live longer than men even during severe famines and epidemics

PubMed Central

Zarulli, Virginia; Barthold Jones, Julia A.; Oksuzyan, Anna; Lindahl-Jacobsen, Rune; Christensen, Kaare; Vaupel, James W.

2018-01-01

Women in almost all modern populations live longer than men. Research to date provides evidence for both biological and social factors influencing this gender gap. Conditions when both men and women experience extremely high levels of mortality risk are unexplored sources of information. We investigate the survival of both sexes in seven populations under extreme conditions from famines, epidemics, and slavery. Women survived better than men: In all populations, they had lower mortality across almost all ages, and, with the exception of one slave population, they lived longer on average than men. Gender differences in infant mortality contributed the most to the gender gap in life expectancy, indicating that newborn girls were able to survive extreme mortality hazards better than newborn boys. Our results confirm the ubiquity of a female survival advantage even when mortality is extraordinarily high. The hypothesis that the survival advantage of women has fundamental biological underpinnings is supported by the fact that under very harsh conditions females survive better than males even at infant ages when behavioral and social differences may be minimal or favor males. Our findings also indicate that the female advantage differs across environments and is modulated by social factors. PMID:29311321

Urinary cadmium and mortality among inhabitants of a cadmium-polluted area in Japan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nakagawa, Hideaki; Nishijo, Muneko; Morikawa, Yuko

The influence of cadmium (Cd) body burden on mortality remains controversial. Excess mortality and the dose-response relationship between mortality and urinary cadmium excretion were investigated in this study among environmentally exposed subjects. A 15-year follow-up study was carried out on 3119 inhabitants (1403 men and 1716 women) of the Cd-polluted Kakehashi River basin, whose urinary Cd concentration was examined in a 1981-1982 health impact survey. The mortality risk of high urinary Cd ({>=}10 {mu}g/g Cr) subjects after adjustment for age using Cox's proportional hazard model was higher than that of moderate urinary Cd (<10 {mu}g/g Cr) subjects in both sexes.more » When the subjects were divided into five groups according to the amount of urinary Cd (<3, 3-5, 5-10, 10-20, {>=}20 {mu}g/g Cr), the mortality risk was significantly increased among the subjects with urinary Cd{>=}3 {mu}g/g Cr in proportion to the increases in the amount of urinary Cd concentration after adjustment for age, especially in women. Furthermore, special causes of death among high and moderate urinary Cd were investigated, and mortality risk ratio for heart failure, which is a cause of death often diagnosed in cases with a gradual deterioration culminating in death, was significantly increased in both sexes, compared with the moderate urinary Cd subjects. Also, in women the mortality risk for renal diseases in the high urinary Cd subjects was significantly higher than that in the moderate urinary Cd subjects. These results suggest that a causal association between Cd body burden and mortality exists among inhabitants environmentally exposed to Cd but that no special disease may be induced except renal diseases.« less

Flavonoid intake and mortality from cardiovascular disease and all causes: A meta-analysis of prospective cohort studies.

PubMed

Kim, Youngyo; Je, Youjin

2017-08-01

Accumulating studies have suggested that flavonoid intake is associated with a decreased risk of coronary heart disease and cardiovascular disease (CVD). There are many epidemiological studies on flavonoid intake and mortality, but no comprehensive investigation has yet been conducted. To quantitatively assess the association between flavonoid intake and mortality from CVD and all-causes, we performed a meta-analysis of prospective cohort studies. Eligible studies were identified by searching PubMed and Web of Science databases for all articles published up to May 2016 and via hand searching. Study-specific estimates adjusting for potential confounders were combined to calculate a pooled relative risk (RR) with 95% confidence interval (CI) using a random-effects model. A total of 15 prospective cohort studies that examined the association between flavonoid intake and mortality from CVD and all-causes were identified. The pooled RR of CVD mortality for the highest versus lowest category of flavonoid intake was 0.86 (95% CI: 0.75, 0.98). By subclass of flavonoids, all classes, except flavonols and isoflavones, showed significant inverse associations. A nonlinear association was found between flavonoid intake and CVD mortality in the dose-response analysis. For total mortality, a high intake of flavonoids was associated with lower total mortality (pooled RR = 0.86, 95% CI: 0.73, 1.00). Our findings indicate that a high intake of flavonoids is associated with reduced risk of mortality from CVD and all causes in men and women. These results support current recommendations of high fruit and vegetables intake as a part of a healthy diet. Copyright © 2017 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Bird mortality during nocturnal migration over Lake Michigan: A case study

USGS Publications Warehouse

Diehl, Robert H.; Bates, John M.; Willard, David E.; Gnoske, Thomas P.

2014-01-01

Millions of birds die each year during migration. Most of this mortality goes unobserved and conditions surrounding the actual events are often not thoroughly documented. We present a case study of substantial migrant casualties along the shores of southwestern Lake Michigan during May 1996 when we found 2,981 dead birds of 114 species, mostly migrant passerines. An unusual sequence of events allowed us to document the circumstances surrounding this migratory bird kill. Bird carcasses appeared on the southwestern shores of Lake Michigan in the days following storm systems that produced high rain and in one case, hail. Encounters between birds and precipitation over open water were recorded by weather radar, and were followed by winds that drifted dead birds toward highly populated shorelines where the kill was observed and documented. Climatologically, May 1996 was exceptional for producing weather conditions that both killed birds en masse and allowed the mortality to be documented. As a result, this is one of the more thoroughly documented instances of a weather-related mass mortality event during migration.

High mortality among patients infected with hypervirulent antimicrobial-resistant capsular type K1 Klebsiella pneumoniae strains in Taiwan.

PubMed

Lin, Yi-Tsung; Cheng, Yi-Hsiang; Juan, Chih-Han; Wu, Ping-Feng; Huang, Yi-Wei; Chou, Sheng-Hua; Yang, Tsuey-Ching; Wang, Fu-Der

2018-06-12

Capsular type K1 Klebsiella pneumoniae, highly virulent strains which are common in Asian countries, can cause pyogenic infections. These hypervirulent strains are usually susceptible to most antimicrobials, except for ampicillin. Little is known regarding the clinical and molecular characteristics of antimicrobial-resistant K1 K. pneumoniae strains. This retrospective study evaluated patients infected with capsular type K1 K. pneumoniae strains in a Taiwanese medical centre between April 2013 and March 2016. Antimicrobial-resistant strains were defined based on non-susceptibility to antimicrobial agents except ampicillin. We compared the clinical outcome of patients infected with and without antimicrobial-resistant strains. The in vivo virulence, genetic relatedness, and resistance mechanisms of these hypervirulent antimicrobial-resistant strains were also investigated. A total of 182 capsular type K1 K. pneumoniae strains were identified, including 18 antimicrobial-resistant strains. The 28-day mortality rate among the 18 cases caused by antimicrobial-resistant strains was significantly higher than that among 164 cases caused by antimicrobial-sensitive strains (50% vs. 10.4%, p < 0.001). Infection with antimicrobial-resistant strain independently increased the 28-day mortality risk. Most antimicrobial -resistant strains were not clonally related, and they exhibited high in vivo virulence in a mouse lethality experiment. The major resistance mechanisms involved the presence of β-lactamases and the overexpression of efflux pumps. In conclusion, hypervirulent antimicrobial-resistant capsular type K1 K. pneumoniae strains can predispose to a fatal outcome. These strains may represent an emerging threat to public health in Taiwan. Copyright © 2018. Published by Elsevier B.V.

Evacuation effect on excess mortality among institutionalized elderly after the fukushima daiichi nuclear power plant accident.

PubMed

Yasumura, Seiji

2014-01-01

The Great East Japan Earthquake hit Fukushima Prefecture on March 11, 2011, just over 3 years ago and it continues to affect our lives. In Fukushima, many people are confirmed dead or still missing due to the earthquake and/or tsunami. Additional "disaster-related deaths" have been attributed to the Fukushima Daiichi Nuclear Power Plant (NPP) accident. Mortality among the institutionalized elderly rates after the NPP accident were exceptionally high during the first 3 months, and persisted at a lower level for 9 months, in comparison with similar periods before the accident. This study demonstrates the great impact of evacuation on mortality of institutionalized elderly, excluding inpatients. We need to pay special attention to evacuation of the elderly, regardless of whether voluntary or forced.

Mortality of white-tailed deer in northeastern Minnesota

USGS Publications Warehouse

Nelson, M.E.; Mech, L.D.

1986-01-01

Two hundred nine white-tailed deer (Odocoileus virginianus) were radiotracked in the central Superior National Forest, Minnesota, from 1973 through winter 1983-84; 85 deaths were recorded. Annual survival was 0.31 for fawns (< 1.0 years old), 0.80 for yearling (1.0-2.0 years old) females, 0.41 for yearling males, 0.79 for adult (.gtoreq. 2.0 years old) females, and 0.47 for adult males. Monthly survival rates were high from May through December (0.94-1.00), except for yearling (0.60) and adult (0.69) bucks during the November hunting season. Most mortality occurred from January through April when gray wolf (Canis lupus) predation was an important mortality source for all cohorts. Yearling males were most vulnerable to hunting and adult males to wolf predation.

Fumigant Toxicity of Essential Oils from Basil and Spearmint Against Two Major Pyralid Pests of Stored Products.

PubMed

Eliopoulos, P A; Hassiotis, C N; Andreadis, S S; Porichi, A-E E

2015-04-01

The fumigant activity of essential oil vapors distilled from sweet basil Ocimum basilicum L. and spearmint Mentha spicata L. (Lamiaceae) were tested against two major stored products pests Ephestia kuehniella (Zeller) and Plodia interpunctella (Hübner) (Lepidoptera: Pyralidae). Various oil doses (0.5, 2.5, 5, 50, 250, 500, 1,000, and 1,500 µl/liter air), for an exposure period of 24 h, were tested. The essential oils were subjected to gas chromatography-mass spectrometry analysis and revealed that the major compounds were for spearmint oil carvone (67.1%) and limonene (+1,8 cineole; 14.3%) and for basil oil linalool (45.9%), 1,8 cineole (16.7%) and eugenol (10.3%). Apart from a few exceptions, no significant differences in insecticidal action were observed between basil and spearmint oil. Both oils were highly effective against adult moths, given that notable mortality (>80%) was recorded after exposure to low doses such as 2.5 µl/liter. Noteworthy, egg mortality was also recorded, reaching 73-79% for basil and 56-60% for spearmint. Toxicity data indicated that larvae and pupae were the most tolerant stages in all cases. Larval mortality never exceeded 21 and 18%, for basil and spearmint, respectively, irrespective of moth species. Basil and spearmint oils displayed mortalities as high as 38 and 28% in pupae. Lethal doses (LD50 and LD99) values were estimated via probit analysis. Developmental stage proved to be a significant factor, whereas the effect of oil species on insect mortality was insignificant. With the exception of adult individuals, basil and spearmint oils did not show satisfactory overall insecticidal activity against E. kuehniella and P. interpunctella. © The Authors 2015. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The U-shaped association of body mass index with mortality: Influence of the traits height, intelligence, and education.

PubMed

Jørgensen, Terese Sara Høj; Osler, Merete; Ängquist, Lars Henrik; Zimmermann, Esther; Christensen, Gunhild Tidemann; Sørensen, Thorkild I A

2016-10-01

The U-shaped association between body mass index (BMI) and mortality may depend on other traits with permanent health effects. Whether the association between BMI and mortality depends on levels of health-related traits known to be inversely associated with mortality throughout adult life such as height, intelligence, and education was investigated. The study was based on a cohort of young men with data on weight, height, intelligence test score, and education from the Danish Conscription Database. In total, 346,500 men born 1939 to 1959 were followed until December 2013. The association between BMI and mortality was analyzed using Cox-regression models including interactions between BMI and height, intelligence, and education, respectively. BMI and mortality showed the U-shaped association from the start of the follow-up period, and it persisted through the subsequent 56 years. As expected, the mortality was inversely associated with height, intelligence, and education, but the U shape of the association between BMI and mortality was unaffected by the levels of these traits except at higher BMI values, where the slopes were steeper for men with higher levels of height, intelligence, and education. High and low BMI was associated with higher mortality throughout life regardless of the levels of height, intelligence, and education. © 2016 The Obesity Society.

Mortality of resprouting chaparral shrubs after a fire and during a record drought: physiological mechanisms and demographic consequences.

PubMed

Pratt, R Brandon; Jacobsen, Anna L; Ramirez, Aaron R; Helms, Anjel M; Traugh, Courtney A; Tobin, Michael F; Heffner, Marcus S; Davis, Stephen D

2014-03-01

We examined postfire regeneration of chaparral shrubs during an intense drought. This study focused on the demography and physiology of shrub species that resprout from a basal lignotuber following fire. We found significant levels of resprout mortality when intense drought occurred in the year following fire during the period of shrub recovery. Three of the seven sampled resprouting species had the greatest or near greatest levels of mortality ever recorded when compared to previous studies. Most shrub mortality occurred during the drought after individuals had resprouted (i.e. individuals survived fire, resprouted and then subsequently died). Physiological measurements of species with high mortality suggested that resprout stems were highly embolized and xylem hydraulic conductivities were close to zero during the peak of the drought. In addition, lignotubers of two of the three species experiencing high mortality were depleted of starch. Population densities of most shrub species declined after the drought compared with their prefire levels, with the exception of one drought tolerant obligate seeding species. Resprouting shrub species may deplete their carbohydrate reserves during the resprouting process, making them particularly vulnerable to drought because of the need to transpire water to acquire the CO2 that is used to supply energy to a large respiring root system. Drought appears to interact with fire by altering postfire shrub recovery and altering species abundances and composition of chaparral communities. © 2013 John Wiley & Sons Ltd.

Heat Wave and Mortality: A Multicountry, Multicommunity Study

PubMed Central

Gasparrini, Antonio; Armstrong, Ben G.; Tawatsupa, Benjawan; Tobias, Aurelio; Lavigne, Eric; Coelho, Micheline de Sousa Zanotti Stagliorio; Pan, Xiaochuan; Kim, Ho; Hashizume, Masahiro; Honda, Yasushi; Guo, Yue-Liang Leon; Wu, Chang-Fu; Zanobetti, Antonella; Schwartz, Joel D.; Bell, Michelle L.; Scortichini, Matteo; Michelozzi, Paola; Punnasiri, Kornwipa; Li, Shanshan; Tian, Linwei; Garcia, Samuel David Osorio; Seposo, Xerxes; Overcenco, Ala; Zeka, Ariana; Goodman, Patrick; Dang, Tran Ngoc; Dung, Do Van; Mayvaneh, Fatemeh; Saldiva, Paulo Hilario Nascimento; Williams, Gail; Tong, Shilu

2017-01-01

Background: Few studies have examined variation in the associations between heat waves and mortality in an international context. Objectives: We aimed to systematically examine the impacts of heat waves on mortality with lag effects internationally. Methods: We collected daily data of temperature and mortality from 400 communities in 18 countries/regions and defined 12 types of heat waves by combining community-specific daily mean temperature ≥90th, 92.5th, 95th, and 97.5th percentiles of temperature with duration ≥2, 3, and 4 d. We used time-series analyses to estimate the community-specific heat wave–mortality relation over lags of 0–10 d. Then, we applied meta-analysis to pool heat wave effects at the country level for cumulative and lag effects for each type of heat wave definition. Results: Heat waves of all definitions had significant cumulative associations with mortality in all countries, but varied by community. The higher the temperature threshold used to define heat waves, the higher heat wave associations on mortality. However, heat wave duration did not modify the impacts. The association between heat waves and mortality appeared acutely and lasted for 3 and 4 d. Heat waves had higher associations with mortality in moderate cold and moderate hot areas than cold and hot areas. There were no added effects of heat waves on mortality in all countries/regions, except for Brazil, Moldova, and Taiwan. Heat waves defined by daily mean and maximum temperatures produced similar heat wave–mortality associations, but not daily minimum temperature. Conclusions: Results indicate that high temperatures create a substantial health burden, and effects of high temperatures over consecutive days are similar to what would be experienced if high temperature days occurred independently. People living in moderate cold and moderate hot areas are more sensitive to heat waves than those living in cold and hot areas. Daily mean and maximum temperatures had similar ability to define heat waves rather than minimum temperature. https://doi.org/10.1289/EHP1026 PMID:28886602

Comparison of in-hospital versus 30-day mortality assessments for selected medical conditions.

PubMed

Borzecki, Ann M; Christiansen, Cindy L; Chew, Priscilla; Loveland, Susan; Rosen, Amy K

2010-12-01

In-hospital mortality measures such as the Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators (IQIs) are easily derived using hospital discharge abstracts and publicly available software. However, hospital assessments based on a 30-day postadmission interval might be more accurate given potential differences in facility discharge practices. To compare in-hospital and 30-day mortality rates for 6 medical conditions using the AHRQ IQI software. We used IQI software (v3.1) and 2004-2007 Veterans Health Administration (VA) discharge and Vital Status files to derive 4-year facility-level in-hospital and 30-day observed mortality rates and observed/expected ratios (O/Es) for admissions with a principal diagnosis of acute myocardial infarction, congestive heart failure, stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia. We standardized software-calculated O/Es to the VA population and compared O/Es and outlier status across sites using correlation, observed agreement, and kappas. Of 119 facilities, in-hospital versus 30-day mortality O/E correlations were generally high (median: r = 0.78; range: 0.31-0.86). Examining outlier status, observed agreement was high (median: 84.7%, 80.7%-89.1%). Kappas showed at least moderate agreement (k > 0.40) for all indicators except stroke and hip fracture (k ≤ 0.22). Across indicators, few sites changed from a high to nonoutlier or low outlier, or vice versa (median: 10, range: 7-13). The AHRQ IQI software can be easily adapted to generate 30-day mortality rates. Although 30-day mortality has better face validity as a hospital performance measure than in-hospital mortality, site assessments were similar despite the definition used. Thus, the measure selected for internal benchmarking should primarily depend on the healthcare system's data linkage capabilities.

Do women live longer or do men die earlier? Reflections on the causes of sex differences in life expectancy.

PubMed

Luy, Marc; Gast, Katrin

2014-01-01

Although many different factors have been identified to contribute to excess male mortality, it is still unclear which path of the complex cause-effect chain is the decisive driver of the life expectancy gap between women and men. The question behind this study is whether these sex differences are caused primarily by factors leading to low female mortality or rather by factors causing high male mortality. We hypothesise that they are to a large extent caused by specific subpopulations of men with particularly high mortality levels that decrease the average life expectancy of men. To test this hypothesis, we investigate in a meta-analysis the variability in mortality (VM) in women and men - defined as the range of death rates prevailing among subpopulations - in empirical studies analysing specific phenomena of mortality differentials. We used the data of 72 empirical studies, including 146 total effects (TE) and 1,718 single effects (SE) for 21 different risk factors. In 85% of TE and three quarters of SE the VM was higher in men than in women, taking into account men's higher overall mortality. The corresponding figures for the direct differences in the VM between women and men are 92 and 82%, respectively. Cases with higher female VM are rare exceptions and appear in particular in the highest age groups. We find support for our hypothesis that the disproportionate high mortality levels of specific male subpopulations are the central cause of the current extent of sex differences in life expectancy. Thus, public health programmes should be targeted toward these disadvantaged subpopulations among men which seem to be related primarily to socioeconomic characteristics.

The relative contribution of climatic, edaphic, and biotic drivers to risk of tree mortality from drought

NASA Astrophysics Data System (ADS)

March, R. G.; Moore, G. W.; Edgar, C. B.; Lawing, A. M.; Washington-Allen, R. A.

2015-12-01

In recorded history, the 2011 Texas Drought was comparable in severity only to a drought that occurred 300 years ago. By mid-September, 88% of the state experienced 'exceptional' conditions, with the rest experiencing 'extreme' or 'severe' drought. By recent estimates, the 2011 Texas Drought killed 6.2% of all the state's trees, at a rate nearly 9 times greater than average. The vast spatial scale and relatively uniform intensity of this drought has provided an opportunity to examine the comparative interactions among forest types, terrain, and edaphic factors across major climate gradients which in 2011 were subjected to extreme drought conditions that ultimately caused massive tree mortality. We used maximum entropy modeling (Maxent) to rank environmental landscape factors with the potential to drive drought-related tree mortality and test the assumption that the relative importance of these factors are scale-dependent. Occurrence data of dead trees were collected during the summer of 2012 from 599 field plots distributed across Texas with 30% used for model evaluation. Bioclimatic variables, ecoregions, soils characteristics, and topographic variables were modeled with drought-killed tree occurrence. Their relative contribution to the model was seen as their relative importance in driving mortality. To test determinants at a more local scale, we examined Landsat 7 scenes in East and West Texas with moderate-resolution data for the same variables above with the exception of climate. All models were significantly better than random in binomial tests of omission and receiver operating characteristic analyses. The modeled spatial distribution of probability of occurrence showed high probability of mortality in the east-central oak woodlands and the mixed pine-hardwood forest region in northeast Texas. Both regional and local models were dominated by biotic factors (ecoregion and forest type, respectively). Forest density and precipitation of driest month also contributed highly to the regional model. The local models gave more importance to available water storage at root zone and hillshade. Understanding how environmental factors drive drought-related mortality can help predict vulnerable landscapes and aid in preparing for future drought events.

Achieving the Millennium Development Goal for Under-five Mortality in Bangladesh: Current Status and Lessons for Issues and Challenges for Further Improvements

PubMed Central

Nury, Abu Taher Md. Sanaullah; Hossain, Md. Delwar

2011-01-01

The study assessed the achievements in, critically reviewed the relevant issues of, and put forward recommendations for achieving the target of the Millennium Development Goal relating to mortality of children aged less than five years (under-five mortality) in Bangladesh within 2015. To materialize the study objectives, a thorough literature review was done. Mortality of under-five children and infants decreased respectively to 65 from 151 and to 52 from 94 per 1,000 livebirths during 1990-2006. The immunization coverage increased from 54% to 81.9% during the same period. The projection shows that Bangladesh will achieve targeted reduction in under-five mortality and infant mortality within the time limit, except immunization coverage. Neonatal mortality contributed to the majority of childhood deaths. Contribution of neonatal mortality to child mortality was the highest. There were remarkable differences in child mortality by sex, division, and residence. To progress further for achieving the target of MDG relating to child mortality, some issues, such as lower use of maternal healthcare services, hazardous environmental effects on childhood illness, high malnutrition among children, shorter duration of exclusive breastfeeding practices, various child injuries leading to death, low healthcare-use of children, probable future threat of financial shortage, and strategies lacking area-wise focus on child mortality, need to be considered. Without these, the achievement of MDG relating to child mortality may not be possible within 2015. PMID:21608418

Warm weather transport of broiler chickens in Manitoba. II. Truck management factors associated with death loss in transit to slaughter.

PubMed

Whiting, Terry L; Drain, Mairead E; Rasali, Drona P

2007-02-01

This observational study was conducted to identify the cause of death and load level factors associated with mortality in 1 090 733 Manitoba broiler chickens transported to slaughter in spring and early summer. Death loss in transit was 0.346% and accounted for 19% of the total carcass condemnation. The death loss pattern was clearly bimodal, with a low death loss in 180 of 198 shipments. Cumulative death loss during the growing phase of production was consistently associated with increased transport mortalities in load level models and when comparing high death loss with low death loss truckloads. High ambient temperature at the time of slaughter and loading density of the truck were the major factors associated with exceptional death loss.

Women live longer than men even during severe famines and epidemics.

PubMed

Zarulli, Virginia; Barthold Jones, Julia A; Oksuzyan, Anna; Lindahl-Jacobsen, Rune; Christensen, Kaare; Vaupel, James W

2018-01-23

Women in almost all modern populations live longer than men. Research to date provides evidence for both biological and social factors influencing this gender gap. Conditions when both men and women experience extremely high levels of mortality risk are unexplored sources of information. We investigate the survival of both sexes in seven populations under extreme conditions from famines, epidemics, and slavery. Women survived better than men: In all populations, they had lower mortality across almost all ages, and, with the exception of one slave population, they lived longer on average than men. Gender differences in infant mortality contributed the most to the gender gap in life expectancy, indicating that newborn girls were able to survive extreme mortality hazards better than newborn boys. Our results confirm the ubiquity of a female survival advantage even when mortality is extraordinarily high. The hypothesis that the survival advantage of women has fundamental biological underpinnings is supported by the fact that under very harsh conditions females survive better than males even at infant ages when behavioral and social differences may be minimal or favor males. Our findings also indicate that the female advantage differs across environments and is modulated by social factors. Copyright © 2018 the Author(s). Published by PNAS.

Demographic and Geographical Characteristics of Pediatric Trauma in Scotland

DTIC Science & Technology

2013-01-01

the 8-fold Scottish Urban/ Rural Classifi- cation [20], which is based on settlement size and drive time to major conurbations. Social deprivation was...distribution, but with some exceptions. Scotland has an eccentrically distributed population, with 69.5% living in urban areas ( Scottish urban/ rural ...high rate of mortality and prehospital death. Acta Anaesthesiol Scand 2003;47:153-6. [20] Scottish Government: Scottish government urban/ rural

The burden of oesophageal cancer in Central and South America.

PubMed

Barrios, Enrique; Sierra, Monica S; Musetti, Carina; Forman, David

2016-09-01

Oesophageal cancer shows marked geographic variations and is one of the leading causes of cancer death worldwide. We described the burden of this malignancy in Central and South America. Regional and national level incidence data were obtained from 48 population-based cancer registries in 13 countries. Mortality data were obtained from the WHO mortality database. Incidence of oesophageal cancer by histological subtype were available from high-quality population-based cancer registries. Males had higher incidence and mortality rates than females (male-to-female ratios: 2-6:1 and 2-5:1). In 2003-2007, the highest rates were in Brazil, Uruguay, Argentina and Chile. Mortality rates followed the incidence patterns. Incidence of oesophageal squamous cell carcinoma (SCC) was higher than adenocarcinoma (AC), except in females from Cuenca (Ecuador). SCC and AC incidence were higher in males than females, except in the Region of Antofagasta and Valdivia (Chile), Manizales (Colombia) and Cuenca (Ecuador). Incidence and mortality rates tended to decline in Argentina, Chile, Brazil (incidence) and Costa Rica from 1997 to 2008. The geographic variation and sex disparity in oesophageal cancer across Central and South America may reflect differences in the prevalence of tobacco smoking and alcohol consumption which highlights the need to implement and/or strengthen tobacco and alcohol control policies. Maté consumption, obesity, diet and Helicobacter pylori infection may also explain the variation in oesophageal cancer rates but these relationships should be evaluated. Continuous monitoring of oesophageal cancer rates is necessary to provide the basis for cancer prevention and control in the region. Copyright © 2015 International Agency for Research on Cancer. Published by Elsevier Ltd.. All rights reserved.

Reproductive Biology and Its Impact on Body Size: Comparative Analysis of Mammalian, Avian and Dinosaurian Reproduction

PubMed Central

Werner, Jan; Griebeler, Eva Maria

2011-01-01

Janis and Carrano (1992) suggested that large dinosaurs might have faced a lower risk of extinction under ecological changes than similar-sized mammals because large dinosaurs had a higher potential reproductive output than similar-sized mammals (JC hypothesis). First, we tested the assumption underlying the JC hypothesis. We therefore analysed the potential reproductive output (reflected in clutch/litter size and annual offspring number) of extant terrestrial mammals and birds (as “dinosaur analogs”) and of extinct dinosaurs. With the exception of rodents, the differences in the reproductive output of similar-sized birds and mammals proposed by Janis and Carrano (1992) existed even at the level of single orders. Fossil dinosaur clutches were larger than litters of similar-sized mammals, and dinosaur clutch sizes were comparable to those of similar-sized birds. Because the extinction risk of extant species often correlates with a low reproductive output, the latter difference suggests a lower risk of population extinction in dinosaurs than in mammals. Second, we present a very simple, mathematical model that demonstrates the advantage of a high reproductive output underlying the JC hypothesis. It predicts that a species with a high reproductive output that usually faces very high juvenile mortalities will benefit more strongly in terms of population size from reduced juvenile mortalities (e.g., resulting from a stochastic reduction in population size) than a species with a low reproductive output that usually comprises low juvenile mortalities. Based on our results, we suggest that reproductive strategy could have contributed to the evolution of the exceptional gigantism seen in dinosaurs that does not exist in extant terrestrial mammals. Large dinosaurs, e.g., the sauropods, may have easily sustained populations of very large-bodied species over evolutionary time. PMID:22194835

Reproductive biology and its impact on body size: comparative analysis of mammalian, avian and dinosaurian reproduction.

PubMed

Werner, Jan; Griebeler, Eva Maria

2011-01-01

Janis and Carrano (1992) suggested that large dinosaurs might have faced a lower risk of extinction under ecological changes than similar-sized mammals because large dinosaurs had a higher potential reproductive output than similar-sized mammals (JC hypothesis). First, we tested the assumption underlying the JC hypothesis. We therefore analysed the potential reproductive output (reflected in clutch/litter size and annual offspring number) of extant terrestrial mammals and birds (as "dinosaur analogs") and of extinct dinosaurs. With the exception of rodents, the differences in the reproductive output of similar-sized birds and mammals proposed by Janis and Carrano (1992) existed even at the level of single orders. Fossil dinosaur clutches were larger than litters of similar-sized mammals, and dinosaur clutch sizes were comparable to those of similar-sized birds. Because the extinction risk of extant species often correlates with a low reproductive output, the latter difference suggests a lower risk of population extinction in dinosaurs than in mammals. Second, we present a very simple, mathematical model that demonstrates the advantage of a high reproductive output underlying the JC hypothesis. It predicts that a species with a high reproductive output that usually faces very high juvenile mortalities will benefit more strongly in terms of population size from reduced juvenile mortalities (e.g., resulting from a stochastic reduction in population size) than a species with a low reproductive output that usually comprises low juvenile mortalities. Based on our results, we suggest that reproductive strategy could have contributed to the evolution of the exceptional gigantism seen in dinosaurs that does not exist in extant terrestrial mammals. Large dinosaurs, e.g., the sauropods, may have easily sustained populations of very large-bodied species over evolutionary time.

Human Development Inequality Index and Cancer Pattern: a Global Distributive Study.

PubMed

Rezaeian, Shahab; Khazaei, Salman; Khazaei, Somayeh; Mansori, Kamyar; Sanjari Moghaddam, Ali; Ayubi, Erfan

2016-01-01

This study aimed to quantify associations of the human development inequality (HDI) index with incidence, mortality, and mortality to incidence ratios for eight common cancers among different countries. In this ecological study, data about incidence and mortality rates of cancers was obtained from the Global Cancer Project for 169 countries. HDI indices for the same countries was obtained from the United Nations Development Program (UNDP) database. The concentration index was defined as the covariance between cumulative percentage of cancer indicators (incidence, mortality and mortality to incidence ratio) and the cumulative percentage of economic indicators (country economic rank). Results indicated that incidences of cancers of liver, cervix and esophagus were mainly concentrated in countries with a low HDI index while cancers of lung, breast, colorectum, prostate and stomach were concentrated mainly in countries with a high HDI index. The same pattern was observed for mortality from cancer except for prostate cancer that was more concentrated in countries with a low HDI index. Higher MIRs for all cancers were more concentrated in countries with a low HDI index. It was concluded that patterns of cancer occurrence correlate with care disparities at the country level.

Season of death and birth predict patterns of mortality in Burkina Faso.

PubMed

Kynast-Wolf, Gisela; Hammer, Gaël P; Müller, Olaf; Kouyaté, Bocar; Becher, Heiko

2006-04-01

Mortality in developing countries has multiple causes. Some of these causes are linked to climatic conditions that differ over the year. Data on season-specific mortality are sparse. We analysed longitudinal data from a population of approximately 35,000 individuals in Burkina Faso. During the observation period 1993-2001, a total number of 4,098 deaths were recorded. The effect of season on mortality was investigated separately by age group as (i) date of death and (ii) date of birth. For (i), age-specific death rates by month of death were calculated. The relative effect of each month was assessed using the floating relative risk method and modelled continuously. For (ii), age-specific death rates by month of birth were calculated and the mean date of birth among deaths and survivors was compared. Overall mortality was found to be consistently higher during the dry season (November to May). The pattern was seen in all age groups except in infants where a peak was seen around the end of the rainy season. In infants we found a strong association between high mortality and being born during the time period September to February. No effect was seen for the other age groups. The observed excess mortality in young children at or around the end of the rainy season can be explained by the effects of infectious diseases and, in particular, malaria during this time period. In contrast, the excess mortality seen in older children and adults during the early dry season remains largely unexplained although specific infectious diseases such as meningitis and pneumonia are possible main causes. The association between high infant mortality and being born at around the end of the rainy season is probably explained by most of the malaria deaths in areas of high transmission intensity occurring in the second half of infancy.

Proportionate mortality of Italian soccer players: is amyotrophic lateral sclerosis an occupational disease?

PubMed

Belli, Stefano; Vanacore, Nicola

2005-01-01

The objective of the study is to investigate the mortality experience of Italian soccer players and to discuss the findings in the light of possible long term effects of doping. Standardized proportionate mortality ratio (SPMR) and standardized proportionate cancer mortality ratio (SPCMR) were computed for 350 deceased subjects deriving from a list of about 24,000 active Italian soccer players from 1960 to 1996 in the three top leagues (A, B and C). When considering SPMRs, there is a substantial adherence of observed to expected mortality, with the only exception of mortality for diseases of the nervous system (13 obs. vs. 6 exp.) mainly explained by an excess of amyotrophic lateral sclerosis (8 obs. vs 0.69 exp.). As far as SPCMRs are concerned, some digestive cancers (namely: colon cancer, liver cancer and pancreas cancer) show a doubled risk. A high risk for amyotrophic lateral sclerosis is observed among Italian soccer players. Epidemiological data on association between sport and Amyotrophic Lateral Sclerosis (ALS) are contrasting. On the basis of the overall available evidence we suggest a possible connection between dietary supplements or drugs used to enhance sporting performance and ALS pathogenesis. Further epidemiological studies are needed to confirm these specific mortality risks among soccer players.

Population cycles: generalities, exceptions and remaining mysteries

PubMed Central

2018-01-01

Population cycles are one of nature's great mysteries. For almost a hundred years, innumerable studies have probed the causes of cyclic dynamics in snowshoe hares, voles and lemmings, forest Lepidoptera and grouse. Even though cyclic species have very different life histories, similarities in mechanisms related to their dynamics are apparent. In addition to high reproductive rates and density-related mortality from predators, pathogens or parasitoids, other characteristics include transgenerational reduced reproduction and dispersal with increasing-peak densities, and genetic similarity among populations. Experiments to stop cyclic dynamics and comparisons of cyclic and noncyclic populations provide some understanding but both reproduction and mortality must be considered. What determines variation in amplitude and periodicity of population outbreaks remains a mystery. PMID:29563267

Trends in Respiratory Syncytial Virus and Bronchiolitis Hospitalization Rates in High-Risk Infants in a United States Nationally Representative Database, 1997–2012

PubMed Central

Doucette, Abigail; Jiang, Xiaohui; Fryzek, Jon; Coalson, Jenna; McLaurin, Kimmie; Ambrose, Christopher S.

2016-01-01

Background Respiratory syncytial virus (RSV) causes significant pediatric morbidity and is the most common cause of bronchiolitis. Bronchiolitis hospitalizations declined among US infants from 2000‒2009; however, rates in infants at high risk for RSV have not been described. This study examined RSV and unspecified bronchiolitis (UB) hospitalization rates from 1997‒2012 among US high-risk infants. Methods The Kids’ Inpatient Database (KID) infant annual RSV (ICD-9 079.6, 466.11, 480.1) and UB (ICD-9 466.19, 466.1) hospitalization rates were estimated using weighted counts. Denominators were based on birth hospitalizations with conditions associated with high-risk for RSV: chronic perinatal respiratory disease (chronic lung disease [CLD]); congenital airway anomalies (CAA); congenital heart disease (CHD); Down syndrome (DS); and other genetic, metabolic, musculoskeletal, and immunodeficiency conditions. Preterm infants could not be identified. Hospitalizations were characterized by mechanical ventilation, inpatient mortality, length of stay, and total cost (2015$). Poisson and linear regression were used to test statistical significance of trends. Results RSV and UB hospitalization rates were substantially elevated for infants with higher-risk CHD, CLD, CAA and DS without CHD compared with all infants. RSV rates declined by 47.0% in CLD and 49.7% in higher-risk CHD infants; no other declines in high-risk groups were observed. UB rates increased in all high-risk groups except for a 22.5% decrease among higher-risk CHD. Among high-risk infants, mechanical ventilation increased through 2012 to 20.4% and 13.5% of RSV and UB hospitalizations; geometric mean cost increased to $31,742 and $25,962, respectively, and RSV mortality declined to 0.9%. Conclusions Among high-risk infants between 1997 and 2012, RSV hospitalization rates declined among CLD and higher-risk CHD infants, coincident with widespread RSV immunoprophylaxis use in these populations. UB hospitalization rates increased in all high-risk groups except higher-risk CHD, suggesting improvement in the health status of higher-risk CHD infants, potentially due to enhanced surgical interventions. Mechanical ventilation use and RSV and UB hospitalization costs increased while RSV mortality declined. PMID:27050095

Geriatric Conditions in Acutely Hospitalized Older Patients: Prevalence and One-Year Survival and Functional Decline

PubMed Central

Buurman, Bianca M.; Hoogerduijn, Jita G.; de Haan, Rob J.; Abu-Hanna, Ameen; Lagaay, A. Margot; Verhaar, Harald J.; Schuurmans, Marieke J.; Levi, Marcel; de Rooij, Sophia E.

2011-01-01

Background To study the prevalence of eighteen geriatric conditions in older patients at admission, their reporting rate in discharge summaries and the impact of these conditions on mortality and functional decline one year after admission. Method A prospective multicenter cohort study conducted between 2006 and 2008 in two tertiary university teaching hospitals and one regional teaching hospital in the Netherlands. Patients of 65 years and older, acutely admitted and hospitalized for at least 48 hours, were invited to participate. Eighteen geriatric conditions were assessed at hospital admission, and outcomes (mortality, functional decline) were assessed one year after admission. Results 639 patients were included, with a mean age of 78 years. IADL impairment (83%), polypharmacy (61%), mobility difficulty (59%), high levels of primary caregiver burden (53%), and malnutrition (52%) were most prevalent. Except for polypharmacy and cognitive impairment, the reporting rate of the geriatric conditions in discharge summaries was less than 50%. One year after admission, 35% had died and 33% suffered from functional decline. A high Charlson comorbidity index score, presence of malnutrition, high fall risk, presence of delirium and premorbid IADL impairment were associated with mortality and overall poor outcome (mortality or functional decline). Obesity lowered the risk for mortality. Conclusion Geriatric conditions were highly prevalent and associated with poor health outcomes after admission. Early recognition of these conditions in acutely hospitalized older patients and improving the handover to the general practitioner could lead to better health outcomes and reduce the burden of hospital admission for older patients. PMID:22110598

Trends in Education-Specific Life Expectancy, Data Quality, and Shifting Education Distributions: A Note on Recent Research.

PubMed

Hendi, Arun S

2017-06-01

Several recent articles have reported conflicting conclusions about educational differences in life expectancy, and this is partly due to the use of unreliable data subject to a numerator-denominator bias previously reported as ranging from 20 % to 40 %. This article presents estimates of life expectancy and lifespan variation by education in the United States using more reliable data from the National Health Interview Survey. Contrary to prior conclusions in the literature, I find that life expectancy increased or stagnated since 1990 among all education-race-sex groups except for non-Hispanic white women with less than a high school education; there has been a robust increase in life expectancy among white high school graduates and a smaller increase among black female high school graduates; lifespan variation did not increase appreciably among high school graduates; and lifespan variation plays a very limited role in explaining educational gradients in mortality. I also discuss the key role that educational expansion may play in driving future changes in mortality gradients. Because of shifting education distributions, within an education-specific synthetic cohort, older age groups are less negatively selected than younger age groups. We could thus expect a greater concentration of mortality at younger ages among people with a high school education or less, which would be reflected in increasing lifespan variability for this group. Future studies of educational gradients in mortality should use more reliable data and should be mindful of the effects of shifting education distributions.

The present and future disease burden of hepatitis C virus infections with today's treatment paradigm - volume 3.

PubMed

Sibley, A; Han, K H; Abourached, A; Lesmana, L A; Makara, M; Jafri, W; Salupere, R; Assiri, A M; Goldis, A; Abaalkhail, F; Abbas, Z; Abdou, A; Al Braiki, F; Al Hosani, F; Al Jaberi, K; Al Khatry, M; Al Mulla, M A; Al Quraishi, H; Al Rifai, A; Al Serkal, Y; Alam, A; Alavian, S M; Alashgar, H I; Alawadhi, S; Al-Dabal, L; Aldins, P; Alfaleh, F Z; Alghamdi, A S; Al-Hakeem, R; Aljumah, A A; Almessabi, A; Alqutub, A N; Alswat, K A; Altraif, I; Alzaabi, M; Andrea, N; Babatin, M A; Baqir, A; Barakat, M T; Bergmann, O M; Bizri, A R; Blach, S; Chaudhry, A; Choi, M S; Diab, T; Djauzi, S; El Hassan, E S; El Khoury, S; Estes, C; Fakhry, S; Farooqi, J I; Fridjonsdottir, H; Gani, R A; Ghafoor Khan, A; Gheorghe, L; Gottfredsson, M; Gregorcic, S; Gunter, J; Hajarizadeh, B; Hamid, S; Hasan, I; Hashim, A; Horvath, G; Hunyady, B; Husni, R; Jeruma, A; Jonasson, J G; Karlsdottir, B; Kim, D Y; Kim, Y S; Koutoubi, Z; Liakina, V; Lim, Y S; Löve, A; Maimets, M; Malekzadeh, R; Matičič, M; Memon, M S; Merat, S; Mokhbat, J E; Mourad, F H; Muljono, D H; Nawaz, A; Nugrahini, N; Olafsson, S; Priohutomo, S; Qureshi, H; Rassam, P; Razavi, H; Razavi-Shearer, D; Razavi-Shearer, K; Rozentale, B; Sadik, M; Saeed, K; Salamat, A; Sanai, F M; Sanityoso Sulaiman, A; Sayegh, R A; Sharara, A I; Siddiq, M; Siddiqui, A M; Sigmundsdottir, G; Sigurdardottir, B; Speiciene, D; Sulaiman, A; Sultan, M A; Taha, M; Tanaka, J; Tarifi, H; Tayyab, G; Tolmane, I; Ud Din, M; Umar, M; Valantinas, J; Videčnik-Zorman, J; Yaghi, C; Yunihastuti, E; Yusuf, M A; Zuberi, B F; Schmelzer, J D

2015-12-01

The total number, morbidity and mortality attributed to viraemic hepatitis C virus (HCV) infections change over time making it difficult to compare reported estimates from different years. Models were developed for 15 countries to quantify and characterize the viraemic population and forecast the changes in the infected population and the corresponding disease burden from 2014 to 2030. With the exception of Iceland, Iran, Latvia and Pakistan, the total number of viraemic HCV infections is expected to decline from 2014 to 2030, but the associated morbidity and mortality are expected to increase in all countries except for Japan and South Korea. In the latter two countries, mortality due to an ageing population will drive down prevalence, morbidity and mortality. On the other hand, both countries have already experienced a rapid increase in HCV-related mortality and morbidity. HCV-related morbidity and mortality are projected to increase between 2014 and 2030 in all other countries as result of an ageing HCV-infected population. Thus, although the total number of HCV countries is expected to decline in most countries studied, the associated disease burden is expected to increase. The current treatment paradigm is inadequate if large reductions in HCV-related morbidity and mortality are to be achieved. © 2015 John Wiley & Sons Ltd.

Waitlist Outcomes for Patients Relisted Following Failed Donation After Cardiac Death Liver Transplant: Implications for Awarding Model for End-Stage Liver Disease Exception Scores.

PubMed

Croome, K P; Lee, D D; Nguyen, J H; Keaveny, A P; Taner, C B

2017-09-01

Understanding of outcomes for patients relisted for ischemic cholangiopathy following a donation after cardiac death (DCD) liver transplant (LT) will help standardization of a Model for End-Stage Liver Disease exception scheme for retransplantation. Early relisting (E-RL) for DCD graft failure caused by primary nonfunction (PNF) or hepatic artery thrombosis (HAT) was defined as relisting ≤14 days after DCD LT, and late relisting (L-RL) due to biliary complications was defined as relisting 14 days to 3 years after DCD LT. Of 3908 DCD LTs performed nationally between 2002 and 2016, 540 (13.8%) patients were relisted within 3 years of transplant (168 [4.3%] in the E-RL group, 372 [9.5%] in the L-RL group). The E-RL and L-RL groups had waitlist mortality rates of 15.4% and 10.5%, respectively, at 3 mo and 16.1% and 14.3%, respectively, at 1 year. Waitlist mortality in the L-RL group was higher than mortality and delisted rates for patients with exception points for both hepatocellular carcinoma (HCC) and hepatopulmonary syndrome (HPS) at 3- to 12-mo time points (p < 0.001). Waitlist outcomes differed in patients with early DCD graft failure caused by PNF or HAT compared with those with late DCD graft failure attributed to biliary complications. In L-RL, higher rates of waitlist mortality were noted compared with patients listed with exception points for HCC or HPS. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

Racial and Ethnic Infant Mortality Gaps and the Role of Socio-Economic Status

PubMed Central

Elder, Todd E.; Goddeeris, John H.; Haider, Steven J.

2016-01-01

We assess the extent to which differences in socio-economic status are associated with racial and ethnic gaps in a fundamental measure of population health: the rate at which infants die. Using micro-level Vital Statistics data from 2000 to 2004, we examine mortality gaps of infants born to white, black, Mexican, Puerto Rican, Asian, and Native American mothers. We find that between-group mortality gaps are strongly and consistently (except for Mexican infants) associated with maternal marital status, education, and age, and that these same characteristics are powerful predictors of income and poverty for new mothers in U.S. Census data. Despite these similarities, we document a fundamental difference in the mortality gap for the three high mortality groups: whereas the black-white and Puerto Rican-white mortality gaps mainly occur at low birth weights, the Native American-white gap occurs almost exclusively at higher birth weights. We further examine the one group whose IMR is anomalous compared to the other groups: infants of Mexican mothers die at relatively low rates given their socio-economic disadvantage. We find that this anomaly is driven by lower infant mortality among foreign-born mothers, a pattern found within many racial/ethnic groups. Overall, we conclude that the infant mortality gaps for our six racial/ethnic groups exhibit many commonalities, and these commonalities suggest a prominent role for socio-economic differences. PMID:27695196

Patterns of in-hospital mortality and bleeding complications following PCI for very elderly patients: insights from the Dartmouth Dynamic Registry.

PubMed

Li, Shawn X; Chaudry, Hannah I; Lee, Jiyong; Curran, Theodore B; Kumar, Vishesh; Wong, Kendrew K; Andrus, Bruce W; DeVries, James T

2018-02-01

Very elderly patients (age ≥ 85 years) are a rapidly increasing segment of the population. As a group, they experience high rates of in-hospital mortality and bleeding complications following percutaneous coronary intervention (PCI). However, the relationship between bleeding and mortality in the very elderly is unknown. Retrospective review was performed on 17,378 consecutive PCI procedures from 2000 to 2015 at Dartmouth-Hitchcock Medical Center. Incidence of bleeding during the index PCI admission (bleeding requiring transfusion, access site hematoma > 5 cm, pseudoaneurysm, and retroperitoneal bleed) and in-hospital mortality were reported for four age groups (< 65 years, 65-74 years, 75-84 years, and ≥ 85 years). The mortality of patients who suffered bleeding complications and those who did not was calculated and multivariate analysis was performed for in-hospital mortality. Lastly, known predictors of bleeding were compared between patients age < 85 years and age ≥ 85 years. Of 17,378 patients studied, 1019 (5.9%) experienced bleeding and 369 (2.1%) died in-hospital following PCI. Incidence of bleeding and in-hospital mortality increased monotonically with increasing age (mortality: 0.94%, 2.27%, 4.24% and 4.58%; bleeding: 3.96%, 6.62%, 10.68% and 13.99% for ages < 65, 65-74, 75-84 and ≥ 85 years, respectively). On multivariate analysis, bleeding was associated with increased mortality for all age groups except patients age ≥ 85 years [odds ratio (95% CI): age < 65 years, 3.65 (1.99-6.74); age 65-74 years, 2.83 (1.62-4.94); age 75-84 years, 3.86 (2.56-5.82), age ≥ 85 years: 1.39 (0.49-3.95)]. Bleeding and mortality following PCI increase with increasing age. For the very elderly, despite high rates of bleeding, bleeding is no longer predictive of in-hospital mortality following PCI.

Temporal trends (1977-2007) and ethnic inequity in child mortality in rural villages of southern Guinea Bissau.

PubMed

Fazzio, Ila; Mann, Vera; Boone, Peter

2011-09-02

Guinea Bissau is one of the poorest countries in the world, with one of the highest under-5 mortality rate. Despite its importance for policy planning, data on child mortality are often not available or of poor quality in low-income countries like Guinea Bissau. Our aim in this study was to use the baseline survey to estimate child mortality in rural villages in southern Guinea Bissau for a 30 years period prior to a planned cluster randomised intervention. We aimed to investigate temporal trends with emphasis on historical events and the effect of ethnicity, polygyny and distance to the health centre on child mortality. A baseline survey was conducted prior to a planned cluster randomised intervention to estimate child mortality in 241 rural villages in southern Guinea Bissau between 1977 and 2007. Crude child mortality rates were estimated by Kaplan-Meier method from birth history of 7854 women. Cox regression models were used to investigate the effects of birth periods with emphasis on historical events, ethnicity, polygyny and distance to the health centre on child mortality. High levels of child mortality were found at all ages under five with a significant reduction in child mortality over the time periods of birth except for 1997-2001. That period comprises the 1998/99 civil war interval, when child mortality was 1.5% higher than in the previous period. Children of Balanta ethnic group had higher hazard of dying under five years of age than children from other groups until 2001. Between 2002 and 2007, Fula children showed the highest mortality. Increasing walking distance to the nearest health centre increased the hazard, though not substantially, and polygyny had a negligible and statistically not significant effect on the hazard. Child mortality is strongly associated with ethnicity and it should be considered in health policy planning. Child mortality, though considerably decreased during the past 30 years, remains high in rural Guinea Bissau. Temporal trends also suggest that civil wars have detrimental effects on child mortality. Current Controlled Trials ISRCTN52433336.

Cause-specific mortality in professional flight crew and air traffic control officers: findings from two UK population-based cohorts of over 20,000 subjects.

PubMed

De Stavola, Bianca L; Pizzi, Costanza; Clemens, Felicity; Evans, Sally Ann; Evans, Anthony D; dos Santos Silva, Isabel

2012-04-01

Flight crew are exposed to several potential occupational hazards. This study compares mortality rates in UK flight crew to those in air traffic control officers (ATCOs) and the general population. A total of 19,489 flight crew and ATCOs were identified from the UK Civil Aviation Authority medical records and followed to the end of 2006. Consented access to medical records and questionnaire data provided information on demographic, behavioral, clinical, and occupational variables. Standardized mortality ratios (SMR) were estimated for these two occupational groups using the UK general population. Adjusted mortality hazard ratios (HR) for flight crew versus ATCOs were estimated via Cox regression models. A total of 577 deaths occurred during follow-up. Relative to the general population, both flight crew (SMR 0.32; 95% CI 0.30, 0.35) and ATCOs (0.39; 0.32, 0.47) had lower all-cause mortality, mainly due to marked reductions in mortality from neoplasms and cardiovascular diseases, although flight crew had higher mortality from aircraft accidents (SMR 42.8; 27.9, 65.6). There were no differences in all-cause mortality (HR 0.99; 95% CI 0.79, 1.25), or in mortality from any major cause, between the two occupational groups after adjustment for health-related variables, again except for those from aircraft accidents. The latter ratios, however, declined with increasing number of hours. The low all-cause mortality observed in both occupational groups relative to the general population is consistent with a strong "healthy worker effect" and their low prevalence of smoking and other risk factors. Mortality among flight crew did not appear to be influenced by occupational exposures, except for a rise in mortality from aircraft accidents.

Relative resistance of Pacific salmon to infectious salmon anaemia virus

USGS Publications Warehouse

Rolland, J.B.; Winton, J.R.

2003-01-01

Infectious salmon anaemia (ISA) is a major disease of Atlantic salmon, Salmo salar, caused by an orthomyxovirus (ISAV). Increases in global aqua culture and the international movement of fish made it important to determine if Pacific salmon are at risk. Steelhead trout, Oncorhynchus mykiss, and chum, O. keta, Chinook, O. tshawytscha, coho, O. kisutch, and Atlantic salmon were injected intraperitoneally with a high, medium, or low dose of a Norwegian strain of ISAV. In a second challenge, the same species, except chum salmon, were injected with a high dose of either a Canadian or the Norwegian strain. Average cumulative mortality of Atlantic salmon in trial 1 was 12% in the high dose group, 20% in the medium dose group and 16% in the low dose group. The average cumulative mortality of Atlantic salmon in trial 2 was 98%. No signs typical of ISA and no ISAV-related mortality occurred among any of the groups of Oncorhynchus spp. in either experiment, although ISAV was reisolated from some fish sampled at intervals post-challenge. The results indicate that while Oncorhynchus spp. are quite resistant to ISAV relative to Atlantic salmon, the potential for ISAV to adapt to Oncorhynchus spp. should not be ignored.

Alcohol, drinking pattern and all-cause, cardiovascular and alcohol-related mortality in Eastern Europe.

PubMed

Bobak, Martin; Malyutina, Sofia; Horvat, Pia; Pajak, Andrzej; Tamosiunas, Abdonas; Kubinova, Ruzena; Simonova, Galina; Topor-Madry, Roman; Peasey, Anne; Pikhart, Hynek; Marmot, Michael G

2016-01-01

Alcohol has been implicated in the high mortality in Central and Eastern Europe but the magnitude of its effect, and whether it is due to regular high intake or episodic binge drinking remain unclear. The aim of this paper was to estimate the contribution of alcohol to mortality in four Central and Eastern European countries. We used data from the Health, Alcohol and Psychosocial factors in Eastern Europe is a prospective multi-centre cohort study in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and six Czech towns. Random population samples of 34,304 men and women aged 45-69 years in 2002-2005 were followed up for a median 7 years. Drinking volume, frequency and pattern were estimated from the graduated frequency questionnaire. Deaths were ascertained using mortality registers. In 230,246 person-years of follow-up, 2895 participants died from all causes, 1222 from cardiovascular diseases (CVD), 672 from coronary heart disease (CHD) and 489 from pre-defined alcohol-related causes (ARD). In fully-adjusted models, abstainers had 30-50% increased mortality risk compared to light-to-moderate drinkers. Adjusted hazard ratios (HR) in men drinking on average ≥60 g of ethanol/day (3% of men) were 1.23 (95% CI 0.95-1.59) for all-cause, 1.38 (0.95-2.02) for CVD, 1.64 (1.02-2.64) for CHD and 2.03 (1.28-3.23) for ARD mortality. Corresponding HRs in women drinking on average ≥20 g/day (2% of women) were 1.92 (1.25-2.93), 1.74 (0.76-3.99), 1.39 (0.34-5.76) and 3.00 (1.26-7.10). Binge drinking increased ARD mortality in men only. Mortality was associated with high average alcohol intake but not binge drinking, except for ARD in men.

Impact of Dietary and Metabolic Risk Factors on Cardiovascular and Diabetes Mortality in South Asia: Analysis From the 2010 Global Burden of Disease Study.

PubMed

Yakoob, Mohammad Y; Micha, Renata; Khatibzadeh, Shahab; Singh, Gitanjali M; Shi, Peilin; Ahsan, Habibul; Balakrishna, Nagalla; Brahmam, Ginnela N V; Chen, Yu; Afshin, Ashkan; Fahimi, Saman; Danaei, Goodarz; Powles, John W; Ezzati, Majid; Mozaffarian, Dariush

2016-12-01

To quantify cardiovascular disease and diabetes deaths attributable to dietary and metabolic risks by country, age, sex, and time in South Asian countries. We used the 2010 Global Burden of Disease national surveys to characterize risk factor levels by age and sex. We derived etiological effects of risk factors-disease endpoints, by age, from meta-analyses. We defined optimal levels. We combined these inputs with cause-specific mortality rates to compute population-attributable fractions as a percentage of total cardiometabolic deaths. Suboptimal diet was the leading cause of cardiometabolic mortality in 4 of 5 countries, with population-attributable fractions from 40.7% (95% uncertainty interval = 37.4, 44.1) in Bangladesh to 56.9% (95% uncertainty interval = 52.4, 61.5) in Pakistan. High systolic blood pressure was the second leading cause, except in Bangladesh, where it superseded suboptimal diet. This was followed in all nations by high fasting plasma glucose, low fruit intake, and low whole grain intake. Other prominent burdens were more variable, such as low intake of vegetables, low omega-3 fats, and high sodium intake in India, Nepal, and Pakistan. Important similarities and differences are evident in cardiometabolic mortality burdens of modifiable dietary and metabolic risks across these countries, informing health policy and program priorities.

High Mortality in Severe Sepsis and Septic Shock Patients with Do-Not-Resuscitate Orders in East Asia.

PubMed

Huang, Chun-Ta; Chuang, Yu-Chung; Tsai, Yi-Ju; Ko, Wen-Je; Yu, Chong-Jen

2016-01-01

Severe sepsis is a potentially deadly illness and always requires intensive care. Do-not-resuscitate (DNR) orders remain a debated issue in critical care and limited data exist about its impact on care of septic patients, particularly in East Asia. We sought to assess outcome of severe sepsis patients with regard to DNR status in Taiwan. A retrospective cohort study was conducted in intensive care units (ICUs) between 2008 and 2010. All severe sepsis patients were included for analysis. Primary outcome was association between DNR orders and ICU mortality. Volume of interventions was used as proxy indicator to indicate aggressiveness of care. Sixty-seven (9.4%) of 712 patients had DNR orders on ICU admission, and these patients were older and had higher disease severity compared with patients without DNR orders. Notably, DNR patients experienced high ICU mortality (90%). Multivariate analysis revealed that the presence of DNR orders was independently associated with ICU mortality (odds ratio: 6.13; 95% confidence interval: 2.66-14.10). In propensity score-matched cohort, ICU mortality rate (91%) in the DNR group was statistically higher than that (62%) in the non-DNR group (p <0.001). Regarding ICU interventions, arterial and central venous catheterization were more commonly used in DNR patients than in non-DNR patients. From the Asian perspective, septic patients placed on DNR orders on ICU admission had exceptionally high mortality. In contrast to Western reports, DNR patients received more ICU interventions, reflecting more aggressive approach to dealing with this patient population. The findings in some ways reflect differences between East and West cultures and suggest that DNR status is an important confounder in ICU studies involving severely septic patients.

Future global mortality from changes in air pollution attributable to climate change

DOE PAGES

Silva, Raquel A.; West, J. Jason; Lamarque, Jean-François; ...

2017-07-31

Ground-level ozone and fine particulate matter (PM2.5) are associated with premature human mortality(1-4); their future concentrations depend on changes in emissions, which dominate the near-term(5), and on climate change(6,7). Previous global studies of the air-quality-related health effects of future climate change(8,9) used single atmospheric models. But, in related studies, mortality results differ among models(10-12). Here we use an ensemble of global chemistry-climate models(13) to show that premature mortality from changes in air pollution attributable to climate change, under the high greenhouse gas scenario RCP8.5 (ref. 14), is probably positive. We estimate 3,340 (-30,300 to 47,100) ozone-related deaths in 2030, relativemore » to 2000 climate, and 43,600 (-195,000 to 237,000) in 2100 (14% of the increase in global ozone-related mortality). For PM2.5, we estimate 55,600 (-34,300 to 164,000) deaths in 2030 and 215,000 (-76,100 to 595,000) in 2100 (countering by 16% the global decrease in PM2.5-related mortality). Premature mortality attributable to climate change is estimated to be positive in all regions except Africa, and is greatest in India and East Asia. Finally, most individual models yield increased mortality from climate change, but some yield decreases, suggesting caution in interpreting results from a single model. Climate change mitigation is likely to reduce air-pollution-related mortality.« less

Future Global Mortality from Changes in Air Pollution Attributable to Climate Change

NASA Technical Reports Server (NTRS)

Silva, Raquel A.; West, J. Jason; Lamarque, Jean-Francois; Shindell, Drew T.; Collins, William J.; Faluvegi, Greg; Folberth, Gerd A.; Horowitz, Larry W.; Nagashima, Tatsuya; Naik, Vaishali;

Future global mortality from changes in air pollution attributable to climate change

DOE Office of Scientific and Technical Information (OSTI.GOV)

Silva, Raquel A.; West, J. Jason; Lamarque, Jean-François

Ground-level ozone and fine particulate matter (PM2.5) are associated with premature human mortality(1-4); their future concentrations depend on changes in emissions, which dominate the near-term(5), and on climate change(6,7). Previous global studies of the air-quality-related health effects of future climate change(8,9) used single atmospheric models. But, in related studies, mortality results differ among models(10-12). Here we use an ensemble of global chemistry-climate models(13) to show that premature mortality from changes in air pollution attributable to climate change, under the high greenhouse gas scenario RCP8.5 (ref. 14), is probably positive. We estimate 3,340 (-30,300 to 47,100) ozone-related deaths in 2030, relativemore » to 2000 climate, and 43,600 (-195,000 to 237,000) in 2100 (14% of the increase in global ozone-related mortality). For PM2.5, we estimate 55,600 (-34,300 to 164,000) deaths in 2030 and 215,000 (-76,100 to 595,000) in 2100 (countering by 16% the global decrease in PM2.5-related mortality). Premature mortality attributable to climate change is estimated to be positive in all regions except Africa, and is greatest in India and East Asia. Finally, most individual models yield increased mortality from climate change, but some yield decreases, suggesting caution in interpreting results from a single model. Climate change mitigation is likely to reduce air-pollution-related mortality.« less

Abortion index and mortality of offspring among women of different age, caste and population groups of north Indian Muslims.

PubMed

Ara, Gulshan; Siddique, Yasir Hasan; Beg, Tanveer; Afzal, Mohammad

2008-05-01

The Muslims of Aligarh city are predominantly Sunnis, although there are also a considerable number of Shias. Among the Sunnis, approximately a quarter belong to Syed, Sheikh, Moghal and Pathan groups, and three-quarters belong to various lower biradaris. In the present study, 304 women attending the Primary Health Centre of the J. N. Medical College and Hospital, Aligarh Muslim University, Uttar Pradesh, were surveyed and the following recorded among Muslim women of high-rank (Ashraf) and low-rank (Ajlaf) castes: incidence of marriage, age of the mother at the time of marriage, present age of the mother, abortions, still births, pre-reproductive mortality and overall mortality. The Ashraf are comprised of the Sheikh, Syed and Pathan, whereas the Ajlafs have Qureshi, Saifi and Ansari biradaris. Maternal age was scored as above and below 45 years in each biradari. Significant effects of maternal age were seen on mortality of offspring, whereas populations did not show consistent differences, except when Ashrafs and Ajlafs were considered separately. The results show higher mortality and abortions for various groups. This may be due to various biological and socio-cultural factors, including hidden inbreeding in the remote past.

Role of hormonal levels on hospital mortality for male patients with severe traumatic brain injury.

PubMed

Hohl, Alexandre; Ronsoni, Marcelo Fernando; Debona, Rodrigo; Ben, Juliana; Schwarzbold, Marcelo Liborio; Diaz, Alexandre Paim; Thais, Maria Emília Rodrigues de Oliveira; Linhares, Marcelo Neves; Latini, Alexandra; Prediger, Rui Daniel; Pizzol, Felipe Dal; Walz, Roger

2014-01-01

Changes in hormone blood levels during the acute phase of traumatic brain injury (TBI) have been described in the literature. The objective was to investigate the association among several hormones plasma levels in the acute phase of severe TBI and the hospital mortality rate of male patients. The independent association among plasma levels of TSH, LH, FSH, GH, free T4, cortisol, IGF-1 and total testosterone was measured 10 hours and 30 hours after severe TBI and the hospital mortality of 60 consecutive male patients was evaluated. At least one hormonal level abnormality was demonstrated in 3.6-73.1% of patients. The multiple logistic regressions showed a trend for an independent association among hospital mortality and normal or elevated LH levels measured at 10 hours (OR = 3.7, 95% CI = 0.8-16.3, p = 0.08) and 30 hours (OR = 3.9, 95% CI = 0.9-16.7, p = 0.06). Admission with abnormal pupils and a lower Glasgow Coma Score also were independently associated with hospital mortality. The hormonal changes are frequent in the acute phase of severe TBI. The hormones plasma levels, excepting the LH, are not highly consistent with the hospital mortality of male patients.

Age-period-cohort analysis of infectious disease mortality in urban-rural China, 1990-2010.

PubMed

Li, Zhi; Wang, Peigang; Gao, Ge; Xu, Chunling; Chen, Xinguang

2016-03-31

Although a number of studies on infectious disease trends in China exist, these studies have not distinguished the age, period, and cohort effects simultaneously. Here, we analyze infectious disease mortality trends among urban and rural residents in China and distinguish the age, period, and cohort effects simultaneously. Infectious disease mortality rates (1990-2010) of urban and rural residents (5-84 years old) were obtained from the China Health Statistical Yearbook and analyzed with an age-period-cohort (APC) model based on Intrinsic Estimator (IE). Infectious disease mortality is relatively high at age group 5-9, reaches a minimum in adolescence (age group 10-19), then rises with age, with the growth rate gradually slowing down from approximately age 75. From 1990 to 2010, except for a slight rise among urban residents from 2000 to 2005, the mortality of Chinese residents experienced a substantial decline, though at a slower pace from 2005 to 2010. In contrast to the urban residents, rural residents experienced a rapid decline in mortality during 2000 to 2005. The mortality gap between urban and rural residents substantially narrowed during this period. Overall, later birth cohorts experienced lower infectious disease mortality risk. From the 1906-1910 to the 1941-1945 birth cohorts, the decrease of mortality among urban residents was significantly faster than that of subsequent birth cohorts and rural counterparts. With the rapid aging of the Chinese population, the prevention and control of infectious disease in elderly people will present greater challenges. From 1990 to 2010, the infectious disease mortality of Chinese residents and the urban-rural disparity have experienced substantial declines. However, the re-emergence of previously prevalent diseases and the emergence of new infectious diseases created new challenges. It is necessary to further strengthen screening, immunization, and treatment for the elderly and for older cohorts at high risk.

Population cycles: generalities, exceptions and remaining mysteries.

PubMed

Myers, Judith H

2018-03-28

Population cycles are one of nature's great mysteries. For almost a hundred years, innumerable studies have probed the causes of cyclic dynamics in snowshoe hares, voles and lemmings, forest Lepidoptera and grouse. Even though cyclic species have very different life histories, similarities in mechanisms related to their dynamics are apparent. In addition to high reproductive rates and density-related mortality from predators, pathogens or parasitoids, other characteristics include transgenerational reduced reproduction and dispersal with increasing-peak densities, and genetic similarity among populations. Experiments to stop cyclic dynamics and comparisons of cyclic and noncyclic populations provide some understanding but both reproduction and mortality must be considered. What determines variation in amplitude and periodicity of population outbreaks remains a mystery. © 2018 The Author(s).

Shape of the association between income and mortality: a cohort study of Denmark, Finland, Norway and Sweden in 1995 and 2003

PubMed Central

Mortensen, Laust H; Rehnberg, Johan; Dahl, Espen; Diderichsen, Finn; Elstad, Jon Ivar; Martikainen, Pekka; Rehkopf, David; Tarkiainen, Lasse; Fritzell, Johan

2016-01-01

Objectives Prior work has examined the shape of the income–mortality association, but work has not compared gradients between countries. In this study, we focus on changes over time in the shape of income–mortality gradients for 4 Nordic countries during a period of rising income inequality. Context and time differentials in shape imply that the relationship between income and mortality is not fixed. Setting Population-based cohort study of Denmark, Finland, Norway and Sweden. Participants We collected data on individuals aged 25 or more in 1995 (n=12.98 million individuals, 0.84 million deaths) and 2003 (n=13.08 million individuals, 0.90 million deaths). We then examined the household size equivalised disposable income at the baseline year in relation to the rate of mortality in the following 5 years. Results A steep income gradient in mortality in men and women across all age groups except the oldest old in Denmark, Finland, Norway and Sweden. From the 1990s to 2000s mortality dropped, but generally more so in the upper part of the income distribution than in the lower part. As a consequence, the shape of the income gradient in mortality changed. The shift in the shape of the association was similar in all 4 countries. Conclusions A non-linear gradient exists between income and mortality in most cases and because of a more rapid mortality decline among those with high income the income gradient has become steeper over time. PMID:28011804

The impact of income inequality and national wealth on child and adolescent mortality in low and middle-income countries.

PubMed

Ward, Joseph L; Viner, Russell M

2017-05-11

Income inequality and national wealth are strong determinants for health, but few studies have systematically investigated their influence on mortality across the early life-course, particularly outside the high-income world. We performed cross-sectional regression analyses of the relationship between income inequality (national Gini coefficient) and national wealth (Gross Domestic Product (GDP) averaged over previous decade), and all-cause and grouped cause national mortality rate amongst infants, 1-4, 5-9, 10-14, 15-19 and 20-24 year olds in low and middle-income countries (LMIC) in 2012. Gini models were adjusted for GDP. Data were available for 103 (79%) countries. Gini was positively associated with increased all-cause and communicable disease mortality in both sexes across all age groups, after adjusting for national wealth. Gini was only positively associated with increased injury mortality amongst infants and 20-24 year olds, and increased non-communicable disease mortality amongst 20-24 year old females. The strength of these associations tended to increase during adolescence. Increasing GDP was negatively associated with all-cause, communicable and non-communicable disease mortality in males and females across all age groups. GDP was also associated with decreased injury mortality in all age groups except 15-19 year old females, and 15-24 year old males. GDP became a weaker predictor of mortality during adolescence. Policies to reduce income inequality, rather than prioritising economic growth at all costs, may be needed to improve adolescent mortality in low and middle-income countries, a key development priority.

Access to Liver Transplantation in Different ABO-Blood Groups and "Exceptions Points" in a Model for End-Stage Liver Disease Allocation System: A Brazilian Single-Center Study.

PubMed

Martino, R B; Waisberg, D R; Dias, A P M; Inoue, V B S; Arantes, R M; Haddad, L B P; Rocha-Santos, V; Pinheiro, R S N; Nacif, L S; D'Albuquerque, L A C

2018-04-01

In the Model for End-Stage Liver Disease (MELD) system, patients with "MELD exceptions" points may have unfair privilege in the competition for liver grafts. Furthermore, organ distribution following identical ABO blood types may also result in unjust organ allocation. The aim of this study was to investigate access to liver transplantation in a tertiary Brazilian center, regarding "MELD exceptions" situations and among ABO-blood groups. A total of 465 adult patients on the liver waitlist from August 2015 to August 2016 were followed up until August 2017. Patients were divided into groups according to ABO-blood type and presence of "exceptions points." No differences in outcomes were observed among ABO-blood groups. However, patients from B and AB blood types spent less time on the list than patients from A and O groups (median, 46, 176, 415, and 401 days, respectively; P = .03). "Exceptions points" were granted for 141 patients (30.1%), hepatocellular carcinoma being the most common reason (52.4%). Patients with "exceptions points" showed higher transplantation rate, lower mortality on the list, and lower delta-MELD than non-exceptions patients (56.7% vs 19.1% [P < .01]; 18.4% vs 38.5% [P < .01], and 2.0 ± 2.6 vs 6.9 ± 7.0 [P < .01], respectively). Patients with refractory ascites had a higher mortality rate than those with other "exceptions" or without (48%). The MELD system provides equal access to liver transplantation among ABO-blood types, despite shorter time on the waitlist for AB and B groups. The current MELD exception system provides advantages for candidates with "exception points," resulting in superior outcomes compared with those without exceptions. Copyright © 2018 Elsevier Inc. All rights reserved.

Stand-structural effects on Heterobasidion abietinum-related mortality following drought events in Abies pinsapo.

PubMed

Linares, Juan Carlos; Camarero, Jesús Julio; Bowker, Matthew A; Ochoa, Victoria; Carreira, José Antonio

2010-12-01

Climate change may affect tree-pathogen interactions. This possibility has important implications for drought-prone forests, where stand dynamics and disease pathogenicity are especially sensitive to climatic stress. In addition, stand structural attributes including density-dependent tree-to-tree competition may modulate the stands' resistance to drought events and pathogen outbreaks. To assess the effects of stand structure on root-rot-related mortality after severe droughts, we focused on Heterobasidion abietinum mortality in relict Spanish stands of Abies pinsapo, a drought-sensitive fir. We compared stand attributes and tree spatial patterns in three plots with H. abietinum root-rot disease and three plots without root-rot. Point-pattern analyses were used to investigate the scale and extent of mortality patterns and to test hypotheses related to the spread of the disease. Dendrochronology was used to date the year of death and to assess the association between droughts and growth decline. We applied a structural equation modelling approach to test if tree mortality occurs more rapidly than predicted by a simple distance model when trees are subjected to high tree-to-tree competition and following drought events. Contrary to expectations of drought mortality, the effect of precipitation on the year of death was strong and negative, indicating that a period of high precipitation induced an earlier tree death. Competition intensity, related to the size and density of neighbour trees, also induced an earlier tree death. The effect of distance to the disease focus was negligible except in combination with intensive competition. Our results indicate that infected trees have decreased ability to withstand drought stress, and demonstrate that tree-to-tree competition and fungal infection act as predisposing factors of forest decline and mortality.

Mortality burden of the 2009 A/H1N1 influenza pandemic in France: comparison to seasonal influenza and the A/H3N2 pandemic.

PubMed

Lemaitre, Magali; Carrat, Fabrice; Rey, Grégoire; Miller, Mark; Simonsen, Lone; Viboud, Cécile

2012-01-01

The mortality burden of the 2009 A/H1N1 pandemic remains unclear in many countries due to delays in reporting of death statistics. We estimate the age- and cause-specific excess mortality impact of the pandemic in France, relative to that of other countries and past epidemic and pandemic seasons. We applied Serfling and Poisson excess mortality approaches to model weekly age- and cause-specific mortality rates from June 1969 through May 2010 in France. Indicators of influenza activity, time trends, and seasonal terms were included in the models. We also reviewed the literature for country-specific estimates of 2009 pandemic excess mortality rates to characterize geographical differences in the burden of this pandemic. The 2009 A/H1N1 pandemic was associated with 1.0 (95% Confidence Intervals (CI) 0.2-1.9) excess respiratory deaths per 100,000 population in France, compared to rates per 100,000 of 44 (95% CI 43-45) for the A/H3N2 pandemic and 2.9 (95% CI 2.3-3.7) for average inter-pandemic seasons. The 2009 A/H1N1 pandemic had a 10.6-fold higher impact than inter-pandemic seasons in people aged 5-24 years and 3.8-fold lower impact among people over 65 years. The 2009 pandemic in France had low mortality impact in most age groups, relative to past influenza seasons, except in school-age children and young adults. The historical A/H3N2 pandemic was associated with much larger mortality impact than the 2009 pandemic, across all age groups and outcomes. Our 2009 pandemic excess mortality estimates for France fall within the range of previous estimates for high-income regions. Based on the analysis of several mortality outcomes and comparison with laboratory-confirmed 2009/H1N1 deaths, we conclude that cardio-respiratory and all-cause mortality lack precision to accurately measure the impact of this pandemic in high-income settings and that use of more specific mortality outcomes is important to obtain reliable age-specific estimates.

Heat-stress-related mortality in five cities in Southern Ontario: 1980-1996.

PubMed

Smoyer, K E; Rainham, D G; Hewko, J N

2000-11-01

The Toronto-Windsor corridor of Southern Ontario, Canada, experiences hot and humid weather conditions in summer, thus exposing the population to heat stress and a greater risk of mortality. In the event of a climate change, heat-stress conditions may become more frequent and severe in Southern Ontario. To assess the impact of summer weather on health, we analyzed heat-related mortality in the elderly (older than 64 years) in the metropolitan areas of Windsor, London, Kitchener-Waterloo-Cambridge, Hamilton, and Toronto for a 17-year period. Demographic, socioeconomic, and housing factors were also evaluated to assess their effect on the potential of the population to adapt and their vulnerability to heat stress. Heat-stress days were defined as those with an apparent temperature (heat index) above 32 degrees C. Mortality among the elderly was significantly higher on heat-stress days than on non-heat-stress days in all cities except Windsor. The strongest relationships occurred in Toronto and London, followed by Hamilton. Cities with the greatest heat-related mortality have relatively high levels of urbanization and high costs of living. Even without the warming induced by a climate change, (1) vulnerability is likely to increase as the population ages, and (2) ongoing urban development and sprawl are expected to intensify heat-stress conditions in Southern Ontario. Actions should be taken to reduce vulnerability to heat stress conditions, and to develop a comprehensive hot weather watch/warning system for the region.

Cervical and female breast cancers in the Americas: current situation and opportunities for action.

PubMed

Luciani, Silvana; Cabanes, Anna; Prieto-Lara, Elisa; Gawryszewski, Vilma

2013-09-01

To understand better the current regional situation and public health response to cervical cancer and female breast cancer in the Americas. Data on cervical cancer and female breast cancers in 33 countries, for the period from 2000 to the last year with available data, were extracted from the Pan American Health Organization (PAHO) Regional Mortality Database and analysed. Changes in mortality rates over the study period - in all countries except those with small populations and large fluctuations in time-series mortality data - were calculated using Poisson regression models. Information from the PAHO Country Capacity Survey on noncommunicable diseases was also analysed. The Bahamas, Trinidad and Tobago and Uruguay showed relatively high rates of death from breast cancer, whereas the three highest rates of death from cervical cancer were observed in El Salvador, Nicaragua and Paraguay. Several countries - particularly Paraguay and Venezuela - have high rates of death from both types of cancer. Although mortality from cervical cancer has generally been decreasing in the Americas, decreases in mortality from breast cancer have only been observed in a few countries in the Region of the Americas. All but one of the 25 countries in the Americas included in the PAHO Country Capacity Survey reported having public health services for the screening and treatment of breast and cervical cancers. Most countries in the Americas have the public health capacity needed to screen for - and treat - breast and cervical cancers and, therefore, the potential to reduce the burden posed by these cancers.

The injury mortality burden in Guinea

PubMed Central

2012-01-01

Background The injury mortality burden of Guinea has been rarely addressed. The paper aimed to report patterns of injury mortality burden in Guinea. Methods We retrieved the mortality data from the Guinean Annual Health Statistics Report 2007. The information about underlying cause of deaths was collected based on Guinean hospital discharge data, Hospital Mortuary and City Council Mortuary data. The causes of death are coded in the 9th International Classification of Diseases (ICD-9). Multivariate Poisson regression was used to test the impacts of sex and age on mortality rates. The statistical analyses were performed using Statatm 10.0. Results In 2007, 7066 persons were reported dying of injuries in Guinea (mortality: 72.8 per 100,000 population). Transportation, fire/burn, falls, homicide and drowning were the five leading causes of fatal injuries for the whole population, accounting for 37%, 22%, 12%, 10% and 6% of total deaths, respectively. In general, age-specific injury causes displayed similar patterns of the whole population except that poisoning replaced falls as a leading cause among children under five years old. Males were at 30-50% more risk of dying from six commonest causes than females and old age groups had higher injury mortality rates than younger age groups. Conclusion Transportation, fire/burn, falls, homicide, and drowning accounted for the majority of total injury mortality burden in Guinea. Males and old adults were high-risk population of fatal injuries and should be targeted by injury prevention. Lots of work is needed to improve weak capacities for injury control in order to reduce the injury mortality burden. PMID:22937768

Changes in the distribution of high-risk births associated with changes in contraceptive prevalence.

PubMed

Stover, John; Ross, John

2013-01-01

Several birth characteristics are associated with high mortality risk: very young or old mothers, short birth intervals and high birth order. One justification for family planning programs is the health benefits associated with better spacing and timing of births. This study examines the extent to which the prevalence of these risk factors changes as a country transitions from high to low fertility. We use data from 194 national surveys to examine both cross section and within-country variation in these risk factors as they relate to the total fertility rate. Declines in the total fertility rate are associated with large declines in the proportion of high order births, those to mothers over the age of 34 and those with multiple risk factors; as well as to increasing proportions of first order births. There is little change in the proportion of births with short birth intervals except in sub-Saharan Africa. The use of family planning is strongly associated with fertility declines. The proportion of second and higher order births with demographic risk factors declines substantially as fertility declines. This creates a potential for reducing child mortality rates. Some of the reduction comes from modifying the birth interval distribution or by bringing maternal age at the time of birth into the 'safe' range of 18-35 years, and some comes from the actual elimination of births that would have a high mortality risk (high parity births).

Reduced in-hospital mortality for heart failure with clinical pathways: the results of a cluster randomised controlled trial.

PubMed

Panella, M; Marchisio, S; Demarchi, M L; Manzoli, L; Di Stanislao, F

2009-10-01

Hospital treatment of heart failure (HF) frequently does not follow published guidelines, potentially contributing to HF high morbidity, mortality and economic cost. The Experimental Prospective Study on the Effectiveness and Efficiency of the Implementation of Clinical Pathways was undertaken to determine how clinical pathways (CP) for hospital treatment of HF affected care variability, guidelines adherence, in-hospital mortality and outcomes at discharge. Methods/ Two-arm, cluster-randomised trial. Fourteen community hospitals were randomised either to the experimental arm (CP: appropriate therapeutic guidelines use, new organisation and procedures, patient education) or to the control arm (usual care). The main outcome was in-hospital mortality; secondary outcomes were length and appropriateness of the stay, rate of unscheduled readmissions, customer satisfaction, usage of diagnostic and therapeutic procedures during hospital stay and quality indicators at discharge. All outcomes were measured using validated instruments available in literature. In-hospital mortality was 5.6% in the experimental arm (n = 12); 15.4% in controls (n = 33, p = 0.001). In CP and usual care groups, the mean rates of unscheduled readmissions were 7.9% and 13.9%, respectively. Adjusting for age, smoking, New York Heart Association score, hypertension and source of referral, patients in the CP group, as compared to controls, had a significantly lower risk of in-hospital death (OR 0.18; 95% CI 0.07 to 0.46) and unscheduled readmissions (OR 0.42; 95% CI 0.20 to 0.87). No differences were found between CP and control with respect to the appropriateness of the stay, costs and patient's satisfaction. Except for electrocardiography, all recommended diagnostic procedures were used more in the CP group. Similarly, pharmaceuticals use was significantly greater in CP, with the exception of diuretics and anti-platelets agents. The introduction of a specifically tailored CP for the hospital treatment of HF was effective in reducing in-hospital mortality and unscheduled readmissions. This study adds to previous knowledge indicating that CP should be used to improve the quality of hospital treatment of HF. NCT00519038.

The Presence of Flour Affects the Efficacy of Aerosolized Insecticides used to Treat the Red Flour Beetle, Tribolium castaneum

PubMed Central

Toews, Michael D.; Campbell, James F.; Arthur, Franklin H.

2010-01-01

Experiments were conducted in tightly sealed pilot scale warehouses to assess the efficacy of common aerosolized insecticides on all life stages of Tribolium castaneum (Herbst) (Coleoptera: Tenebrionidae) when exposed in dishes containing 0 to 2 g of wheat flour either under pallets or out in the open. Petri dishes containing 0, 0.1, 1, or 2 g of flour were prepared with 25 eggs, 3rd instars, pupae, or adults and then immediately treated with aerosolized solvent, Pyrethrins, or esfenvalerate. Twenty-four h after insecticide exposure, the dishes were brought to the laboratory and placed in a growth chamber and held for a 3 day moribund (knockdown) assessment and a 21 day mortality assessment. Mortality in untreated controls was generally less than 10%, with the exception of the 21 day counts of adults and eggs. Solvent-treated replications followed similar trends, except that additional mortality was observed in exposed larvae and pupae. In the insecticide-treated dishes, mortality of T. castaneum provisioned with flour generally showed a linear decrease with increasing flour deposits. Regardless of life stage, mortality did not exceed 60% when individuals were exposed in petri dishes containing 2 g of flour. Exposure location also made a significant difference in observed mortality. While mortality never exceeded 75% in dishes positioned under pallets, there was never less than 80% mortality in dishes exposed in the open. Although there was a perceptible increase in mortality with esfenvalerate compared to Pyrethrins, these differences were considerably less than the variation observed among flour deposits. The study suggests that sanitation and preparation prior to aerosol insecticide treatments were more important than choice of a particular insecticide. PMID:21268701

In vitro effects of Apixaban on 5 different cancer cell lines

PubMed Central

Guasti, Luigina; Moretto, Paola; Vigetti, Davide; Ageno, Walter; Dentali, Francesco; Maresca, Andrea M.; Campiotti, Leonardo; Grandi, Anna M.; Passi, Alberto

2017-01-01

Background Cancer is associated with hypercoagulability. However, several data suggest that anticoagulant drugs may have an effect on tumor development and progression mediated by both coagulation dependent processes and non-coagulation dependent processes. Therefore, we investigated the in vitro effects of Apixaban on cell proliferation, mortality, cell migration, gene expression and matrix metalloproteinase in 5 different cancer cell lines. Methods The following cancer cell lines, and 2 normal fibroblast cultures (lung and dermal fibroblasts), were studied: OVCAR3 (ovarian cancer), MDA MB 231 (breast cancer), CaCO-2 (colon cancer), LNCaP (prostate cancer) and U937 (histiocytic lymphoma). Proliferation and cell mortality were assessed in control cells and Apixaban treated cultures (dose from 0.1 to 5 μg/ml, 0 to 96-h). Necrosis/Apoptosis (fluorescence microscopy), cell migration (24-h after scratch test), matrix metalloproteinase (MMP) activity and mRNA expression (RT PCR) of p16, p21, p53 and HAS were also assessed. Results High-dose (5 μg/ml) Apixaban incubation was associated with a significantly reduced proliferation in 3 cancer cell lines (OVCAR3, CaCO-2 and LNCaP) and with increased cancer cell mortality in all, except LNCaP, cancer lines. Apoptosis seems to account for the increased mortality. The migration capacity seems to be impaired after high-dose Apixaban incubation in OVCAR3 and CaCO-2 cells. Data on mRNA expression suggest a consistent increase in tumor suppression gene p16 in all cell lines. Conclusions Our data suggest that high-dose Apixaban may be able to interfere with cancer cell in vitro, reducing proliferation and increasing cancer cell mortality through apoptosis in several cancer cell lines. PMID:29023465

Comparison of cancer incidence and mortality in three GDP per capita levels in China, 2013

PubMed Central

Yang, Zhixun; Zheng, Rongshou; Zhang, Siwei; Zeng, Hongmei; Xia, Changfa; Li, He; Wang, Li; Wang, Yanhong; Chen, Wanqing

2017-01-01

Objective In this research, the patterns of cancer incidence and mortality in areas with different gross domestic product per capita (GDPPC) levels in China were explored, using data from population-based cancer registries in 2013, collected by the National Central Cancer Registry (NCCR). Methods Data from 255 cancer registries were qualified and included in this analysis. Based on the GDPPC data of 2014, cities/counties were divided into 3 levels: high-, middle- and low-GDPPC areas, with 40,000 and 80,000 RMB per year as cut points. We calculated cancer incidences and mortalities in these three levels, stratified by gender and age group. The national population of the Fifth Census in 2000 and Segi’s population were applied for age-standardized rates. Results The crude incidence and mortality rates as well as age-standardized incidence rate (ASIR) showed positive associations with GDPPC level. The age-standardized mortality rate (ASMR) nevertheless showed a negative association with GDPPC level. The ASMR in high-, middle- and low-GDPPC areas was 103.12/100,000, 112.49/100,000 and 117.43/100,000, respectively. Lung cancer was by far the most common cancer in all three GDPPC levels. It was also the leading cause of cancer death, regardless of gender and GDPPC level. Negative associations with GDPPC level were found for the ASIRs of lung, stomach, esophageal and liver cancer, whereas colorectal and breast cancer showed positive associations. Except for breast cancer, the ASMRs of the other five cancers were always higher in middle- and low-GDPPC areas than in high-GDPPC areas. Conclusions The economic development is one of the main factors of the heavy cancer burden on Chinese population. It would be reasonable to implement cancer control strategies referring to the local GDPPC level. PMID:29142457

Comparison of cancer incidence and mortality in three GDP per capita levels in China, 2013.

PubMed

Yang, Zhixun; Zheng, Rongshou; Zhang, Siwei; Zeng, Hongmei; Xia, Changfa; Li, He; Wang, Li; Wang, Yanhong; Chen, Wanqing

2017-10-01

In this research, the patterns of cancer incidence and mortality in areas with different gross domestic product per capita (GDPPC) levels in China were explored, using data from population-based cancer registries in 2013, collected by the National Central Cancer Registry (NCCR). Data from 255 cancer registries were qualified and included in this analysis. Based on the GDPPC data of 2014, cities/counties were divided into 3 levels: high-, middle- and low-GDPPC areas, with 40,000 and 80,000 RMB per year as cut points. We calculated cancer incidences and mortalities in these three levels, stratified by gender and age group. The national population of the Fifth Census in 2000 and Segi's population were applied for age-standardized rates. The crude incidence and mortality rates as well as age-standardized incidence rate (ASIR) showed positive associations with GDPPC level. The age-standardized mortality rate (ASMR) nevertheless showed a negative association with GDPPC level. The ASMR in high-, middle- and low-GDPPC areas was 103.12/100,000, 112.49/100,000 and 117.43/100,000, respectively. Lung cancer was by far the most common cancer in all three GDPPC levels. It was also the leading cause of cancer death, regardless of gender and GDPPC level. Negative associations with GDPPC level were found for the ASIRs of lung, stomach, esophageal and liver cancer, whereas colorectal and breast cancer showed positive associations. Except for breast cancer, the ASMRs of the other five cancers were always higher in middle- and low-GDPPC areas than in high-GDPPC areas. The economic development is one of the main factors of the heavy cancer burden on Chinese population. It would be reasonable to implement cancer control strategies referring to the local GDPPC level.

Post universal health coverage trend and geographical inequalities of mortality in Thailand.

PubMed

Aungkulanon, Suchunya; Tangcharoensathien, Viroj; Shibuya, Kenji; Bundhamcharoen, Kanitta; Chongsuvivatwong, Virasakdi

2016-11-22

Thailand has achieved remarkable improvement in health status since the achievement of universal health coverage in 2002. Health equity has improved significantly. However, challenges on health inequity still remain.This study aimed to determine the trends of geographical inequalities in disease specific mortality in Thailand after the country achieved universal health coverage. National vital registration data from 2001 to 2014 were used to calculate age-adjusted mortality rate and standardized mortality ratio (SMR). To minimize large variations in mortality across administrative districts, the adjacent districts were systematically grouped into "super-districts" by taking into account the population size and proximity. Geographical mortality inequality among super-districts was measured by the coefficient of variation. Mixed effects modeling was used to test the difference in trends between super-districts. The overall SMR steadily declined from 1.2 in 2001 to 0.9 in 2014. The upper north and upper northeast regions had higher SMR whereas Greater Bangkok achieved the lowest SMR. Decreases in SMR were mostly seen in Greater Bangkok and the upper northern region. Coefficient of variation of SMR rapidly decreased from 20.0 in 2001 to 12.5 in 2007 and remained close to this value until 2014. The mixed effects modelling revealed significant differences in trends of SMR across super-districts. Inequality in mortality declined among adults (≥15 years old) but increased in children (0-14 years old). A declining trend in inequality of mortality was seen in almost all regions except Greater Bangkok where the inequality in SMR remained high throughout the study period. A decline in the adult mortality inequality across almost all regions of Thailand followed universal health coverage. Inequalities in child mortality rates and among residents of Greater Bangkok need further exploration.

Shape of the association between income and mortality: a cohort study of Denmark, Finland, Norway and Sweden in 1995 and 2003.

PubMed

Mortensen, Laust H; Rehnberg, Johan; Dahl, Espen; Diderichsen, Finn; Elstad, Jon Ivar; Martikainen, Pekka; Rehkopf, David; Tarkiainen, Lasse; Fritzell, Johan

2016-12-23

Prior work has examined the shape of the income-mortality association, but work has not compared gradients between countries. In this study, we focus on changes over time in the shape of income-mortality gradients for 4 Nordic countries during a period of rising income inequality. Context and time differentials in shape imply that the relationship between income and mortality is not fixed. Population-based cohort study of Denmark, Finland, Norway and Sweden. We collected data on individuals aged 25 or more in 1995 (n=12.98 million individuals, 0.84 million deaths) and 2003 (n=13.08 million individuals, 0.90 million deaths). We then examined the household size equivalised disposable income at the baseline year in relation to the rate of mortality in the following 5 years. A steep income gradient in mortality in men and women across all age groups except the oldest old in Denmark, Finland, Norway and Sweden. From the 1990s to 2000s mortality dropped, but generally more so in the upper part of the income distribution than in the lower part. As a consequence, the shape of the income gradient in mortality changed. The shift in the shape of the association was similar in all 4 countries. A non-linear gradient exists between income and mortality in most cases and because of a more rapid mortality decline among those with high income the income gradient has become steeper over time. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Anorexia nervosa in males: excess mortality and psychiatric co-morbidity in 609 Swedish in-patients.

PubMed

Kask, J; Ramklint, M; Kolia, N; Panagiotakos, D; Ekbom, A; Ekselius, L; Papadopoulos, F C

2017-06-01

Anorexia nervosa (AN) is a psychiatric disorder with high mortality. A retrospective register study of 609 males who received hospitalized care for AN in Sweden between 1973 and 2010 was performed. The standardized mortality ratios (SMRs) and Cox regression-derived hazard ratios (HRs) were calculated as measures of mortality. The incidence rate ratios (IRRs) were calculated to compare the mortality rates in patients with AN and controls both with and without psychiatric diagnoses. The SMR for all causes of death was 4.1 [95% confidence interval (CI) 3.1-5.3]. For those patients with psychiatric co-morbidities, the SMR for all causes of death was 9.1 (95% CI 6.6-12.2), and for those without psychiatric co-morbidity, the SMR was 1.6 (95% CI 0.9-2.7). For the group of patients with alcohol use disorder, the SMR for natural causes of death was 11.5 (95% CI 5.0-22.7), and that for unnatural causes was 35.5 (95% CI 17.7-63.5). The HRs confirmed the increased mortality for AN patients with psychiatric co-morbidities, even after adjusting for confounders. The IRRs revealed no significant difference in mortality patterns between the AN patients with psychiatric co-morbidity and the controls with psychiatric diagnoses, with the exceptions of alcohol use disorder and neurotic, stress-related and somatoform disorders, which seemed to confer a negative synergistic effect on mortality. Mortality in male AN patients was significantly elevated compared with the general population among only the patients with psychiatric co-morbidities. Specifically, the presence of alcohol and other substance use disorders was associated with more profound excess mortality.

The impact of migration on deaths and hospital admissions from work-related injuries in Australia.

PubMed

Reid, Alison; Peters, Susan; Felipe, Nieves; Lenguerrand, Erik; Harding, Seeromanie

2016-02-01

The shift from an industrial to a service-based economy has seen a decline in work-related injuries (WRIs) and mortality. How this relates to migrant workers, who traditionally held high-risk jobs is unknown. This study examined deaths and hospital admissions from WRI, among foreign and Australian-born workers. Tabulated population data from the 1991 to 2011 censuses, national deaths 1991-2002 and hospital admission for 2001-10. Direct age standardised mortality and hospital admission rates (DSRs) and rate ratios (RRs) were derived to examine differences in work-related mortality/hospital admissions by gender, country of birth, employment skill level and years of residence in Australia. DSRs and RRs were generally lower or no different between Australian and foreign-born workers. Among men, mortality DSRs were lower for nine of 16 country of birth groups, and hospital admissions DSRs for 14 groups. An exception was New Zealand-born men, with 9% (95%CI 9-13) excess mortality and 24% (95%CI 22-26) excess hospital admissions. Four decades ago, foreign-born workers were generally at higher risk of WRI than Australian-born. This pattern has reversed. The local-born comprise 75% of the population and a pro-active approach to health and safety regulation could achieve large benefits. © 2015 Public Health Association of Australia.

Leading causes of death and all-cause mortality in American Indians and Alaska Natives.

PubMed

Espey, David K; Jim, Melissa A; Cobb, Nathaniel; Bartholomew, Michael; Becker, Tom; Haverkamp, Don; Plescia, Marcus

2014-06-01

We present regional patterns and trends in all-cause mortality and leading causes of death in American Indians and Alaska Natives (AI/ANs). US National Death Index records were linked with Indian Health Service (IHS) registration records to identify AI/AN deaths misclassified as non-AI/AN. We analyzed temporal trends for 1990 to 2009 and comparisons between non-Hispanic AI/AN and non-Hispanic White persons by geographic region for 1999 to 2009. Results focus on IHS Contract Health Service Delivery Area counties in which less race misclassification occurs. From 1990 to 2009 AI/AN persons did not experience the significant decreases in all-cause mortality seen for Whites. For 1999 to 2009 the all-cause death rate in CHSDA counties for AI/AN persons was 46% more than that for Whites. Death rates for AI/AN persons varied as much as 50% among regions. Except for heart disease and cancer, subsequent ranking of specific causes of death differed considerably between AI/AN and White persons. AI/AN populations continue to experience much higher death rates than Whites. Patterns of mortality are strongly influenced by the high incidence of diabetes, smoking prevalence, problem drinking, and social determinants. Much of the observed excess mortality can be addressed through known public health interventions.

Predictors of Mortality in Staphylococcus aureus Bacteremia

PubMed Central

Jensen, Slade O.; Vaska, Vikram L.; Espedido, Björn A.; Paterson, David L.; Gosbell, Iain B.

2012-01-01

Summary: Staphylococcus aureus bacteremia (SAB) is an important infection with an incidence rate ranging from 20 to 50 cases/100,000 population per year. Between 10% and 30% of these patients will die from SAB. Comparatively, this accounts for a greater number of deaths than for AIDS, tuberculosis, and viral hepatitis combined. Multiple factors influence outcomes for SAB patients. The most consistent predictor of mortality is age, with older patients being twice as likely to die. Except for the presence of comorbidities, the impacts of other host factors, including gender, ethnicity, socioeconomic status, and immune status, are unclear. Pathogen-host interactions, especially the presence of shock and the source of SAB, are strong predictors of outcomes. Although antibiotic resistance may be associated with increased mortality, questions remain as to whether this reflects pathogen-specific factors or poorer responses to antibiotic therapy, namely, vancomycin. Optimal management relies on starting appropriate antibiotics in a timely fashion, resulting in improved outcomes for certain patient subgroups. The roles of surgery and infectious disease consultations require further study. Although the rate of mortality from SAB is declining, it remains high. Future international collaborative studies are required to tease out the relative contributions of various factors to mortality, which would enable the optimization of SAB management and patient outcomes. PMID:22491776

A population-based study of the epidemiology of pancreatic cancer: a brief report

PubMed Central

Raju, R.S.; Coburn, N.; Liu, N.; Porter, J.M.; Seung, S.J.; Cheung, M.C.; Goyert, N.; Leighl, N.B.; Hoch, J.S.; Trudeau, M.E.; Evans, W.K.; Dainty, K.N.; Earle, C.C.; Mittmann, N.

2015-01-01

Objective Administrative data are used to describe the pancreatic cancer (pcc) population. The analysis examines demographic details, incidence, site, survival, and factors influencing mortality in a cohort of individuals diagnosed with pcc. Methods Incident cases of pcc diagnosed in Ontario between 1 January 2004 and 31 December 2011 were extracted from the Ontario Cancer Registry. They were linked by encrypted health card number to several administrative databases to obtain demographic and mortality information. Descriptive, bivariate, and survival analyses were conducted. Results During the period of interest, 9221 new cases of pcc (4548 in men, 4673 in women) were diagnosed, for an age-adjusted standardized annual incidence in the range of 8.6–9.5 per 100,000 population. Mean age at diagnosis was 70.3 ± 12.5 years (standard deviation). Five-year survival was 7.2% (12.8% for those <60 years of age and 3.6% for those >80 years of age). Survival varied by sex, older age, rural residence, lower income, site of involvement in the pancreas, and presence of comorbidity. Conclusions The mortality rate in pcc is exceptionally high. With an increasing incidence and a mortality positively associated with age, additional support will be needed for this highly fatal disease as demographics in Ontario continue to trend toward a higher proportion of older individuals. PMID:26715886

Air pollution and mortality in São Paulo, Brazil: Effects of multiple pollutants and analysis of susceptible populations.

PubMed

Bravo, Mercedes A; Son, Jiyoung; de Freitas, Clarice Umbelino; Gouveia, Nelson; Bell, Michelle L

2016-01-01

Health impacts of air pollution may differ depending on sex, education, socioeconomic status (SES), location at time of death, and other factors. In São Paulo, Brazil, questions remain regarding roles of individual and community characteristics. We estimate susceptibility to air pollution based on individual characteristics, residential SES, and location at time of death (May 1996-December 2010). Exposures for particulate matter with an aerodynamic diameter ≤ 10 μm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) were estimated using ambient monitors. Time-stratified case-crossover analysis was used with individual-level health data. Increased risk of non-accidental, cardiovascular, and respiratory mortality were associated with all pollutants (P < 0.05), except O3 and cardiovascular mortality. For non-accidental mortality, effect estimates for those with > 11 years education were lower than estimates for those with 0 years education for NO2, SO2, and CO (1.66% (95% confidence interval: 0.23%, 3.08%); 1.51% (0.51%, 2.51%); and 2.82% (0.23%, 5.35%), respectively). PM10 cardiovascular mortality effects were (3.74% (0.044%, 7.30%)) lower for the high education group (> 11 years) compared with the no education group. Positive, significant associations between pollutants and mortality were observed for in-hospital deaths, but evidence of differences in air pollution-related mortality risk by location at time of death was not strong.

A comparison of patient characteristics and survival in two trauma centres located in different countries.

PubMed

Templeton, J; Oakley, P A; MacKenzie, G; Cook, A L; Brand, D; Mullins, R J; Trunkey, D D

2000-09-01

The aim of the study was to compare patient characteristics and mortality in severely injured patients in two trauma centres located in different countries, allowing for differences in case-mix. It represents a direct bench-marking exercise between the trauma centres at the North Staffordshire Hospital (NSH), Stoke-on-Trent, UK and the Oregon Health Sciences University (OHSU) Hospital, Portland, Oregon, USA. Patients of all ages admitted to the two hospitals during 1995 and 1996 with an Injury Severity Score >15 were included, except for those who died in the emergency departments. Twenty-three factors were studied, including the Injury Severity Score, Glasgow Coma Score, mechanism of injury and anatomical site of injury. Outcome analysis was based on mortality at discharge. The pattern of trauma differed significantly between Stoke and Portland. Patients from Stoke tended to be older, presented with a lower conscious level and a lower systolic blood pressure and were intubated less frequently before arriving at hospital. Mortality depended on similar factors in both centres, especially age, highest AIS score, systolic blood pressure and Glasgow Coma Score.The crude analysis of mortality showed a highly significant odds-ratio of 1.64 in Stoke compared with Portland. Single-factor adjustments were made for the above four factors, which had a similar influence on mortality in both centres. Adjusting for the first three factors individually did not alter the odds-ratio, which stayed in the range 1.53-1.59 and remained highly significant. Adjusting for the Glasgow Coma Score reduced the odds-ratio to 0.82 and rendered it non-significant. In a multi-factor logistic regression model incorporating all of the factors shown to influence mortality in either centre, the odds-ratio was 1.7 but was not significant. The analysis illustrates the limitations and pitfalls of making crude outcome comparisons between centres. Highly significant differences in crude mortality were rendered non-significant by case-mix adjustments, supporting the null hypothesis that the two centres were equally effective in terms of this short-term indicator of outcome. To achieve a meaningful comparison between centres, adjustments must be made for the factors which affect mortality.

County Poverty Concentration and Disparities in Unintentional Injury Deaths: A Fourteen-Year Analysis of 1.6 Million U.S. Fatalities

PubMed Central

Karb, Rebecca A.; Subramanian, S. V.; Fleegler, Eric W.

2016-01-01

Unintentional injury is the fourth leading cause of death in the United States, and mortality due to injury has risen over the past decade. The social determinants behind these rising trends have not been well documented. This study examines the relationship between county-level poverty and unintentional injury mortality in the United States from 1999–2012. Complete annual compressed mortality and population data for 1999–2012 were obtained from the National Center for Health Statistics and linked with census yearly county poverty measures. The outcomes examined were unintentional injury fatalities, overall and by six specific mechanisms: motor vehicle collisions, falls, accidental discharge of firearms, drowning, exposure to smoke or fire, and unintentional poisoning. Age-adjusted mortality rates and time trends for county poverty categories were calculated, and multivariate negative binomial regression was used to determine changes over time in both the relative risk of living in high poverty concentration areas and the population attributable fraction. Age-adjusted mortality rates for counties with > 20% poverty were 66% higher mortality in 1999 compared with counties with < 5% poverty (45.25 vs. 27.24 per 100,000; 95% CI for rate difference 15.57,20.46), and that gap widened in 2012 to 79% (44.54 vs. 24.93; 95% CI for rate difference 17.13,22.09). The relative risk of living in the highest poverty counties has increased for all injury mechanisms with the exception of accidental discharge of firearms. The population attributable fraction for all unintentional injuries rose from 0.22 (95% CI 0.13,0.30) in 1999 to 0.35 (95% CI 0.22,0.45) in 2012. This is the first study that uses comprehensive mortality data to document the associations between county poverty and injury mortality rates for the entire US population over a 14 year period. This study suggests that injury reduction interventions should focus on areas of high or increasing poverty. PMID:27144919

County Poverty Concentration and Disparities in Unintentional Injury Deaths: A Fourteen-Year Analysis of 1.6 Million U.S. Fatalities.

PubMed

Karb, Rebecca A; Subramanian, S V; Fleegler, Eric W

2016-01-01

Unintentional injury is the fourth leading cause of death in the United States, and mortality due to injury has risen over the past decade. The social determinants behind these rising trends have not been well documented. This study examines the relationship between county-level poverty and unintentional injury mortality in the United States from 1999-2012. Complete annual compressed mortality and population data for 1999-2012 were obtained from the National Center for Health Statistics and linked with census yearly county poverty measures. The outcomes examined were unintentional injury fatalities, overall and by six specific mechanisms: motor vehicle collisions, falls, accidental discharge of firearms, drowning, exposure to smoke or fire, and unintentional poisoning. Age-adjusted mortality rates and time trends for county poverty categories were calculated, and multivariate negative binomial regression was used to determine changes over time in both the relative risk of living in high poverty concentration areas and the population attributable fraction. Age-adjusted mortality rates for counties with > 20% poverty were 66% higher mortality in 1999 compared with counties with < 5% poverty (45.25 vs. 27.24 per 100,000; 95% CI for rate difference 15.57,20.46), and that gap widened in 2012 to 79% (44.54 vs. 24.93; 95% CI for rate difference 17.13,22.09). The relative risk of living in the highest poverty counties has increased for all injury mechanisms with the exception of accidental discharge of firearms. The population attributable fraction for all unintentional injuries rose from 0.22 (95% CI 0.13,0.30) in 1999 to 0.35 (95% CI 0.22,0.45) in 2012. This is the first study that uses comprehensive mortality data to document the associations between county poverty and injury mortality rates for the entire US population over a 14 year period. This study suggests that injury reduction interventions should focus on areas of high or increasing poverty.

A Swiss paradox? Higher income inequality of municipalities is associated with lower mortality in Switzerland.

PubMed

Clough-Gorr, Kerri M; Egger, Matthias; Spoerri, Adrian

2015-08-01

It has long been surmised that income inequality within a society negatively affects public health. However, more recent studies suggest there is no association, especially when analyzing small areas. This study aimed to evaluate the effect of income inequality on mortality in Switzerland using the Gini index on municipality level. The study population included all individuals >30 years at the 2000 Swiss census (N = 4,689,545) living in 2,740 municipalities with 35.5 million person-years of follow-up and 456,211 deaths over follow-up. Cox proportional hazard regression models were adjusted for age, gender, marital status, nationality, urbanization, and language region. Results were reported as hazard ratios (HR) with 95% confidence intervals. The mean Gini index across all municipalities was 0.377 (standard deviation 0.062, range 0.202-0.785). Larger cities, high-income municipalities and tourist areas had higher Gini indices. Higher income inequality was consistently associated with lower mortality risk, except for death from external causes. Adjusting for sex, marital status, nationality, urbanization and language region only slightly attenuated effects. In fully adjusted models, hazards of all-cause mortality by increasing Gini index quintile were HR = 0.99 (0.98-1.00), HR = 0.98 (0.97-0.99), HR = 0.95 (0.94-0.96), HR = 0.91 (0.90-0.92) compared to the lowest quintile. The relationship of income inequality with mortality in Switzerland is contradictory to what has been found in other developed high-income countries. Our results challenge current beliefs about the effect of income inequality on mortality on small area level. Further investigation is required to expose the underlying relationship between income inequality and population health.

Occurrence of OsHV-1 in Crassostrea gigas Cultured in Ireland during an Exceptionally Warm Summer. Selection of Less Susceptible Oysters

PubMed Central

Prado-Alvarez, Maria; Darmody, Grainne; Hutton, Stephen; O'Reilly, Amy; Lynch, Sharon A.; Culloty, Sarah C.

2016-01-01

The occurrence of OsHV-1, a herpes virus causing mass mortality in the Pacific oyster Crassostrea gigas was investigated with the aim to select individuals with different susceptibility to the infection. Naïve spat transferred to infected areas and juveniles currently being grown at those sites were analyzed using molecular and histology approaches. The survey period distinguishes itself by very warm temperatures reaching up to 3.5°C above the average. The virus was not detected in the virus free area although a spread of the disease could be expected due to high temperatures. Overall mortality, prevalence of infection and viral load was higher in spat confirming the higher susceptibility in early life stages. OsHV-1 and oyster mortality were detected in naïve spat after 15 days of cohabitation with infected animals. Although, infection was associated with mortality in spat, the high seawater temperatures could also be the direct cause of mortality at the warmest site. One stock of juveniles suffered an event of abnormal mortality that was significantly associated with OsHV-1 infection. Those animals were infected with a previously undescribed microvariant whereas the other stocks were infected with OsHV-1 μVar. Cell lesions due to the infection were observed by histology and true infections were corroborated by in situ hybridization. Survivors from the natural outbreak were exposed to OsHV-1 μVar by intramuscular injection and were compared to naïve animals. The survival rate in previously exposed animals was significantly higher than in naïve oysters. Results derived from this study allowed the selection of animals that might possess interesting characteristics for future analysis on OsHV-1 resistance. PMID:27877131

Outcomes of repeat revascularization in diabetic patients with prior coronary surgery.

PubMed

Cole, Jason H; Jones, Ellis L; Craver, Joseph M; Guyton, Robert A; Morris, Douglas C; Douglas, John S; Ghazzal, Ziyad; Weintraub, William S

2002-12-04

This study evaluated both short- and long-term outcomes of diabetic patients who underwent repeat coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) after initial CABG. Although diabetic patients who have multivessel coronary disease and require initial revascularization may benefit from CABG as compared with PCI, the uncertainty concerning the choice of revascularization may be greater for diabetic patients who have had previous CABG. Data were obtained over 15 years for diabetic patients undergoing PCI procedures or repeat CABG after previous coronary surgery. Baseline characteristics were compared between groups, and in-hospital, 5-year, and 10-year mortality rates were calculated. Multivariate correlates of in-hospital and long-term mortality were determined. Both PCI (n = 1,123) and CABG (n = 598) patients were similar in age, gender, years of diabetes, and insulin dependence, but they varied in presence of hypertension, prior myocardial infarction, angina severity, heart failure, ejection fraction, and left main disease. In-hospital mortality was greater for CABG, but differences in long-term mortality were not significant (10 year mortality, 68% PCI vs. 74% CABG, p = 0.14). Multivariate correlates of long-term mortality were older age, hypertension, low ejection fraction, and an interaction between heart failure and choice of PCI. The PCI itself did not correlate with mortality. The increased initial risk of redo CABG in diabetic patients and the comparable high long-term mortality regardless of type of intervention suggest that, except for patients with severe heart failure, PCI be strongly considered in all patients for whom there is a percutaneous alternative.

Timber resource statistics for all forest land, except national forests, in eastern Oregon.

Treesearch

Donald R. Gedney; Patricia M. Bassett; Mary A. Mei

1989-01-01

This report summarizes a 1987 timber resource inventory of all forest land, except National Forests, in the 17 counties (Baker, Crook, Deschutes, Gilliam, Grant, Harney, Jefferson, Klamath, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa, Wasco, and Wheeler Counties) in eastern Oregon. Detailed tables of forest area, timber volume, growth, mortality, and...

Work and health among immigrants and native Swedes 1990-2008: a register-based study on hospitalization for common potentially work-related disorders, disability pension and mortality.

PubMed

Johansson, Bo; Helgesson, Magnus; Lundberg, Ingvar; Nordquist, Tobias; Leijon, Ola; Lindberg, Per; Vingård, Eva

2012-10-05

There are many immigrants in the Swedish workforce, but knowledge of their general and work-related health is limited. The aim of this register-based study was to explore whether documented migrant residents in Sweden have a different health status regarding receipt of a disability pension, mortality and hospitalization for lung, heart, psychiatric, and musculoskeletal disorders compared with the native population, and if there were variations in relation to sex, geographical origin, position on the labor market, and time since first immigration. This study included migrants to Sweden since 1960 who were 28-47 years old in 1990, and included 243 860 individuals. The comparison group comprised a random sample of 859 653 native Swedes. These cohorts were followed from 1991 to 2008 in national registers. The immigrants were divided into four groups based on geographic origin. Hazard ratios for men and women from different geographic origins and with different employment status were analyzed separately for the six outcomes, with adjustment for age, education level, and income. The influence of length of residence in Sweden was analyzed separately. Nordic immigrants had increased risks for all investigated outcomes while most other groups had equal or lower risks for those outcomes than the Swedes. The lowest HRs were found in the EU 15+ group (from western Europe, North America, Australia and New Zealand). All groups, except Nordic immigrants, had lower risk of mortality, but all had higher risk of disability pension receipt compared with native Swedes. Unemployed non-Nordic men displayed equal or lower HRs for most outcomes, except disability pension receipt, compared with unemployed Swedish men. A longer time since first immigration improved the health status of men, while women showed opposite results. Employment status and length of residence are important factors for health. The contradictory results of low mortality and high disability pension risks need more attention. There is great potential to increase the knowledge in this field in Sweden, because of the high quality registers.

Work and health among immigrants and native Swedes 1990–2008: a register-based study on hospitalization for common potentially work-related disorders, disability pension and mortality

PubMed Central

2012-01-01

Background There are many immigrants in the Swedish workforce, but knowledge of their general and work-related health is limited. The aim of this register-based study was to explore whether documented migrant residents in Sweden have a different health status regarding receipt of a disability pension, mortality and hospitalization for lung, heart, psychiatric, and musculoskeletal disorders compared with the native population, and if there were variations in relation to sex, geographical origin, position on the labor market, and time since first immigration. Methods This study included migrants to Sweden since 1960 who were 28–47 years old in 1990, and included 243 860 individuals. The comparison group comprised a random sample of 859 653 native Swedes. These cohorts were followed from 1991 to 2008 in national registers. The immigrants were divided into four groups based on geographic origin. Hazard ratios for men and women from different geographic origins and with different employment status were analyzed separately for the six outcomes, with adjustment for age, education level, and income. The influence of length of residence in Sweden was analyzed separately. Results Nordic immigrants had increased risks for all investigated outcomes while most other groups had equal or lower risks for those outcomes than the Swedes. The lowest HRs were found in the EU 15+ group (from western Europe, North America, Australia and New Zealand). All groups, except Nordic immigrants, had lower risk of mortality, but all had higher risk of disability pension receipt compared with native Swedes. Unemployed non-Nordic men displayed equal or lower HRs for most outcomes, except disability pension receipt, compared with unemployed Swedish men. A longer time since first immigration improved the health status of men, while women showed opposite results. Conclusions Employment status and length of residence are important factors for health. The contradictory results of low mortality and high disability pension risks need more attention. There is great potential to increase the knowledge in this field in Sweden, because of the high quality registers. PMID:23039821

Global mortality from storm surges is decreasing

NASA Astrophysics Data System (ADS)

Bouwer, Laurens M.; Jonkman, Sebastiaan N.

2018-01-01

Changes in society’s vulnerability to natural hazards are important to understand, as they determine current and future risks, and the need to improve protection. Very large impacts including high numbers of fatalities occur due to single storm surge flood events. Here, we report on impacts of global coastal storm surge events since the year 1900, based on a compilation of events and data on loss of life. We find that over the past, more than eight thousand people are killed and 1.5 million people are affected annually by storm surges. The occurrence of very substantial loss of life (>10 000 persons) from single events has however decreased over time. Moreover, there is a consistent decrease in event mortality, measured by the fraction of exposed people that are killed, for all global regions, except South East Asia. Average mortality for storm surges is slightly higher than for river floods, but lower than for flash floods. We also find that for the same coastal surge water level, mortality has decreased over time. This indicates that risk reduction efforts have been successful, but need to be continued with projected climate change, increased rates of sea-level rise and urbanisation in coastal zones.

Evidence and Implications of Mortality Associated with Acute Plasmodium vivax Malaria

PubMed Central

2013-01-01

Vivax malaria threatens patients despite relatively low-grade parasitemias in peripheral blood. The tenet of death as a rare outcome, derived from antiquated and flawed clinical classifications, disregarded key clinical evidence, including (i) high rates of mortality in neurosyphilis patients treated with vivax malaria; (ii) significant mortality from zones of endemicity; and (iii) the physiological threat inherent in repeated, very severe paroxysms in any patient, healthy or otherwise. The very well-documented course of this infection, with the exception of parasitemia, carries all of the attributes of “perniciousness” historically linked to falciparum malaria, including severe disease and fatal outcomes. A systematic analysis of the parasite biomass in severely ill patients that includes blood, marrow, and spleen may ultimately explain this historic misunderstanding. Regardless of how this parasite is pernicious, recent data demonstrate that the infection comes with a significant burden of morbidity and associated mortality. The extraordinary burden of malaria is not heavily weighted upon any single continent by a single species of parasite—it is a complex problem for the entire endemic world, and both species are of fundamental importance. Humanity must rally substantial resources, intellect, and energy to counter this daunting but profound threat. PMID:23297258

Optimum moisture levels for biodegradation of mortality composting envelope materials.

PubMed

Ahn, H K; Richard, T L; Glanville, T D

2008-01-01

Moisture affects the physical and biological properties of compost and other solid-state fermentation matrices. Aerobic microbial systems experience different respiration rates (oxygen uptake and CO2 evolution) as a function of moisture content and material type. In this study the microbial respiration rates of 12 mortality composting envelope materials were measured by a pressure sensor method at six different moisture levels. A wide range of respiration (1.6-94.2mg O2/g VS-day) rates were observed for different materials, with alfalfa hay, silage, oat straw, and turkey litter having the highest values. These four envelope materials may be particularly suitable for improving internal temperature and pathogen destruction rates for disease-related mortality composting. Optimum moisture content was determined based on measurements across a range that spans the maximum respiration rate. The optimum moisture content of each material was observed near water holding capacity, which ranged from near 60% to over 80% on a wet basis for all materials except a highly stabilized soil compost blend (optimum around 25% w.b.). The implications of the results for moisture management and process control strategies during mortality composting are discussed.

Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis.

PubMed

Sud, Sachin; Friedrich, Jan O; Adhikari, Neill K J; Taccone, Paolo; Mancebo, Jordi; Polli, Federico; Latini, Roberto; Pesenti, Antonio; Curley, Martha A Q; Fernandez, Rafael; Chan, Ming-Cheng; Beuret, Pascal; Voggenreiter, Gregor; Sud, Maneesh; Tognoni, Gianni; Gattinoni, Luciano; Guérin, Claude

2014-07-08

Mechanical ventilation in the prone position is used to improve oxygenation and to mitigate the harmful effects of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). We sought to determine the effect of prone positioning on mortality among patients with ARDS receiving protective lung ventilation. We searched electronic databases and conference proceedings to identify relevant randomized controlled trials (RCTs) published through August 2013. We included RCTs that compared prone and supine positioning during mechanical ventilation in patients with ARDS. We assessed risk of bias and obtained data on all-cause mortality (determined at hospital discharge or, if unavailable, after longest follow-up period). We used random-effects models for the pooled analyses. We identified 11 RCTs (n=2341) that met our inclusion criteria. In the 6 trials (n=1016) that used a protective ventilation strategy with reduced tidal volumes, prone positioning significantly reduced mortality (risk ratio 0.74, 95% confidence interval 0.59-0.95; I2=29%) compared with supine positioning. The mortality benefit remained in several sensitivity analyses. The overall quality of evidence was high. The risk of bias was low in all of the trials except one, which was small. Statistical heterogeneity was low (I2<50%) for most of the clinical and physiologic outcomes. Our analysis of high-quality evidence showed that use of the prone position during mechanical ventilation improved survival among patients with ARDS who received protective lung ventilation. © 2014 Canadian Medical Association or its licensors.

Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis

PubMed Central

Sud, Sachin; Friedrich, Jan O.; Adhikari, Neill K. J.; Taccone, Paolo; Mancebo, Jordi; Polli, Federico; Latini, Roberto; Pesenti, Antonio; Curley, Martha A.Q.; Fernandez, Rafael; Chan, Ming-Cheng; Beuret, Pascal; Voggenreiter, Gregor; Sud, Maneesh; Tognoni, Gianni; Gattinoni, Luciano; Guérin, Claude

2014-01-01

Background: Mechanical ventilation in the prone position is used to improve oxygenation and to mitigate the harmful effects of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). We sought to determine the effect of prone positioning on mortality among patients with ARDS receiving protective lung ventilation. Methods: We searched electronic databases and conference proceedings to identify relevant randomized controlled trials (RCTs) published through August 2013. We included RCTs that compared prone and supine positioning during mechanical ventilation in patients with ARDS. We assessed risk of bias and obtained data on all-cause mortality (determined at hospital discharge or, if unavailable, after longest follow-up period). We used random-effects models for the pooled analyses. Results: We identified 11 RCTs (n = 2341) that met our inclusion criteria. In the 6 trials (n = 1016) that used a protective ventilation strategy with reduced tidal volumes, prone positioning significantly reduced mortality (risk ratio 0.74, 95% confidence interval 0.59–0.95; I2 = 29%) compared with supine positioning. The mortality benefit remained in several sensitivity analyses. The overall quality of evidence was high. The risk of bias was low in all of the trials except one, which was small. Statistical heterogeneity was low (I2 < 50%) for most of the clinical and physiologic outcomes. Interpretation: Our analysis of high-quality evidence showed that use of the prone position during mechanical ventilation improved survival among patients with ARDS who received protective lung ventilation. PMID:24863923

Cervical and female breast cancers in the Americas: current situation and opportunities for action

PubMed Central

Cabanes, Anna; Prieto-Lara, Elisa; Gawryszewski, Vilma

2013-01-01

Abstract Objective To understand better the current regional situation and public health response to cervical cancer and female breast cancer in the Americas. Methods Data on cervical cancer and female breast cancers in 33 countries, for the period from 2000 to the last year with available data, were extracted from the Pan American Health Organization (PAHO) Regional Mortality Database and analysed. Changes in mortality rates over the study period – in all countries except those with small populations and large fluctuations in time–series mortality data – were calculated using Poisson regression models. Information from the PAHO Country Capacity Survey on noncommunicable diseases was also analysed. Findings The Bahamas, Trinidad and Tobago and Uruguay showed relatively high rates of death from breast cancer, whereas the three highest rates of death from cervical cancer were observed in El Salvador, Nicaragua and Paraguay. Several countries – particularly Paraguay and Venezuela – have high rates of death from both types of cancer. Although mortality from cervical cancer has generally been decreasing in the Americas, decreases in mortality from breast cancer have only been observed in a few countries in the Region of the Americas. All but one of the 25 countries in the Americas included in the PAHO Country Capacity Survey reported having public health services for the screening and treatment of breast and cervical cancers. Conclusion Most countries in the Americas have the public health capacity needed to screen for – and treat – breast and cervical cancers and, therefore, the potential to reduce the burden posed by these cancers. PMID:24101780

The lack of effect of low temperature and high turbidity on operational Bacillus thuringiensis subsp. israelensis activity against larval black flies (Diptera: Simuliidae).

PubMed

Gray, Elmer W; Wyatt, Roger D; Adler, Peter H; Smink, John; Cox, Julie E; Noblet, Ray

2012-06-01

Black fly suppression programs are conducted across a wide range of environmental conditions, targeting a variety of pest species with diverse life histories. Operational applications of Vectobac 12AS (Bacillus thuringiensis subsp. israelensis) were conducted during times characterized by water temperature and turbidity extremes. Applications were conducted in the Yellow River in central Wisconsin targeting Simulium annulus and S. johannseni when water temperatures were 1-2 degrees C. Applications were conducted in the Green River in western North Carolina targeting the S. jenningsi group after a rain event, when portions of the treatment zone experienced turbidities of 276 nephelometric turbidity units. Excellent larvicidal activity was observed in both programs, with 97% mortality or greater being observed at distances over 5 km downstream of a treatment site. Mortality data for larval black flies in 2 operational suppression programs conducted in 2011 demonstrated a negligible effect of near-freezing water temperatures and exceptionally high turbidity on Bti activity.

Endoparasites in common eiders Somateria mollissima from birds killed by an oil spill in the northern Wadden Sea

NASA Astrophysics Data System (ADS)

Thieltges, David W.; Hussel, Birgit; Baekgaard, Henrik

2006-05-01

Mass mortalities of common eiders Somateria mollissima have been ascribed to high parasite loads. However, the actual role of parasites in mortalities is disputed as in the case of a mass mortality of eiders in the Wadden Sea in the winter of 1999/2000. A critical evaluation of the role of parasites in eider mass mortalities is hampered by (1) a lack of data on actual parasite loads of the birds involved, (2) missing regional data for comparison, and (3) a lack of unbiased samples: investigations are often based on dead beached individuals, which are presumably the more heavily infected birds of a population and thus more likely to die and be washed ashore. Although published data on parasite loads in birds of the winter 1999/2000 mortality are available, no data on background parasitism in eiders from the Wadden Sea exist, making an evaluation of the potential role of parasites in this mortality event difficult. By investigating endoparasites of 102 eiders affected by an oil spill in the northern Wadden Sea in winter 1998/1999, we provide a data set of background parasitism in wintering eiders from the Wadden Sea. We found 13 different parasite taxa with high prevalence values (% infected birds) in the acanthocephalan Profilicollis botulus, the nematode Amidostomum acutum, cestodes and trematodes. In some taxa we observed pronounced differences in prevalence values between juvenile eiders and adults, as well as between adult sexes. The parasite composition shows that bivalves, crabs ( Carcinus maenas) and other crustaceans are important sources of infections by being intermediate hosts. This is partly mirrored in the food content of eider stomachs where bivalves and crabs were predominantly found. Intensities of the acanthocephalan P. botulus, suspected of causing eider mortalities, were especially high in juveniles (1112 ± 416 ind per infected host), but lower in adult males (40 ± 7) and adult females (81 ± 18). However, no extraordinary mortality event was observed in the winter of 1998/1999, indicating no or a very weak effect of the parasites on host condition. A comparison with the parasite loads of eiders from the mass mortality in the winter of 1999/2000 shows that parasite numbers were by no means exceptional for birds from the area. Hence, parasites alone are unlikely to have caused this mortality. Regional background parasite loads are important to differentiate between primary and secondary roles of parasites in anomalous mortality events.

Aging in the natural world: comparative data reveal similar mortality patterns across primates.

PubMed

Bronikowski, Anne M; Altmann, Jeanne; Brockman, Diane K; Cords, Marina; Fedigan, Linda M; Pusey, Anne; Stoinski, Tara; Morris, William F; Strier, Karen B; Alberts, Susan C

2011-03-11

Human senescence patterns-late onset of mortality increase, slow mortality acceleration, and exceptional longevity-are often described as unique in the animal world. Using an individual-based data set from longitudinal studies of wild populations of seven primate species, we show that contrary to assumptions of human uniqueness, human senescence falls within the primate continuum of aging; the tendency for males to have shorter life spans and higher age-specific mortality than females throughout much of adulthood is a common feature in many, but not all, primates; and the aging profiles of primate species do not reflect phylogenetic position. These findings suggest that mortality patterns in primates are shaped by local selective forces rather than phylogenetic history.

Exceptionally high mortality rate of the 1918 influenza pandemic in the Brazilian naval fleet.

PubMed

Schuck-Paim, Cynthia; Shanks, G Dennis; Almeida, Francisco E A; Alonso, Wladimir J

2013-01-01

The naval experience with the 1918 pandemic during World War I remains underexplored despite its key role on the pandemic's global diffusion and the epidemiological interest of isolated and relatively homogeneous populations. The pandemic outbreak in the Brazilian naval fleet is of particular interest both because of its severity and the fact that it was the only Latin American military force deployed to war. To study the mortality patterns of the pandemic in the Brazilian fleet sent to patrol the West African coast in 1918. We investigated mortality across vessels, ranks, and occupations based on official population and mortality records from the Brazilian Navy Archives. The outbreak that swept this fleet included the highest influenza mortality rate on any naval ship reported to date. Nearly 10% of the crews died, with death rates reaching 13-14% on two destroyers. While overall mortality was lower for officers, stokers and engineer officers were significantly more likely to die from the pandemic, possibly due to the pulmonary damage from constant exposure to the smoke and coal dust from the boilers. The fatality patterns observed provide valuable data on the conditions that can exacerbate the impact of a pandemic. While the putative lack of exposure to a first pandemic wave may have played a role in the excessive mortality observed in this fleet, our results indicate that strenuous labor conditions, dehydration, and exposure to coal dust were major risk factors. The unequal death rates among vessels remain an open question. © 2012 Blackwell Publishing Ltd.

Iteroparity in the variable environment of the salamander Ambystoma tigrinum

USGS Publications Warehouse

Church, D.R.; Bailey, L.L.; Wilbur, H.M.; Kendall, W.L.; Hines, J.E.

2007-01-01

Simultaneous estimation of survival, reproduction, and movement is essential to understanding how species maximize lifetime reproduction in environments that vary across space and time. We conducted a four-year, capture–recapture study of three populations of eastern tiger salamanders (Ambystoma tigrinum tigrinum) and used multistate mark–recapture statistical methods to estimate the manner in which movement, survival, and breeding probabilities vary under different environmental conditions across years and among populations and habitats. We inferred how individuals may mitigate risks of mortality and reproductive failure by deferring breeding or by moving among populations. Movement probabilities among populations were extremely low despite high spatiotemporal variation in reproductive success and survival, suggesting possible costs to movements among breeding ponds. Breeding probabilities varied between wet and dry years and according to whether or not breeding was attempted in the previous year. Estimates of survival in the nonbreeding, forest habitat varied among populations but were consistent across time. Survival in breeding ponds was generally high in years with average or high precipitation, except for males in an especially ephemeral pond. A drought year incurred severe survival costs in all ponds to animals that attempted breeding. Female salamanders appear to defer these episodic survival costs of breeding by choosing not to breed in years when the risk of adult mortality is high. Using stochastic simulations of survival and breeding under historical climate conditions, we found that an interaction between breeding probabilities and mortality limits the probability of multiple breeding attempts differently between the sexes and among populations.

Changes in the management of liver trauma leading to reduced mortality: 15-year experience in a major trauma centre.

PubMed

Suen, Kary; Skandarajah, Anita R; Knowles, Brett; Judson, Rodney; Thomson, Benjamin N

2016-11-01

Worldwide, the evolution of management of liver injury has resulted in improved outcomes. The aim of this study was to examine the trend in the management and outcomes of patients with liver injury. Primary outcomes were defined as mortality and hospital length of stay. The secondary aim was to identify independent predictors of mortality. This study utilized hospital trauma registry data of all trauma patients with liver injuries admitted from 1999 to 2013. Patients in this 15-year period were divided into three periods of 5 years each and compared in terms of demographics, management and outcomes. A total of 725 patients with hepatic trauma were included. Patient demographics were similar, except for an increase in patient transfers from rural locations. Non-operative management increased significantly. There was a significant increase in the use of damage control surgery with perihepatic packing in high-grade liver injuries managed operatively. Hepatic angioembolization commenced midway through the study period. The overall mortality decreased by approximately threefold (P < 0.001) and mortality within 24 h of arrival to hospital by approximately fivefold (P < 0.001). Controlling for independent predictive factors of mortality, the mortality within 24 h reduced from 18.8% in period 1 to 3.6% in period 3 (P = 0.001). At this institution, an integrated trauma service has led to an evolution in the management of hepatic trauma, favouring non-operative management, damage control surgery and the use of hepatic angioembolization. We experienced a significantly improved mortality within 24 h of arrival to hospital in patients with liver trauma. © 2015 Royal Australasian College of Surgeons.

Cause-Specific Mortality Due to Malignant and Non-Malignant Disease in Korean Foundry Workers

PubMed Central

Yoon, Jin-Ha; Ahn, Yeon-Soon

2014-01-01

Background Foundry work is associated with serious occupational hazards. Although several studies have investigated the health risks associated with foundry work, the results of these studies have been inconsistent with the exception of an increased lung cancer risk. The current study evaluated the mortality of Korean foundry workers due to malignant and non-malignant diseases. Methods This study is part of an ongoing investigation of Korean foundry workers. To date, we have observed more than 150,000 person-years in male foundry production workers. In the current study, we stratified mortality ratios by the following job categories: melting-pouring, molding-coremaking, fettling, and uncategorized production work. We calculated standard mortality ratios (SMR) of foundry workers compare to general Korean men and relative risk (RR) of mortality of foundry production workers reference to non-production worker, respectively. Results Korean foundry production workers had a significantly higher risk of mortality due to malignant disease, including stomach (RR: 3.96; 95% CI: 1.41–11.06) and lung cancer (RR: 2.08; 95% CI: 1.01–4.30), compared with non-production workers. High mortality ratios were also observed for non-malignant diseases, including diseases of the circulatory (RR: 1.92; 95% CI: 1.18–3.14), respiratory (RR: 1.71; 95% CI: 1.52–21.42 for uncategorized production worker), and digestive (RR: 2.27; 95% CI: 1.22–4.24) systems, as well as for injuries (RR: 2.36; 95% CI: 1.52–3.66) including suicide (RR: 3.64; 95% CI: 1.32–10.01). Conclusion This study suggests that foundry production work significantly increases the risk of mortality due to some kinds of malignant and non-malignant diseases compared with non-production work. PMID:24505454

Influence of social and material individual and area deprivation on suicide mortality among 2.7 million Canadians: a prospective study.

PubMed

Burrows, Stephanie; Auger, Nathalie; Gamache, Philippe; St-Laurent, Danielle; Hamel, Denis

2011-07-19

Few studies have investigated how area-level deprivation influences the relationship between individual disadvantage and suicide mortality. The aim of this study was to examine individual measures of material and social disadvantage in relation to suicide mortality in Canada and to determine whether these relationships were modified by area deprivation. Using the 1991-2001 Canadian Census Mortality Follow-up Study cohort (N = 2,685,400), measures of individual social (civil status, family structure, living alone) and material (education, income, employment) disadvantage were entered into Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for male and female suicide mortality. Two indices of area deprivation were computed - one capturing social, and the other material, dimensions - and models were run separately for high versus low deprivation. After accounting for individual and area characteristics, individual social and material disadvantage were associated with higher suicide mortality, especially for individuals not employed, not married, with low education and low income. Associations between social and material area deprivation and suicide mortality largely disappeared upon adjustment for individual-level disadvantage. In stratified analyses, suicide risk was greater for low income females in socially deprived areas and males living alone in materially deprived areas, and there was no evidence of other modifying effects of area deprivation. Individual disadvantage was associated with suicide mortality, particularly for males. With some exceptions, there was little evidence that area deprivation modified the influence of individual disadvantage on suicide risk. Prevention strategies should primarily focus on individuals who are unemployed or out of the labour force, and have low education or income. Individuals with low income or who are living alone in deprived areas should also be targeted.

Heat-related mortality in the Florentine area (Italy) before and after the exceptional 2003 heat wave in Europe: an improved public health response?

PubMed

Morabito, Marco; Profili, Francesco; Crisci, Alfonso; Francesconi, Paolo; Gensini, Gian Franco; Orlandini, Simone

2012-09-01

High ambient temperatures have been associated with increased mortality across the world. Several studies suggest that timely preventive measures may reduce heat-related excess mortality. The main aim of this study was to detect the temporal modification of heat-related mortality, in older adults (aged 65-74) and in elderly ≥75 years old, in the Florentine area by comparing previous (1999-2002) and subsequent (2004-2007) periods to the summer of 2003, when a regional Heat-Health Warning System (HHWS) was set up. Mortality data from 1999 to 2007 (May-September) were provided by the Mortality Registry of the Tuscany Region (n = 21,092). Weather data were used to assess daily apparent temperatures (AT). Case-crossover time-stratified designs and constrained segmented distributed lag models were applied. No significant heat-related mortality odds ratio (OR) variations were observed among the sub-periods. Nevertheless, a general OR decrease dating from 1999-2002 (OR 1.23; lack of HHWS) to 2004-2005 (OR 1.21; experimental HHWS running only for Florence) and to 2006-2007 (OR 1.12; official HHWS extended to the whole Florentine area) was observed when the maximum AT was considered. This modification was only evident in subjects ≥75 years old. The heat effect was higher and sustained for more days (until lag 9) during the period 1999-2002 than 2004-2007. The decrease of the excessive heat effect on mortality between periods with the absence and existence of a HHWS is also probably due to the mitigation of preventive measures and the implementation of a HHWS with specific interventions for safeguarding the health of the "frail elderly".

Leading Causes of Death and All-Cause Mortality in American Indians and Alaska Natives

PubMed Central

Jim, Melissa A.; Cobb, Nathaniel; Bartholomew, Michael; Becker, Tom; Haverkamp, Don; Plescia, Marcus

2014-01-01

Objectives. We present regional patterns and trends in all-cause mortality and leading causes of death in American Indians and Alaska Natives (AI/ANs). Methods. US National Death Index records were linked with Indian Health Service (IHS) registration records to identify AI/AN deaths misclassified as non-AI/AN. We analyzed temporal trends for 1990 to 2009 and comparisons between non-Hispanic AI/AN and non-Hispanic White persons by geographic region for 1999 to 2009. Results focus on IHS Contract Health Service Delivery Area counties in which less race misclassification occurs. Results. From 1990 to 2009 AI/AN persons did not experience the significant decreases in all-cause mortality seen for Whites. For 1999 to 2009 the all-cause death rate in CHSDA counties for AI/AN persons was 46% more than that for Whites. Death rates for AI/AN persons varied as much as 50% among regions. Except for heart disease and cancer, subsequent ranking of specific causes of death differed considerably between AI/AN and White persons. Conclusions. AI/AN populations continue to experience much higher death rates than Whites. Patterns of mortality are strongly influenced by the high incidence of diabetes, smoking prevalence, problem drinking, and social determinants. Much of the observed excess mortality can be addressed through known public health interventions. PMID:24754554

Health spending, macroeconomics and fiscal space in countries of the World Health Organization South-East Asia Region.

PubMed

Gupta, Indrani; Mondal, Swadhin

2014-01-01

The paper examines the issues around mobilization of resources for the 11 countries of the South-East Asia Region of the World Health Organization (WHO), by analysing their macroeconomic situation, health spending, fiscal space and other determinants of health. With the exception of a few, most of these countries have made fair progress on their own Millennium Development Goal (MDG) targets of maternal mortality ratio and mortality rate in children aged under 5 years. However, the achieved targets have been very modest - with the exception of Thailand and Sri Lanka - indicating the continued need for additional efforts to improve these indicators. The paper discusses the need for investment, by looking at evidence on economic growth, the availability of fiscal space, and improvements in "macroeconomic-plus" factors like poverty, female literacy, governance and efficiency of the health sector. The analysis indicates that, overall, the countries of the WHO South-East Asia Region are collectively in a position to make the transition from low public spending to moderate or even high health spending, which is required, in turn, for transition from lowcoverage-high out-of-pocket spending (OOPS) to highcoverage-low OOPS. However, explicit prioritization for health within the overall government budget for low spenders would require political will and champions who can argue the case of the health sector. Additional innovative avenues of raising resources, such as earmarked taxes or a health levy can be considered in countries with good macroeconomic fundamentals. With the exception of Thailand, this is applicable for all the countries of the region. However, countries with adverse macroeconomic-plus factors, as well as inefficient health systems, need to be alert to the possibility of overinvesting - and thereby wasting - resources for modest health gains, making the challenge of increasing health sector spending alongside competing demands for spending on other areas of the social sector difficult.

Maternal obesity and gestational weight gain are risk factors for infant death

PubMed Central

Bodnar, Lisa M.; Siminerio, Lara L.; Himes, Katherine P.; Hutcheon, Jennifer A.; Lash, Timothy L.; Parisi, Sara M.; Abrams, Barbara

2015-01-01

Objective To assess the joint and independent relationships of gestational weight gain and prepregnancy body mass index (BMI) on risk of infant mortality. Methods We used Pennsylvania linked birth-infant death records (2003–2011) from infants without anomalies to underweight (n=58,973), normal weight (n=610,118), overweight (n=296,630), grade 1 obese (n=147,608), grade 2 obese (n=71,740), and grade 3 obese (n=47,277) mothers. Multivariable logistic regression models stratified by BMI category were used to estimate dose-response associations between z-scores of gestational weight gain and infant death after confounder adjustment. Results Infant mortality risk was lowest among normal weight women and increased with rising BMI category. For all BMI groups except for grade 3 obesity, there were U-shaped associations between gestational weight gain and risk of infant death. Weight loss and very low weight gain among women with grade 1 and 2 obesity were associated with high risks of infant mortality. However, even when gestational weight gain in women with obesity was optimized, the predicted risk of infant death remained higher than that of normal weight women. Conclusions Interventions aimed at substantially reducing preconception weight among women with obesity and avoiding very low or very high gestational weight gain may reduce risk of infant death. PMID:26572932

Using broiler litter and swine manure lagoon effluent in sawdust-based swine mortality composts: Effects on nutrients, bacteria, and gaseous emissions.

PubMed

McLaughlin, M R; Brooks, J P; Adeli, A; Miles, D M

2015-11-01

Disposition of mortalities challenges confined animal feeding operations (CAFOs), especially sow (farrowing) farms, which experience mortalities daily. Regulations and transportation costs may preclude incineration, landfill burial, and rendering; therefore, swine CAFOs in Mississippi in the Mid-South U.S. often compost mortalities. In this study, a farm-standard composting mix of sawdust (S) and water (W) was compared with mixes where N was supplied by broiler litter (L) and water was replaced with swine lagoon effluent (E). The objective was to assess the effects of these manure byproducts: 1) on nutrients and bacteria in composts destined for land application; and 2) on emissions of ammonia and greenhouse gases. Three replications of four mixes (SW, SLW, SE, SLE) were compared in microcosms comprising modified plastic recycling bins. The experiment was repeated three times in different seasons in one year. Mixes were compared for differences in temperature, water content, nutrients (C, N, P, K, Ca, Mg, Na, Mn, Fe, Cu, Zn), bacteria (Gram-, Gram+, Clostridium perfringens, Salmonella, Listeria, Escherichia coli), and emissions (NH3, CO2, CH4, N2O). Litter addition increased composting temperatures initially and after aerations; increased nutrient concentrations, except C, in start mixes and all except C and N, in finish mixes; increased Gram+ bacteria, Salmonella, and E. coli in start mixes, but only Gram+s in finish mixes; and increased emissions. Effluent addition increased early composting temperatures; had no effect on nutrients or bacteria, except increased C. perfringens in start, but not finish mixes; and had no effect on emissions. Nutrients in finish composts did not differ among mixes for N (average 3.3%), but litter composts had more P and K, and lower N:P than composts without litter. Improving mortality composting is of global importance as increasing livestock populations and intensive animal production systems require practical, safe, environmentally sound disposal of carcasses. Published by Elsevier B.V.

Macro determinants of cause-specific injury mortality in the OECD countries: an exploration of the importance of GDP and unemployment.

PubMed

Muazzam, Sana; Nasrullah, Muazzam

2011-08-01

Gross Domestic Product (GDP) and unemployment has a strong documented impact on injury mortality. The aim of our study is to investigate the relationship of GDP per capita and unemployment with gender- and cause-specific injury mortalities in the member nations of Organization for Economic Cooperation and Development (OECD). Country-based data on injury mortality per 100,000 population, including males and females aged 1-74, for the 4 year period 1996-1999, were gathered from the World Health Organization's Statistical Information System. We selected fourteen cause-specific injury mortalities. Data on GDP, unemployment rate and population growth were taken from World Development Indicators. GDP and unemployment rate per 100 separately were regressed on total and cause-specific injury mortality rate per 100,000 for males and females. Overall in the OECD countries, GDP per capita increased 12.5% during 1996-1999 (P = 0.03) where as unemployment rate decreased by 12.3% (P = 0.05). Among males, most cause-specific injury mortality rates decreased with increasing GDP except motor vehicle traffic crashes (MTC) that increased with increasing GDP (coefficient = 0.75; P < 0.001). Similar trend was found in females, except suicidal injury mortalities that also increased with increasing GDP (coefficient = 0.31; P = 0.04). When we modeled cause-specific injury mortality rates with unemployment, injuries due to firearm missiles (coefficient = 0.53; P < 0.001), homicide (coefficient = 0.36; P < 0.001), and other violence (coefficient = 0.41; P < 0.001) increased with increase in unemployment rate among males. However, among females only accidental falls (coefficient = 0.36; P = 0.01) were found significantly associated with increasing unemployment rate. GDP is more related to cause-specific injury mortality than unemployment. Injury mortality does not relate similarly to each diagnosis-specific cause among males and females. Further research on causation with more predictors is needed.

Twenty-five years after Chernobyl: outcome of radioiodine treatment in children and adolescents with very high-risk radiation-induced differentiated thyroid carcinoma.

PubMed

Reiners, Christoph; Biko, Johannes; Haenscheid, Heribert; Hebestreit, Helge; Kirinjuk, Stalina; Baranowski, Oleg; Marlowe, Robert J; Demidchik, Ewgeni; Drozd, Valentina; Demidchik, Yuri

2013-07-01

After severe reactor emergencies with release of radioactive iodine, elevated thyroid cancer risk in children and adolescents is considered the main health consequence for the population exposed. We studied thyroid cancer outcome after 11.3 years' median follow-up in a selected, very high-risk cohort, 234 Chernobyl-exposed Belarusian children and adolescents undergoing postsurgical radioiodine therapy (RIT) in Germany. Cumulatively 100 children with or (without; n = 134) distant metastasis received a median 4 (2) RITs and 16.9 (6.6) GBq, corresponding to 368 (141) MBq/kg iodine-131. Outcomes were response to therapy and disease status, mortality, and treatment toxicity. Of 229 patients evaluable for outcome, 147 (64.2%) attained complete remission [negative iodine-131 whole-body scan and TSH-stimulated serum thyroglobulin (Tg) < 1 μg /L], 69 (30.1%) showed nearly complete remission (complete response, except stimulated Tg 1-10 μg/L), and 11 (4.8%) had partial remission (Tg > 10 μg/L, decrease from baseline in radioiodine uptake intensity in ≥ 1 focus, in tumor volume or in Tg). Except for 2 recurrences (0.9%) after partial remission, no recurrences, progression, or disease-specific mortality were noted. One patient died of lung fibrosis 17.5 years after therapy, 2 of apparently thyroid cancer-unrelated causes. The only RIT side effect observed was pulmonary fibrosis in 5 of 69 patients (7.2%) with disseminated lung metastases undergoing intensive pulmonary surveillance. Experience of a large, very high-risk pediatric cohort with radiation-induced differentiated thyroid carcinoma suggests that even when such disease is advanced and initially suboptimally treated, response to subsequent RIT and final outcomes are mostly favorable.

[Adherence to pharmaceutical guidance in patients over 85 years of age with chronic heart failure-stage C. Effects on 12-month mortality].

PubMed

Esteve Arríen, Ainhoa; Domínguez de Pablos, Gema; Minaya Saiz, Jesús

2009-01-01

To describe factors related to prescription on discharge of treatment for Chronic Heart Failure(CHF)-Stage C and to analyse whether this is related to 12month-mortality. Observational follow-up study of patients over 85 hospitalized during 2006/7 with Stage C-Chronic Heart Failure in an outskirt support hospital. Drug-prescription adherence was assessed according to the American Heart Society 2005-Guidelines and recommendations of the American Geriatrics Society-2007. A multivariate analysis of logistic regression was performed to obtain odds for 12-month mortality for each recommended therapy, adjusting by mortality risk factors. 104 patients aged 90+/-3yr were followed on discharge, 85% of which were women. NYHA-classes were distributed NYHA I-28,2%, II-37,9%, III-30,1%, IV-3,9%. Most frequently prescribed drugs were loop diuretics (83,3%) and IACEs/ARB (62%), and the less frequent beta-blockers (19,1%). IACEs/ARB were prescribed to those with lower functional impairment (p=0.04), and beta-blockers to those with worse NYHA class (p=0.02). All recommended prescriptions had a tendency to 12 month mortality risk reduction, even adjusted by age, functional status, co-morbidity, NYHA class and co-morbid atrial fibrillation, except for spironolactone (OR-1,8; IC95% 0,48-17,19). Treatment with CHF disease-modifying therapies except for spironolactone can reduce 12 month risk mortality, also in the oldest old. There exists room for improvement in frequency of drug prescription in this group of age.

Habitat shifts and spatial distribution of the intertidal crab Neohelice ( Chasmagnathus ) granulata Dana

NASA Astrophysics Data System (ADS)

Casariego, Agustina Mendez; Alberti, Juan; Luppi, Tomás; Daleo, Pedro; Iribarne, Oscar

2011-08-01

Intertidal zones of estuaries and embayments of the SW Atlantic are dominated by the semiterrestrial burrowing grapsid crab, Neohelice ( Chasmagnathus) granulata, and characterized by extensive mud flats surrounded by salt marshes. In this work we examined spatial patterns of distribution of N. granulata during two years to explain their movement patterns. The results of the population sampling showed segregation by sex and size throughout the intertidal, with seasonal variations in densities and different condition indices for adults and juveniles at the different zones. The comparison of seasonal activity (ambulatory activity outside burrows) between marshes and mudflats shows that short term (e.g. daily) variations in activity were controlled by tides. Crabs were active at high tides but increased their activity on days with higher tidal amplitude. Seasonal activity showed that at both areas, females remain with low activity except for a peak in winter, while males showed the highest activity during summer in the mudflat zone, but not so in the marsh. This pattern can be the response to differences in stress tolerance, suggesting that high temperatures are limiting the performance of adult crabs during summer, especially at the marsh where physical conditions can be more critical. The spatial size segregation can be explained by differential mortality in each zone (estimated with tethered crabs), and by the juvenile movement between these zones (estimated with movement traps). Juvenile mortality is higher at the mudflat, while adult mortality is higher in the marsh. Smaller juveniles moved to the marsh, where the mortality is lower, and the larger juveniles moved towards the mudflat. This mortality is due almost exclusively to cannibalism, so our results suggest that this movement of different size classes between zones is controlled, at least in part, by intraspecific predation.

Study of ECG changes and its relation to mortality in cases of cerebrovascular accidents.

PubMed

Purushothaman, Suja; Salmani, Deepalaxmi; Prarthana, Kaleramma Gopalakrishna; Bandelkar, Srinidhi Muddanna Gundappa; Varghese, Sarah

2014-07-01

Its being long recognized about the highly debilitating and destructive nature of cerebrovascular accidents (CVAs). Around the world CVAs has posed as a major factor in medical morbidity and mortality. It has thrown up challenges with regards to their medical management and also towards posttreatment rehabilitation. It is well-known that neurologic disorder contributes variously towards varied electrocardiogram (ECG) changes and stroke is no exception. To study the ECG changes and its relation to mortality in cases of CVA. A total of 100 patients with acute stroke were enrolled in the study. All the 100 patients underwent ECG recording within first 24 h of admission. The patients were divided into ischemic and hemorrhagic group depending on the nature of lesion. Out of 100 cases, 58 were ischemic and 42 were hemorrhagic. The ECG changes were noted in 78 patients. Among the ischemic group, the changes noted in the ECG were: T wave inversion (34.48%), ST segment depression (32.75%), QTc prolongation (29.31%), and presence of U waves (27.58%). In cases of hemorrhagic stroke, it was: T wave inversion (33.33%), arrhythmias (33.33%), U waves (30.95%), and ST segment depression (23.80%). Mortality was higher in patients with ST-T changes in ischemic group (66.66%) and in patients with positive U waves (60%) in hemorrhagic group. In acute stroke patients, changes in ECG were commonly seen. The changes varied from T-wave inversion to ST segment depression in ischemic stroke. In hemorrhagic stroke it consisted of T wave inversion and arrhythmias. Overall mortality was high in cases of hemorrhagic compared to ischemic group.

Study of ECG changes and its relation to mortality in cases of cerebrovascular accidents

PubMed Central

Purushothaman, Suja; Salmani, Deepalaxmi; Prarthana, Kaleramma Gopalakrishna; Bandelkar, Srinidhi Muddanna Gundappa; Varghese, Sarah

2014-01-01

Background: Its being long recognized about the highly debilitating and destructive nature of cerebrovascular accidents (CVAs). Around the world CVAs has posed as a major factor in medical morbidity and mortality. It has thrown up challenges with regards to their medical management and also towards posttreatment rehabilitation. It is well-known that neurologic disorder contributes variously towards varied electrocardiogram (ECG) changes and stroke is no exception. Objective: To study the ECG changes and its relation to mortality in cases of CVA. Materials and Methods: A total of 100 patients with acute stroke were enrolled in the study. All the 100 patients underwent ECG recording within first 24 h of admission. The patients were divided into ischemic and hemorrhagic group depending on the nature of lesion. Results: Out of 100 cases, 58 were ischemic and 42 were hemorrhagic. The ECG changes were noted in 78 patients. Among the ischemic group, the changes noted in the ECG were: T wave inversion (34.48%), ST segment depression (32.75%), QTc prolongation (29.31%), and presence of U waves (27.58%). In cases of hemorrhagic stroke, it was: T wave inversion (33.33%), arrhythmias (33.33%), U waves (30.95%), and ST segment depression (23.80%). Mortality was higher in patients with ST-T changes in ischemic group (66.66%) and in patients with positive U waves (60%) in hemorrhagic group. Conclusion: In acute stroke patients, changes in ECG were commonly seen. The changes varied from T-wave inversion to ST segment depression in ischemic stroke. In hemorrhagic stroke it consisted of T wave inversion and arrhythmias. Overall mortality was high in cases of hemorrhagic compared to ischemic group. PMID:25097430

Annual Trends of Gastrointestinal Cancers Mortality in Iran During 1990-2015; NASBOD Study.

PubMed

Salimzadeh, Hamideh; Delavari, Farnaz; Sauvaget, Catherine; Rezaee, Negar; Delavari, Alireza; Kompani, Farzad; Rezaei, Nazila; Sheidaei, Ali; Modirian, Mitra; Haghshenas, Rosa; Chegini, Maryam; Gohari, Kimiya; Zokaiee, Hossein; Farzadfar, Farshad; Malekzadeh, Reza

2018-02-01

Gastrointestinal (GI) neoplasms are among the most common cancers in Iran. This study aimed to measure annual trends in mortality rates from GI cancers in Iran between 1990 and 2015. This study was part of an ongoing study termed the 'National and Subnational Burden of Diseases' study in Iran. Data used in this study was obtained from the Iranian Death Registration System (1995 to 2010) and from 2 major cemeteries in Tehran (1995 to 2010) and Isfahan (2007 to 2010). All-cause mortality rates were estimated using the spatio-temporal model and the Gaussian process regression model. Age-standardized mortality rates (ASMR) per 100 000 person-years was calculated using data from Iran and the standard world population for comparison. Among GI cancers, gastric cancer represented the leading cause of mortality followed by cancers of the esophagus, liver, and colorectal cancers with the ASMR of 20.5, 5.8, 4.4, and 4.0 per 100 000 persons-years, respectively, between 1990 and 2015. While a decreasing trend occurred in mortality of esophageal, gastric, and colorectal cancers, particularly in the recent decade, we recorded an upward pattern and steady rise in mortality rates from liver, pancreatic, and gallbladder cancers during the study period. The ASMR of all studied causes were enhanced by advancing age and were found to be more prominent in adults aged 50 or older. Among all age-groups, higher death rates were detected in males versus females for all studied cancers except for gallbladder and biliary tract cancers. Gastric cancer mortality is still high and death rates from several other GI cancers are increasing in the nation. Interventions for cancer prevention, early detection, and access to high quality cancer treatment services are needed to reduce GI cancer burden and death rates in Iran and in the region. © 2018 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disparities in Breast Cancer Survival Among Asian Women by Ethnicity and Immigrant Status: A Population-Based Study

PubMed Central

Clarke, Christina A.; Shema, Sarah J.; Chang, Ellen T.; Keegan, Theresa H. M.; Glaser, Sally L.

2010-01-01

Objectives. We investigated heterogeneity in ethnic composition and immigrant status among US Asians as an explanation for disparities in breast cancer survival. Methods. We enhanced data from the California Cancer Registry and the Surveillance, Epidemiology, and End Results program through linkage and imputation to examine the effect of immigrant status, neighborhood socioeconomic status, and ethnic enclave on mortality among Chinese, Japanese, Filipino, Korean, South Asian, and Vietnamese women diagnosed with breast cancer from 1988 to 2005 and followed through 2007. Results. US-born women had similar mortality rates in all Asian ethnic groups except the Vietnamese, who had lower mortality risk (hazard ratio [HR] = 0.3; 95% confidence interval [CI] = 0.1, 0.9). Except for Japanese women, all foreign-born women had higher mortality than did US-born Japanese, the reference group. HRs ranged from 1.4 (95% CI = 1.2, 1.7) among Koreans to 1.8 (95% CI = 1.5, 2.2) among South Asians and Vietnamese. Little of this variation was explained by differences in disease characteristics. Conclusions. Survival after breast cancer is poorer among foreign- than US-born Asians. Research on underlying factors is needed, along with increased awareness and targeted cancer control. PMID:20299648

Evolving Practice Trends of Aortic Root Surgery in North America.

PubMed

Caceres, Manuel; Ma, Yicheng; Rankin, J Scott; Saha-Chaudhuri, Paramita; Gammie, James S; Suri, Rakesh M; Thourani, Vinod H; Englum, Brian R; Esmailian, Fardad; Czer, Lawrence S; Puskas, John D; Svensson, Lars G

2014-08-19

Aortic-valve sparing (AVS) techniques have emerged as alternatives to composite graft-valve replacement (CVR) for treatment of aortic root aneurysm. This study analyzed recent practice trends of aortic root surgery using the Society of Thoracic Surgeons database. From January 2000 through June 2011, 31,747, Overall patients received AVS (n=3,585/31,747; 11.3%) or CVR (n=28,162/31,747; 88.7%). A High-Risk Subgroup was defined as: age >75 years, endocarditis, aortic stenosis, dialysis, multi-valve surgery, valve reoperation, or emergency/salvage status, and high-risk patients were less likely to receive AVS (n=20,356/31,747 [64.1%]; 6% AVS; unadjusted operative mortality 10.5% AVS and 11.7% CVR). The remaining patients comprised a Low-Risk Subgroup, in which AVS was more common (n=11,388/31,747 [35.9%]; 21% AVS; unadjusted operative mortality 1.4% AVS and 3.1% CVR). Procedural changes over 3 equal time periods (P1-P2-P3) were evaluated by Cochran-Armitage trends analysis. Compared to AVS, Overall CVR patients had worse baseline risk profiles and higher unadjusted operative mortality. In High-Risk patients, AVS mortality was comparable to CVR (10.5% vs 11.7%, p=0.19), but AVS mortality was lower in the Low-Risk group (1.4% vs 3%, p<0.0001). For P1/P2/P3, AVS percentages and trend p-values were: High-Risk (6%/6%/7%, p=0.26) and Low-Risk (12%/21%/25%, p<0.0001). CVR prosthesis type (mechanical/bioprosthesis/homograft) also changed: P1 (63%/22%/15%), P2 (58%/38%/4%), and P3 (53%/44%/3%) (all p<0.0001, except mechanical valves in High-Risk patients p=0.18). Patients receiving CVR tended to have higher risk profiles. AVS increased over time in Low-Risk patients while bioprostheses increased in CVR. Favorable outcomes support the trend toward further expansion of AVS. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Causes of Mortality After Dose-Escalated Radiation Therapy and Androgen Deprivation for High-Risk Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tendulkar, Rahul D., E-mail: tendulr@ccf.org; Hunter, Grant K.; Reddy, Chandana A.

Purpose: Men with high-risk prostate cancer have other competing causes of mortality; however, current risk stratification schema do not account for comorbidities. We aim to identify the causes of death and factors predictive for mortality in this population. Methods and Materials: A total of 660 patients with high-risk prostate cancer were treated with definitive high-dose external beam radiation therapy (≥74 Gy) and androgen deprivation (AD) between 1996 and 2009 at a single institution. Cox proportional hazards regression analysis was conducted to determine factors predictive of survival. Results: The median radiation dose was 78 Gy, median duration of AD was 6more » months, and median follow-up was 74 months. The 10-year overall survival (OS) was 60.6%. Prostate cancer was the leading single cause of death, with 10-year mortality of 14.1% (95% CI 10.7-17.6), compared with other cancers (8.4%, 95% CI 5.7-11.1), cardiovascular disease (7.3%, 95% CI 4.7-9.9), and all other causes (10.4%, 95% CI 7.2-13.6). On multivariate analysis, older age (HR 1.55, P=.002) and Charlson comorbidity index score (CS) ≥1 (HR 2.20, P<.0001) were significant factors predictive of OS, whereas Gleason score, T stage, prostate-specific antigen, duration of AD, radiation dose, smoking history, and body mass index were not. Men younger than 70 years of age with CS = 0 were more likely to die of prostate cancer than any other cause, whereas older men or those with CS ≥1 more commonly suffered non-prostate cancer death. The cumulative incidences of prostate cancer-specific mortality were similar regardless of age or comorbidities (P=.60). Conclusions: Men with high-risk prostate cancer are more likely to die of causes other than prostate cancer, except for the subgroup of men younger than 70 years of age without comorbidities. Only older age and presence of comorbidities significantly predicted for OS, whereas prostate cancer- and treatment-related factors did not.« less

The impact of occurrence of exceptional solar events on mortality from diseases of the nervous system

NASA Astrophysics Data System (ADS)

Podolska, Katerina

2015-04-01

The aim of this conference paper is to analyse relationships between strong changes of solar, geomagnetic and ionospheric physical parameters, and mortality by medical cause of death from diagnosis group Diseases of the nervous system by ICD-10 WHO. The aggregated daily number of deaths of 6 largest individual causes of death of group VI. Diseases of the nervous system on the occurrence of exceptional solar and geomagnetic events is investigated. Analysis is performed for the period of the solar cycles No. 23 and 24 (years 1994-2013) in the Czech Republic. The correlation between the intensity of mortality from diseases Multiple sclerosis, Epilepsy, Cerebral palsy, Parkinson disease, Secondary parkinsonism and Alzheimer disease and the solar, geomagnetic and ionospheric physical parameters is examined using stochastic method of graphical models of conditional dependences. We study the daily number of deaths separately for both sexes at the age groups under 39 and 40+. Differences are found for maximum solar activity and during the ascending and descending epoch of the solar cycles.

Implementation strategy for achieving replacement level fertility.

PubMed

1993-01-01

The recommendation of the Bali Declaration on Population and Sustainable Development at the ESCAP regional conference was to adopt strategies for attaining replacement-level fertility of 2.1 or 2.2 children by 2010. East Asian countries, except Mongolia and the Democratic People's Republic of Korea, and the Southeast Asian countries Singapore and Thailand have already reached replacement-level fertility. Most larger Oceanic countries have also done so. Only South Asian Sri Lanka and southern India have attained replacement level. The following conditions slow or hinder the goal, but they do not provide an "absolute" barrier to fertility decline: social welfare schemes and old age security, son preference, lack of government family planning, poverty, relatively high mortality, low status of women, and education status. Theories of demographic transition have postulated that economic and social development initially brings a decline in mortality, and later brings a decline in fertility; and high fertility was an adaptation to high mortality. Policy gets caught in the lag between mortality and fertility decline. Eventually the cultural motives for high fertility are undercut by social and economic development. Although the generalization that economic growth slows fertility is true for South Asia, the correlation is uneven. Forceful government-sponsored family planning programs in Bangladesh and China may lead the way to strategies for decline in ESCAP region. A Thailand study suggested important factors were fundamental social change, the increased cost of children, cultural acceptance of birth control, a latent demand for fertility control, and government efforts in family planning. ESCAP countries have in common relatively high morality and inadequate public health programs, patriarchal structures, and limited female autonomy, poverty and landlessness, lack of community cohesiveness, and inadequate family planning programs. Weaknesses in programs are attributed to failure to recognize policies that affect reproduction and the difference between male power and female responsibility. Direct strategies should involve strong government support for male and female contraception, government promotion of delayed marriage, and an emphasis on reproductive health in female family planning programs.

Threshold Levels of Infant and Under-Five Mortality for Crossover between Life Expectancies at Ages Zero, One and Five in India: A Decomposition Analysis.

PubMed

Dubey, Manisha; Ram, Usha; Ram, Faujdar

2015-01-01

Under the prevailing conditions of imbalanced life table and historic gender discrimination in India, our study examines crossover between life expectancies at ages zero, one and five years for India and quantifies the relative share of infant and under-five mortality towards this crossover. We estimate threshold levels of infant and under-five mortality required for crossover using age specific death rates during 1981-2009 for 16 Indian states by sex (comprising of India's 90% population in 2011). Kitagawa decomposition equations were used to analyse relative share of infant and under-five mortality towards crossover. India experienced crossover between life expectancies at ages zero and five in 2004 for menand in 2009 for women; eleven and nine Indian states have experienced this crossover for men and women, respectively. Men usually experienced crossover four years earlier than the women. Improvements in mortality below ages five have mostly contributed towards this crossover. Life expectancy at age one exceeds that at age zero for both men and women in India except for Kerala (the only state to experience this crossover in 2000 for men and 1999 for women). For India, using life expectancy at age zero and under-five mortality rate together may be more meaningful to measure overall health of its people until the crossover. Delayed crossover for women, despite higher life expectancy at birth than for men reiterates that Indian women are still disadvantaged and hence use of life expectancies at ages zero, one and five become important for India. Greater programmatic efforts to control leading causes of death during the first month and 1-59 months in high child mortality areas can help India to attain this crossover early.

Health System Resource Gaps and Associated Mortality from Pandemic Influenza across Six Asian Territories

PubMed Central

Rudge, James W.; Hanvoravongchai, Piya; Krumkamp, Ralf; Chavez, Irwin; Adisasmito, Wiku; Ngoc Chau, Pham; Phommasak, Bounlay; Putthasri, Weerasak; Shih, Chin-Shui; Stein, Mart; Timen, Aura; Touch, Sok; Reintjes, Ralf; Coker, Richard

2012-01-01

Background Southeast Asia has been the focus of considerable investment in pandemic influenza preparedness. Given the wide variation in socio-economic conditions, health system capacity across the region is likely to impact to varying degrees on pandemic mitigation operations. We aimed to estimate and compare the resource gaps, and potential mortalities associated with those gaps, for responding to pandemic influenza within and between six territories in Asia. Methods and Findings We collected health system resource data from Cambodia, Indonesia (Jakarta and Bali), Lao PDR, Taiwan, Thailand and Vietnam. We applied a mathematical transmission model to simulate a “mild-to-moderate” pandemic influenza scenario to estimate resource needs, gaps, and attributable mortalities at province level within each territory. The results show that wide variations exist in resource capacities between and within the six territories, with substantial mortalities predicted as a result of resource gaps (referred to here as “avoidable” mortalities), particularly in poorer areas. Severe nationwide shortages of mechanical ventilators were estimated to be a major cause of avoidable mortalities in all territories except Taiwan. Other resources (oseltamivir, hospital beds and human resources) are inequitably distributed within countries. Estimates of resource gaps and avoidable mortalities were highly sensitive to model parameters defining the transmissibility and clinical severity of the pandemic scenario. However, geographic patterns observed within and across territories remained similar for the range of parameter values explored. Conclusions The findings have important implications for where (both geographically and in terms of which resource types) investment is most needed, and the potential impact of resource mobilization for mitigating the disease burden of an influenza pandemic. Effective mobilization of resources across administrative boundaries could go some way towards minimizing avoidable deaths. PMID:22363739

Health system resource gaps and associated mortality from pandemic influenza across six Asian territories.

PubMed

Rudge, James W; Hanvoravongchai, Piya; Krumkamp, Ralf; Chavez, Irwin; Adisasmito, Wiku; Chau, Pham Ngoc; Phommasak, Bounlay; Putthasri, Weerasak; Shih, Chin-Shui; Stein, Mart; Timen, Aura; Touch, Sok; Reintjes, Ralf; Coker, Richard

2012-01-01

Southeast Asia has been the focus of considerable investment in pandemic influenza preparedness. Given the wide variation in socio-economic conditions, health system capacity across the region is likely to impact to varying degrees on pandemic mitigation operations. We aimed to estimate and compare the resource gaps, and potential mortalities associated with those gaps, for responding to pandemic influenza within and between six territories in Asia. We collected health system resource data from Cambodia, Indonesia (Jakarta and Bali), Lao PDR, Taiwan, Thailand and Vietnam. We applied a mathematical transmission model to simulate a "mild-to-moderate" pandemic influenza scenario to estimate resource needs, gaps, and attributable mortalities at province level within each territory. The results show that wide variations exist in resource capacities between and within the six territories, with substantial mortalities predicted as a result of resource gaps (referred to here as "avoidable" mortalities), particularly in poorer areas. Severe nationwide shortages of mechanical ventilators were estimated to be a major cause of avoidable mortalities in all territories except Taiwan. Other resources (oseltamivir, hospital beds and human resources) are inequitably distributed within countries. Estimates of resource gaps and avoidable mortalities were highly sensitive to model parameters defining the transmissibility and clinical severity of the pandemic scenario. However, geographic patterns observed within and across territories remained similar for the range of parameter values explored. The findings have important implications for where (both geographically and in terms of which resource types) investment is most needed, and the potential impact of resource mobilization for mitigating the disease burden of an influenza pandemic. Effective mobilization of resources across administrative boundaries could go some way towards minimizing avoidable deaths.

Mortality profiles in a country facing epidemiological transition: An analysis of registered data

PubMed Central

Huicho, Luis; Trelles, Miguel; Gonzales, Fernando; Mendoza, Walter; Miranda, Jaime

2009-01-01

Background Sub-national analyses of causes of death and time-trends help to define public health policy priorities. They are particularly important in countries undergoing epidemiological transition like Peru. There are no studies exploring Peruvian national and regional characteristics of such epidemiological transition. We aimed to describe Peru's national and regional mortality profiles between 1996 and 2000. Methods Registered mortality data for the study period were corrected for under-registration following standardized methods. Main causes of death by age group and by geographical region were determined. Departmental mortality profiles were constructed to evaluate mortality transition, using 1996 data as baseline. Annual cumulative slopes for the period 1996–2000 were estimated for each department and region. Results For the study period non-communicable diseases explained more than half of all causes of death, communicable diseases more than one third, and injuries 10.8% of all deaths. Lima accounted for 32% of total population and 20% of total deaths. The Andean region, with 38% of Peru's population, accounted for half of all country deaths. Departmental mortality predominance shifted from communicable diseases in 1996 towards non-communicable diseases and injuries in 2000. Maternal and perinatal conditions, and nutritional deficiencies and nutritional anaemia declined markedly in all departments and regions. Infectious diseases decreased in all regions except Lima. In all regions acute respiratory infections are a leading cause of death, but their proportion ranged from 9.3% in Lima and Callao to 15.3% in the Andean region. Tuberculosis and injuries ranked high in Lima and the Andean region. Conclusion Peruvian mortality shows a double burden of communicable and non-communicable, with increasing importance of non-communicable diseases and injuries. This challenges national and sub-national health system performance and policy making. PMID:19187553

Mortality during the first year of potent antiretroviral therapy in HIV-1-infected patients in 7 sites throughout Latin America and the Caribbean

PubMed Central

2009-01-01

Background Although nearly 2 million people live with HIV in Latin America and the Caribbean, mortality rates after initiation of highly active antiretroviral therapy (HAART) have not been well-described. Methods 5,152 HIV-infected, antiretroviral-naïve adults from clinics in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru starting HAART during 1996–2007 were included. First-year mortality rates and their association with demographics, regimen, baseline CD4, and clinical stage were assessed. Results Overall 1-year mortality rate was 8.3% (95% confidence interval [CI]:7.6–9.1%), although variable across sites: 2.6, 3.7, 6.0, 13.0, 10.8, 3.5, and 9.8% for clinics in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru, respectively. 80% of deaths occurred within the first 6 months. Median baseline CD4 was 107 cells/μL, ranging from 79 (Peru) to 163 (Argentina). Mortality estimates adjusting for CD4 were similar across sites (1.1–2.8% for CD4=200), except for Haiti, 7.5%, and Honduras, 7.0%. Death was associated with lower CD4 (adjusted hazard ratio [HR] for CD4=200 vs CD4=50 was 0.58; 95% CI:0.40–0.85) and clinical AIDS (HR=3.1; 95% CI:2.1–4.5). Conclusions Mortality rates were similar to those reported elsewhere for resource-limited settings. Disease stage at HAART initiation, treatment eligibility criteria, program age, and background mortality rates may explain some variability in prognosis between sites. PMID:19430306

Toxicity of the herbicide glufosinate-ammonium to predatory insects and mites of Tetranychus urticae (Acari: Tetranychidae) under laboratory conditions.

PubMed

Ahn, Y J; Kim, Y J; Yoo, J K

2001-02-01

The toxicities of the herbicide glufosinate-ammonium to three predatory insect and two predatory mite species of Tetranychus urticae Koch were determined in the laboratory by the direct contact application. At a concentration of 540 ppm (a field application rate for weed control in apple orchards), glufosinate-ammonium was almost nontoxic to eggs of Amblyseius womersleyi Schicha, Phytoseiulus persimilis Athias-Henriot, and T. urticae but highly toxic to nymphs and adults of these three mite species, indicating that a common mode of action between predatory and phytophagous mites might be involved. In tests with predatory insects using 540 ppm, glufosinate-ammonium revealed little or no harm to larvae and pupae of Chrysopa pallens Rambur but was slightly harmful to eggs (71.2% mortality), nymphs (65.0% mortality), and adults (57.7% mortality) of Orius strigicollis Poppius. The herbicide showed no direct effect on eggs and adults of Harmonia axyridis (Pallas) but was harmful, slightly harmful, and harmless to first instars (100% mortality), fourth instars (51.1% mortality), and pupae (24.5% mortality), respectively. The larvae and nymphs of predators died within 12 h after treatment, suggesting that the larvicidal and nymphicidal action may be attributable to a direct effect rather than an inhibitory action of chitin synthesis. On the basis of our data, glufosinate-ammonium caused smaller effects on test predators than on T. urticae with the exception of P. persimilis, although the mechanism or cause of selectivity remains unknown. Glufosinate-ammonium merits further study as a key component of integrated pest management.

The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project.

PubMed

D'Ippoliti, Daniela; Michelozzi, Paola; Marino, Claudia; de'Donato, Francesca; Menne, Bettina; Katsouyanni, Klea; Kirchmayer, Ursula; Analitis, Antonis; Medina-Ramón, Mercedes; Paldy, Anna; Atkinson, Richard; Kovats, Sari; Bisanti, Luigi; Schneider, Alexandra; Lefranc, Agnès; Iñiguez, Carmen; Perucci, Carlo A

2010-07-16

The present study aimed at developing a standardized heat wave definition to estimate and compare the impact on mortality by gender, age and death causes in Europe during summers 1990-2004 and 2003, separately, accounting for heat wave duration and intensity. Heat waves were defined considering both maximum apparent temperature and minimum temperature and classified by intensity, duration and timing during summer. The effect was estimated as percent increase in daily mortality during heat wave days compared to non heat wave days in people over 65 years. City specific and pooled estimates by gender, age and cause of death were calculated. The effect of heat waves showed great geographical heterogeneity among cities. Considering all years, except 2003, the increase in mortality during heat wave days ranged from + 7.6% in Munich to + 33.6% in Milan. The increase was up to 3-times greater during episodes of long duration and high intensity. Pooled results showed a greater impact in Mediterranean (+ 21.8% for total mortality) than in North Continental (+ 12.4%) cities. The highest effect was observed for respiratory diseases and among women aged 75-84 years. In 2003 the highest impact was observed in cities where heat wave episode was characterized by unusual meteorological conditions. Climate change scenarios indicate that extreme events are expected to increase in the future even in regions where heat waves are not frequent. Considering our results prevention programs should specifically target the elderly, women and those suffering from chronic respiratory disorders, thus reducing the impact on mortality.

‘Kangaroo mother care’ to prevent neonatal deaths due to preterm birth complications

PubMed Central

Lawn, Joy E; Mwansa-Kambafwile, Judith; Horta, Bernardo L; Barros, Fernando C; Cousens, Simon

2010-01-01

Background ‘Kangaroo mother care’ (KMC) includes thermal care through continuous skin-to-skin contact, support for exclusive breastfeeding or other appropriate feeding, and early recognition/response to illness. Whilst increasingly accepted in both high- and low-income countries, a Cochrane review (2003) did not find evidence of KMC’s mortality benefit, and did not report neonatal-specific data. Objectives The objectives of this study were to review the evidence, and estimate the effect of KMC on neonatal mortality due to complications of preterm birth. Methods We conducted systematic reviews. Standardized abstraction tables were used and study quality assessed by adapted GRADE methodology. Meta-analyses were undertaken. Results We identified 15 studies reporting mortality and/or morbidity outcomes including nine randomized controlled trials (RCTs) and six observational studies all from low- or middle-income settings. Except one, all were hospital-based and included only babies of birth-weight <2000 g (assumed preterm). The one community-based trial had missing birthweight data, as well as other limitations and was excluded. Neonatal-specific data were supplied by two authors. Meta-analysis of three RCTs commencing KMC in the first week of life showed a significant reduction in neonatal mortality [relative risk (RR) 0.49, 95% confidence interval (CI) 0.29–0.82] compared with standard care. A meta-analysis of three observational studies also suggested significant mortality benefit (RR 0.68, 95% CI 0.58–0.79). Five RCTs suggested significant reductions in serious morbidity for babies <2000 g (RR 0.34, 95% CI 0.17–0.65). Conclusion This is the first published meta-analysis showing that KMC substantially reduces neonatal mortality amongst preterm babies (birth weight <2000 g) in hospital, and is highly effective in reducing severe morbidity, particularly from infection. However, KMC remains unavailable at-scale in most low-income countries. PMID:20348117

Inequalities in Maternal Health Care Utilization in Sub-Saharan African Countries: A Multiyear and Multi-Country Analysis

PubMed Central

Alam, Nazmul; Hajizadeh, Mohammad; Dumont, Alexandre; Fournier, Pierre

2015-01-01

To assess social inequalities in the use of antenatal care (ANC), facility based delivery (FBD), and modern contraception (MC) in two contrasting groups of countries in sub-Saharan Africa divided based on their progress towards maternal mortality reduction. Six countries were included in this study. Three countries (Ethiopia, Madagascar, and Uganda) had <350 MMR in 2010 with >4.5% average annual reduction rate while another three (Cameroon, Zambia, and Zimbabwe) had >550 MMR in 2010 with only <1.5% average annual reduction rate. All of these countries had at least three rounds of Demographic and Health Surveys (DHS) before 2012. We measured rate ratios and differences, as well as relative and absolute concentration indices in order to examine within-country geographical and wealth-based inequalities in the utilization of ANC, FBD, and MC. In the countries which have made sufficient progress (i.e. Ethiopia, Madagascar, and Uganda), ANC use increased by 8.7, 9.3 and 5.7 percent, respectively, while the utilization of FBD increased by 4.7, 0.7 and 20.2 percent, respectively, over the last decade. By contrast, utilization of these services either plateaued or decreased in countries which did not make progress towards reducing maternal mortality, with the exception of Cameroon. Utilization of MC increased in all six countries but remained very low, with a high of 40.5% in Zimbabwe and low of 16.1% in Cameroon as of 2011. In general, relative measures of inequalities were found to have declined overtime in countries making progress towards reducing maternal mortality. In countries with insufficient progress towards maternal mortality reduction, these indicators remained stagnant or increased. Absolute measures for geographical and wealth-based inequalities remained high invariably in all six countries. The increasing trend in the utilization of maternal care services was found to concur with a steady decline in maternal mortality. Relative inequality declined overtime in countries which made progress towards reducing maternal mortality. PMID:25853423

Minimum prices for alcohol and educational disparities in alcohol-related mortality.

PubMed

Herttua, Kimmo; Mäkelä, Pia; Martikainen, Pekka

2015-05-01

Minimum price of alcohol is one of the proposed set of alcohol policies in many high-income countries. However, the extent to which alcohol-related harm is associated with minimum prices across socioeconomic groups is not known. Using Finnish national registers in 1988-2007, we investigated, by means of time-series analysis, the association between minimum prices for alcohol overall, as well as for various types of alcoholic beverages, and alcohol-related mortality, among men and women ages 30-79 years across three educational groups. We defined quarterly aggregations of alcohol-related deaths, based on a sample including 80% of all deaths, in accordance with information on both underlying and contributory causes of death. About 62,500 persons died from alcohol-related causes during the 20-year follow-up. The alcohol-related mortality rate was more than threefold higher among those with a basic education than among those with a tertiary education. Among men with a basic education, an increase of 1% in the minimum price of alcohol was associated with a decrease of 0.03% (95% confidence interval = 0.01, 0.04%) in deaths per 100,000 person-years. Changes in the minimum prices of distilled spirits, intermediate products, and strong beer were also associated with changes in the opposite direction among men with a basic education and among women with a secondary education, whereas among the most highly educated there were no associations between the minimum prices of any beverages and mortality. Moreover, we found no evidence of an association between lower minimum prices for wine and higher rates of alcohol-related mortality in any of the population sub-groups. The results reveal associations between higher minimum prices and lower alcohol-related mortality among men with a basic education and women with a secondary education for all beverage types except wine.

Interaction of maternal protein and carbon monoxide on pup mortality in mice: implications for global infant mortality.

PubMed

Singh, Jarnail

2006-06-01

The United States Surgeon General declared 2005 as the "Year of Healthy Child." To improve the health of all children, we need to start before pregnancy, with their mothers. Unfortunately, protein deficiency in the diets of poor pregnant mothers in developing countries is widespread. Carbon monoxide (CO) pollution is serious public health problem in developed and developing countries. A two-way factorial experimental design was used. Mice were maintained on 27%, 16%, 8%, or 4% protein diets. Dams were exposed to 0 ppm (control), 65 ppm, or 125 ppm CO in air, in environmental chambers for 6 hr/day during the first 2 weeks of pregnancy. Controls were also subjected to environmental chamber conditions. Food and water were available at all times. Animals were allowed to deliver, and data on pup mortality was recorded. Litter size was not affected by CO exposure, but was directly related to the dietary protein levels. Pup weight was inversely related to the CO exposure level, and directly related to the dietary protein levels. Pup mortality on date of birth was increased by CO exposure and was inversely related to the dietary protein levels. Pup mortality at 1 week of age was increased by CO exposure and 55% of all pups died in 125 ppm CO exposed group. Pup mortality at 1 week of age was inversely related to dietary protein levels. All pups in the 4% dietary protein and in all concentrations of CO died. All pups in the 8% protein group and in all CO concentrations died except in 125 ppm CO group. Pup mortality in the 16% dietary protein group ranged from 14.8% in 0 ppm to 36.8% in 65 ppm CO groups. Pup mortality in the 27% dietary protein group ranged from 14.3% in the 0 ppm to 41.1% in the 125 ppm CO groups. DATA suggest that protein deficiency and CO exposure enhance pup mortality. The protein and CO also interact to increase pup mortality in 16% and 27% protein groups. Carbon monoxide exposure, along with protein deficiency during gestation, may be contributing factors for high rates of infant mortality in developing countries. The results of the study also suggest that un-vented combustion for heating and cooking, ambient pollution, and biomass smoke may have a major impact on the health of children worldwide; and may explain the causes of high infant mortality in poor countries and some sections of the United States population.

Toxicity of plant essential oils to Tetranychus urticae (Acari: Tetranychidae) and Phytoseiulus persimilis (Acari: Phytoseiidae).

PubMed

Choi, Won-Il; Lee, Sang-Geui; Park, Hyung-Man; Ahn, Young-Joon

2004-04-01

Fifty-three plant essential oils were tested for their toxicity against eggs and adults of Tetranychus urticae Koch as well as adults of Phytoseiulus persimilis Athias-Henriot, by using a filter paper diffusion bioassay without allowing direct contact. Responses varied according to oil type and dose, and mite species. In a plastic container (4.5 by 9.5 cm) bioassay at 14 x 10(-3) microl/ml air, caraway seed, citronella java, lemon eucalyptus, pennyroyal, and peppermint oils gave > 90% mortality against adult T. urticae, whereas 82 and 81% mortality was observed with sage and spearmint oils, respectively. With the exception of sage oil, the other six essential oils were highly effective against T. urticae eggs at 9.3 x 10(-3) microl/ml air. Against adult P. persimilis, these six test oils caused > 90% mortality at 7.1 x 10(-3) microl/ml air. Particularly peppermint oil at 4.7 x 10(-3) microl/ml air was highly toxic. In an acrylic cage (30 by 30 by 40 cm ) test, lemon eucalyptus, pennyroyal, peppermint, and spearmint oils were highly effective against adult T. urticae at 1.4 x 10(-3) microl/ml air. These results indicate that the mode of delivery of these essential oils was largely a result of action in the vapor phase via the respiratory system. The essential oils described herein merit further study as potential fumigants for T. urticae control.

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

PubMed

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

2013-01-29

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. Random effects meta-analysis using pooled individual participant data. 46 cohorts from Europe, North and South America, Asia, and Australasia. 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 m(2)) and urinary albumin-creatinine ratio (mg/g). 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 (P(interaction)<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 (P(interaction)<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 disease risk. Both sexes face increased risk of all-cause mortality, cardiovascular mortality, and end stage renal disease with lower estimated glomerular filtration rates and higher albuminuria. These findings were robust across a large global consortium.

Suicide In Doctors And Wives Of Doctors

PubMed Central

Sakinofsky, Isaac

1980-01-01

This paper re-examines the widespread belief that doctors have a proneness for suicide greater than the general population. The Standardized Mortality Ratio for male physicians is 335 and for single women doctors 257. Doctors' wives have an even greater risk: their SMR is 458. These rates for doctors are higher than for most other professional groups (except pharmacists) and the rate for doctors' wives far exceeds that for wives of other professionals. The intrinsic causes of the physician's high occupational mortality include his knowledge of toxicology and ready access to lethal drugs, so that impulsive suicide is more often successful. Professional stress and overwork, particularly the unrelenting responsibility for decisions upon which the lives of others may depend, have been inculpated. These stresses interact with the decline in the doctors' self-respect and with a personality that is prestige-oriented and independent. Some physicians turn in their frustration to alcohol/and or drugs, accelerating the process of deterioration. The high suicide rate in doctors' wives appears to be the result of unrequited needs for caring and dependency which the doctors' career demands and personality deny them. PMID:21293651

Suicide in doctors and wives of doctors.

PubMed

Sakinofsky, I

1980-06-01

This paper re-examines the widespread belief that doctors have a proneness for suicide greater than the general population. The Standardized Mortality Ratio for male physicians is 335 and for single women doctors 257. Doctors' wives have an even greater risk: their SMR is 458. These rates for doctors are higher than for most other professional groups (except pharmacists) and the rate for doctors' wives far exceeds that for wives of other professionals. The intrinsic causes of the physician's high occupational mortality include his knowledge of toxicology and ready access to lethal drugs, so that impulsive suicide is more often successful. Professional stress and overwork, particularly the unrelenting responsibility for decisions upon which the lives of others may depend, have been inculpated. These stresses interact with the decline in the doctors' self-respect and with a personality that is prestige-oriented and independent. Some physicians turn in their frustration to alcohol/and or drugs, accelerating the process of deterioration. The high suicide rate in doctors' wives appears to be the result of unrequited needs for caring and dependency which the doctors' career demands and personality deny them.

Evolution of Cardiovascular Diseases Mortality in the Counties of the State of Rio de Janeiro from 1979 to 2010

PubMed Central

Soares, Gabriel Porto; Klein, Carlos Henrique; Silva, Nelson Albuquerque de Souza e; de Oliveira, Glaucia Maria Moraes

2015-01-01

Background Cardiovascular Diseases (CVD) are the leading cause of death in Brazil. Objective To estimate total CVD, cerebrovascular disease (CBVD), and ischemic heart disease (IHD) mortality rates in adults in the counties of the state of Rio de Janeiro (SRJ), from 1979 to 2010. Methods The counties of the SRJ were analysed according to their denominations stablished by the geopolitical structure of 1950, Each new county that have since been created, splitting from their original county, was grouped according to their former origin. Population Data were obtained from the Brazilian Institute of Geography and Statistics (IBGE), and data on deaths were obtained from DataSus/MS. Mean CVD, CBVD, and IHD mortality rates were estimated, compensated for deaths from ill-defined causes, and adjusted for age and sex using the direct method for three periods: 1979–1989, 1990–1999, and 2000–2010, Such results were spatially represented in maps. Tables were also constructed showing the mortality rates for each disease and year period. Results There was a significant reduction in mortality rates across the three disease groups over the the three defined periods in all the county clusters analysed, Despite an initial mortality rate variation among the counties, it was observed a homogenization of such rates at the final period (2000–2010). The drop in CBVD mortality was greater than that in IHD mortality. Conclusion Mortality due to CVD has steadily decreased in the SRJ in the last three decades. This reduction cannot be explained by greater access to high technology procedures or better control of cardiovascular risk factors as these facts have not occurred or happened in low proportion of cases with the exception of smoking which has decreased significantly. Therefore, it is necessary to seek explanations for this decrease, which may be related to improvements in the socioeconomic conditions of the population. PMID:25789882

Evolution of Cardiovascular Diseases Mortality in the Counties of the State of Rio de Janeiro from 1979 to 2010.

PubMed

Soares, Gabriel Porto; Klein, Carlos Henrique; Silva, Nelson Albuquerque de Souza e; Oliveira, Glaucia Maria Moraes de

2015-05-01

Cardiovascular Diseases (CVD) are the leading cause of death in Brazil. To estimate total CVD, cerebrovascular disease (CBVD), and ischemic heart disease (IHD) mortality rates in adults in the counties of the state of Rio de Janeiro (SRJ), from 1979 to 2010. The counties of the SRJ were analysed according to their denominations stablished by the geopolitical structure of 1950, Each new county that have since been created, splitting from their original county, was grouped according to their former origin. Population Data were obtained from the Brazilian Institute of Geography and Statistics (IBGE), and data on deaths were obtained from DataSus/MS. Mean CVD, CBVD, and IHD mortality rates were estimated, compensated for deaths from ill-defined causes, and adjusted for age and sex using the direct method for three periods: 1979-1989, 1990-1999, and 2000-2010, Such results were spatially represented in maps. Tables were also constructed showing the mortality rates for each disease and year period. There was a significant reduction in mortality rates across the three disease groups over the the three defined periods in all the county clusters analysed, Despite an initial mortality rate variation among the counties, it was observed a homogenization of such rates at the final period (2000-2010). The drop in CBVD mortality was greater than that in IHD mortality. Mortality due to CVD has steadily decreased in the SRJ in the last three decades. This reduction cannot be explained by greater access to high technology procedures or better control of cardiovascular risk factors as these facts have not occurred or happened in low proportion of cases with the exception of smoking which has decreased significantly. Therefore, it is necessary to seek explanations for this decrease, which may be related to improvements in the socioeconomic conditions of the population.

Is income inequality a determinant of population health? Part 2. U.S. National and regional trends in income inequality and age- and cause-specific mortality.

PubMed

Lynch, John; Smith, George Davey; Harper, Sam; Hillemeier, Marianne

2004-01-01

This article describes U.S. income inequality and 100-year national and 30-year regional trends in age- and cause-specific mortality. There is little congruence between national trends in income inequality and age- or cause-specific mortality except perhaps for suicide and homicide. The variable trends in some causes of mortality may be associated regionally with income inequality. However, between 1978 and 2000 those regions experiencing the largest increases in income inequality had the largest declines in mortality (r= 0.81, p < 0.001). Understanding the social determinants of population health requires appreciating how broad indicators of social and economic conditions are related, at different times and places, to the levels and social distribution of major risk factors for particular health outcomes.

Diseases and partial mortality in Montastraea annularis species complex in reefs with differing environmental conditions (NW Caribbean and Gulf of Mexico).

PubMed

Jordán-Dahlgren, Eric; Maldonado, Miguel Angel; Rodríguez-Martínez, Rosa Elisa

2005-01-25

We documented the prevalence of diseases, syndromes and partial mortality in colonies of the Montastraea annularis species complex on 3 reefs, and tested the assumption that a higher prevalence of these parameters occurs when reefs are closer to point-sources of pollution. One reef was isolated from the impact of local factors with the exception of fishing, 1 potentially influenced by local industrial pollutants, and 1 influenced by local urban pollution. Two reefs were surveyed in 1996 and again in 2001 and 1 in 1998 and again in 2001. In 2001, colonies on all reefs had a high prevalence of the yellow-band syndrome and a relatively high degree of recent partial mortality, while the prevalence of black-band and white-plague diseases was low although a new sign, that we named the thin dark line, had relatively high prevalence in all reefs. As no direct relationship was found between disease prevalence and local environmental quality, our results open the possibility that regional and/or global factors may already be playing an important role in the prevalence of coral disease in the Caribbean, and contradict the theory that coral disease prevalence is primarily related to local environmental degradation. Reasons that may partially explain these findings are the high level of potential pathogen connectivity within the Caribbean as a result of its circulation patterns coupled to the large land-derived pollutants and pathogens input into this Mediterranean sea, together with the surface water warming effects which stress corals and enhance pathogen activity.

Long-term trends and spatial patterns of PM2.5-induced premature mortality in South and Southeast Asia from 1999 to 2014.

PubMed

Shi, Yusheng; Matsunaga, Tsuneo; Yamaguchi, Yasushi; Zhao, Aimei; Li, Zhengqiang; Gu, Xingfa

2018-08-01

Fine particulate matter (PM 2.5 ) poses a potential threat to human health, including premature mortality under long-term exposure. Based on a long-term series of high-resolution (0.01°×0.01°) satellite-retrieved PM 2.5 concentrations, this study estimated the premature mortality attributable to PM 2.5 in South and Southeast Asia (SSEA) from 1999 to 2014. Then, the long-term trends and spatial characteristics of PM 2.5 -induced premature deaths (1999-2014) were analyzed using trend analyses and standard deviation ellipses. Results showed the estimated number of PM 2.5 -induced average annual premature deaths in SSEA was 1,447,000. The numbers increased from 1,179,400 in 1999 to 1,724,900 in 2014, with a growth rate of 38% and net increase of 545,500. Stroke and ischemic heart disease were the two principal contributors, accounting for 39% and 35% of the total, respectively. High values were concentrated in North India, Bangladesh, East Pakistan, and some metropolitan areas of Southeast Asia. An estimated 991,600 deaths in India was quantified (i.e., ~69% of the total premature deaths in SSEA). The long-term trends (1999-2014) of PM 2.5 -related premature mortality exhibited consistent incremental tendencies in all countries except Sri Lanka. The findings of this study suggest that strict controls of PM 2.5 concentrations in SSEA are urgently required. Copyright © 2018 Elsevier B.V. All rights reserved.

Junctional and allele-specific residues are critical for MERS-CoV neutralization by an exceptionally potent germline-like antibody

DOE PAGES

Ying, Tianlei; Prabakaran, Ponraj; Du, Lanying; ...

2015-09-15

The MERS-CoV is an emerging virus, which already infected more than 1,300 humans with high (~36%) mortality. Here, we show that m336, an exceptionally potent human anti-MERS-CoV antibody, is almost germline with only one somatic mutation in the heavy chain. The structure of Fab m336 in complex with the MERS-CoV receptor-binding domain reveals that its IGHV1-69-derived heavy chain provides more than 85% binding surface and that its epitope almost completely overlaps with the receptor-binding site. Analysis of antibodies from 69 healthy humans suggests an important role of the V(D)J recombination-generated junctional and allele-specific residues for achieving high affinity of bindingmore » at such low levels of somatic hypermutation. Our results also have important implications for development of vaccine immunogens based on the newly identified m336 epitope as well as for elucidation of mechanisms of neutralization by m336-like antibodies and their elicitation in vivo.« less

Rigid shells enhance survival of gekkotan eggs.

PubMed

Andrews, Robin M

2015-11-01

The majority of lizards and snakes produce permeable parchment-shelled eggs that require high moisture conditions for successful embryonic development. One clade of gekkotan lizards is an exception; females produce relatively impermeable rigid-shelled eggs that normally incubate successfully under low moisture conditions. I tested the hypothesis that the rigid-shell increases egg survival during incubation, but only under low moisture conditions. To test this hypothesis, I incubated rigid-shelled eggs of Chondrodactylus turneri under low and under high moisture conditions. Eggs were incubated with parchment-shelled eggs of Eublepharis macularius to insure that incubation conditions were suitable for parchment-shelled eggs. Chondrodactylus turneri eggs had very high survival (>90%) when they were incubated under low moisture conditions. In contrast, eggs incubated under high moisture conditions had low survival overall, and lower survival than those of the parchment-shelled eggs of E. macularius. Mortality of C. turneri and E. macularius eggs incubated under high moisture conditions was the result of fungal infection, a common source of egg mortality for squamates under laboratory and field conditions. These observations document high survival of rigid-shelled eggs under low moisture conditions because eggs escape from fungal infection. Highly mineralized rigid shells also make egg survival independent of moisture availability and may also provide protection from small invertebrates in nature. Enhanced egg survival could thus compensate for the low reproductive output of gekkotans that produce rigid-shelled eggs. © 2015 Wiley Periodicals, Inc.

Asymptomatic Bacteriuria Caused by Chromobacterium violaceum in an Immunocompetent Adult.

PubMed

Pant, Narayan Dutt; Sharma, Manisha; Khatiwada, Saroj

2015-01-01

Because of increasing antimicrobial resistance, the treatment of the asymptomatic bacteriuria is not considered except in specific circumstances like during pregnancy or before invasive urologic procedures. We are reporting a first case of asymptomatic bacteriuria caused by Chromobacterium violaceum in a 16-year-old male. With the reporting of the C. violaceum which is notorious for its high propensity for hematogenous dissemination causing fatal sepsis (with reported mortality rate up to 65-80%) if prompt proper treatment is not given, as causative agent of asymptomatic bacteriuria, it is recommended to treat the asymptomatic bacteriuria caused by this organism.

Maternal obesity and gestational weight gain are risk factors for infant death.

PubMed

Bodnar, Lisa M; Siminerio, Lara L; Himes, Katherine P; Hutcheon, Jennifer A; Lash, Timothy L; Parisi, Sara M; Abrams, Barbara

2016-02-01

Assessment of the joint and independent relationships of gestational weight gain and prepregnancy body mass index (BMI) on risk of infant mortality was performed. This study used Pennsylvania linked birth-infant death records (2003-2011) from infants without anomalies born to mothers with prepregnancy BMI categorized as underweight (n = 58,973), normal weight (n = 610,118), overweight (n = 296,630), grade 1 obesity (n = 147,608), grade 2 obesity (n = 71,740), and grade 3 obesity (n = 47,277). Multivariable logistic regression models stratified by BMI category were used to estimate dose-response associations between z scores of gestational weight gain and infant death after confounder adjustment. Infant mortality risk was lowest among normal-weight women and increased with rising BMI category. For all BMI groups except for grade 3 obesity, there were U-shaped associations between gestational weight gain and risk of infant death. Weight loss and very low weight gain among women with grades 1 and 2 obesity were associated with high risks of infant mortality. However, even when gestational weight gain in women with obesity was optimized, the predicted risk of infant death remained higher than that of normal-weight women. Interventions aimed at substantially reducing preconception weight among women with obesity and avoiding very low or very high gestational weight gain may reduce risk of infant death. © 2015 The Obesity Society.

Pregnancy outcome in women with Eisenmenger's syndrome: a case series from west China.

PubMed

Duan, Ruiqi; Xu, Xiumei; Wang, Xiaodong; Yu, Haiyan; You, Yong; Liu, Xinghui; Xing, Aiyun; Zhou, Rong; Xi, Mingrong

2016-11-16

Eisenmenger's syndrome (ES) consists of pulmonary hypertension with a reversed or bidirectional shunt at the atrioventricular, or aortopulmonary level. The cardiovascular changes that occur during the pregnancy contribute to the high maternal morbidity and mortality in patients with ES. This study is to assess maternal and fetal outcomes in patients with ES. This study is a retrospective analysis of 11 pregnancies in women with ES who delivered at a tertiary care center in west China between 2010 and 2014. Cases were divided into group I (maternal survival) and group II (maternal death). Clinical data were noted and analyzed. All ES patients presented with severe pulmonary arterial hypertension (PAH). Four maternal deaths were recorded (maternal mortality of 36%). Only one pregnancy continued to term. Ventricular septal defect diameter in group II was larger than that in group I (2.93 ± 0.76 cm vs. 1.90 ± 0.54 cm, p < 0.05). Arterial oxygen saturation and pre-delivery arterial oxygen tension during oxygen inhalation were significantly lower in group II (p < 0.05). Pulmonary arterial blood pressure (PABP) in both groups were high while ejection fractions (EF) were significantly lower in group II (p < 0.05). The incidence of pre-delivery heart failure in group II was substantially higher than in survivors (100 vs.14.3%, p < 0.05). Fetal complications were exceptionally high: preterm delivery (88%), small for gestational age (83%), fetal mortality (27%) and neonatal mortality (25%). In west China,the perinatal outcome of pregnant women with ES is poor, especially when complicated with high pulmonary arterial hypertension (PAH). Pregnancy remains strongly contraindicated in ES. Effective contraception is essential, and the option of terminating pregnancy in the first trimester should be presented to pregnant women with ES.

[Clinical Characteristics and Evolution of Recurrent Infectious Endocarditis in non Drug Addicts].

PubMed

Rodríguez, M; Anguita, M; Castillo, J M; Torres, F; Siles, J R; Mesa, D; Franco, M; García-Alegría, J; Concha, M; Vallés, F

2001-09-01

Recurrence of infection is observed in a high proportion of patients who have had infective endocarditis in the past. The aim of our study was to evaluate the possible differences between the first and the recurrent episodes of endocarditis, as well as to assess the outcome and prognosis of patients with recurrent endocarditis. We reviewed a series of 13 episodes of recurrent endocarditis from among 196 cases of infective endocarditis involving non-drug-addict patients in two hospitals from 1987 to 2000. There were no differences between recurrent and first episodes of endocarditis according to age, sex, heart valve involved or causal microorganisms. Prosthetic valve endocarditis was more common in patients with recurrent endocarditis (86% versus 27%; p < 0.001). Although there were no differences in the rate of complications or early surgery, overall mortality was significantly higher in patients with recurrent endocarditis (53% versus 27%: p < 0.05). When early and late mortality were analysed separately, the differences did not achieve significance. Recurrent endocarditis was frequent in our series (7% of all cases). The features were similar to those of the first episode except for a higher rate of prosthetic valve endocarditis and a higher overall mortality.

Cyanotoxins as the "common suspects" for the Dalmatian pelican (Pelecanus crispus) deaths in a Mediterranean reconstructed reservoir.

PubMed

Papadimitriou, T; Katsiapi, M; Vlachopoulos, K; Christopoulos, A; Laspidou, C; Moustaka-Gouni, M; Kormas, K

2018-03-01

Toxic cyanobacterial blooms have been implicated for their negative consequences on many terrestrial and aquatic organisms. Water birds belong to the most common members of the freshwater food chains and are most likely to be affected by the consumption of toxic cyanobacteria as food. However, the contribution of cyanotoxins in bird mortalities is under-studied. The aim of the study was to investigate the likely role of cyanotoxins in a mass mortality event of the Dalmatian pelican (Pelecanus crispus) in the Karla Reservoir, in Greece. Water, scum, tissues and stomach content of dead birds were examined for the presence of microcystins, cylindrospermopsins and saxitoxins by an enzyme-linked immunosorbent assay. High abundances of potential toxic cyanobacterial species and significant concentrations of cyanotoxins were recorded in the reservoir water. All examined tissues and stomach content of the Dalmatian pelicans contained significant concentrations of microcystins and saxitoxins. Cylindrospermopsin concentrations were detected in all tissues except from the brain. Our results suggest that cyanotoxins are a plausible cause for this bird mass mortality episode in the Karla Reservoir. Copyright © 2017 Elsevier Ltd. All rights reserved.

[The short-term effects of air pollution on mortality. The results of the EMECAM project in the city of Valencia, 1994-96. Estudio Multcéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad].

PubMed

Tenías Burillo, J M; Pérez-Hoyos, S; Molina Quilis, R; González-Aracil, J; Ballester Díez, F

1999-01-01

To determine the short-term impact of air pollution on mortality in the city of Valencia throughout the 1994-1996 period by employing the analysis method of the Spanish multicenter study with regard to the relationship between air pollution and the mortality (EMECAM Project). The daily levels of black smoke, sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and ozone (O3) were obtained from the Valencia air pollution monitoring network. The death rate indicators analyzed were the daily number of death due to all causes, except the external ones, the deaths of those over age 70, and the deaths resulting from respiratory and cardiovascular diseases. Following the methods of the EMECAM Project, autoregressive Poison regression models were built up, controlling the different confounding factors (seasonality, trend, calendar, weather variables and flu impact). For total mortality except the external ones, a significant impact of black smoke (RR 10 micrograms/m3: 1.013; CI95% 1.003 to 1.023) and for CO 24 la (RR 1 mg/m3: 1.024; CI95% 1.003 to 1.046) was found. For the mortality of those individuals over 70, the estimated impact was somewhat greater than for black smoke (RR 10 micrograms/m3: 1.017; CI95% 1.005-1.029), as well as for CO2 1 h (RR 10 micrograms/m3: 1.007; CI95% 1.001-1.013). No significant relationship was found with the mortality due to respiratory or cardiovascular diseases for the entire period. The current levels of pollution in the city of Valencia show a significant impact on daily mortality. These findings are consistent with the previous research and are coherent with those obtained on analyzing the relationship between air pollution and morbidity indicators.

40 years of progress in female cancer death risk: a Bayesian spatio-temporal mapping analysis in Switzerland.

PubMed

Herrmann, Christian; Ess, Silvia; Thürlimann, Beat; Probst-Hensch, Nicole; Vounatsou, Penelope

2015-10-09

In the past decades, mortality of female gender related cancers declined in Switzerland and other developed countries. Differences in the decrease and in spatial patterns within Switzerland have been reported according to urbanisation and language region, and remain controversial. We aimed to investigate geographical and temporal trends of breast, ovarian, cervical and uterine cancer mortality, assess whether differential trends exist and to provide updated results until 2011. Breast, ovarian, cervical and uterine cancer mortality and population data for Switzerland in the period 1969-2011 was retrieved from the Swiss Federal Statistical office (FSO). Cases were grouped into <55 year olds, 55-74 year olds and 75+ year olds. The geographical unit of analysis was the municipality. To explore age- specific spatio-temporal patterns we fitted Bayesian hierarchical spatio-temporal models on subgroup-specific death rates indirectly standardized by national references. We used linguistic region and degree of urbanisation as covariates. Female cancer mortality continuously decreased in terms of rates in all age groups and cancer sites except for ovarian cancer in 75+ year olds, especially since 1990 onwards. Contrary to other reports, we found no systematic difference between language regions. Urbanisation as a proxy for access to and quality of medical services, education and health consciousness seemed to have no influence on cancer mortality with the exception of uterine and ovarian cancer in specific age groups. We observed no obvious spatial pattern of mortality common for all cancer sites. Rate reduction in cervical cancer was even stronger than for other cancer sites. Female gender related cancer mortality is continuously decreasing in Switzerland since 1990. Geographical differences are small, present on a regional or canton-overspanning level, and different for each cancer site and age group. No general significant association with cantonal or language region borders could be observed.

Do women in Europe live longer and happier lives than men?

PubMed

Solé-Auró, Aïda; Jasilionis, Domantas; Li, Peng; Oksuzyan, Anna

2018-05-08

The article examines gender differences in happy life expectancy at age 50 (LE50) and computes the age-specific contributions of mortality and happiness effects to gender differences in happy LE50 in 16 European countries. Abridged life tables and happy LE50 were calculated using conventional life tables and Sullivan's method. Age-specific death rates were calculated from deaths and population exposures in the Human Mortality Database. Happiness prevalence was estimated using the 2010-11 Survey of Health, Ageing and Retirement in Europe. Happiness was defined using a single question about life satisfaction on a scale of 0-10. A decomposition algorithm was applied to estimate the exact contributions of the differences in mortality and happiness to the overall gender gap in happy LE50. Gender differences in happy LE50 favour women in all countries except Portugal (0.43 years in Italy and 3.55 years in Slovenia). Generally, the contribution of the gender gap in happiness prevalence is smaller than the one in mortality. The male advantage in the prevalence of happiness partially offsets the effects of the female advantage in mortality on the total gender gap in happy LE50. Gender differences in unhappy life years make up the greatest share of the gender gap in total LE50 in all countries except Denmark, Germany, Netherlands, Slovenia and Sweden. Countries with the largest gender gap in LE are not necessarily the countries with larger differences in happy LE50. The remaining years of life of women are expected to be spent not only in unhealthy but also in unhappy state.

Long-term mortality and causes of death associated with Staphylococcus aureus bacteremia. A matched cohort study.

PubMed

Gotland, N; Uhre, M L; Mejer, N; Skov, R; Petersen, A; Larsen, A R; Benfield, T

2016-10-01

Data describing long-term mortality in patients with Staphylococcus aureus bacteremia (SAB) is scarce. This study investigated risk factors, causes of death and temporal trends in long-term mortality associated with SAB. Nationwide population-based matched cohort study. Mortality rates and ratios for 25,855 cases and 258,547 controls were analyzed by Poisson regression. Hazard ratio of death was computed by Cox proportional hazards regression analysis. The majority of deaths occurred within the first year of SAB (44.6%) and a further 15% occurred within the following 2-5 years. The mortality rate was 14-fold higher in the first year after SAB and 4.5-fold higher overall for cases compared to controls. Increasing age, comorbidity and hospital contact within 90 days of SAB was associated with an increased risk of death. The overall relative risk of death decreased gradually by 38% from 1992-1995 to 2012-2014. Compared to controls, SAB patients were more likely to die from congenital malformation, musculoskeletal/skin disease, digestive system disease, genitourinary disease, infectious disease, endocrine disease, injury and cancer and less likely to die from respiratory disease, nervous system disease, unknown causes, psychiatric disorders, cardiovascular disease and senility. Over time, rates of death decreased or were stable for all disease categories except for musculoskeletal and skin disease where a trend towards an increase was seen. Long-term mortality after SAB was high but decreased over time. SAB cases were more likely to die of eight specific causes of death and less likely to die of five other causes of death compared to controls. Causes of death decreased for most disease categories. Risk factors associated with long-term mortality were similar to those found for short-term mortality. To improve long-term survival after SAB, patients should be screened for comorbidity associated with SAB. Copyright © 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

The standard deviation of extracellular water/intracellular water is associated with all-cause mortality and technique failure in peritoneal dialysis patients.

PubMed

Tian, Jun-Ping; Wang, Hong; Du, Feng-He; Wang, Tao

2016-09-01

The mortality rate of peritoneal dialysis (PD) patients is still high, and the predicting factors for PD patient mortality remain to be determined. This study aimed to explore the relationship between the standard deviation (SD) of extracellular water/intracellular water (E/I) and all-cause mortality and technique failure in continuous ambulatory PD (CAPD) patients. All 152 patients came from the PD Center between January 1st 2006 and December 31st 2007. Clinical data and at least five-visit E/I ratio defined by bioelectrical impedance analysis were collected. The patients were followed up till December 31st 2010. The primary outcomes were death from any cause and technique failure. Kaplan-Meier analysis and Cox proportional hazards models were used to identify risk factors for mortality and technique failure in CAPD patients. All patients were followed up for 59.6 ± 23.0 months. The patients were divided into two groups according to their SD of E/I values: lower SD of E/I group (≤0.126) and higher SD of E/I group (>0.126). The patients with higher SD of E/I showed a higher all-cause mortality (log-rank χ (2) = 10.719, P = 0.001) and technique failure (log-rank χ (2) = 9.724, P = 0.002) than those with lower SD of E/I. Cox regression analysis found that SD of E/I independently predicted all-cause mortality (HR  3.551, 95 % CI 1.442-8.746, P = 0.006) and technique failure (HR  2.487, 95 % CI 1.093-5.659, P = 0.030) in CAPD patients after adjustment for confounders except when sensitive C-reactive protein was added into the model. The SD of E/I was a strong independent predictor of all-cause mortality and technique failure in CAPD patients.

Recent trends in mortality in Australia--an analysis of the causes of death through the application of life table techniques.

PubMed

Jain, S K

1992-05-01

"The paper examines the post-1971 reduction in Australian mortality in light of data on causes of death. Multiple-decrement life tables for eleven leading causes of death by sex are calculated and the incidence of each cause of death is presented in terms of the values of the life table functions. The study found that in the overall decline in mortality over the last 20 years significant changes occurred in the contribution of the various causes to total mortality.... The sex-age-cause-specific incidence of mortality changed and the median age at death increased for all causes except for deaths due to motor-vehicle accidents for both sexes and suicide for males. The paper also deciphers the gains in the expectation of life at birth over various time periods and the sex-differentials in the expectation of life at birth at a point in time in terms of the contributions made by the various sex-age-cause-specific mortality rates." excerpt

Low levels of maternal education and the proximate determinants of childhood mortality: a little learning is not a dangerous thing.

PubMed

Basu, Alaka Malwade; Stephenson, Rob

2005-05-01

This paper examines the impact of 'low' levels of maternal education on the proximate determinants of child mortality using data from the 1992/93 Indian National Family Health Survey. Twenty-two outcomes are investigated, representing child mortality and morbidity, illness management, service utilization and health behaviours. Maternal education is a significant correlate of each of the outcomes, and even low levels of education increase child survival prospects and health-related behaviours, except for neonatal mortality and the effective management of diarrhoea. We speculate on some of the possible mechanisms behind such impressive findings and suggest that rather than female autonomy, it may be the 'hidden curriculum' values of discipline and obedience of authority that account for them.

Social life factors affecting the mortality, longevity, and birth rate of total Japanese population: effects of rapid industrialization and urbanization.

PubMed

Araki, S; Uchida, E; Murata, K

1990-12-01

To expand upon the findings that lower mortality was found in Japanese urban areas in contrast to the Western model where in the US and Britain the risk of death was higher in metropolitan areas and conurbations, 22 social life indicators are examined among 46 prefectures in Japan in terms of their effect on age specific mortality, life expectancy, and age adjusted marriage, divorce, and birth rates. The effects of these factors on age adjusted mortality for 8 major working and nonworking male populations, where also analyzed. The 22 social life factors were selected from among 227 indicators in the system of Statistical Indicators on Life. Factor analysis was used to classify the indicators into 8 groups of factors for 1970 and 7 for 1975. Factors 1-3 for both years were rural or urban residence, low income and unemployment, and prefectural age distribution. The 4th for 1970 was home help for the elderly and for 1975, social mobility. The social life indicators were classified form 1 to 8 as rural residence in 1970 and 1975, urban residence, low income, high employment, old age, young age, social mobility, and home help for the elderly which moved from 8th place in 1970 to 1st in 1975. Between 1960-75, rapid urbanization took place with the proportion of farmers, fishermen, and workers declining from 43% in 1960 to 19% in 1975. The results of stepwise regression analysis indicate a positive relationship of urban residence with mortality of men and women except school-aged and middle-aged women, and the working populations, as well as life expectancy at birth for males and females and ages 20 and 40 years for males. Rural residence was positively associated with the male marriage rate, whereas the marriage rate for females was affected by industrialization and urbanization. High employment and social mobility were positively related to the female marriage rate. Low income was positively related to the divorce rate for males and females. Rural residence and high employment were positively related to the birth rate. The birth rate is higher in rural areas. Mortality of professional, engineering, and administrative workers was slightly lower than the total working population, while sales workers, those in farming, fishing, and forestry, and in personal and domestic service had significantly higher mortality. The mortality of the nonworking population was 6-8 times higher than sales, transportation, and communication, and personal and domestic service as well as the total population.

The influence of energy standardisation on the alternate Mediterranean diet score and its association with mortality in the Multiethnic Cohort.

PubMed

Shvetsov, Yurii B; Harmon, Brook E; Ettienne, Reynolette; Wilkens, Lynne R; Le Marchand, Loic; Kolonel, Laurence N; Boushey, Carol J

2016-11-01

The alternate Mediterranean diet (aMED) score is an adaptation of the original Mediterranean diet score. Raw (aMED) and energy-standardised (aMED-e) versions have been used. How the diet scores and their association with health outcomes differ between the two versions is unclear. We examined differences in participants' total and component scores and compared the association of aMED and aMED-e with all-cause, CVD and cancer mortality. As part of the Multiethnic Cohort, 193 527 men and women aged 45-75 years from Hawaii and Los Angeles completed a baseline FFQ and were followed up for 13-18 years. The association of aMED and aMED-e with mortality was examined using Cox's regression, with adjustment for total energy intake. The correlation between aMED and aMED-e total scores was lower among people with higher BMI. Participants who were older, leaner, more educated and consumed less energy scored higher on aMED-e components compared with aMED, except for the red and processed meat and alcohol components. Men reporting more physical activity scored lower on most aMED-e components compared with aMED, whereas the opposite was observed for the meat component. Higher scores of both aMED and aMED-e were associated with lower risk of all-cause, CVD and cancer mortality. Although individuals may score differently with aMED and aMED-e, both scores show similar reductions in mortality risk for persons scoring high on the index scale. Either version can be used in studies of diet and mortality. Comparisons can be performed across studies using different versions of the score.

Ebola virus disease in children during the 2014-2015 epidemic in Guinea: a nationwide cohort study.

PubMed

Chérif, Mahamoud Sama; Koonrungsesomboon, Nut; Kassé, Diénaba; Cissé, Sékou Ditinn; Diallo, Saliou Bella; Chérif, Fatoumata; Camara, Facély; Koné, Alpha; Avenido, Eleonor Fundan; Diakité, Mandiou; Diallo, Mamadou Pathé; Le Gall, Edouard; Cissé, Mohamed; Karbwang, Juntra; Hirayama, Kenji

2017-06-01

The most recent epidemic of Ebola virus disease (EVD) has resulted in more than 11,000 deaths in West Africa. It has threatened child health in the affected countries, including Guinea. This nationwide retrospective cohort study included all children under 20 years of age with laboratory-confirmed EVD in Guinea during the 2014-2015 Ebola outbreak for analysis. Of 8,448 children with probable or suspected EVD, 695 cases were laboratory-confirmed EVD. The overall case fatality rate (CFR) was 62.9%. Pediatric patients with younger age had a significantly higher rate of death (adjusted OR = 0.995; 95%CI = 0.990-1.000; p = 0.046), with the highest CFR of 82.9% in children aged less than 5 years. Fever (91%), fatigue (87%), and gastrointestinal signs and symptoms (70%) were common clinical features on admission of the pediatric patients, while bleeding signs were not occurring often (24%). None of clinical features and epidemiologic risk factors for Ebola were associated with mortality outcome in our cohort study. EVD is a major threat to child health, especially among children under 5 years of age. To date, none of demographic and clinical features, except younger age, have been consistently shown to affect mortality outcome in children infected with Ebola virus. What is Known: • The 2014-2015 West Africa Ebola epidemic is the largest and most widespread outbreak of Ebola virus disease (EVD) in history, with more than 11,000 deaths in Guinea, Liberia, and Sierra Leone. • During ongoing outbreak investigations, it is suggested that young children aged less than 5 years are particularly vulnerable and highly susceptible to death. What is New: • Demographic and clinical characteristics of the nationwide cohort of pediatric patients with laboratory-confirmed EVD in Guinea are reported. • The results confirm the high rate of death among EVD children under 5 years of age, while none of demographic and clinical features, except younger age, could serve as a predictor of mortality outcome in pediatric patients with EVD.

The business cycle and mortality: Urban versus rural counties.

PubMed

Sameem, Sediq; Sylwester, Kevin

2017-02-01

Many studies have found that mortality declines during recessions, but do such results remain consistent in both urban and rural settings? To help uncover explanations for such a pro-cyclical nature of mortality, the present study revisits this topic but allows for associations between unemployment and mortality to differ between urban and rural areas. Using a total of 66 863 observations across 3066 counties of the U.S. from 1990 to 2013, we allow the coefficient on unemployment to differ between urban and rural counties. With an exception of deaths due to external accidents being pro-cyclical in rural settings, we find that the negative association between unemployment and mortality more generally holds for urban areas, particularly for females and the elderly. Moreover, we find death due to circulatory disease or influenza/pneumonia to be especially more prevalent in urban areas. Given that the negative associations between unemployment and mortality are generally stronger in cities, views attempting to explain pro-cyclical mortality should focus on characteristics in urban settings. Copyright © 2016 Elsevier Ltd. All rights reserved.

Mortality of smelt, Osmerus mordax (Mitchill), in Lakes Huron and Michigan during the fall and winter of 1942-1943

USGS Publications Warehouse

Van Oosten, John

1947-01-01

The smelt from the Escanaba area of Green Bay were without exception significantly longer and heavier in 1944 and 1945 than were fish of corresponding age captured in the same region in 1941. Furthermore, three of four comparisons indicated significantly greater size in 1945 than in 1944. This improvement in growth rate is believed to have been associated with the reduction in the smelt population brought about by the 1942–1943 mortality.

Hot Spots and Hot Times: Wildlife Road Mortality in a Regional Conservation Corridor.

PubMed

Garrah, Evelyn; Danby, Ryan K; Eberhardt, Ewen; Cunnington, Glenn M; Mitchell, Scott

2015-10-01

Strategies to reduce wildlife road mortality have become a significant component of many conservation efforts. However, their success depends on knowledge of the temporal and spatial patterns of mortality. We studied these patterns along the 1000 Islands Parkway in Ontario, Canada, a 37 km road that runs adjacent to the St. Lawrence River and bisects the Algonquin-to-Adirondacks international conservation corridor. Characteristics of all vertebrate road kill were recorded during 209 bicycle surveys conducted from 2008 to 2011. We estimate that over 16,700 vertebrates are killed on the road from April to October each year; most are amphibians, but high numbers of birds, mammals, and reptiles were also found, including six reptiles considered at-risk in Canada. Regression tree analysis was used to assess the importance of seasonality, weather, and traffic on road kill magnitude. All taxa except mammals exhibited distinct temporal peaks corresponding to phases in annual life cycles. Variations in weather and traffic were only important outside these peak times. Getis-Ord analysis was used to identify spatial clusters of mortality. Hot spots were found in all years for all taxa, but locations varied annually. A significant spatial association was found between multiyear hot spots and wetlands. The results underscore the notion that multi-species conservation efforts must account for differences in the seasonality of road mortality among species and that multiple years of data are necessary to identify locations where the greatest conservation good can be achieved. This information can be used to inform mitigation strategies with implications for conservation at regional scales.

Hot Spots and Hot Times: Wildlife Road Mortality in a Regional Conservation Corridor

NASA Astrophysics Data System (ADS)

Garrah, Evelyn; Danby, Ryan K.; Eberhardt, Ewen; Cunnington, Glenn M.; Mitchell, Scott

2015-10-01

Strategies to reduce wildlife road mortality have become a significant component of many conservation efforts. However, their success depends on knowledge of the temporal and spatial patterns of mortality. We studied these patterns along the 1000 Islands Parkway in Ontario, Canada, a 37 km road that runs adjacent to the St. Lawrence River and bisects the Algonquin-to-Adirondacks international conservation corridor. Characteristics of all vertebrate road kill were recorded during 209 bicycle surveys conducted from 2008 to 2011. We estimate that over 16,700 vertebrates are killed on the road from April to October each year; most are amphibians, but high numbers of birds, mammals, and reptiles were also found, including six reptiles considered at-risk in Canada. Regression tree analysis was used to assess the importance of seasonality, weather, and traffic on road kill magnitude. All taxa except mammals exhibited distinct temporal peaks corresponding to phases in annual life cycles. Variations in weather and traffic were only important outside these peak times. Getis-Ord analysis was used to identify spatial clusters of mortality. Hot spots were found in all years for all taxa, but locations varied annually. A significant spatial association was found between multiyear hot spots and wetlands. The results underscore the notion that multi-species conservation efforts must account for differences in the seasonality of road mortality among species and that multiple years of data are necessary to identify locations where the greatest conservation good can be achieved. This information can be used to inform mitigation strategies with implications for conservation at regional scales.

Reduced high-density lipoprotein cholesterol: A valuable, independent prognostic marker in peripheral arterial disease.

PubMed

Martinez-Aguilar, Esther; Orbe, Josune; Fernández-Montero, Alejandro; Fernández-Alonso, Sebastián; Rodríguez, Jose A; Fernández-Alonso, Leopoldo; Páramo, Jose A; Roncal, Carmen

2017-11-01

The prognosis of patients with peripheral arterial disease (PAD) is characterized by an exceptionally high risk for myocardial infarction, ischemic stroke, and death; however, studies in search of new prognostic biomarkers in PAD are scarce. Even though low levels of high-density lipoprotein cholesterol (HDL-C) have been associated with higher risk of cardiovascular (CV) complications and death in different atherosclerotic diseases, recent epidemiologic studies have challenged its prognostic utility. The aim of this study was to test the predictive value of HDL-C as a risk factor for ischemic events or death in symptomatic PAD patients. Clinical and demographic parameters of 254 symptomatic PAD patients were recorded. Amputation, ischemic coronary disease, cerebrovascular disease, and all-cause mortality were recorded during a mean follow-up of 2.7 years. Multivariate analyses showed that disease severity (critical limb ischemia) was significantly reduced in patients with normal HDL-C levels compared with the group with low HDL-C levels (multivariate analysis odds ratio, 0.09; 95% confidence interval [CI], 0.03-0.24). A decreased risk for mortality (hazard ratio, 0.46; 95% CI, 0.21-0.99) and major adverse CV events (hazard ratio, 0.38; 95% CI, 0.16-0.86) was also found in patients with normal vs reduced levels of HDL-C in both Cox proportional hazards models and Kaplan-Meier estimates, after adjustment for confounding factors. Reduced HDL-C levels were significantly associated with higher risk for development of CV complications as well as with mortality in PAD patients. These findings highlight the usefulness of this simple test for early identification of PAD patients at high risk for development of major CV events. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Effects of Insecticides and Fungicides Commonly Used in Tomato Production on Phytoseiulus persimilis (Acari: Phtyoseiidae).

PubMed

Ditillo, J L; Kennedy, G G; Walgenbach, J F

2016-12-01

The twospotted spider mite, Tetranychus urticae Koch (Acari: Tetranychidae), is an important pest of tomatoes in North Carolina. Resident populations of the predatory mite Phytoseiulus persimilis have recently been detected on field-grown tomatoes in central North Carolina, and potentially can be a useful biological control agent against T. urticae Laboratory bioassays were used to assess lethal and reproductive effects of 10 insecticides and five fungicides commonly used in commercial tomato production (chlorantraniliprole, spinetoram, permethrin, imidacloprid, dimethoate, dinotefuran, thiamethoxam, bifenthrin, fenpropathrin, lambda-cyhalothrin, azoxystrobin, chlorothalonil, boscalid, cyazofamid, and mancozeb) on P. persimilis adult females and eggs. Insecticides were tested using concentrations equivalent to 1×, 0.5×, and 0.1× of the recommended field rates. Fungicides were tested at the 1× rate only. Dimethoate strongly impacted P. persimilis with high adult mortality, reduced fecundity, and reduced hatch of eggs laid by treated adults, particularly at high concentrations. The pyrethroids lambda-cyhalothrin, bifenthrin, and fenpropathrin were associated with repellency and reproductive effects at high concentrations. Bifenthrin additionally caused increased mortality at high concentrations. Chlorantraniliprole, dinotefuran, and permethrin did not significantly affect mortality or reproduction. Imidacloprid significantly reduced fecundity and egg viability, but was not lethal to adult P. persimilis Thiamethoxam negatively impacted fecundity at the 1× rate. There were no negative effects associated with fungicide exposure with the exception of mancozeb, which impacted fecundity. Field trials were conducted to explore the in vivo impacts of screened insecticides on P. persimilis populations in the field. Field trials supported the incompatibility of dimethoate with P. persimilis populations. © The Authors 2016. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Gender differences in socioeconomic inequality of alcohol-attributable mortality: A systematic review and meta-analysis.

PubMed

Probst, Charlotte; Roerecke, Michael; Behrendt, Silke; Rehm, Jürgen

2015-05-01

The present analysis contributes to understanding the societal distribution of alcohol-attributable harm by investigating socioeconomic inequality and related gender differences in alcohol-attributable mortality. A systematic literature search was performed on Web of Science, MEDLINE, PsycINFO and ETOH from their inception until February 2013. Articles were included when they reported data on alcohol-attributable mortality by socioeconomic status (SES), operationalised as education, occupation, employment status or income. Gender-specific relative risks (RR) comparing low with high SES were pooled using random effects meta-analyses. Gender differences were additionally investigated in random effects meta-regressions. Nineteen articles from 14 countries were included. For women, significant RRs across all measures of SES, except employment status, were found, ranging between 1.75 [95% confidence interval (CI) 1.21-2.54; occupation] and 4.78 (95% CI 2.57-8.87; income). For men, all measures of SES showed significant RRs ranging between 2.88 (95% CI 2.45-3.40; income) and 12.25 (95% CI 11.45-13.10; employment status). While RRs for men were in general slightly higher, only for occupation this gender difference was above chance (P = 0.01). Results refer to deaths 100% attributable to alcohol. The results are predominantly based on data from high-income countries, limiting generalisability. Alcohol-attributable mortality is strongly distributed to the disadvantage of persons with a low SES. Marked gender differences in this inequality were found for occupation. Possibly male-dominated occupations of low SES were more strongly related to risky drinking cultures compared with female-dominated occupations of the same SES. © 2014 Australasian Professional Society on Alcohol and other Drugs.

Assessment of Malawi's success in child mortality reduction through the lens of the Catalytic Initiative Integrated Health Systems Strengthening programme: Retrospective evaluation.

PubMed

Doherty, Tanya; Zembe, Wanga; Ngandu, Nobubelo; Kinney, Mary; Manda, Samuel; Besada, Donela; Jackson, Debra; Daniels, Karen; Rohde, Sarah; van Damme, Wim; Kerber, Kate; Daviaud, Emmanuelle; Rudan, Igor; Muniz, Maria; Oliphant, Nicholas P; Zamasiya, Texas; Rohde, Jon; Sanders, David

2015-12-01

Malawi is estimated to have achieved its Millennium Development Goal (MDG) 4 target. This paper explores factors influencing progress in child survival in Malawi including coverage of interventions and the role of key national policies. We performed a retrospective evaluation of the Catalytic Initiative (CI) programme of support (2007-2013). We developed estimates of child mortality using four population household surveys undertaken between 2000 and 2010. We recalculated coverage indicators for high impact child health interventions and documented child health programmes and policies. The Lives Saved Tool (LiST) was used to estimate child lives saved in 2013. The mortality rate in children under 5 years decreased rapidly in the 10 CI districts from 219 deaths per 1000 live births (95% confidence interval (CI) 189 to 249) in the period 1991-1995 to 119 deaths (95% CI 105 to 132) in the period 2006-2010. Coverage for all indicators except vitamin A supplementation increased in the 10 CI districts across the time period 2000 to 2013. The LiST analysis estimates that there were 10 800 child deaths averted in the 10 CI districts in 2013, primarily attributable to the introduction of the pneumococcal vaccine (24%) and increased household coverage of insecticide-treated bednets (19%). These improvements have taken place within a context of investment in child health policies and scale up of integrated community case management of childhood illnesses. Malawi provides a strong example for countries in sub-Saharan Africa of how high impact child health interventions implemented within a decentralised health system with an established community-based delivery platform, can lead to significant reductions in child mortality.

Assessment of Malawi’s success in child mortality reduction through the lens of the Catalytic Initiative Integrated Health Systems Strengthening programme: Retrospective evaluation

PubMed Central

Doherty, Tanya; Zembe, Wanga; Ngandu, Nobubelo; Kinney, Mary; Manda, Samuel; Besada, Donela; Jackson, Debra; Daniels, Karen; Rohde, Sarah; van Damme, Wim; Kerber, Kate; Daviaud, Emmanuelle; Rudan, Igor; Muniz, Maria; Oliphant, Nicholas P; Zamasiya, Texas; Rohde, Jon; Sanders, David

2015-01-01

Background Malawi is estimated to have achieved its Millennium Development Goal (MDG) 4 target. This paper explores factors influencing progress in child survival in Malawi including coverage of interventions and the role of key national policies. Methods We performed a retrospective evaluation of the Catalytic Initiative (CI) programme of support (2007–2013). We developed estimates of child mortality using four population household surveys undertaken between 2000 and 2010. We recalculated coverage indicators for high impact child health interventions and documented child health programmes and policies. The Lives Saved Tool (LiST) was used to estimate child lives saved in 2013. Results The mortality rate in children under 5 years decreased rapidly in the 10 CI districts from 219 deaths per 1000 live births (95% confidence interval (CI) 189 to 249) in the period 1991–1995 to 119 deaths (95% CI 105 to 132) in the period 2006–2010. Coverage for all indicators except vitamin A supplementation increased in the 10 CI districts across the time period 2000 to 2013. The LiST analysis estimates that there were 10 800 child deaths averted in the 10 CI districts in 2013, primarily attributable to the introduction of the pneumococcal vaccine (24%) and increased household coverage of insecticide–treated bednets (19%). These improvements have taken place within a context of investment in child health policies and scale up of integrated community case management of childhood illnesses. Conclusions Malawi provides a strong example for countries in sub–Saharan Africa of how high impact child health interventions implemented within a decentralised health system with an established community–based delivery platform, can lead to significant reductions in child mortality. PMID:26649176

Immunologic evaluation of 10 different adjuvants for use in vaccines for chickens against highly pathogenic avian influenza virus.

PubMed

Lone, Nazir Ahmed; Spackman, Erica; Kapczynski, Darrell

2017-06-08

Avian influenza viruses (AIV) are a threat to poultry production worldwide. Vaccination is utilized as a component of control programs for both high pathogenicity (HP) and low pathogenicity (LP) AIV. Over 95% of all AIV vaccine used in poultry are inactivated, adjuvanted products. To identify the best formulations for chickens, vaccines were prepared with beta-propiolactone (BPL) inactivated A/British Columbia/314514-1/2004 H7N3 LP AIV using ten commercially available or experimental adjuvants. Each vaccine formulation was evaluated for immunogenicity in chickens. Challenge studies with an antigenically homologous strain of HPAIV were conducted to compare protection against mortality and measure reductions in virus levels in oral swabs. The four best adjuvants from the studies with BPL inactivated antigen were selected and tested identically, but with vaccines prepared from formalin inactivated virus. Mineral and vegetable oil based adjuvants generally induced the highest antibody titers with 100% seroconversion by 3weeks post vaccination. Chitosan induced positive antibody titers in 100% of the chickens, but the titers were significantly lower than those of most of the oil based adjuvants. Antibody levels from calcium phosphate and alginate adjuvanted groups were similar to those of non-adjuvanted virus. All groups that received adjuvanted vaccines induced similar levels of protection against mortality (0-20%) except the groups vaccinated with calcium phosphate adjuvanted vaccines, where mortality was similar (70%) to groups that received non-adjuvanted inactivated virus or no vaccine (60-100% mortality). Virus shedding in oral swabs was variable among the treatment groups. Formalin inactivated vaccine induced similar antibody titers and protection against challenge compared to BPL inactivated vaccine groups. These studies support the use of oil adjuvanted vaccines for use in the poultry industry for control for AIV. Published by Elsevier Ltd.

Socioeconomic deprivation and mortality in people after ischemic stroke: The China National Stroke Registry.

PubMed

Pan, Yuesong; Song, Tian; Chen, Ruoling; Li, Hao; Zhao, Xingquan; Liu, Liping; Wang, Chunxue; Wang, Yilong; Wang, Yongjun

2016-07-01

Previous findings of the association between socioeconomic deprivation and mortality after ischemic stroke are inconsistent. There is a lack of data on the association with combined low education, occupational class, and income. We assessed the associations of three indicators with mortality. We examined data from the China National Stroke Registry, recording all stroke patients occurred between September 2007 and August 2008. Baseline socioeconomic deprivation was measured using low levels of education at <6 years, occupation as manual laboring, and average family income per capita at ≤¥1000 per month. A total of 12,246 patients with ischemic stroke were analyzed. In a 12-month follow-up 1640 patients died. After adjustment for age, sex, cardiovascular risk factors, severity of stroke, and prehospital medications, odds ratio for mortality in patients with low education was 1.25 (95%CI 1.05-1.48), manual laboring 1.37 (1.09-1.72), and low income 1.19 (1.03-1.37). Further adjustment for acute care and medications in and after hospital made no substantial changes in these odds ratios, except a marginal significant odds ratio for low income (1.15, 0.99-1.33). The odds ratio for low income was 1.27 (1.01-1.60) within patients with high education. Compared with no socioeconomic deprivation, the odds ratio in patients with socioeconomic deprivation determined by any one indicator was 1.33 (1.11-1.59), by any two indicators 1.36 (1.10-1.69), and by all three indicators 1.56 (1.23-1.97). There are significant inequalities in survival after ischemic stroke in China in terms of social and material forms of deprivation. General socioeconomic improvement, targeting groups at high risk of mortality is likely to reduce inequality in survival after stroke. © 2016 World Stroke Organization.

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 disease risk. Conclusions Both sexes face increased risk of all-cause mortality, cardiovascular mortality, and end stage renal disease with lower estimated glomerular filtration rates and higher albuminuria. These findings were robust across a large global consortium. PMID:23360717

Effects of saline drinking water on early gosling development

USGS Publications Warehouse

Stolley, D.S.; Bissonette, J.A.; Kadlec, J.A.; Coster, D.

1999-01-01

Relatively high levels of saline drinking water may adversely affect the growth, development, and survival of young waterfowl. Saline drinking water was suspect in the low survival rate of Canada goose (Branta canadensis) goslings at Fish Springs National Wildlife Refuge (FSNWR) in western Utah. Hence, we investigated the effects of saline drinking water on the survival and growth of captive, wild-strain goslings from day 1-28 following hatch. We compared survival and growth (as measured by body mass, wing length, and culmen length) between a control group on tap water with a mean specific conductivity of 650 ??S/cm, and 2 saline water treatments: (1) intermediate level (12,000 ??S/cm), and (2) high level (18,000 ??S/cm). Gosling mortality occurred only in the 18,000 ??S/cm treatment group (33%; n = 9). Slopes of regressions of mean body mass, wing length, and culmen length on age were different from each other (P < 0.05), except for culmen length for the intermediate and high treatment levels. We predict that free-ranging wild goslings will experience mortality at even lower salinity levels than captive goslings because of the combined effects of depressed growth and environmental stresses, including hot desert temperatures and variable food quality over summer.

Coho salmon spawner mortality in western US urban watersheds: bioinfiltration prevents lethal storm water impacts.

PubMed

Spromberg, Julann A; Baldwin, David H; Damm, Steven E; McIntyre, Jenifer K; Huff, Michael; Sloan, Catherine A; Anulacion, Bernadita F; Davis, Jay W; Scholz, Nathaniel L

2016-04-01

Adult coho salmon Oncorhynchus kisutch return each autumn to freshwater spawning habitats throughout western North America. The migration coincides with increasing seasonal rainfall, which in turn increases storm water run-off, particularly in urban watersheds with extensive impervious land cover. Previous field assessments in urban stream networks have shown that adult coho are dying prematurely at high rates (>50%). Despite significant management concerns for the long-term conservation of threatened wild coho populations, a causal role for toxic run-off in the mortality syndrome has not been demonstrated.We exposed otherwise healthy coho spawners to: (i) artificial storm water containing mixtures of metals and petroleum hydrocarbons, at or above concentrations previously measured in urban run-off; (ii) undiluted storm water collected from a high traffic volume urban arterial road (i.e. highway run-off); and (iii) highway run-off that was first pre-treated via bioinfiltration through experimental soil columns to remove pollutants.We find that mixtures of metals and petroleum hydrocarbons - conventional toxic constituents in urban storm water - are not sufficient to cause the spawner mortality syndrome. By contrast, untreated highway run-off collected during nine distinct storm events was universally lethal to adult coho relative to unexposed controls. Lastly, the mortality syndrome was prevented when highway run-off was pretreated by soil infiltration, a conventional green storm water infrastructure technology.Our results are the first direct evidence that: (i) toxic run-off is killing adult coho in urban watersheds, and (ii) inexpensive mitigation measures can improve water quality and promote salmon survival. Synthesis and applications . Coho salmon, an iconic species with exceptional economic and cultural significance, are an ecological sentinel for the harmful effects of untreated urban run-off. Wild coho populations cannot withstand the high rates of mortality that are now regularly occurring in urban spawning habitats. Green storm water infrastructure or similar pollution prevention methods should be incorporated to the maximal extent practicable, at the watershed scale, for all future development and redevelopment projects, particularly those involving transportation infrastructure.

Estimates of cancer burden in Sardinia.

PubMed

Budroni, Mario; Sechi, Ornelia; Cossu, Antonio; Palmieri, Giuseppe; Tanda, Francesco; Foschi, Roberto; Rossi, Silvia

2013-01-01

Cancer registration in Sardinia covers 43% of the population and started in 1992 in the Sassari province. The aim of this paper is to provide estimates of the incidence, mortality and prevalence of seven major cancers for the entire region in the period 1970-2015. The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence figures starting from mortality and relative survival data. Estimates were compared with the available observed data. In 2012 the lowest incidence was estimated for stomach cancer and melanoma among men, with 140 and 74 new cases, respectively, per 100,000. The mortality rates were highest for lung cancer and were very close to the incidence rates (77 and 95 per 100,000, respectively). In women, breast was by far the most frequent cancer site both in terms of incidence (1,512 new cases) and mortality (295 deaths), followed by colon-rectum (493 cases and 201 deaths), lung (205 cases and 167 deaths), melanoma (106 cases and 15 deaths), stomach (82 cases and 61 deaths), and uterine cervix (36 cases and 19 deaths). The highest prevalence was estimated for breast cancer (15,180 cases), followed by colorectal cancer with about 7,300 prevalent cases in both sexes. This paper provides a description of the burden of the major cancers in Sardinia until 2015. The comparisons between the estimated age-standardized incidence rates and those observed in the Sassari registry indicate good agreement. The estimates show a general decrease in cancer mortality, with the exception of female lung cancer. By contrast, the prevalence is steeply increasing for all considered cancers (with the only exception of cancer of the uterine cervix). This points to the need for more strongly supporting evidence-based prevention campaigns focused on contrasting female smoking, unhealthy nutrition and sun exposure.

Estimates of cancer burden in Lazio.

PubMed

Rashid, Ivan; Pannozzo, Fabio; Rossi, Silvia; Foschi, Roberto

2013-01-01

Since 1983 a population-based cancer registry has been operating in Lazio which provides incidence and survival data and covers the entire Latina province, amounting to 10% of the regional population. The aim of this paper is to provide estimates of the incidence, mortality and prevalence for seven major cancers in the Lazio region for the period 1970-2015. The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence figures starting from mortality and relative survival data. Survival was modeled on the basis of published data from the Italian cancer registries. In 2012 the most frequent cancer sites were breast, colon-rectum and prostate with 5,529, 5,315 and 4,759 new diagnosed cases, respectively. The cancers with increasing incidence trends were breast cancer, lung cancer and skin melanoma in women, and prostate cancer, colorectal cancer and melanoma in men. The incidence rates of uterine cervix and stomach cancer decreased. The male lung cancer rates increased, reaching a peak in the late 1980s, and then decreased. Prevalence increased for all the considered cancers except cervix cancer. In 2012 breast, colorectal and prostate cancer had the highest prevalence, with 68,239, 36,617 and 33,934 prevalent cases, respectively. In the final period of the study the mortality declined for all cancers except female lung cancer. In 2012, the highest mortality rates were estimated for lung cancer in both men and women, with 89 and 40 deaths per 100,000, respectively. These estimates give a useful description of the present and future cancer patterns in the Lazio region. Incidence, mortality and prevalence projections provide new information for health resource planning. Furthermore, they point to the need to reinforce the organized screening programs, especially for breast and colorectal cancer.

[Fetal bradycardia: a retrospective study in 9 Spanish centers].

PubMed

Perin, F; Rodríguez Vázquez del Rey, M M; Deiros Bronte, L; Ferrer Menduiña, Q; Rueda Nuñez, F; Zabala Arguelles, J I; García de la Calzada, D; Teodoro Marin, S; Centeno Malfaz, F; Galindo Izquierdo, A

2014-11-01

The aim of this study is to review the current management and outcomes of fetal bradycardia in 9 Spanish centers. Retrospective multicenter study: analysis of all fetuses with bradycardia diagnosed between January 2008 and September 2010. Underlying mechanisms of fetal bradyarrhythmias were studied with echocardiography. A total of 37 cases were registered: 3 sinus bradycardia, 15 blocked atrial bigeminy, and 19 high grade atrioventricular blocks. Sinus bradycardia: 3 cases (100%) were associated with serious diseases. Blocked atrial bigeminy had an excellent outcome, except for one case with post-natal tachyarrhythmia. Of the atrioventricular blocks, 16% were related to congenital heart defects with isomerism, 63% related to the presence of maternal SSA/Ro antibodies, and 21% had unclear etiology. Overall mortality was 20% (37%, if terminations of pregnancy are taken into account). Risk factors for mortality were congenital heart disease, hydrops and/or ventricular dysfunction. Management strategies differed among centers. Steroids were administrated in 73% of immune-mediated atrioventricular blocks, including the only immune-mediated IInd grade block. More than half (58%) of atrioventricular blocks had a pacemaker implanted in a follow-up of 18 months. Sustained fetal bradycardia requires a comprehensive study in all cases, including those with sinus bradycardia. Blocked atrial bigeminy has a good prognosis, but tachyarrhythmias may develop. Heart block has significant mortality and morbidity rates, and its management is still highly controversial. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Colonic perforation with peritonitis in amoebiasis: a tropical disease with high mortality.

PubMed

Jain, Bhupendra Kumar; Garg, Pankaj Kumar; Kumar, Anjay; Mishra, Kiran; Mohanty, Debajyoti; Agrawal, Vivek

2013-01-01

Invasive colonic amoebiasis presents primarily with dysentery; colonic perforation occurs rarely. Cases of amoebic colonic perforations have been reported sporadically over the past 20 years. A retrospective study was done in the surgical unit of a tertiary care hospital in North India. The case records of those patients were reviewed who underwent exploratory laparotomy from January 2011 to September 2012 and were diagnosed with amoebic colonic perforation on histopathological examination. Details concerning the clinical presentation, investigations, intraoperative findings, operative procedures, and postoperative outcomes were retrieved. Amongst, a total of 186 emergency exploratory laparotomies carried out during the study, 15 patients of amoebic colonic perforation were identified. The median age of the patients was 42 years (IQR 32.0-58.0) and the male to female ratio was 13:2. Previous history of colitis was present in only 1 patient. The preoperative diagnosis was perforation peritonitis in 12 patients; and intussusception, intestinal obstruction and ruptured liver abscess in 1 patient each. Ten patients had single perforation while 5 had multiple colonic perforations. All the patients except one had perforations in the right colon. Bowel resection was performed depending upon the site and extent of the colon involved-right hemicolectomy (8), limited ileocolic resection (6) and sigmoidectomy (1). Bowel continuity could be restored only in 2 of the 15 patients and a stoma was constructed in the remaining 13 patients. The overall mortality rate was found to be 40% (6/15). Amoebic colonic perforation is associated with unusually high mortality.

[Candida parapsilosis: a major cause of bloodstream infection in a tertiary care hospital in Costa Rica].

PubMed

Villalobos, Juan M; Castro, José A; Avilés, Alvaro; Peláez, M Claudia; Somogyi, Teresita; Sandoval, Lilliana

2016-04-01

Invasive Candida bloodstream infections are frequent and display high mortality in clinical practice. There is scarce published on this topic in Central America. To characterize the epidemiology of candidemia in a hospital setting in Costa Rica. 210 cases of nosocomial candidemia were analyzed in patients over 17 years of age, admitted to Hospital Mexico, between 2007 and 2011. Descriptive and temporary analyses were performed and the risk factors associated with C. parapsilosis and survival were evaluated. The incidence rate of candidemia was 1.47 cases per 1,000 admissions. The non-albicans Candida represented 62% of the isolated yeasts. Except for 2009, C. parapsilosis was the most commonly isolated species in four out of the five years reviewed, followed by C. albicans. There was a strong association between C. parapsilosis, the presence of a central venous catheter (OR: 4.8, CI 95%: 1.8-14.6, p < 0.001) and the use of parenteral nutrition (p: 0.008). The 30-day mortality was 50%. Candida albicans displayed the highest mortality and C. parapsilosis the lowest. Patients who did not receive anti-fungal treatment showed a significantly higher probability of death. The high incidence of candidemia from C. parapsilosis is directly related to the use of central venous catheters and parenteral nutrition. There is a need for creating local guidelines addressing the use of central venous catheters and parenteral nutrition, as well as implementing hand hygiene protocols.

[The economic crisis at the beginning of the XXI century and mortality in Spain. Trend and impact on social inequalities. SESPAS Report 2014].

PubMed

Ruiz-Ramos, Miguel; Córdoba-Doña, Juan Antonio; Bacigalupe, Amaia; Juárez, Sol; Escolar-Pujolar, Antonio

2014-06-01

This study aimed to assess the impact of the current economic crisis on mortality trends in Spain and its effect on social inequalities in mortality in Andalusia. We used data from vital statistics and the Population Register for 1999 to 2011, as provided by the Spanish Institute of Statistics, to estimate general and sex- and age-specific mortality rates. The Longitudinal Database of the Andalusian Population (2001 census cohort) was used to estimate general mortality rates and ratios by educational level. The annual percentages of change and trends were calculated using Joinpoint regressions. No significant change in the mortality trend was observed in Spain from 2008 onward. A downward trend after 1999 was confirmed for all causes and both sexes, with the exception of nervous system-related diseases. The reduction in mortality due to traffic accidents accelerated after 2003, while the negative trend in suicide was unchanged throughout the period studied. In Andalusia, social inequalities in mortality have increased among men since the beginning of the crisis, mainly due to a more intense reduction in mortality among persons with a higher educational level. Among women, no changes were observed in the pattern of inequality. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

Reproductive justice & preventable deaths: state funding, family planning, abortion, and infant mortality, US 1980-2010.

PubMed

Krieger, Nancy; Gruskin, Sofia; Singh, Nakul; Kiang, Mathew V; Chen, Jarvis T; Waterman, Pamela D; Beckfield, Jason; Coull, Brent A

2016-12-01

Little current research examines associations between infant mortality and US states' funding for family planning services and for abortion, despite growing efforts to restrict reproductive rights and services and documented associations between unintended pregnancy and infant mortality. We obtained publicly available data on state-only public funding for family planning and abortion services (years available: 1980, 1987, 1994, 2001, 2006, and 2010) and corresponding annual data on US county infant death rates. We modeled the funding as both fraction of state expenditures and per capita spending (per woman, age 15-44). State-level covariates comprised: Title X and Medicaid per capita funding, fertility rate, and percent of counties with no abortion services; county-level covariates were: median family income, and percent: black infants, adults without a high school education, urban, and female labor force participation. We used Possion log-linear models for: (1) repeat cross-sectional analyses, with random state and county effects; and (2) panel analysis, with fixed state effects. Four findings were robust to analytic approach. First, since 2000, the rate ratio for infant death comparing states in the top funding quartile vs. no funding for abortion services ranged (in models including all covariates) between 0.94 to 0.98 (95% confidence intervals excluding 1, except for the 2001 cross-sectional analysis, whose upper bound equaled 1), yielding an average 15% reduction in risk (range: 8 to 22%). Second, a similar risk reduction for state per capita funding for family planning services occurred in 1994. Third, the excess risk associated with lower county income increased over time, and fourth, remained persistently high for counties with a high percent of black infants. Insofar as reducing infant mortality is a government priority, our data underscore the need, despite heightened contention, for adequate public funding for abortion services and for redressing health inequities.

Acute kidney injury burden in different clinical units: Data from nationwide survey in China

PubMed Central

Yu, Shengqiang; Yang, Li; Mei, Changlin

2017-01-01

Background The inpatient morbidity and mortality of acute kidney injury (AKI) vary considerably in different clinical units, yet studies to compare the difference remain limited. Methods We compared the clinical characteristics of AKI in Intensive Care Unit (ICU), medical and surgical departments by using the data derived from the 2013 nationwide cross-sectional survey of AKI in China to capture variations among different clinical departments in recognition, management, and outcomes of AKI. Suspected AKI patients were identified based on changes in serum creatinine during hospitalization, and confirmed by reviewing medical records. Results The detection rate of AKI was the highest in ICU (22.46%), followed by the rates in medical (1.96%) and surgical departments (0.96%). However, the absolute number of cases was the largest in medical departments, which contributed to 50% of the cases. In medical departments, 78% of AKI cases were extensively distributed in cardiac, nephrology, oncology, gastroenterology, pneumology and neurology departments. In contrast, 87% of AKI cases in surgical departments were mainly from urology, general surgery and cardiothoracic departments. The in-time recognition rates were extremely low in all departments except nephrology. Only 10.5~15.0% AKI patients from non-nephrology departments received renal referral. Among all the death cases, 50% and 39% came from ICU and medical departments while only 11% from surgical departments. Older age, higher AKI stage and renal replacement therapy indication were identified as risk factors for high mortality in all departments. Delayed recognition and no renal referral were significantly associated with increased mortality in medical and ICU patients. Conclusions These findings suggest that ICU and medical departments are major affected departments in China with a large number of AKI cases and subsequent high mortality. The reality is more alarming considering the low awareness of AKI and the paucity of effective interventions in the high-risk patients in these departments. PMID:28152018

The effect of telehealth, telephone support or usual care on quality of life, mortality and healthcare utilization in elderly high-risk patients with multiple chronic conditions. A prospective study.

PubMed

Valdivieso, Bernardo; García-Sempere, Anibal; Sanfélix-Gimeno, Gabriel; Faubel, Raquel; Librero, Julian; Soriano, Elisa; Peiró, Salvador

2018-04-25

To assess the effect of home based telehealth or structured telephone support interventions with respect to usual care on quality of life, mortality and healthcare utilization in elderly high-risk multiple chronic condition patients. 472 elderly high-risk patients with plurimorbidity in the region of Valencia (Spain) were recruited between June 2012 and May 2013, and followed for 12 months from recruitment. Patients were allocated to either: (a) a structured telephone intervention, a nurse-led case management program with telephone follow up every 15 days; (b) telehealth, which adds technology for remote self-management and the exchange of clinical data; or (c) usual care. Main outcome measures was quality of life measured by the EuroQol (EQ-5D) instrument, cognitive impairment, functional status, mortality and healthcare resource use. Inadequate randomization process led us to used propensity scores for adjusted analyses to control for imbalances between groups at baseline. EQ-5D score was significantly higher in the telehealth group compared to usual care (diff: 0.19, 0.08-0.30), but was not different to telephone support (diff: 0.04, -0.05 to 0.14). In adjusted analyses, inclusion in the telehealth group was associated with an additional 0.18 points in the EQ-5D score compared to usual care at 12 months (p<0.001), and with a gain of 0.13 points for the telephone support group (p<0.001). No differences in mortality or utilization were found, except for a borderline significant increase in General Practitioner visits. Telehealth was associated with better quality of life. Important limitations of the study and similarity of effects to telephone intervention call for careful endorsement of telemedicine. Clinicaltrials.gov (identifier: NCT02447562). Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Spatiotemporal analysis for the effect of ambient particulate matter on cause-specific respiratory mortality in Beijing, China.

PubMed

Wang, Xuying; Guo, Yuming; Li, Guoxing; Zhang, Yajuan; Westerdahl, Dane; Jin, Xiaobin; Pan, Xiaochuan; Chen, Liangfu

2016-06-01

This study explored the association between particulate matter with an aerodynamic diameter of less than 10 μm (PM10) and the cause-specific respiratory mortality. We used the ordinary kriging method to estimate the spatial characteristics of ambient PM10 at 1-km × 1-km resolution across Beijing during 2008-2009 and subsequently fit the exposure-response relationship between the estimated PM10 and the mortality due to total respiratory disease, chronic lower respiratory disease, chronic obstructive pulmonary disease (COPD), and pneumonia at the street or township area levels using the generalized additive mixed model (GAMM). We also examined the effects of age, gender, and season in the stratified analysis. The effects of ambient PM10 on the cause-specific respiratory mortality were the strongest at lag0-5 except for pneumonia, and an inter-quantile range increase in PM10 was associated with an 8.04 % (95 % CI 4.00, 12.63) increase in mortality for total respiratory disease, a 6.63 % (95 % CI 1.65, 11.86) increase for chronic lower respiratory disease, and a 5.68 % (95 % CI 0.54, 11.09) increase for COPD, respectively. Higher risks due to the PM10 exposure were observed for females and elderly individuals. Seasonal stratification analysis showed that the effects of PM10 on mortality due to pneumonia were stronger during spring and autumn. While for COPD, the effect of PM10 in winter was statistically significant (15.54 %, 95 % CI 5.64, 26.35) and the greatest among the seasons. The GAMM model evaluated stronger associations between concentration of PM10. There were significant associations between PM10 and mortality due to respiratory disease at the street or township area levels. The GAMM model using high-resolution PM10 could better capture the association between PM10 and respiratory mortality. Gender, age, and season also acted as effect modifiers for the relationship between PM10 and respiratory mortality.

Chaparral Shrub Hydraulic Traits, Size, and Life History Types Relate to Species Mortality during California’s Historic Drought of 2014

PubMed Central

MacKinnon, Evan D.; Dario, Hannah L.; Jacobsen, Anna L.; Pratt, R. Brandon; Davis, Stephen D.

2016-01-01

Chaparral is the most abundant vegetation type in California and current climate change models predict more frequent and severe droughts that could impact plant community structure. Understanding the factors related to species-specific drought mortality is essential to predict such changes. We predicted that life history type, hydraulic traits, and plant size would be related to the ability of species to survive drought. We evaluated the impact of these factors in a mature chaparral stand during the drought of 2014, which has been reported as the most severe in California in the last 1,200 years. We measured tissue water potential, native xylem specific conductivity, leaf specific conductivity, percentage loss in conductivity, and chlorophyll fluorescence for 11 species in February 2014, which was exceptionally dry following protracted drought. Mortality among the 11 dominant species ranged from 0 to 93%. Total stand density was reduced 63.4% and relative dominance of species shifted after the drought. Mortality was negatively correlated with water potential, native xylem specific conductivity, and chlorophyll fluorescence, but not with percent loss in hydraulic conductivity and leaf specific conductivity. The model that best explained mortality included species and plant size as main factors and indicated that larger plants had greater survival for 2 of the species. In general, species with greater resistance to water-stress induced cavitation showed greater mortality levels. Despite adult resprouters typically being more vulnerable to cavitation, results suggest that their more extensive root systems enable them to better access soil moisture and avoid harmful levels of dehydration. These results are consistent with the hypothesis that short-term high intensity droughts have the strongest effect on mature plants of shallow-rooted dehydration tolerant species, whereas deep-rooted dehydration avoiding species fare better in the short-term. Severe droughts can drive changes in chaparral structure as a result of the differential mortality among species. PMID:27391489

Threshold Levels of Infant and Under-Five Mortality for Crossover between Life Expectancies at Ages Zero, One and Five in India: A Decomposition Analysis

PubMed Central

Dubey, Manisha

2015-01-01

Objectives Under the prevailing conditions of imbalanced life table and historic gender discrimination in India, our study examines crossover between life expectancies at ages zero, one and five years for India and quantifies the relative share of infant and under-five mortality towards this crossover. Methods We estimate threshold levels of infant and under-five mortality required for crossover using age specific death rates during 1981–2009 for 16 Indian states by sex (comprising of India’s 90% population in 2011). Kitagawa decomposition equations were used to analyse relative share of infant and under-five mortality towards crossover. Findings India experienced crossover between life expectancies at ages zero and five in 2004 for menand in 2009 for women; eleven and nine Indian states have experienced this crossover for men and women, respectively. Men usually experienced crossover four years earlier than the women. Improvements in mortality below ages five have mostly contributed towards this crossover. Life expectancy at age one exceeds that at age zero for both men and women in India except for Kerala (the only state to experience this crossover in 2000 for men and 1999 for women). Conclusions For India, using life expectancy at age zero and under-five mortality rate together may be more meaningful to measure overall health of its people until the crossover. Delayed crossover for women, despite higher life expectancy at birth than for men reiterates that Indian women are still disadvantaged and hence use of life expectancies at ages zero, one and five become important for India. Greater programmatic efforts to control leading causes of death during the first month and 1–59 months in high child mortality areas can help India to attain this crossover early. PMID:26683617

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

PubMed

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

2015-11-24

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. 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). 31 provinces in China. 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. 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Chaparral Shrub Hydraulic Traits, Size, and Life History Types Relate to Species Mortality during California's Historic Drought of 2014.

PubMed

Venturas, Martin D; MacKinnon, Evan D; Dario, Hannah L; Jacobsen, Anna L; Pratt, R Brandon; Davis, Stephen D

2016-01-01

Chaparral is the most abundant vegetation type in California and current climate change models predict more frequent and severe droughts that could impact plant community structure. Understanding the factors related to species-specific drought mortality is essential to predict such changes. We predicted that life history type, hydraulic traits, and plant size would be related to the ability of species to survive drought. We evaluated the impact of these factors in a mature chaparral stand during the drought of 2014, which has been reported as the most severe in California in the last 1,200 years. We measured tissue water potential, native xylem specific conductivity, leaf specific conductivity, percentage loss in conductivity, and chlorophyll fluorescence for 11 species in February 2014, which was exceptionally dry following protracted drought. Mortality among the 11 dominant species ranged from 0 to 93%. Total stand density was reduced 63.4% and relative dominance of species shifted after the drought. Mortality was negatively correlated with water potential, native xylem specific conductivity, and chlorophyll fluorescence, but not with percent loss in hydraulic conductivity and leaf specific conductivity. The model that best explained mortality included species and plant size as main factors and indicated that larger plants had greater survival for 2 of the species. In general, species with greater resistance to water-stress induced cavitation showed greater mortality levels. Despite adult resprouters typically being more vulnerable to cavitation, results suggest that their more extensive root systems enable them to better access soil moisture and avoid harmful levels of dehydration. These results are consistent with the hypothesis that short-term high intensity droughts have the strongest effect on mature plants of shallow-rooted dehydration tolerant species, whereas deep-rooted dehydration avoiding species fare better in the short-term. Severe droughts can drive changes in chaparral structure as a result of the differential mortality among species.

What Pertussis Mortality Rates Make Maternal Acellular Pertussis Immunization Cost-Effective in Low- and Middle-Income Countries? A Decision Analysis

PubMed Central

Russell, Louise B.; Pentakota, Sri Ram; Toscano, Cristiana Maria; Cosgriff, Ben; Sinha, Anushua

2016-01-01

Background. Despite longstanding infant vaccination programs in low- and middle-income countries (LMICs), pertussis continues to cause deaths in the youngest infants. A maternal monovalent acellular pertussis (aP) vaccine, in development, could prevent many of these deaths. We estimated infant pertussis mortality rates at which maternal vaccination would be a cost-effective use of public health resources in LMICs. Methods. We developed a decision model to evaluate the cost-effectiveness of maternal aP immunization plus routine infant vaccination vs routine infant vaccination alone in Bangladesh, Nigeria, and Brazil. For a range of maternal aP vaccine prices, one-way sensitivity analyses identified the infant pertussis mortality rates required to make maternal immunization cost-effective by alternative benchmarks ($100, 0.5 gross domestic product [GDP] per capita, and GDP per capita per disability-adjusted life-year [DALY]). Probabilistic sensitivity analysis provided uncertainty intervals for these mortality rates. Results. Infant pertussis mortality rates necessary to make maternal aP immunization cost-effective exceed the rates suggested by current evidence except at low vaccine prices and/or cost-effectiveness benchmarks at the high end of those considered in this report. For example, at a vaccine price of $0.50/dose, pertussis mortality would need to be 0.051 per 1000 infants in Bangladesh, and 0.018 per 1000 in Nigeria, to cost 0.5 per capita GDP per DALY. In Brazil, a middle-income country, at a vaccine price of $4/dose, infant pertussis mortality would need to be 0.043 per 1000 to cost 0.5 per capita GDP per DALY. Conclusions. For commonly used cost-effectiveness benchmarks, maternal aP immunization would be cost-effective in many LMICs only if the vaccine were offered at less than $1–$2/dose. PMID:27838677

All-Cause and Cause-Specific Mortality by Socioeconomic Status Among Employed Persons in 27 US States, 1984–1997

PubMed Central

Steenland, Kyle; Hu, Sherry; Walker, James

2004-01-01

Objectives. We investigated mortality differences according to socioeconomic status (SES) for employed persons in 27 states during 1984–1997. Methods. SES was determined for persons aged 35–64 years according to the “usual occupation” listed on their death certificates. We used US Census denominator data. Results. For all-cause mortality, rate ratios from lowest to highest SES quartile for men and women were 2.02, 1.69, 1.25, and 1.00 and 1.29, 1.01, 1.07, and 1.00, respectively. Percentage of all deaths attributable to being in the lowest 3 SES quartiles was 27%. Inverse SES gradients were strong for most major causes of death except breast cancer and colorectal cancer. Heart disease mortality for highest and lowest SES quartiles dropped 45% and 25%, respectively, between 1984 and 1997. Conclusions. Mortality differences by SES were sustained through the 1990s and are increasing for men. PMID:15249312

Mortality among hourly motor vehicle manufacturing workers.

PubMed

Delzell, Elizabeth; Brown, David A; Matthews, Robert

2003-08-01

We evaluated mortality among 198,245 motor vehicle industry workers during the period of 1973 to 1995. Workers' mortality rates were lower than expected overall (40,131 observed/43,859 expected deaths, standardized mortality ratio [SMR] = 92, CI = 91-92) and for all major cause of death categories except cancer (SMR = 100, CI = 98-102). Mortality rates were higher than expected for lung cancer overall (SMR = 110, CI = 107-113) and among employees in transmission/gear manufacturing (SMR = 121, CI = 112-130), casting operations (SMR = 122, CI = 110-135), engine manufacturing (SMR = 111, CI = 101-123), and vehicle assembly (SMR = 111, CI = 105-117); for stomach cancer in engine manufacturing (SMR = 147, CI = 110-192); and for prostate cancer in casting operations (SMR = 128, CI = 102-158). Excesses of lung cancer in transmission, vehicle assembly, and casting operations and of stomach cancer in engine manufacturing have been observed in other investigations. Further information on employees' occupational exposures and personal attributes is required to clarify the interpretation of these results.

Educational inequalities in young-adult mortality between the 1990s and the 2000s: regional differences in Belgium.

PubMed

De Grande, Hannelore; Vandenheede, Hadewijch; Deboosere, Patrick

2015-01-01

This study addresses educational inequalities in young-adult mortality between the 1990s and the 2000s by comparing trends in the three different regions in Belgium stratified by sex. Social inequalities in mortality are of major concern to public health but are rarely studied at young ages. Substantial health differences have been found between the Flemish (FR) and Walloon region (WR) concerning (healthy) life expectancy and avoidable mortality, but little is known about regional differentials in young-adult mortality, and comparisons with the Brussels-Capital Region (BCR) have thus far never been made. Data are derived from record linkage between the Belgian censuses of 1991 and 2001 and register data on death and emigration for the periods 01/03/1991-01/03/1999 and 01/10/2001-01/10/2009. Analyses are restricted to young adults aged 25 to 34 years at the moment of each of the censuses. Absolute (directly standardized mortality rates (ASMRs)) and relative (mortality rate ratio using Poisson regression) measures were calculated. There is a significant drop in young-adult mortality between the 1990s and the 2000s in all regions and both sexes, with the strongest decline in the BCR (e.g. ASMR of men declined from 165.6 [151.1-180.1] per 100,000 person years to 73.8 [88.3-98.3]). The mortality rates remain highest in the WR in the 2000s Between the 1990s and the 2000s, a remarkable change in the educational distribution occurred as well, with much lower proportions of primary educated in all regions in the 2000s in favour of higher proportions in all other educational levels, especially in higher education. All educational groups show lower mortality over time, except for lower educated men in the FR. There is a positive evolution towards lower mortality among the young-adult Belgian population. The WR trails behind in this evolution, which calls for tailored preventive actions. Educational inequalities are marked in all regions and time periods. A more general discussion is needed on the responsibility of society in rendering support and capability to enhance the state of well-being of those not able to achieve a high social position.

Inequality in mortality by occupation related to economic crisis from 1980 to 2010 among working-age Japanese males.

PubMed

Wada, Koji; Gilmour, Stuart

2016-03-03

The mortality rate for Japanese males aged 30-59 years in managerial and professional spiked in 2000 and remains worse than that of other occupations possibly associated with the economic downturn of the 1990s and the global economic stagnation after 2008. The present study aimed to assess temporal occupation-specific mortality trends from 1980 to 2010 for Japanese males aged 30-59 years for major causes of death. We obtained data from the Occupation-specific Vital Statistics. We calculated age-standardized mortality rates for the four leading causes of death (all cancers, suicide, ischaemic heart disease, and cerebrovascular disease). We used a generalized estimating equation model to determine specific effects of the economic downturn after 2000. The age-standardized mortality rate for the total working-age population steadily declined up to 2010 in all major causes of death except suicide. Managers had a higher risk of mortality in all leading causes of death compared with before 1995. Mortality rates among unemployed people steadily decreased for all cancers and ischaemic heart disease. Economic downturn may have caused the prolonged increase in suicide mortality. Unemployed people did not experience any change in mortality due to suicide and cerebrovascular disease and saw a decline in cancer and ischemic heart disease mortality, perhaps because the basic properties of Japan's social welfare system were maintained even during economic recession.

Potential impact of an exceptional bloom of Karenia mikimotoi on dissolved oxygen levels in waters off western Ireland.

PubMed

O'Boyle, Shane; McDermott, Georgina; Silke, Joe; Cusack, Caroline

2016-03-01

In the summer of 2005 an exceptional bloom of the dinoflagellate Karenia mikimotoi occurred along Ireland's Atlantic seaboard and was associated with the mass mortality of both benthic and pelagic marine life. Oxygen depletion, cellular toxicity and physical smothering, are considered to be the main factors involved in mortality. In this paper we use a theoretical approach based on stoichiometry (the Anderson ratio) and an average K. mikimotoi cellular carbon content of 329pgCcell -1 (n=20) to calculate the carbonaceous and nitrogenous oxygen demand following bloom collapse. The method was validated against measurements of biochemical oxygen demand and K. mikimotoi cell concentration. The estimated potential oxygen utilisation (POU) was in good agreement with field observations across a range of cell concentrations. The magnitude of POU following bloom collapse, with the exception of three coastal areas, was considered insufficient to cause harm to most marine organisms. This indicates that the widespread occurrence of mortality was primarily due to other factors such as cellular toxicity and/or mucilage production, and not oxygen depletion or related phenomena. In Donegal Bay, Kilkieran Bay and inner Dingle Bay, where cell densities were in the order of 10 6 cellsL -1 , estimated POU was sufficient to cause hypoxia. Of the three areas, Donegal Bay is considered to be the most vulnerable due to its hydrographic characteristics (seasonally stratified, weak residual flow) and hypoxic conditions (2.2mgL -1 O 2 ) were directly observed in the Bay post bloom collapse. Here, depending on the time of bloom collapse, depressed DO levels could persist for weeks and continue to have a potentially chronic impact on the Bay. Copyright © 2015 Elsevier B.V. All rights reserved.

Association of Pretransplantion Opioid Use with Graft Loss or Death in Liver Transplantation Patients with Model of End-Stage Liver Disease Exceptions.

PubMed

Fleming, James N; Taber, David J; Pilch, Nicole A; Mardis, Caitlin R; Gilbert, Rachael E; Wilson, Lytani Z; Patel, Neha; Ball, Sarah; Mauldin, Patrick; Baliga, Prabhakar K

2018-04-01

Up to 77% of liver transplantation candidates experience pain, and the majority are prescribed opioids. Previous studies have shown increased readmissions and mortality in liver transplant recipients who were prescribed opioids before transplantation. Our aim was to identify specific populations that are at the highest risk for deleterious outcomes with opioid use before transplantation. This was a single-center retrospective cohort study of adult receiving liver transplants between 2010 and 2016 to assess the impact of pretransplantation opioid use on mortality and graft loss after liver transplantation. A total of 446 liver transplant recipients were included in the study, 148 (33%) of which were identified as pretransplantation opioid users. Opioid use increased significantly during the course of the study. There were no differences in the overall cohort between opioid users and non-opioid users with regard to graft or patient outcomes. However, the influence of opioid use on outcomes varied based on Model for End-Stage Liver Disease (MELD) and functional status. In patients with any MELD exception, opioid use was an independent predictor of time to graft loss or death (adjusted hazard ratio 2.36; 95% CI 1.05 to 5.28; p = 0.037). It also independently predicted time to graft loss or death in patients with low laboratory MELD scores (adjusted hazard ratio 2.38; 95% CI 1.10 to 5.13; p = 0.027). In our 6-year retrospective cohort, pretransplantation opioid use based on medication reconciliation was independently associated with time to graft loss or mortality in liver transplant recipients with MELD exceptions and laboratory MELD scores ≤15. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

High Israeli mortality rates from diabetes and renal failure - Can international comparison of multiple causes of death reflect differences in choice of underlying cause?

PubMed

Goldberger, Nehama; Applbaum, Yael; Meron, Jill; Haklai, Ziona

2015-01-01

The age-adjusted mortality rate in Israel is low compared to most Western countries although mortality rates from diabetes and renal failure in Israel are amongst the highest, while those from cardiovascular diseases (CVD) are amongst the lowest. This study aims to assess validity of choice of underlying causes (UC) in Israel by analyzing Israeli and international data on the prevalence of these diseases as multiple causes of death (MCOD) compared to UC, and data on comorbidity (MCOD based). Age-adjusted death rates were calculated for UC and MCOD and the corresponding ratio of multiple to underlying cause of death (SRMU) for available years between 1999 and 2012. Comorbidity was explored by calculating cause of death association indicators (CDAI) and frequency of comorbid disease. These results were compared to data from USA, France, Italy, Australia and the Czech Republic for 2009 or other available year. Mortality rates for all these diseases except renal failure have decreased in Israel between 1999 and 2012 as UC and MCOD. In 2009, the SRMU for diabetes was 2.7, slightly lower than other Western countries (3.0-3.5) showing more frequent choice as UC. Similar results were found for renal failure. In contrast, the SRMU for ischemic heart disease (IHD) and cerebrovascular disease were 2.0 and 2.6, respectively, higher than other countries (1.4-1.6 and 1.7-1.9, respectively), showing less frequent choice as UC. CDAI data showed a strong association between heart and cerebrovascular disease, and diabetes in all countries. In Israel, 40 % of deaths with UC diabetes had IHD and 24 % had cerebrovascular disease. Renal disease was less strongly associated with IHD. This international comparison suggests that diabetes and renal failure may be coded more frequently in Israel as UC, sometimes instead of heart and cerebrovascular disease. Even with some changes in coding, mortality rates would be high compared to other countries, similar to the comparatively high diabetes prevalence in Israel at older ages and high rate of end-stage renal failure. This study highlights the importance of physician training on death certification practice and need for further progress towards automation in recording and coding death causes.

Stability analysis of a model gene network links aging, stress resistance, and negligible senescence.

PubMed

Kogan, Valeria; Molodtsov, Ivan; Menshikov, Leonid I; Shmookler Reis, Robert J; Fedichev, Peter

2015-08-28

Several animal species are considered to exhibit what is called negligible senescence, i.e. they do not show signs of functional decline or any increase of mortality with age. Recent studies in naked mole rat and long-lived sea urchins showed that these species do not alter their gene-expression profiles with age as much as other organisms do. This is consistent with exceptional endurance of naked mole rat tissues to various genotoxic stresses. We conjectured, therefore, that the lifelong transcriptional stability of an organism may be a key determinant of longevity. We analyzed the stability of a simple genetic-network model and found that under most common circumstances, such a gene network is inherently unstable. Over a time it undergoes an exponential accumulation of gene-regulation deviations leading to death. However, should the repair systems be sufficiently effective, the gene network can stabilize so that gene damage remains constrained along with mortality of the organism. We investigate the relationship between stress-resistance and aging and suggest that the unstable regime may provide a mathematical basis for the Gompertz "law" of aging in many species. At the same time, this model accounts for the apparently age-independent mortality observed in some exceptionally long-lived animals.

Recent age- and gender-specific trends in mortality during stroke hospitalization in the United States.

PubMed

Ovbiagele, Bruce; Markovic, Daniela; Towfighi, Amytis

2011-10-01

Advancements in diagnosis and treatment have resulted in better clinical outcomes after stroke; however, the influence of age and gender on recent trends in death during stroke hospitalization has not been specifically investigated. We assessed the impact of age and gender on nationwide patterns of in-hospital mortality after stroke. Data were obtained from all US states that contributed to the Nationwide Inpatient Sample. All patients admitted to hospitals between 1997 and 1998 (n=1 351 293) and 2005 and 2006 (n=1 202 449), with a discharge diagnosis of stroke (identified by the International Classification of Diseases, Ninth Revision procedure codes), were included. Time trends for in-hospital mortality after stroke were evaluated by gender and age group based on 10-year age increments (<55, 55-64, 65-74, 75-84, >84) using multivariable logistic regression. Between 1997 and 2006, in-hospital mortality rates decreased across time in all sub-groups (all P<0·01), except in men >84 years. In unadjusted analysis, men aged >84 years in 1997-1998 had poorer mortality outcomes than similarly aged women (odds ratio 0·93, 95% confidence interval=0·88-0·98). This disparity worsened by 2005-2006 (odds ratio 0·88, 95% confidence interval=0·84-0·93). After adjusting for confounders, compared with similarly aged women, the mortality outcomes among men aged >84 years were poorer in 1997-1998 (odds ratio 0·97, 95% confidence interval=0·92-1·02) and were poorer in 2005-2006 (odds ratio 0·92, 95% confidence interval=0·87-0·96), P=0·04, for gender × time trend. Over the last decade, in-hospital mortality rates after stroke in the United States have declined for every age/gender group, except men aged >84 years. Given the rapidly ageing US population, avenues for boosting in-hospital survival among very elderly men with stroke need to be explored. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.

Toxic materials, fishing, and environmental variation: simulated effects on striped bass population trends

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goodyear, C.P.

1985-01-01

Decreased survival of larval striped bass Morone saxatilis resulting from toxic chemicals in the environment and decreased survival of adults caused by fishing both are suspected as agents contributing to the decline in the Chesapeake Bay stock since the mid-1970s. The relative power of each type of mortality to cause population declines was evaluated with simulation techniques. Equivalent levels of added mortality induced qualitatively identical and quantitatively similar trends in population simulations for all conditions examined except if strong density-dependent mortality preceded the contaminant toxicity. In this case the contaminant effect caused a greater reduction in yield, but the populationmore » did not tend toward extinction. The results indicate that the observed downward trend in the Chesapeake Bay population can be halted or reversed by a reduction in fishing mortality, even if contaminant toxicity is the proximate cause for the decline. 28 references, 1 figure, 1 table.« less

Trends in Mortality of Tuberculosis Patients in the United States: The Long-term Perspective

PubMed Central

Barnes, Richard F.W.; Moore, Maria Luisa; Garfein, Richard S.; Brodine, Stephanie; Strathdee, Steffanie A.; Rodwell, Timothy C.

2011-01-01

PURPOSE To describe long-term trends in TB mortality and to compare trends estimated from two different sources of public health surveillance data. METHODS Trends and changes in trend were estimated by joinpoint regression. Comparisons between datasets were made by fitting a Poisson regression model. RESULTS Since 1900, TB mortality rates estimated from death certificates have declined steeply, except for a period of no change in the 1980s. This decade had long-term consequences resulting in more TB deaths in later years than would have occurred had there been no flattening of the trend. Recent trends in TB mortality estimated from National Tuberculosis Surveillance System (NTSS) data, which record all-cause mortality, differed from trends based on death certificates. In particular, NTSS data showed TB mortality rates flattening since 2002. CONCLUSIONS Estimates of trends in TB mortality vary by data source, and therefore interpretation of the success of control efforts will depend upon the surveillance dataset used. The datasets may be subject to different biases that vary with time. One dataset showed a sustained improvement in the control of TB since the early 1990s while the other indicated that the rate of TB mortality was no longer declining. PMID:21820320

Impact of endoscopic screening on mortality reduction from gastric cancer

PubMed Central

Hamashima, Chisato; Ogoshi, Kazuei; Narisawa, Rintarou; Kishi, Tomoki; Kato, Toshiyuki; Fujita, Kazutaka; Sano, Masatoshi; Tsukioka, Satoshi

2015-01-01

AIM: To investigate mortality reduction from gastric cancer based on the results of endoscopic screening. METHODS: The study population consisted of participants of gastric cancer screening by endoscopy, regular radiography, and photofluorography at Niigata city in 2005. The observed numbers of cumulative deaths from gastric cancers and other cancers were accumulated by linkage with the Niigata Prefectural Cancer Registry. The standardized mortality ratio (SMR) of gastric cancer and other cancer deaths in each screening group was calculated by applying the mortality rate of the reference population. RESULTS: Based on the results calculated from the mortality rate of the population of Niigata city, the SMRs of gastric cancer death were 0.43 (95%CI: 0.30-0.57) for the endoscopic screening group, 0.68 (95%CI: 0.55-0.79) for the regular radiographic screening group, and 0.85 (95%CI: 0.71-0.94) for the photofluorography screening group. The mortality reduction from gastric cancer was higher in the endoscopic screening group than in the regular radiographic screening group despite the nearly equal mortality rates of all cancers except gastric cancer. CONCLUSION: The 57% mortality reduction from gastric cancer might indicate the effectiveness of endoscopic screening for gastric cancer. Further studies and prudent interpretation of results are needed. PMID:25741155

All-Cause and Cause-Specific Mortality Associated with Bariatric Surgery: A Review.

PubMed

Adams, Ted D; Mehta, Tapan S; Davidson, Lance E; Hunt, Steven C

2015-12-01

The question of whether or not nonsurgical intentional or voluntary weight loss results in reduced mortality has been equivocal, with long-term mortality following weight loss being reported as increased, decreased, and not changed. In part, inconsistent results have been attributed to the uncertainty of whether the intentionality of weight loss is accurately reported in large population studies and also that achieving significant and sustained voluntary weight loss in large intervention trials is extremely difficult. Bariatric surgery has generally been free of these conflicts. Patients voluntarily undergo surgery and the resulting weight is typically significant and sustained. These elements, combined with possible non-weight loss-related mechanisms, have resulted in improved comorbidities, which likely contribute to a reduction in long-term mortality. This paper reviews the association between bariatric surgery and long-term mortality. From these studies, the general consensus is that bariatric surgical patients have: 1) significantly reduced long-term all-cause mortality when compared to severely obese non-bariatric surgical control groups; 2) greater mortality when compared to the general population, with the exception of one study; 3) reduced cardiovascular-, stroke-, and cancer-caused mortality when compared to severely obese non-operated controls; and 4) increased risk for externally caused death such as suicide.

M-CASTL 2008 synthesis report : volume 2, teen driver safety.

DOT National Transportation Integrated Search

2008-05-01

Teen drivers have the highest crash rates of any age-group of drivers, with the possible : exception of the very oldest drivers. Motor vehicle crashes are the leading cause of morbidity : and mortality among teens. Not only are teen drivers more like...

High incidence of lung cancer and malignant mesothelioma linked to erionite fibre exposure in a rural community in Central Mexico.

PubMed

Ortega-Guerrero, M Adrián; Carrasco-Núñez, Gerardo; Barragán-Campos, Héctor; Ortega, Martín R

2015-03-01

To report the high incidence of lung cancer (LC) and malignant mesothelioma (MM) linked to environmental exposure to erionite fibres in a rural village of central Mexico. This is a retrospective survey of clinical and mortality records from the years 2000-2012, accompanied by an environmental survey for nine Group-1 lung and pleura carcinogenic agents listed by the International Agency for Research on Cancer (IARC). Out of a total of 45 deaths between 2000 and 2012, 14 deaths correspond to different neoplasms of the lung, and at least four deaths to MM. The ages at diagnosis of MM were between 30 and 54 years. Annual age-standardised mortality rates per thousand due to LC and MM in the village (age >20 years) are 7.09 and 2.48 for males, and 4.75 and 1.05 for females, respectively. Erionite fibres were found in exposed rocks and soils, which can easily become airborne and be carried into streets and recreational areas near schools and homes. Other carcinogenic elements and minerals are found only in trace amounts, except for quartz dust and asbestos (chrysotile) cement sheeting, which are also present in the neighbouring villages. These results indicate that environmental exposure to erionite is the main cause of the high rates of MM mortality in the Village of Tierra Blanca, supporting previous similar reports for people exposed to erionite fibres in villages in Turkey. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Country-level economic disparity and child mortality related to housing and injuries: a study in 26 European countries.

PubMed

Sengoelge, Mathilde; Elling, Berty; Laflamme, Lucie; Hasselberg, Marie

2013-10-01

Adverse living standards are associated with poorer child health and safety. This study investigates whether adverse housing and neighbourhood conditions contribute to explain country-level associations between a country's economic level and income inequality and child mortality, specifically injury mortality. Ecological, cross-sectional study. Twenty-six European countries were grouped according to two country-level economic measures from Eurostat: gross domestic product (GDP) and income inequality. Adverse country-level housing and neighbourhood conditions were assessed using data from the 2006 European Union Income Social Inclusion and Living Conditions Database (n=203 000). Child mortality incidence rates were derived for children aged 1-14 years for all causes, all injuries, road traffic injuries and unintentional injuries excluding road traffic. Linear regression analysis was applied to measure whether housing or neighbourhood conditions have a significant association with child mortality and whether a strain modified the association between GDP/income inequality and mortality. Country-level income inequality and GDP demonstrated a significant association with child mortality for all outcomes. A significant association was also found between housing strain and all child mortality outcomes, but not for neighbourhood strain. Housing strain partially modified the relationship between income inequality and GDP and all child mortality outcomes, with the exception of income inequality and road traffic injury mortality showing full mediation by housing strain. Adverse housing conditions are a likely pathway in the country-level association between income inequality and economic GDP and child injury mortality.

Contribution of smoking to socioeconomic inequalities in mortality: a study of 14 European countries, 1990-2004.

PubMed

Gregoraci, G; van Lenthe, F J; Artnik, B; Bopp, M; Deboosere, P; Kovács, K; Looman, C W N; Martikainen, P; Menvielle, G; Peters, F; Wojtyniak, B; de Gelder, R; Mackenbach, J P

2017-05-01

Smoking contributes to socioeconomic inequalities in mortality, but the extent to which this contribution has changed over time and driven widening or narrowing inequalities in total mortality remains unknown. We studied socioeconomic inequalities in smoking-attributable mortality and their contribution to inequalities in total mortality in 1990-1994 and 2000-2004 in 14 European countries. We collected, harmonised and standardised population-wide data on all-cause and lung-cancer mortality by age, gender, educational and occupational level in 14 European populations in 1990-1994 and 2000-2004. Smoking-attributable mortality was indirectly estimated using the Preston-Glei-Wilmoth method. In 2000-2004, smoking-attributable mortality was higher in lower socioeconomic groups in all countries among men, and in all countries except Spain, Italy and Slovenia, among women, and the contribution of smoking to socioeconomic inequalities in mortality varied between 19% and 55% among men, and between -1% and 56% among women. Since 1990-1994, absolute inequalities in smoking-attributable mortality and the contribution of smoking to inequalities in total mortality have decreased in most countries among men, but increased among women. In many European countries, smoking has become less important as a determinant of socioeconomic inequalities in mortality among men, but not among women. Inequalities in smoking remain one of the most important entry points for reducing inequalities in mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The 1994 heat wave in South Korea: mortality impacts and recurrence probability in a changing climate

NASA Astrophysics Data System (ADS)

Kysely, J.; Kim, J.

2010-03-01

The study deals with mortality impacts of the July-August 1994 heat wave in the population of South Korea, including the megacity of Seoul (with the population exceeding 10 million for the city and 20 million for the metropolitan area), and estimates recurrence probability of the heat wave in a changing climate in terms of simulations of daily temperature series with a stochastic model. The 1994 heat wave is found exceptional with respect to both climatological characteristics and the mortality effects: significantly elevated mortality occurred in all population groups, including children up to 14 years of age, and the total death toll exceeded 3000 in the Korean population, which ranks the 1994 heat wave among the worst weather-related disasters in East Asia. The estimate represents net excess mortality as no mortality displacement effect appeared. A comparison with other documented natural disasters shows that the death toll of the heat wave was much higher than those of the most disastrous floodings and typhoons over Korean Peninsula in the 20th century. The mortality response was stronger in males than females although males are found to be less vulnerable during average heat waves. A climatological analysis reveals that the July-August 1994 heat wave might be considered an extremely rare event with a return period in the order of hundreds of years if stationarity of temperature time series is assumed. However, under a more realistic assumption of gradual warming related to climate change, recurrence probability of an event analogous to the 1994 heat wave sharply rises for near-future time horizons. If warming of 0.04°C/year is assumed over 2001-2060, the recurrence interval of a very long spell of days with temperature exceeding a high threshold (as in the 1994 heat wave) is estimated to decrease to around 40 (10) years in the 2021-2030 (2041-2050) decade. This emphasizes the need for setting up an efficient heat-watch-warning system in this area in order to reduce human mortality impacts of heat waves.

Cross-National Systematic Review of Neonatal Mortality and Postnatal Newborn Care: Special Focus on Pakistan.

PubMed

Ahmed, Mansoor; Won, Youngjoon

2017-11-23

The latest nationwide survey of Pakistan showed that considerable progress has been made toward reducing all child mortality indicators except neonatal mortality. The aim of this study is to compare Pakistan's under-five mortality, neonatal mortality, and postnatal newborn care rates with those of other countries. Neonatal mortality rates and postnatal newborn care rates from the Demographic and Health Surveys (DHSs) of nine low- and middle-income countries (LMIC) from Asia and Africa were analyzed. Pakistan's maternal, newborn, and child health (MNCH) policies and programs, which have been implemented in the country since 1990, were also analyzed. The results highlighted that postnatal newborn care in Pakistan was higher compared with the rest of countries, yet its neonatal mortality remained the worst. In Zimbabwe, both mortality rates have been increasing, whereas the neonatal mortality rates in Nepal and Afghanistan remained unchanged. An analysis of Pakistan's MNCH programs showed that there is no nationwide policy on neonatal health. There were only a few programs concerning the health of newborns, and those were limited in scale. Pakistan's example shows that increased coverage of neonatal care without ensuring quality is unlikely to improve neonatal survival rates. It is suggested that Pakistan needs a comprehensive policy on neonatal health similar to other countries, and its effective programs need to be scaled up, in order to obtain better neonatal health outcomes.

Cancer epidemiology in Central and South Eastern European countries

PubMed Central

Vrdoljak, Eduard; Wojtukiewicz, Marek Z; Pienkowski, Tadeusz; Bodoky, Gyorgy; Berzinec, Peter; Finek, Jindrich; Todorović, Vladimir; Borojević, Nenad; Croitoru, Adina

2011-01-01

Aim To collect cancer epidemiology data in South Eastern European countries as a basis for potential comparison of their performance in cancer care. Methods The South Eastern European Research Oncology Group (SEEROG) collected and analyzed epidemiological data on incidence and mortality that reflect cancer management in 8 countries – Croatia, Czech Republic, Hungary, Romania, Poland, Slovakia, and Serbia and Montenegro in the last 20-40 years. Results The most common cancer type in men in all countries was lung cancer, followed by colorectal and prostate cancer, with the exception of the Czech Republic, where prostate cancer and colorectal cancer were more common. The most frequent cancer in women was breast cancer followed by colorectal cancer, with the exceptions of Romania and Central Serbia where cervical cancer was the second most common. Cancer mortality data from the last 20-40 years revealed two different patterns in men. In Romania and in Serbia and Montenegro, there was a trend toward an increase, while in the other countries mortality was declining, after increasing for a number of years. In women, a steady decline was observed over many years in the Czech Republic, Hungary, and Slovakia, while in the other countries it remained unchanged. Conclusions There are striking variations in the risk of different cancers by geographic area. Most of the international variation is due to exposure to known or suspected risk factors which provides a clear challenge to prevention. There are some differences in incidence and mortality that cannot be explained by exposure to known risk factors or treatment availabilities. PMID:21853542

Transfer time to a specialist burn service and influence on burn mortality in Australia and New Zealand: A multi-centre, hospital based retrospective cohort study.

PubMed

Cassidy, T John; Edgar, Dale W; Phillips, Michael; Cameron, Peter; Cleland, Heather; Wood, Fiona M

2015-06-01

In Australia and New Zealand (ANZ), health care is provided for ∼26 million people dispersed across the eight million square kilometres of the two countries. Providing optimal care prior to and during transfer across such vast distances is challenging. Lengthening the time taken to definitive burn care has a negative impact on burn outcome. The aims of this study were to determine if transfer time and admission pathway influenced burn mortality and to identify the factors predicting burn mortality in ANZ. The study included all adult burn patient admission data from 15 of 17 burn services submitted to the Australian and New Zealand Burn Association bi-national registry (2010-2012). Multivariate logistic regression analyses were conducted to address the study aims. Of the 2892 patients, 69 (2.4%) died following burn. Time to admission and direct admission to a burn centre did not independently influence burn mortality except when patients with inhalation injury took >16 h to transfer to definitive care. The risk of death was increased 5.7 times in the presence of inhalation injury. Burn size and age amplified the risk of death while gender did not. In ANZ, pre-hospital transport systems and peripheral hospital stabilisation were not associated with an increased risk of death due to burn except when inhalation injury was present. The results of this study indicate that burn patients with inhalation injury should be stabilised and transferred to a burn service within 16 h of burn. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

21 CFR 558.530 - Roxarsone.

Code of Federal Regulations, 2011 CFR

2011-04-01

... for reduction of mortality due to E. coli infections susceptible to chlortetracycline. As in paragraph... paragraph (d)(3)(i) of this section; and for treatment of bacterial enteritis caused by E. coli and S... Escherichia coli susceptible to chlortetracycline. As in paragraph (d)(1)(i) of this section except feed...

21 CFR 558.530 - Roxarsone.

Code of Federal Regulations, 2010 CFR

2010-04-01

... for reduction of mortality due to E. coli infections susceptible to chlortetracycline. As in paragraph... paragraph (d)(3)(i) of this section; and for treatment of bacterial enteritis caused by E. coli and S... Escherichia coli susceptible to chlortetracycline. As in paragraph (d)(1)(i) of this section except feed...

Trends in inequalities in premature cancer mortality by educational level in Colombia, 1998–2007

PubMed Central

de Vries, Esther; Arroyave, Ivan; Pardo, Constanza; Wiesner, Carolina; Murillo, Raul; Forman, David; Burdorf, Alex; Avendaño, Mauricio

2015-01-01

Background There is paucity of studies on socioeconomic inequalities in cancer mortality in developing countries. We examined trends in inequalities in cancer mortality by educational attainment in Colombia during a period of epidemiological transition and a rapid expansion of health insurance coverage. Methods Population mortality data (1998–2007) were linked to census data to obtain age-standardised cancer mortality rates by educational attainment at ages 25–64 years for stomach, cervical, prostate, lung, colorectal, breast and other cancers. We used Poisson regression to model mortality by educational attainment and estimated the contribution of specific cancers to the Slope Index of Inequality in cancer mortality. Results We observed large educational inequalities in cancer mortality, particularly for cancer of the cervix (RR primary versus tertiary groups=5.75, contributing 51% of cancer inequalities), stomach (RR=2.56 for males, contributing 49% of total cancer inequalities, and RR=1.98 for females, contributing 14% to total cancer inequalities), and lung (RR=1.64 for males contributing 17% of total cancer inequalities, and 1.32 for females contributing 5% to total cancer inequalities). Total cancer mortality rates declined faster among those with higher education, with the exception of mortality from cervical cancer, which declined more rapidly in the lower educational groups. Conclusion There are large socioeconomic inequalities in preventable cancer mortality in Colombia, which underscore the need for intensifying prevention efforts. Reducing cervical cancer through reducing HPV infection, early detection and improved access to treatment of preneoplasic lesions. Reinforcing anti-tobacco measures may be particularly important to curb inequalities in cancer mortality. PMID:25492898

Association of BMI with risk of CVD mortality and all-cause mortality.

PubMed

Kee, Chee Cheong; Sumarni, Mohd Ghazali; Lim, Kuang Hock; Selvarajah, Sharmini; Haniff, Jamaiyah; Tee, Guat Hiong Helen; Gurpreet, Kaur; Faudzi, Yusoff Ahmad; Amal, Nasir Mustafa

2017-05-01

To determine the relationship between BMI and risk of CVD mortality and all-cause mortality among Malaysian adults. Population-based, retrospective cohort study. Participants were followed up for 5 years from 2006 to 2010. Mortality data were obtained via record linkages with the Malaysian National Registration Department. Multiple Cox regression was applied to compare risk of CVD and all-cause mortality between BMI categories adjusting for age, gender and ethnicity. Models were generated for all participants, all participants the first 2 years of follow-up, healthy participants, healthy never smokers, never smokers, current smokers and former smokers. All fourteen states in Malaysia. Malaysian adults (n 32 839) aged 18 years or above from the third National Health and Morbidity Survey. Total follow-up time was 153 814 person-years with 1035 deaths from all causes and 225 deaths from CVD. Underweight (BMI<18·5 kg/m2) was associated with a significantly increased risk of all-cause mortality, while obesity (BMI ≥30·0 kg/m2) was associated with a heightened risk of CVD mortality. Overweight (BMI=25·0-29·9 kg/m2) was inversely associated with risk of all-cause mortality. Underweight was significantly associated with all-cause mortality in all models except for current smokers. Overweight was inversely associated with all-cause mortality in all participants. Although a positive trend was observed between BMI and CVD mortality in all participants, a significant association was observed only for severe obesity (BMI≥35·0 kg/m2). Underweight was associated with increased risk of all-cause mortality and obesity with increased risk of CVD mortality. Therefore, maintaining a normal BMI through leading an active lifestyle and healthy dietary habits should continue to be promoted.

Inequalities in premature mortality in Britain: observational study from 1921 to 2007.

PubMed

Thomas, Bethan; Dorling, Danny; Smith, George Davey

2010-07-22

To report on the extent of inequality in premature mortality as measured between geographical areas in Britain. Observational study of routinely collected mortality data and public records. Population subdivided by age, sex, and geographical area (parliamentary constituencies from 1991 to2007, pre-1974 local authorities over a longer time span). Great Britain. Entire population aged under 75 from 1990 to 2007, and entire population aged under 65 in the periods 1921-39, 1950-3, 1959-63, 1969-73, and 1981-2007. Relative index of inequality (RII) and ratios of inequality in age-sex standardised mortality ratios under ages 75 and 65. The relative index of inequality is the relative rate of mortality for the hypothetically worst-off compared with the hypothetically best-off person in the population, assuming a linear association between socioeconomic position and risk of mortality. The ratio of inequality is the ratio of the standardised mortality ratio of the most deprived 10% to the least deprived 10%. When measured by the relative index of inequality, geographical inequalities in age-sex standardised rates of mortality below age 75 have increased every two years from 1990-1 to 2006-7 without exception. Over this period the relative index of inequality increased from 1.61 (95% confidence interval 1.52 to 1.69) in 1990-1 to 2.14 (2.02 to 2.27) in 2006-7. Simple ratios indicated a brief period around 2001 when a small reduction in inequality was recorded, but this was quickly reversed and inequalities up to the age of 75 have now reached the highest levels reported since at least 1990. Similarly, inequalities in mortality ratios under the age of 65 improved slightly in the early years of this century but the latest figures surpass the most extreme previously reported. Comparison of crudely age-sex standardised rates for those below age 65 from historical records showed that geographical inequalities in mortality are higher in the most recent decade than in any similar time period for which records are available since at least 1921. Inequalities in premature mortality between areas of Britain continued to rise steadily during the first decade of the 21st century. The last time in the long economic record that inequalities were almost as high was in the lead up to the economic crash of 1929 and the economic depression of the 1930s. The economic crash of 2008 might precede even greater inequalities in mortality between areas in Britain.

Two denominators for one numerator: the example of neonatal mortality.

PubMed

Harmon, Quaker E; Basso, Olga; Weinberg, Clarice R; Wilcox, Allen J

2018-06-01

Preterm delivery is one of the strongest predictors of neonatal mortality. A given exposure may increase neonatal mortality directly, or indirectly by increasing the risk of preterm birth. Efforts to assess these direct and indirect effects are complicated by the fact that neonatal mortality arises from two distinct denominators (i.e. two risk sets). One risk set comprises fetuses, susceptible to intrauterine pathologies (such as malformations or infection), which can result in neonatal death. The other risk set comprises live births, who (unlike fetuses) are susceptible to problems of immaturity and complications of delivery. In practice, fetal and neonatal sources of neonatal mortality cannot be separated-not only because of incomplete information, but because risks from both sources can act on the same newborn. We use simulations to assess the repercussions of this structural problem. We first construct a scenario in which fetal and neonatal factors contribute separately to neonatal mortality. We introduce an exposure that increases risk of preterm birth (and thus neonatal mortality) without affecting the two baseline sets of neonatal mortality risk. We then calculate the apparent gestational-age-specific mortality for exposed and unexposed newborns, using as the denominator either fetuses or live births at a given gestational age. If conditioning on gestational age successfully blocked the mediating effect of preterm delivery, then exposure would have no effect on gestational-age-specific risk. Instead, we find apparent exposure effects with either denominator. Except for prediction, neither denominator provides a meaningful way to define gestational-age-specific neonatal mortality.

Inequality in mortality by occupation related to economic crisis from 1980 to 2010 among working-age Japanese males

PubMed Central

Wada, Koji; Gilmour, Stuart

2016-01-01

The mortality rate for Japanese males aged 30–59 years in managerial and professional spiked in 2000 and remains worse than that of other occupations possibly associated with the economic downturn of the 1990s and the global economic stagnation after 2008. The present study aimed to assess temporal occupation-specific mortality trends from 1980 to 2010 for Japanese males aged 30–59 years for major causes of death. We obtained data from the Occupation-specific Vital Statistics. We calculated age-standardized mortality rates for the four leading causes of death (all cancers, suicide, ischaemic heart disease, and cerebrovascular disease). We used a generalized estimating equation model to determine specific effects of the economic downturn after 2000. The age-standardized mortality rate for the total working-age population steadily declined up to 2010 in all major causes of death except suicide. Managers had a higher risk of mortality in all leading causes of death compared with before 1995. Mortality rates among unemployed people steadily decreased for all cancers and ischaemic heart disease. Economic downturn may have caused the prolonged increase in suicide mortality. Unemployed people did not experience any change in mortality due to suicide and cerebrovascular disease and saw a decline in cancer and ischemic heart disease mortality, perhaps because the basic properties of Japan’s social welfare system were maintained even during economic recession. PMID:26936097

Excess mortality during heat waves and cold spells in Moscow, Russia.

PubMed

Revich, B; Shaposhnikov, D

2008-10-01

To estimate excess mortality during heat waves and cold spells, and to identify vulnerable population groups by age and cause of death. Daily mortality in Moscow, Russia from all non-accidental, cardiovascular and respiratory causes between January 2000 and February 2006 was analysed. Mortality and displaced mortality during cold spells and heat waves were estimated using independent samples t tests. Cumulative excess non-accidental mortality during the 2001 heat wave was 33% (95% CI 20% to 46%), or approximately 1200 additional deaths, with short-term displaced mortality contributing about 10% of these. Mortality from coronary heart disease increased by 32% (95% CI 16% to 48%), cerebrovascular mortality by 51% (95% CI 29% to 73%) and respiratory mortality by 80% (95% CI 57% to 101%). In the 75+ age group, corresponding mortality increments were consistently higher except respiratory deaths. An estimated 560 extra deaths were observed during the three heat waves of 2002, when non-accidental mortality increased by 8.5%, 7.8% and 6.1%, respectively. About 40% of these deaths were brought forward by only a few days, bringing net mortality change down to 3.2% (95% CI 0.8% to 5.5%). The cumulative effects of the two cold spells in 2006 on mortality were significant only in the 75+ age group, for which average daily mortality from all non-accidental causes increased by 9.9% (95% CI 8.0% to 12%) and 8.9% (95% CI 6.7% to 11%), resulting in 370 extra deaths; there were also significant increases in coronary disease mortality and cerebrovascular mortality. This study confirms that daily mortality in Moscow increases during heat waves and cold spells. A considerable proportion of excess deaths during heat waves occur a short time earlier than they would otherwise have done. Harvesting, or short-term mortality displacement, may be less significant for longer periods of sustained heat stress.

Effects of elevated CO2 on fine root dynamics in a Mojave Desert community: A FACE study

USGS Publications Warehouse

Phillips, D.L.; Johnson, M.G.; Tingey, D.T.; Catricala, C.E.; Hoyman, T.L.; Nowak, R.S.

2006-01-01

Fine roots (??? 1mm diameter) are critical in plant water and nutrient absorption, and it is important to understand how rising atmospheric CO2 will affect them as part of terrestrial ecosystem responses to global change. This study's objective was to determine effects of elevated CO2 on production, mortality, and standing crops of fine root length over 2 years in a free-air CO2 enrichment (FACE) facility in the Mojave Desert of southern Nevada, USA. Three replicate 25m diameter FACE rings were maintained at ambient (??? 370 ??mol mol-1) and elevated CO2 (??? 550 ??mol mol-1) atmospheric concentrations. Twenty-eight minirhizotron tubes were placed in each ring to sample three microsite locations: evergreen Larrea shrubs, drought-deciduous Ambrosia shrubs, and along systematic community transects (primarily in shrub interspaces which account for ??? 85% of the area). Seasonal dynamics were similar for ambient and elevated CO2: fine root production peaked in April-June, with peak standing crop occurring about 1 month later, and peak mortality occurring during the hot summer months, with higher values for all three measures in a wet year compared with a dry year. Fine root standing crop, production, and mortality were not significantly different between treatments except standing crop along community transects, where fine root length was significantly lower in elevated CO2. Fine root turnover (annual cumulative mortality/mean standing crop) ranged from 2.33 to 3.17 year-1, and was not significantly different among CO2 treatments, except for community transect tubes where it was significantly lower for elevated CO2. There were no differences in fine root responses to CO2 between evergreen (Larrea) and drought-deciduous (Ambrosia) shrubs. Combined with observations of increased leaf-level water-use efficiency and lack of soil moisture differences, these results suggest that under elevated CO2 conditions, reduced root systems (compared with ambient CO2) appear sufficient to provide resources for modest aboveground production increases across the community, but in more fertile shrub microsites, fine root systems of comparable size with those in ambient CO2 were required to support the greater aboveground production increases. For community transects, development of the difference in fine root standing crops occurred primarily through lower stimulation of fine root production in the elevated CO2 treatment during periods of high water availability. ?? 2005 Blackwell Publishing Ltd.

Mortality from non‐malignant respiratory diseases among people with silicosis in Hong Kong: exposure–response analyses for exposure to silica dust

PubMed Central

Tse, L A; Yu, I T S; Leung, C C; Tam, W; Wong, T W

2007-01-01

Objectives To examine the exposure–response relationships between various indices of exposure to silica dust and the mortality from non‐malignant respiratory diseases (NMRDs) or chronic obstructive pulmonary diseases (COPDs) among a cohort of workers with silicosis in Hong Kong. Methods The concentrations of respirable silica dust were assigned to each industry and job task according to historical industrial hygiene measurements documented previously in Hong Kong. Exposure indices included cumulative dust exposure (CDE) and mean dust concentration (MDC). Penalised smoothing spline models were used as a preliminary step to detect outliers and guide further analyses. Multiple Cox's proportional hazard models were used to estimate the dust effects on the risk of mortality from NMRDs or COPDs after truncating the highest exposures. Results 371 of the 853 (43.49%) deaths occurring among 2789 workers with silicosis during 1981–99 were from NMRDs, and 101 (27.22%) NMRDs were COPDs. Multiple Cox's proportional hazard models showed that CDE (p = 0.009) and MDC (p<0.001) were significantly associated only with NMRD mortality. Subgroup analysis showed that deaths from NMRDs (p<0.01) and COPDs (p<0.05) were significantly associated with both CDE and MDC among underground caisson workers and among those ever employed in other occupations with high exposure to silica dust. No exposure–response relationship was observed for surface construction workers with low exposures. A clear upward trend for both NMRDs and COPDs mortality was found with increasing severity of radiological silicosis. Conclusion This study documented an exposure–response relationship between exposure to silica dust and the risk of death from NMRDs or COPDs among workers with silicosis, except for surface construction workers with low exposures. The risk of mortality from NMRDs increased significantly with the progression of International Labor Organization categories, independent of dust effects. PMID:16973737

Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital.

PubMed

Jabbour, Gaby; El-Menyar, Ayman; Peralta, Ruben; Shaikh, Nissar; Abdelrahman, Husham; Mudali, Insolvisagan Natesa; Ellabib, Mohamed; Al-Thani, Hassan

2016-01-01

Necrotizing fasciitis (NF) is a fatal aggressive infectious disease. We aimed to assess the major contributing factors of mortality in NF patients. A retrospective study was conducted at a single surgical intensive care unit between 2000 and 2013. Patients were categorized into 2 groups based on their in-hospital outcome (survivors versus non-survivors). During a14-year period, 331 NF patients were admitted with a mean age of 50.8 ± 15.4 years and 74 % of them were males Non-survivors (26 %) were 14.5 years older (p = 0.001) and had lower frequency of pain (p = 0.01) and fever (p = 0.001) than survivors (74 %) at hospital presentation. Diabetes mellitus, hypertension, and coronary artery disease were more prevalent among non-survivors (p = 0.001). The 2 groups were comparable for the site of infection; except for sacral region that was more involved in non-survivors (p = 0.005). On admission, non-survivors had lower hemoglobin levels (p = 0.001), platelet count (p = 0.02), blood glucose levels (p = 0.07) and had higher serum creatinine (p = 0.001). Non-survivors had greater median LRINEC (Laboratory Risk Indicator for NECrotizing fasciitis score) and Sequential Organ Failure Assessment (SOFA) scores (p = 0.001). Polybacterial and monobacterial gram negative infections were more evident in non-survivors group. Monobacterial pseudomonas (p = 0.01) and proteus infections (p = 0.005) were reported more among non-survivors. The overall mortality was 26 % and the major causes of death were bacteremia, septic shock and multiorgan failure. Multivariate analysis showed that age and SOFA score were independent predictors of mortality in the entire study population. The mortality rate is quite high as one quarter of NF patients died during hospitalization. The present study highlights the clinical and laboratory characteristics and predictors of mortality in NF patients.

National, regional, and global sex ratios of infant, child, and under-5 mortality and identification of countries with outlying ratios: a systematic assessment.

PubMed

Alkema, Leontine; Chao, Fengqing; You, Danzhen; Pedersen, Jon; Sawyer, Cheryl C

2014-09-01

Under natural circumstances, the sex ratio of male to female mortality up to the age of 5 years is greater than one but sex discrimination can change sex ratios. The estimation of mortality by sex and identification of countries with outlying levels is challenging because of issues with data availability and quality, and because sex ratios might vary naturally based on differences in mortality levels and associated cause of death distributions. For this systematic analysis, we estimated country-specific mortality sex ratios for infants, children aged 1-4 years, and children under the age of 5 years (under 5s) for all countries from 1990 (or the earliest year of data collection) to 2012 using a Bayesian hierarchical time series model, accounting for various data quality issues and assessing the uncertainty in sex ratios. We simultaneously estimated the global relation between sex ratios and mortality levels and constructed estimates of expected and excess female mortality rates to identify countries with outlying sex ratios. Global sex ratios in 2012 were 1·13 (90% uncertainty interval 1·12-1·15) for infants, 0·95 (0·93-0·97) for children aged 1-5 years, and 1·08 (1·07-1·09) for under 5s, an increase since 1990 of 0·01 (-0·01 to 0·02) for infants, 0·04 (0·02 to 0·06) for children aged 1-4 years, and 0·02 (0·01 to 0·04) for under 5s. Levels and trends varied across regions and countries. Sex ratios were lowest in southern Asia for 1990 and 2012 for all age groups. Highest sex ratios were seen in developed regions and the Caucasus and central Asia region. Decreasing mortality was associated with increasing sex ratios, except at very low infant mortality, where sex ratios decreased with total mortality. For 2012, we identified 15 countries with outlying under-5 sex ratios, of which ten countries had female mortality higher than expected (Afghanistan, Bahrain, Bangladesh, China, Egypt, India, Iran, Jordan, Nepal, and Pakistan). Although excess female mortality has decreased since 1990 for the vast majority of countries with outlying sex ratios, the ratios of estimated to expected female mortality did not change substantially for most countries, and worsened for India. Important differences exist between boys and girls with respect to survival up to the age of 5 years. Survival chances tend to improve more rapidly for girls compared with boys as total mortality decreases, with a reversal of this trend at very low infant mortality. For many countries, sex ratios follow this pattern but important exceptions exist. An explanation needs to be sought for selected countries with outlying sex ratios and action should be undertaken if sex discrimination is present. The National University of Singapore and the United Nations Children's Fund (UNICEF). Copyright © 2014 Alkema et al. Open Access article distributed under the terms of CC BY-NC-SA. Published by .. All rights reserved.

[Acute necrotic hemorrhagic pancreatitis. Major complications (author's transl)].

PubMed

Reynaert, M; Bauer, G; Haot, J; Bellassai, J; Trémouroux, J

1981-01-01

Forty-four cases of acute necrotic haemorrhagic pancreatitis are studied. Fourteen cases were treated medically by peritoneal dialysis, 20 were treated surgically of which 16 had been medically treated by peritoneal dialysis. Fifteen died or 34%. Forty-one patients, 93.1% presented 8 major complications on admission and 2 complications were observed during the course of medical treatment (pulmonary shock and high digestive haemorrhage). The post surgical complications are excluded from this study. We report in order of frequency; effusion of the large peritoneal cavity (37 cases : 84%), hypocalcaemia less than or equal to 8 mg% (21 cases : 47.7%), renal insufficiency defined by a creatinaemia greater than or equal 2 mg% (17 cases : 38.6%), state of shock (13 cases : 29.5%), severe neurological disorders (11 cases : 25%), peritoneal haemorrhage (3 cases : 4.5%), disseminated intravascular coagulation (1 case : 2.2%), acute rabdomyolysis (1 case : 2.2%). Certain cases are particularly derogatory : pulmonary shock : 2 cases -- 2 deaths (100%); hypocalcaemia less than or equal to 7 mg/ : 6 cases -- 5 deaths (83.3%); acute tubular necrosis : 8 cases -- 6 deaths (75%); hypocalcaemia less than or equal 8 mg% : 21 cases -- 12 deaths (57.1%); high digestive haemorrhage : 3 cases -- 1 death (33.3%); amber known brown peritoneal effusion : 27 cases -- 12 deaths (44.4%); shock : 13 cases -- 5 deaths (38.5%). When in the same patients, less than 3 complications were present, the mortality rate was 20.8%. If more than 3 signs were observed the mortality rate rose to 53.3%. Except for pulmonary shock, six major complications were needed to give 100% mortality rate.

Emergency surgery for bowel obstruction in extremely aged patients.

PubMed

Oldani, Alberto; Gentile, Valentina; Magaton, Chiara; Calabrò, Marcello; Maroso, Fabio; Ravizzini, Lidia; Deiro, Giacomo; Amato, Maurizio; Gentilli, Sergio

2018-04-13

As a result of the increasing of life expectancy, the incidence of pathologies that can lead to operation for bowel obstruction is also increasing. Comorbidities and reduced physiological reserve can decrease elderly patients' ability to tolerate operations especially in an emergency context. We retrospectively evaluated the treatment and outcomes of a cohort of patients aged more than 85 years who underwent emergency surgery for intestinal occlusion. 278 patients who were admitted to our Institution and operated for acute bowel obstruction have been included in our study. We divided the study population in 2 groups (group A: patients aged > 85 years old; group B patients aged ≤ 85 years). We evaluated the differences between the two groups in terms of intestinal occlusion aetiology, surgical procedures, morbidity and mortality rates. Group A consisted of 57 patients, group B of 221; elderly patients trend in ASA score classification was significantly towards high risk for elderly group; statistical analysis did not show differences in terms of bowel obstruction aetiology (except colon volvulus, more frequent in advanced age), type of procedure, duration of hospital stay, procedure - related complication rate. Perioperative mortality was significantly higher in elderly group, due to the mayor incidence of cardiovascular and respiratory fatal events directly related to pre - existing comorbidities. Despite the high surgical risk, early diagnosis and treatment of the obstructive disease can lead to achieve encouraging outcomes also in extremely advanced age; an aggressive evaluation of comorbidies and the cardio - respiratory risks reduction, when possible, could be useful in improve postoperative outcomes in terms of mortality.

Beyond reducing fire hazard: fuel treatment impacts on overstory tree survival

USGS Publications Warehouse

Collins, Brandon M.; Das, Adrian J.; Battles, John J.; Fry, Danny L.; Krasnow, Kevin D.; Stephens, Scott L.

2014-01-01

Fuel treatment implementation in dry forest types throughout the western United States is likely to increase in pace and scale in response to increasing incidence of large wildfires. While it is clear that properly implemented fuel treatments are effective at reducing hazardous fire potential, there are ancillary ecological effects that can impact forest resilience either positively or negatively depending on the specific elements examined, as well as treatment type, timing, and intensity. In this study, we use overstory tree growth responses, measured seven years after the most common fuel treatments, to estimate forest health. Across the five species analyzed, observed mortality and future vulnerability were consistently low in the mechanical-only treatment. Fire-only was similar to the control for all species except Douglas-fir, while mechanical-plus-fire had high observed mortality and future vulnerability for white fir and sugar pine. Given that overstory trees largely dictate the function of forests and services they provide (e.g., wildlife habitat, carbon sequestration, soil stability) these results have implications for understanding longer-term impacts of common fuel treatments on forest resilience.

Beyond reducing fire hazard: fuel treatment impacts on overstory tree survival.

PubMed

Collins, Brandon M; Das, Adrian J; Battles, John J; Fry, Danny L; Krasnow, Kevin D; Stephens, Scott L

Fuel treatment implementation in dry forest types throughout the western United States is likely to increase in pace and scale in response to increasing incidence of large wildfires. While it is clear that properly implemented fuel treatments are effective at reducing hazardous fire potential, there are ancillary ecological effects that can impact forest resilience either positively or negatively depending on the specific elements examined, as well as treatment type, timing, and intensity. In this study, we use overstory tree growth responses, measured seven years after the most common fuel treatments, to estimate forest health. Across the five species analyzed, observed mortality and future vulnerability were consistently low in the mechanical- only treatment. Fire-only was similar to the control for all species except Douglas-fir, while mechanical-plus-fire had high observed mortality and future vulnerability for white fir and sugar pine. Given that overstory trees largely dictate the function of forests and services they provide (e.g., wildlife habitat, carbon sequestration, soil stability) these results have implications for understanding longer-term impacts of common fuel treatments on forest resilience.

Washington's public and private forests.

Treesearch

Charles L. Bolsinger; Neil McKay; Donald FL Gedney; Carol Alerich

1997-01-01

This report summarizes and analyzes 1988-91 timber inventories of western and eastern Washington. These inventories were conducted on all private and public lands except National Forests. Timber resource statistics from National Forest inventories also are presented. Detailed tables provide estimates of forest area, timber volume, growth, mortality, and harvest. Data...

An improved brine shrimp larvae lethality microwell test method.

PubMed

Zhang, Yi; Mu, Jun; Han, Jinyuan; Gu, Xiaojie

2012-01-01

This article described an improved brine shrimp larvae lethality microwell test method. A simply designed connecting vessel with alternative photoperiod was used to culture and collect high yield of active Artemia parthenogenetica nauplii for brine shrimp larvae lethality microwell test. Using this method, pure A. parthenogenetica nauplii suspension was easily cultured and harvested with high density about 100-150 larvae per milliliter and the natural mortality was reduced to near zero by elimination of unnecessary artificial disturbance. And its sensitivity was validated by determination of LC(50)-24 h of different reference toxicants including five antitumor agents, two pesticides, three organic pollutants, and four heavy metals salts, most of which exhibited LC(50)-24 h between 0.07 and 58.43 mg/L except for bleomycin and mitomycin C with LC(50)-24 h over 300 mg/L.

[Geographical bias in the inhospital mortality estimated by the Hospital Morbidity Survey].

PubMed

Librero, Julián; Peiró, Salvador; Ridao-López, Manuel; Bernal-Delgado, Enrique

2008-01-01

The Hospital Morbidity Survey (EMH) includes, at the moment, 85% of hospitals and 90% of discharges, and is the only national data source that allows to deepen with information about diagnostics, gender or age, in the study of hospitals as place of death. This work aims to analyze the presence of inhospital mortality geographical biases in the EMH in relation to the sample universe represented by the Statistics of Health Establishments with Inpatient Regime (EESCRI). We compared, for each province in 2004, the EMH estimations for discharges, deaths and the percent of mortality with the data from the EESCRI, and adjusting one linear regression model for the number of deaths and a second model for the percent of mortality. The EMH infraestimated the volume of discharges and deaths (-8.6% and -11.4%), but not the inhospital mortality rate (3.55% vs. 3.45%). In spite of the excellent correlation in the number of deaths, figures in the EMH are inferior to the EESCRI figures in most provinces, and in 13 provinces the discrepancies overcome the 20%. The percent of mortality showed discrepancies overcoming 20% in 9 provinces. In 2004, the EMH infraestimates the discharges and deaths figures but, except for 9 provinces, there are not evidence of important biases in the percent of mortality.

Investigation of cancer mortality inequalities between rural and urban areas in South Korea.

PubMed

Choi, Kyung-Mee

2016-02-01

Little is known about rural-urban cancer disparities, particularly in South Korea, and this study is to identify cancer-specific mortality inequalities between the rural and urban areas of the country. For 11 specific cancer sites, age-standardised mortality rates were analysed for the rural and urban administrative districts of South Korea during 2006-2011. The Poisson log linear regression models were employed to estimate cancer-specific mortality rates, and Bonferroni comparison method was used to identify rural-urban disparities. There were significant rural-urban disparities observed for all cancer sites except prostate, pancreas and leukaemia. The mortality rates of lung, liver and stomach cancers, the three most common cancers in the country, were observed to be significantly higher in rural areas than in metropolitan areas. In contrast, the reverse relationship was observed for the reproductive system (breast and uterus) and colon cancers. Central nervous system cancer mortality was observed to be significantly higher in rural areas than in non-metro urban areas. For the first time ever, significant rural-urban disparity patterns in cancer mortality rates in South Korea have been identified in this paper. Future investigations on cancer risk factors for the country should address these disparity patterns. © 2015 National Rural Health Alliance Inc.

Patterns in mortality among people with severe mental disorders across birth cohorts: a register-based study of Denmark and Finland in 1982-2006.

PubMed

Gissler, Mika; Laursen, Thomas Munk; Ösby, Urban; Nordentoft, Merete; Wahlbeck, Kristian

2013-09-11

Mortality among patients with mental disorders is higher than in general population. By using national longitudinal registers, we studied mortality changes and excess mortality across birth cohorts among people with severe mental disorders in Denmark and Finland. A cohort of all patients admitted with a psychiatric disorder in 1982-2006 was followed until death or 31 December 2006. Total mortality rates were calculated for five-year birth cohorts from 1918-1922 until 1983-1987 for people with mental disorder and compared to the mortality rates among the general population. Mortality among patients with severe mental disorders declined, but patients with mental disorders had a higher mortality than general population in all birth cohorts in both countries. We observed two exceptions to the declining mortality differences. First, the excess mortality stagnated among Finnish men born in 1963-1987, and remained five to six times higher than at ages 15-24 years in general. Second, the excess mortality stagnated for Danish and Finnish women born in 1933-1957, and remained six-fold in Denmark and Finland at ages 45-49 years and seven-fold in Denmark at ages 40-44 years compared to general population. The mortality gap between people with severe mental disorders and the general population decreased, but there was no improvement for young Finnish men with mental disorders. The Finnish recession in the early 1990s may have adversely affected mortality of adolescent and young adult men with mental disorders. Among women born 1933-1957, the lack of improvement may reflect adverse effects of the era of extensive hospitalisation of people with mental disorders in both countries.

Waaler revisited: The anthropometrics of mortality.

PubMed

Koch, Daniel

2011-01-01

Although many studies have been written about the relationship between BMI and human height on the one hand and mortality on the other, the issue of socio-economic status as confounding variable has been at times less emphasized. This study analyzes the influence of education and income on the relationship between BMI and mortality and between height and mortality. It is based on data collected between 1963 and 1975 by the Norwegian National Health Screening Service. 1.7 million subjects were recorded. The Norwegian statistics bureau linked these data to the national death records and to socio-economic information. We apply Cox proportional hazards regressions in order to determine whether adding income and education as covariates affects the relations among BMI, height, and mortality. Previous findings and insights are either not present or ambiguous. We conclude that the omission of SES does not significantly bias the effect of BMI on most causes of death, with one exception: type 2 diabetes mellitus, where the effect of BMI is substantially lower for both adults and adolescents when adjusted for education. Copyright © 2010 Elsevier B.V. All rights reserved.

Molecular comparison of isolates of an emerging fish pathogen, koi herpesvirus, and the effect of water temperature on mortality of experimentally infected koi.

PubMed

Gilad, Oren; Yun, Susan; Adkison, Mark A; Way, Keith; Willits, Neil H; Bercovier, Herve; Hedrick, Ronald P

2003-10-01

Koi herpesvirus (KHV) has been associated with devastating losses of common carp (Cyprinus carpio carpio) and koi (Cyprinus carpio koi) in North America, Europe, Israel and Asia. A comparison of virion polypeptides and genomic restriction fragments of seven geographically diverse isolates of KHV indicated that with one exception they represented a homogeneous group. A principal environmental factor influencing the onset and severity of disease is water temperature. Optimal growth of KHV in a koi fin cell line occurred at temperatures from 15-25 degrees C. There was no growth or minimal growth at 4, 10, 30 or 37 degrees C. Experimental infections of koi with KHV at a water temperature of 23 degrees C resulted in a cumulative mortality of 95.2 %. Disease progressed rapidly but with lower mortality (89.4-95.2 %) at 28 degrees C. Mortality (85.0 %) also occurred at 18 degrees C but not at 13 degrees C. Shifting virus-exposed fish from 13-23 degrees C resulted in the rapid onset of mortality.

European seasonal mortality and influenza incidence due to winter temperature variability

NASA Astrophysics Data System (ADS)

Ballester, Joan; Rodó, Xavier; Robine, Jean-Marie; Herrmann, François Richard

2016-10-01

Recent studies have vividly emphasized the lack of consensus on the degree of vulnerability (see ref. ) of European societies to current and future winter temperatures. Here we consider several climate factors, influenza incidence and daily numbers of deaths to characterize the relationship between winter temperature and mortality in a very large ensemble of European regions representing more than 400 million people. Analyses highlight the strong association between the year-to-year fluctuations in winter mean temperature and mortality, with higher seasonal cases during harsh winters, in all of the countries except the United Kingdom, the Netherlands and Belgium. This spatial distribution contrasts with the well-documented latitudinal orientation of the dependency between daily temperature and mortality within the season. A theoretical framework is proposed to reconcile the apparent contradictions between recent studies, offering an interpretation to regional differences in the vulnerability to daily, seasonal and long-term winter temperature variability. Despite the lack of a strong year-to-year association between winter mean values in some countries, it can be concluded that warmer winters will contribute to the decrease in winter mortality everywhere in Europe.

Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience.

PubMed

Veysi, Veysi T; Nikolaou, Vassilios S; Paliobeis, Christos; Efstathopoulos, Nicolas; Giannoudis, Peter V

2009-10-01

A review of prospectively collected data in our trauma unit for the years 1998-2003 was undertaken. Adult patients who suffered multiple trauma with an Injury Severity Score (ISS) of >/=16, admitted to hospital for more than 72 hours and with sustained blunt chest injuries were included in the study. Demographic details including pre-hospital care, trauma history, admission vital signs, blood transfusions, details of injuries and their abbreviated injury scores (AIS), operations, length of intensive care unit and hospital stays, Injury Severity Score (ISS) and mortality were analysed. Fulfilling the inclusion criteria with at least one chest injury were 1,164 patients. The overall mortality reached 18.7%. As expected, patients in the higher AIS groups had both a higher overall ISS and mortality rate with one significant exception; patients with minor chest injuries (AIS(chest) = 1) were associated with mortality comparable to injuries involving an AIS(chest) = 3. Additionally, the vast majority of polytraumatised patients with an AIS(chest) = 1 died in ICU sooner than patients of groups 2-5.

Extremely cold and hot temperatures increase the risk of ischaemic heart disease mortality: epidemiological evidence from China.

PubMed

Guo, Yuming; Li, Shanshan; Zhang, Yanshen; Armstrong, Ben; Jaakkola, Jouni J K; Tong, Shilu; Pan, Xiaochuan

2013-02-01

To examine the effects of extremely cold and hot temperatures on ischaemic heart disease (IHD) mortality in five cities (Beijing, Tianjin, Shanghai, Wuhan and Guangzhou) in China; and to examine the time relationships between cold and hot temperatures and IHD mortality for each city. A negative binomial regression model combined with a distributed lag non-linear model was used to examine city-specific temperature effects on IHD mortality up to 20 lag days. A meta-analysis was used to pool the cold effects and hot effects across the five cities. 16 559 IHD deaths were monitored by a sentinel surveillance system in five cities during 2004-2008. The relationships between temperature and IHD mortality were non-linear in all five cities. The minimum-mortality temperatures in northern cities were lower than in southern cities. In Beijing, Tianjin and Guangzhou, the effects of extremely cold temperatures were delayed, while Shanghai and Wuhan had immediate cold effects. The effects of extremely hot temperatures appeared immediately in all the cities except Wuhan. Meta-analysis showed that IHD mortality increased 48% at the 1st percentile of temperature (extremely cold temperature) compared with the 10th percentile, while IHD mortality increased 18% at the 99th percentile of temperature (extremely hot temperature) compared with the 90th percentile. Results indicate that both extremely cold and hot temperatures increase IHD mortality in China. Each city has its characteristics of heat effects on IHD mortality. The policy for response to climate change should consider local climate-IHD mortality relationships.

Examining the Relationship between Trace Lithium in Drinking Water and the Rising Rates of Age-Adjusted Alzheimer's Disease Mortality in Texas.

PubMed

Fajardo, Val Andrew; Fajardo, Val Andrei; LeBlanc, Paul J; MacPherson, Rebecca E K

2018-01-01

Alzheimer's disease (AD) mortality rates have steadily increased over time. Lithium, the current gold standard treatment for bipolar disorder, can exert neuroprotective effects against AD. We examined the relationship between trace levels of lithium in drinking water and changes in AD mortality across several Texas counties. 6,180 water samples from public wells since 2007 were obtained and averaged for 234 of 254 Texas counties. Changes in AD mortality rates were calculated by subtracting aggregated age-adjusted mortality rates obtained between 2000-2006 from those obtained between 2009-2015. Using aggregated rates maximized the number of counties with reliable mortality data. Correlational analyses between average lithium concentrations and changes in AD mortality were performed while also adjusting for gender, race, education, rural living, air pollution, physical inactivity, obesity, and type 2 diabetes. Age-adjusted AD mortality rate was significantly increased over time (+27%, p < 0.001). Changes in AD mortality were negatively correlated with trace lithium levels (p = 0.01, r = -0.20), and statistical significance was maintained after controlling for most risk factors except for physical inactivity, obesity, and type 2 diabetes. Furthermore, the prevalence of obesity and type 2 diabetes positively correlated with changes in AD mortality (p = 0.01 and 0.03, respectively), but also negatively correlated with trace lithium in drinking water (p = 0.05 and <0.0001, respectively). Trace lithium in water is negatively linked with changes in AD mortality, as well as obesity and type 2 diabetes, which are important risk factors for AD.

Time trends in avoidable cancer mortality in Switzerland and neighbouring European countries 1996-2010.

PubMed

Feller, Anita; Mark, Michael Thomas; Steiner, Annik; Clough-Gorr, Kerri M

2015-01-01

What are the trends in avoidable cancer mortality in Switzerland and neighbouring countries? Mortality data and population estimates 1996-2010 were obtained from the Swiss Federal Statistical Office for Switzerland and the World Health Organization Mortality Database (http://www.who.int/healthinfo/mortality_data/en/) for Austria, Germany, France and Italy. Age standardised mortality rates (ASMRs, European standard) per 100 000 person-years were calculated for the population <75 years old by sex for the following groups of cancer deaths: (1) avoidable through primary prevention; (2) avoidable through early detection and treatment; (3) avoidable through improved treatment and medical care; and (4) remaining cancer deaths. To assess time trends in ASMRs, estimated annual percentage changes (EAPCs) with 95% confidence intervals (95% CIs) were calculated. In Switzerland and neighbouring countries cancer mortality in persons <75 years old continuously decreased 1996-2010. Avoidable cancer mortality decreased in all groups of avoidable cancer deaths in both sexes, with one exception. ASMRs for causes avoidable through primary prevention increased in females in all countries (in Switzerland from 16.2 to 20.3 per 100 000 person years, EAPC 2.0 [95% CI 1.4 to 2.6]). Compared with its neighbouring countries, Switzerland showed the lowest rates for all groups of avoidable cancer mortality in males 2008-2010. Overall avoidable cancer mortality decreased, indicating achievements in cancer care and related health policies. However, increasing trends in avoidable cancer mortality through primary prevention for females suggest there is a need in Switzerland and its European neighbouring countries to improve primary prevention.

Combined Non-Target Effects of Insecticide and High Temperature on the Parasitoid Bracon nigricans

PubMed Central

Abbes, Khaled; Biondi, Antonio; Kurtulus, Alican; Ricupero, Michele; Russo, Agatino; Siscaro, Gaetano; Chermiti, Brahim; Zappalà, Lucia

2015-01-01

We studied the acute toxicity and the sublethal effects, on reproduction and host-killing activity, of four widely used insecticides on the generalist parasitoid Bracon nigricans (Hymenoptera: Braconidae), a natural enemy of the invasive tomato pest, Tuta absoluta (Lepidoptera: Gelechiidae). Laboratory bioassays were conducted applying maximum insecticide label rates at three constant temperatures, 25, 35 and 40°C, considered as regular, high and very high, respectively. Data on female survival and offspring production were used to calculate population growth indexes as a measure of population recovery after pesticide exposure. Spinetoram caused 80% mortality at 25°C and 100% at higher temperatures, while spinosad caused 100% mortality under all temperature regimes. Cyantraniliprole was slightly toxic to B. nigricans adults in terms of acute toxicity at the three temperatures, while it did not cause any sublethal effects in egg-laying and host-killing activities. The interaction between the two tested factors (insecticide and temperature) significantly influenced the number of eggs laid by the parasitoid, which was the lowest in the case of females exposed to chlorantraniliprole at 35°C. Furthermore, significantly lower B. nigricans demographic growth indexes were estimated for all the insecticides under all temperature conditions, with the exception of chlorantraniliprole at 25°C. Our findings highlight an interaction between high temperatures and insecticide exposure, which suggests a need for including natural stressors, such as temperature, in pesticide risk assessments procedures. PMID:26382245

Growing gaps: The importance of income and family for educational inequalities in mortality among Swedish men and women 1990-2009.

PubMed

Östergren, Olof

2015-08-01

Although absolute levels of mortality have decreased among Swedish men and women in recent decades, educational inequalities in mortality have increased, especially among women. The aim of this study is to disentangle the role of income and family type in educational inequalities in mortality in Sweden during 1990-2009, focusing on gender differences. Data on individuals born in Sweden between the ages of 30 and 74 years were collected from total population registries, covering a total of 529,275 deaths and 729 million person-months. Temporary life expectancies (age 30-74 years) by education were calculated using life tables, and rate ratios were estimated with Poisson regression with robust standard errors. Temporary life expectancy improved among all groups except low educated women. Relative educational inequalities in mortality (RRs) increased from 1.79 to 1.98 among men and from 1.78 to 2.10 among women. Variation in family type explained some of the inequalities among men, but not among women, and did not contribute to the trend. Variation in income explained a larger part of the educational inequalities among men compared to women and also explained the increase in educational inequalities in mortality among men and women. Increasing educational inequalities in mortality in Sweden may be attributed to the increase in income inequalities in mortality. © 2015 the Nordic Societies of Public Health.

Time trends and epidemiological patterns of perinatal lamb mortality in Norway.

PubMed

Holmøy, Ingrid Hunter; Waage, Steinar

2015-09-30

Perinatal mortality is a major cause of loss in the sheep industry. Our aim was to explore time trends in crude population stillbirth and neonatal mortality rates in Norway. We used data on 6,435,715 lambs from flocks enrolled in the Norwegian Sheep Recording System (NSRS) from 2000 through 2010 for descriptive analysis of trends. Longitudinal patterns of mortality rates were compared for lambs within different levels of variables suspected to be associated with perinatal loss. There was an approximately linear increase in the annual proportion of stillborn lambs during the study period, from 3.3 % in 2000 to 4.7 % in 2010. In the same time period, average litter size of ewes in NSRS flocks increased from 2.00 to 2.19. However, a steady rise in stillbirth rate was observed within each litter size group, suggesting a gradually increasing impact on stillbirth risk of other, yet unidentified, factors. Average flock size increased during the study period. The highest stillbirth rates were found in the largest and smallest flocks. Early neonatal mortality rates (0-5 days of life) varied from year to year (minimum 2.2 %, maximum 3.2 %) and were invariably higher among triplets and quadruplets than among singletons and twins. Annual fluctuations were parallel within the various litter sizes. A significant overall decreasing trend was present within all litter sizes with the exception of singletons. Weather data for the prime lambing months (April and May) 2000-2010 indicated a relationship between low temperatures and high neonatal mortality rates. At the flock level, there was a significant positive correlation between stillbirths and early neonatal mortality rates (r = 0.13), between stillbirth rates in two consecutive years (r = 0.43) and between early neonatal mortality rates in two consecutive years (r = 0.40). The substantial increase in ovine stillbirth rate in recent years in Norway was to some extent related to a corresponding increase in the proportion of lambs in triplet or larger litters; however, other factors apparently have contributed. Early neonatal mortality rate exhibited year-to-year variations, partly following temperature fluctuations, which is somewhat unexpected, considering that lambing mainly occurs indoors in Norway.

Description of cervical cancer mortality in Belgium using Bayesian age-period-cohort models

PubMed Central

2009-01-01

Objective To correct cervical cancer mortality rates for death cause certification problems in Belgium and to describe the corrected trends (1954-1997) using Bayesian models. Method Cervical cancer (cervix uteri (CVX), corpus uteri (CRP), not otherwise specified (NOS) uterus cancer and other very rare uterus cancer (OTH) mortality data were extracted from the WHO mortality database together with population data for Belgium and the Netherlands. Different ICD (International Classification of Diseases) were used over time for death cause certification. In the Netherlands, the proportion of not-otherwise specified uterine cancer deaths was small over large periods and therefore internal reallocation could be used to estimate the corrected rates cervical cancer mortality. In Belgium, the proportion of improperly defined uterus deaths was high. Therefore, the age-specific proportions of uterus cancer deaths that are probably of cervical origin for the Netherlands was applied to Belgian uterus cancer deaths to estimate the corrected number of cervix cancer deaths (corCVX). A Bayesian loglinear Poisson-regression model was performed to disentangle the separate effects of age, period and cohort. Results The corrected age standardized mortality rate (ASMR) decreased regularly from 9.2/100 000 in the mid 1950s to 2.5/100,000 in the late 1990s. Inclusion of age, period and cohort into the models were required to obtain an adequate fit. Cervical cancer mortality increases with age, declines over calendar period and varied irregularly by cohort. Conclusion Mortality increased with ageing and declined over time in most age-groups, but varied irregularly by birth cohort. In global, with some discrete exceptions, mortality decreased for successive generations up to the cohorts born in the 1930s. This decline stopped for cohorts born in the 1940s and thereafter. For the youngest cohorts, even a tendency of increasing risk of dying from cervical cancer could be observed, reflecting increased exposure to risk factors. The fact that this increase was limited for the youngest cohorts could be explained as an effect of screening. Bayesian modeling provided similar results compared to previously used classical Poisson models. However, Bayesian models are more robust for estimating rates when data are sparse (youngest age groups, most recent cohorts) and can be used to for predicting future trends.

Characterization of Xenorhabdus isolates from La Rioja (Northern Spain) and virulence with and without their symbiotic entomopathogenic nematodes (Nematoda: Steinernematidae).

PubMed

Campos-Herrera, R; Tailliez, P; Pagès, S; Ginibre, N; Gutiérrez, C; Boemare, N E

2009-10-01

Eighteen Xenorhabdus isolates associated with Spanish entomopathogenic nematodes of the genus Steinernema were characterized using a polyphasic approach including phenotypic and molecular methods. Two isolates were classified as Xenorhabdus nematophila and were associated with Steinernema carpocapsae. Sixteen isolates were classified as Xenorhabdus bovienii, of which fifteen were associated with Steinernema feltiae and one with Steinernema kraussei. Two X. bovienii Phase II were also isolated, one instable phase isolated from S. feltiae strain Rioja and one stable phase from S. feltiae strain BZ. Four representative bacterial isolates were chosen to study their pathogenicity against Spodoptera littoralis with and without the presence of their nematode host. The four bacterial isolates were pathogenic for S. littoralis leading to septicemia 24h post-injection and killing around 90% of the insect larvae 36 h post-injection, except for that isolated from S. kraussei. After 48 h of injection, this latter isolate showed a lower final population in the larval hemolymph (10(7) instead of 10(8)CFU per larvae) and a lower larval mortality (70% instead of 95-100%). The virulence of the nematode-bacteria complexes against S. littoralis showed similar traits with a significant insect larvae mortality (80-90%) 5 days post-infection except for S. kraussei, although this strain reached similar of larval mortality at 7 days after infection.

Earlier Endpoints Are Required for Hemorrhagic Shock Trials among Severely Injured Patients

PubMed Central

Fox, Erin E.; Holcomb, John B.; Wade, Charles E.; Bulger, Eileen M.; Tilley, Barbara C.

2016-01-01

Background Choosing the appropriate endpoint for a trauma hemorrhage control trial can determine the likelihood of its success. Recent Phase 3 trials and observational studies have used 24-hour and/or 30-day all-cause mortality as the primary endpoint and some have not used exception from informed consent (EFIC), resulting in multiple failed trials. Five recent high-quality prospective studies among 4,064 hemorrhaging trauma patients provide new evidence to support earlier primary endpoints. Methods The goal of this project was to determine the optimal endpoint for hemorrhage control trials using existing literature and new analyses of previously published data. Results Recent studies among bleeding trauma patients show that hemorrhagic deaths occur rapidly, at a high rate, and in a consistent pattern. Early preventable deaths among trauma patients are largely due to hemorrhage and the median time to hemorrhagic death from admission is 2.0-2.6 hours. Approximately 85% of hemorrhagic deaths occur within 6 hours. The hourly mortality rate due to traumatic injury decreases rapidly after enrollment from 4.6% per hour at 1 hour post-enrollment to 1% per hour at 6 hours to <0.1% per hour by 9 hours and thereafter. Early primary endpoints (within 6 hours) have critically important benefits for hemorrhage control trials, including being congruent with the median time to hemorrhagic death, biologic plausibility, and enabling the use of all-cause mortality, which is definitive and objective. Conclusions Primary endpoints should be congruent with the timing of the disease process. Therefore, if a resuscitation/hemorrhage control intervention is under study, a primary endpoint of all-cause mortality evaluated within the first 6 hours is appropriate. Before choosing the timing of the primary endpoint for a large multicenter trial, we recommend performing a Phase 2 trial under EFIC to better understand the effects of the hemorrhage control intervention and distribution of time to death. When early primary endpoints are used, patients should be monitored for multiple subsequent secondary safety endpoints, including 24 hour and 30 day all-cause mortality as well as the customary safety endpoints. PMID:28207628

Characteristics, clinical course, and outcomes of homeless and non-homeless patients admitted to ICU: A retrospective cohort study

PubMed Central

Kaur, Maninder; Ashraf, Said

2017-01-01

Background Little is known about homeless patients in intensive care units (ICUs). Objectives To compare clinical characteristics, treatments, and outcomes of homeless to non-homeless patients admitted to four ICUs in a large inner-city academic hospital. Methods 63 randomly-selected homeless compared to 63 age-, sex-, and admitting-ICU-matched non-homeless patients. Results Compared to matched non-homeless, homeless patients (average age 48±12 years, 90% male, 87% admitted by ambulance, 56% mechanically ventilated, average APACHE II 17) had similar comorbidities and illness severity except for increased alcohol (70% vs 17%,p<0.001) and illicit drug(46% vs 8%,p<0.001) use and less documented hypertension (16% vs 40%,p = 0.005) or prescription medications (48% vs 67%,p<0.05). Intensity of ICU interventions was similar except for higher thiamine (71% vs 21%,p<0.0001) and nicotine (38% vs 14%,p = 0.004) prescriptions. Homeless patients exhibited significantly lower Glasgow Coma Scores and significantly more bacterial respiratory cultures. Longer durations of antibiotics, vasopressors/inotropes, ventilation, ICU and hospital lengths of stay were not statistically different, but homeless patients had higher hospital mortality (29% vs 8%,p = 0.005). Review of all deaths disclosed that withdrawal of life-sustaining therapy occurred in similar clinical circumstances and proportions in both groups, regardless of family involvement. Using multivariable logistic regression, homelessness did not appear to be an independent predictor of hospital mortality. Conclusions Homeless patients, admitted to ICU matched to non-homeless patients by age and sex (characteristics most commonly used by clinicians), have higher hospital mortality despite similar comorbidities and illness severity. Trends to longer durations of life supports may have contributed to the higher mortality. Additional research is required to validate this higher mortality and develop strategies to improve outcomes in this vulnerable population. PMID:28604792

Impact of Timing of Birth and Resident Duty-Hour Restrictions on Outcome of Small Preterm Infants

PubMed Central

Bell, Edward F.; Hansen, Nellie I.; Morriss, Frank H.; Stoll, Barbara J.; Ambalavanan, Namasivayam; Gould, Jeffrey B.; Laptook, Abbot R.; Walsh, Michele C.; Carlo, Waldemar A.; Shankaran, Seetha; Das, Abhik; Higgins, Rosemary D.

2010-01-01

OBJECTIVE To examine the impact of birth at night, on the weekend, and during July or August – the first months of the academic year – and the impact of resident duty-hour restrictions on mortality and morbidity of VLBW infants. METHODS Outcomes were analyzed for 11,137 infants with birth weight 501–1250 grams enrolled in the NICHD Neonatal Research Network registry 2001–2005. Approximately half were born before the introduction of resident duty-hour restrictions in 2003. Follow-up assessment at 18–22 months was completed for 4,508 infants. Mortality (7-day and 28-day), short-term morbidities, and neurodevelopmental outcome were examined with respect to the timing of birth: night vs day, weekend vs weekday, and July or August vs other months, and after vs before implementation of resident duty-hour restrictions. RESULTS There was no effect of hour, day, or month of birth on mortality and no impact on the risks of short-term morbidities except the risk of ROP requiring operative treatment was lower for infants born during the late night hours than during the day. There was no impact of timing of birth on neurodevelopmental outcome except the risk of hearing impairment or death was slightly lower among infants born in July or August compared with other months. The introduction of resident and fellow duty-hour restrictions had no impact on mortality or neurodevelopmental outcome. The only change in short-term morbidity after duty-hour restrictions were introduced was an increase in the risk of ROP (stage 2 or higher). CONCLUSION In this network of academic centers, the timing of birth and the introduction of duty-hour restrictions had little effect on the risks of mortality and morbidity of VLBW infants, suggesting that staffing patterns were adequate to provide consistent care. PMID:20643715

Haemodialysis in an emerging centre in a developing country: a two year review and predictors of mortality

PubMed Central

2011-01-01

Background Haemodialysis is the most common form of renal replacement therapy in Nigeria. The high cost of haemodialysis has made optimal therapy of end-stage renal disease difficult in Nigeria. This paper is a review of data collected over two years of provision of dialysis services in a new tertiary hospital in Southern Nigeria. Methods This retrospective analysis is done on data obtained from the patient case files and dialysis records in the first two years of provision of dialysis services in our centre. A gender comparison of the patients' baseline sociodemographic, clinical and biochemical was performed and a logistic regression model used to assess the predictors of mortality. Results A total of 98 patients had 471 sessions in the two years under review. Males and females had similar characteristics at baseline except for a higher median serum urea in the males. The commonest causes of end-stage renal disease were chronic glomerulonephritis (34.5%), hypertension (32.1%) and diabetes mellitus (17.9%). The main predictor of mortality was under treatment with haemodialysis due to inability to pay for more than a few dialysis sessions. Conclusions This study has highlighted the unchanging demographics of our advanced kidney failure patients. Efforts should be aimed at subsidizing the cost of dialysis for our teeming population of dialysis dependent chronic kidney disease patients. PMID:21962220

A Few Large Roads or Many Small Ones? How to Accommodate Growth in Vehicle Numbers to Minimise Impacts on Wildlife

PubMed Central

Rhodes, Jonathan R.; Lunney, Daniel; Callaghan, John; McAlpine, Clive A.

2014-01-01

Roads and vehicular traffic are among the most pervasive of threats to biodiversity because they fragmenting habitat, increasing mortality and opening up new areas for the exploitation of natural resources. However, the number of vehicles on roads is increasing rapidly and this is likely to continue into the future, putting increased pressure on wildlife populations. Consequently, a major challenge is the planning of road networks to accommodate increased numbers of vehicles, while minimising impacts on wildlife. Nonetheless, we currently have few principles for guiding decisions on road network planning to reduce impacts on wildlife in real landscapes. We addressed this issue by developing an approach for quantifying the impact on wildlife mortality of two alternative mechanisms for accommodating growth in vehicle numbers: (1) increasing the number of roads, and (2) increasing traffic volumes on existing roads. We applied this approach to a koala (Phascolarctos cinereus) population in eastern Australia and quantified the relative impact of each strategy on mortality. We show that, in most cases, accommodating growth in traffic through increases in volumes on existing roads has a lower impact than building new roads. An exception is where the existing road network has very low road density, but very high traffic volumes on each road. These findings have important implications for how we design road networks to reduce their impacts on biodiversity. PMID:24646891

A few large roads or many small ones? How to accommodate growth in vehicle numbers to minimise impacts on wildlife.

PubMed

Rhodes, Jonathan R; Lunney, Daniel; Callaghan, John; McAlpine, Clive A

2014-01-01

Roads and vehicular traffic are among the most pervasive of threats to biodiversity because they fragmenting habitat, increasing mortality and opening up new areas for the exploitation of natural resources. However, the number of vehicles on roads is increasing rapidly and this is likely to continue into the future, putting increased pressure on wildlife populations. Consequently, a major challenge is the planning of road networks to accommodate increased numbers of vehicles, while minimising impacts on wildlife. Nonetheless, we currently have few principles for guiding decisions on road network planning to reduce impacts on wildlife in real landscapes. We addressed this issue by developing an approach for quantifying the impact on wildlife mortality of two alternative mechanisms for accommodating growth in vehicle numbers: (1) increasing the number of roads, and (2) increasing traffic volumes on existing roads. We applied this approach to a koala (Phascolarctos cinereus) population in eastern Australia and quantified the relative impact of each strategy on mortality. We show that, in most cases, accommodating growth in traffic through increases in volumes on existing roads has a lower impact than building new roads. An exception is where the existing road network has very low road density, but very high traffic volumes on each road. These findings have important implications for how we design road networks to reduce their impacts on biodiversity.

Why cachexia kills: examining the causality of poor outcomes in wasting conditions.

PubMed

Kalantar-Zadeh, Kamyar; Rhee, Connie; Sim, John J; Stenvinkel, Peter; Anker, Stefan D; Kovesdy, Csaba P

2013-06-01

Weight loss is the hallmark of any progressive acute or chronic disease state. In its extreme form of significant lean body mass (including skeletal muscle) and fat loss, it is referred to as cachexia. It has been known for millennia that muscle and fat wasting leads to poor outcomes including death. On one hand, conditions and risk factors that lead to cachexia and inadequate nutrition may independently lead to increased mortality. Additionaly, cachexia per se, withdrawal of nutritional support in progressive cachexia, and advanced age may lead to death via cachexia-specific pathways. Despite the strong and consistent association of cachexia with mortality, no unifying mechanism has yet been suggested as to why wasting conditions are associated with an exceptionally high mortality risk. Hence, the causality of the cachexia-death association, even though it is biologically plausible, is widely unknown. This century-long uncertainty may have played a role as to why the field of cachexia treatment development has not shown major advances over the past decades. We suggest that cachexia-associated relative thrombocytosis and platelet activation may play a causal role in cachexia-related death, while other mechanisms may also contribute including arrhythmia-associated sudden deaths, endocrine disorders such as hypothyroidism, and immune system compromise leading to infectious events and deaths. Multidimensional research including examining biologically plausible models is urgently needed to investigate the causality of the cachexia-death association.

Attack rates of Sirex noctilio and patterns of pine tree defenses and mortality in northern Patagonia.

PubMed

Martinson, S J; Fernádez Ajó, A A; Martínez, A S; Krivak-Tetley, F E; Villacide, J M; Ayres, M P; Corley, J C

2018-04-18

Accidental and intentional global movement of species has increased the frequency of novel plant-insect interactions. In Patagonia, the European woodwasp, Sirex noctilio, has invaded commercial plantations of North American pines. We compared the patterns of resin defenses and S. noctilio-caused mortality at two mixed-species forests near San Carlos de Bariloche, Argentina. We observed lower levels of resin flow and higher levels of mortality in Pinus contorta compared with Pinus ponderosa. In general, S. noctilio attacked trees with lower resin compared with neighboring trees. Resin production in P. ponderosa was not related to growth rates, but for P. contorta, slower growing trees produced less resin than faster growing conspecifics. For all infested trees, attack density and number of drills (ovipositor probes) per attack did not vary with resin production. Most attacks resulted in one or two drills. Attack rates and drills/attack were basically uniform across the bole of the tree except for a decrease in both drills/attack and attack density in the upper portion of the crown, and an increase in the attack density for the bottom 10% of the tree. Planted pines in Patagonia grow faster than their counterparts in North America, and produce less resin, consistent with the growth-differentiation balance hypothesis. Limited resin defenses may help to explain the high susceptibility of P. contorta to woodwasps in Patagonia.

Consumption of a durable termite bait matrix by subterranean termites (Isoptera: Rhinotermitidae) and resulting insecticidal activity.

PubMed

Hamm, Ronda L; DeMark, Joseph J; Chin-Heady, Eva; Tolley, Mike P

2013-04-01

A novel durable termite bait was developed to enable continuous bait availability and lengthen the monitoring interval to 1 year. Laboratory studies were conducted to determine the palatability and insecticidal activity of this bait to Reticulitermes flavipes (Kollar), R. virginicus (Banks), R. hesperus Banks, Coptotermes formosanus Shiraki and Heterotermes aureus (Synder). Consumption of the blank durable bait matrix was significantly higher than consumption of a blank preferred textured cellulose matrix (PTC) by R. virginicus, R. flavipes and C. formosanus. R. flavipes, R. hesperus and H. aureus consumed significantly more durable bait than PTC when both contained the active ingredient noviflumuron. All bait treatments resulted in significant mortality relative to the untreated controls. Survivorship of R. virginicus, C. formosanus and H. aureus was 2% or less and not significantly different between the durable bait and PTC treatments containing noviflumuron. The durable bait matrix lagged behind the PTC matrix in mortality over time for all species tested except H. aureus. The durable bait was highly palatable and effective in inducing mortality to R. flavipes, R. virginicus, R. hesperus, C. formosanus and H. aureus in the laboratory. This unique bait matrix will be available to termites continuously and allows for an annual monitoring interval. The durability of this bait matrix is unprecedented, allowing for bait to remain active for years and thus providing continuous structural protection. © 2012 Society of Chemical Industry.

Favorable long-term outcomes of bilateral adrenalectomy in Cushing's disease.

PubMed

Oßwald, Andrea; Plomer, Eva; Dimopoulou, Christina; Milian, Monika; Blaser, Rainer; Ritzel, Katrin; Mickisch, Anne; Knerr, Ferengis; Stanojevic, Milan; Hallfeldt, Klaus; Schopohl, Jochen; Kuhn, Klaus A; Stalla, Günter; Beuschlein, Felix; Reincke, Martin

2014-08-01

Bilateral adrenalectomy (BADX) is an important treatment option for patients with Cushing's syndrome (CS). Our aim is to analyze the long-term outcomes, surgical, biochemical, and clinical as well as morbidity and mortality, of patients who underwent BADX. A total of 50 patients who underwent BADX since 1990 in two German centers were identified. Of them, 34 patients had Cushing's disease (CD), nine ectopic CS (ECS), and seven ACTH-independent bilateral adrenal hyperplasia (BAH). Standardized follow-up examination was performed in 36 patients with a minimum follow-up time of 6 months after BADX and a median follow-up time of 11 years. Surgical morbidity and mortality were 6 and 4% respectively. All patients were found to be in remission after BADX. Almost all Cushing's-specific comorbidities except for psychiatric diseases improved significantly. Health-related quality of life remained impaired in 45.0% of female and 16.7% of male patients compared with a healthy population. The median number of adrenal crises per 100 patient-years was four. Nelson tumor occurred in 24% of CD patients after a median time span of 51 months. Long-term mortality after 10 years was high in ECS (44%) compared with CD (3%) and BAH (14%). BADX is an effective and relatively safe treatment option especially in patients with CD. The majority of patients experience considerable improvement of Cushing's symptoms. © 2014 European Society of Endocrinology.

Associations Between Health-Related Quality of Life and Mortality in Older Adults

PubMed Central

Thompson, William W.; Zack, Matthew M.; Arnold, Sarah E.; Barile, John P.

2015-01-01

This study measures the use and relative importance of different measures of health-related quality of life (HRQOL) as predictors of mortality in a large sample of older US adults. We used Cox proportional hazards models to analyze the association between general self-reported health and three “healthy days” (HDs) measures of HRQOL and mortality at short-term (90-day) and long-term (2.5 years) follow-up. The data were from Cohorts 6 through 8 of the Medicare Health Outcomes Survey, a national sample of older adults who completed baseline surveys in 2003–2005. At the long term, reduced HRQOL in general health and all categories of the HDs were separately and significantly associated with greater mortality (P <0.001). In multivariate analysis of long-term mortality, at least one HD category remained significant for each measure, but the associations between mental health and mortality were inconsistent. For short-term mortality, the physical health measures had larger hazard ratios, but fewer categories were significant. Hazard ratios decreased over time for all measures of HRQOL except mental health. In conclusion, HRQOL measures were shown to be significant predictors of short- and long-term mortality, further supporting their value in health surveillance and as markers of risk for targeted prevention efforts. Although all four measures of HRQOL significantly predicted mortality, general self-rated health and age were more important predictors than the HDs. PMID:24189743

Impact of the present-on-admission indicator on hospital quality measurement: experience with the Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators.

PubMed

Glance, Laurent G; Osler, Turner M; Mukamel, Dana B; Dick, Andrew W

2008-02-01

The Agency for Healthcare Research and Quality (AHRQ) has constructed Inpatient Quality Indicator (IQI) mortality measures to measure hospital quality using routinely available administrative data. With the exception of California, New York State, and Wisconsin, administrative data do not include a present-on-admission (POA) indicator to distinguish between preexisting conditions and complications. The extent to which the lack of a POA indicator biases quality assessment based on the AHRQ mortality measures is unknown. To examine the impact of the POA indicator on hospital quality assessment based on the AHRQ mortality measures using enhanced administrative data from California, which includes a POA indicator. Retrospective cohort study based on 2.07 million inpatient admissions between 1998 and 2000 in the California State Inpatient Database. The AHRQ IQI software was used to calculate risk-adjusted mortality rates using either (1) routine administrative data that included all the International Classification of Diseases (ICD)-9-CM codes or (2) enhanced administrative data that included only the ICD-9-CM codes representing preexisting conditions. The inclusion of the POA indicator frequently results in changes in the quality ranking of hospitals classified as high-quality or low-quality using routine administrative data. Twenty-seven percent (stroke) to 94% (coronary artery bypass graft) of hospitals classified as high-quality using routine administrative data were reclassified as intermediate- or low-quality hospitals using the enhanced administrative data. Twenty-five percent (congestive heart failure) to 76% (percutaneous coronary intervention) of hospitals classified as low-quality hospitals using enhanced administrative data were misclassified as intermediate-quality hospitals using routine administrative data. Despite the fact that the AHRQ IQIs were primarily intended to serve as a screening tool, they are being increasingly used to publicly report hospital quality. Our findings emphasize the need to improve the "quality" of administrative data by including a POA indicator if these data are to serve as the information infrastructure for quality reporting.

Towns with extremely low mortality due to ischemic heart disease in Spain

PubMed Central

2012-01-01

Background The cause of coronary disease inframortality in Spain is unknown. The aim of this study is to identify Spanish towns with very low ischemic heart disease mortality, describe their health and social characteristics, and analyze the relationship with a series of contextual factors. Methods We obtained the number of deaths registered for each of 8,122 Spanish towns in the periods 1989-1998 and 1999-2003. Expected deaths, standardized mortality ratio (SMR), smoothed Relative Risk (RR), and Posterior Probability (PP) of RR > 1 were calculated using Bayesian hierarchical models. Inframortality was defined as any town that displayed an RR below the 10th percentile, an SMR of under 1 for both sexes, and a PP of RR > 1 less than or equal to 0.002 for male and 0.005 for female mortality, during the two periods covered. All the remaining towns, except for those with high mortality classified as "tourist towns", were selected as controls. The association among socioeconomic, health, dietary, lifestyle and vascular risk factors was analyzed using sequential mixed logistic regression models, with province as the random-effects variable. Results We identified 32 towns in which ischemic heart disease mortality was half the national rate and four times lower than the European Union rate, situated in lightly populated provinces spread across the northern half of Spain, and revealed a surprising pattern of geographic aggegation for 23 of the 32 towns. Variables related with inframortality were: a less aged population (OR 0.93, 95% CI 0.89-0.99); a contextual dietary pattern marked by a high fish content (OR 2.13, 95% CI 1.38-3.28) and wine consumption (OR 1.50, 95% CI 1.08-2.07); and a low prevalence of obesity (OR 0.47, 95% CI 0.22-1.01); and, in the case of towns of over 1000 inhabitants, a higher physician-population ratio (OR 3.80, 95% CI 1.17-12.3). Conclusions Results indicate that dietary and health care factors have an influence on inframortality. The geographical aggregation suggests that other factors with a spatial pattern, e.g., genetic or environmental might also be implicated. These results will have to be confirmed by studies in situ, with objective measurements at an individual level. PMID:22404881

Trends in inequalities in premature cancer mortality by educational level in Colombia, 1998-2007.

PubMed

de Vries, Esther; Arroyave, Ivan; Pardo, Constanza; Wiesner, Carolina; Murillo, Raul; Forman, David; Burdorf, Alex; Avendaño, Mauricio

2015-05-01

There is a paucity of studies on socioeconomic inequalities in cancer mortality in developing countries. We examined trends in inequalities in cancer mortality by educational attainment in Colombia during a period of epidemiological transition and rapid expansion of health insurance coverage. Population mortality data (1998-2007) were linked to census data to obtain age-standardised cancer mortality rates by educational attainment at ages 25-64 years for stomach, cervical, prostate, lung, colorectal, breast and other cancers. We used Poisson regression to model mortality by educational attainment and estimated the contribution of specific cancers to the slope index of inequality in cancer mortality. We observed large educational inequalities in cancer mortality, particularly for cancer of the cervix (rate ratio (RR) primary vs tertiary groups=5.75, contributing 51% of cancer inequalities), stomach (RR=2.56 for males, contributing 49% of total cancer inequalities and RR=1.98 for females, contributing 14% to total cancer inequalities) and lung (RR=1.64 for males contributing 17% of total cancer inequalities and 1.32 for females contributing 5% to total cancer inequalities). Total cancer mortality rates declined faster among those with higher education, with the exception of mortality from cervical cancer, which declined more rapidly in the lower educational groups. There are large socioeconomic inequalities in preventable cancer mortality in Colombia, which underscore the need for intensifying prevention efforts. Reduction of cervical cancer can be achieved through reducing human papilloma virus infection, early detection and improved access to treatment of preneoplastic lesions. Reinforcing antitobacco measures may be particularly important to curb inequalities in cancer mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Decreases in Smoking-Related Cancer Mortality Rates Are Associated with Birth Cohort Effects in Korean Men.

PubMed

Jee, Yon Ho; Shin, Aesun; Lee, Jong-Keun; Oh, Chang-Mo

2016-12-05

Background: This study aimed to examine trends in smoking-related cancer mortality rates and to investigate the effect birth cohort on smoking-related cancer mortality in Korean men. Methods: The number of smoking-related cancer deaths and corresponding population numbers were obtained from Statistics Korea for the period 1984-2013. Joinpoint regression analysis was used to detect changes in trends in age-standardized mortality rates. Birth-cohort specific mortality rates were illustrated by 5 year age groups. Results: The age-standardized mortality rates for oropharyngeal decreased from 2003 to 2013 (annual percent change (APC): -3.1 (95% CI, -4.6 to -1.6)) and lung cancers decreased from 2002 to 2013 (APC -2.4 (95% CI -2.7 to -2.2)). The mortality rates for esophageal declined from 1994 to 2002 (APC -2.5 (95% CI -4.1 to -0.8)) and from 2002 to 2013 (APC -5.2 (95% CI -5.7 to -4.7)) and laryngeal cancer declined from 1995 to 2013 (average annual percent change (AAPC): -3.3 (95% CI -4.7 to -1.8)). By the age group, the trends for the smoking-related cancer mortality except for oropharyngeal cancer have changed earlier to decrease in the younger age group. The birth-cohort specific mortality rates and age-period-cohort analysis consistently showed that all birth cohorts born after 1930 showed reduced mortality of smoking-related cancers. Conclusions: In Korean men, smoking-related cancer mortality rates have decreased. Our findings also indicate that current decreases in smoking-related cancer mortality rates have mainly been due to a decrease in the birth cohort effect, which suggest that decrease in smoking rates.

Decreases in Smoking-Related Cancer Mortality Rates Are Associated with Birth Cohort Effects in Korean Men

PubMed Central

Jee, Yon Ho; Shin, Aesun; Lee, Jong-Keun; Oh, Chang-Mo

2016-01-01

Background: This study aimed to examine trends in smoking-related cancer mortality rates and to investigate the effect birth cohort on smoking-related cancer mortality in Korean men. Methods: The number of smoking-related cancer deaths and corresponding population numbers were obtained from Statistics Korea for the period 1984–2013. Joinpoint regression analysis was used to detect changes in trends in age-standardized mortality rates. Birth-cohort specific mortality rates were illustrated by 5 year age groups. Results: The age-standardized mortality rates for oropharyngeal decreased from 2003 to 2013 (annual percent change (APC): −3.1 (95% CI, −4.6 to −1.6)) and lung cancers decreased from 2002 to 2013 (APC −2.4 (95% CI −2.7 to −2.2)). The mortality rates for esophageal declined from 1994 to 2002 (APC −2.5 (95% CI −4.1 to −0.8)) and from 2002 to 2013 (APC −5.2 (95% CI −5.7 to −4.7)) and laryngeal cancer declined from 1995 to 2013 (average annual percent change (AAPC): −3.3 (95% CI −4.7 to −1.8)). By the age group, the trends for the smoking-related cancer mortality except for oropharyngeal cancer have changed earlier to decrease in the younger age group. The birth-cohort specific mortality rates and age-period-cohort analysis consistently showed that all birth cohorts born after 1930 showed reduced mortality of smoking-related cancers. Conclusions: In Korean men, smoking-related cancer mortality rates have decreased. Our findings also indicate that current decreases in smoking-related cancer mortality rates have mainly been due to a decrease in the birth cohort effect, which suggest that decrease in smoking rates. PMID:27929405

Use of proton pump inhibitors and mortality after hip fracture in a nationwide study.

PubMed

Brozek, W; Reichardt, B; Zwerina, J; Dimai, H P; Klaushofer, K; Zwettler, E

2017-05-01

We analyzed the association of proton pump inhibitors (PPIs) with mortality after osteoporosis-related hip fracture in Austria. PPIs were associated with reduced 90-day mortality but elevated mortality after half a year when initiated pre-fracture. Inpatients and discharged patients on PPIs showed lowered in-hospital and 90-day mortality, respectively. We herein investigated use of proton pump inhibitors (PPIs) and mortality among hip fracture patients in a nationwide study in Austria. In this retrospective cohort study, data on use of PPIs were obtained from 31,668 Austrian patients ≥50 years with a hip fracture between July 2008 and December 2010. All-cause mortality in patients without anti-osteoporotic drug treatment who had received their first recorded PPI prescription in the study period either before or after fracture was compared with hip fracture patients on neither PPIs nor anti-osteoporotic medication using logistic and Cox regression analysis. With PPI use, 90-day mortality was significantly reduced, both at initiation before (OR 0.66; p < 0.0001) and after hip fracture (OR 0.23; p < 0.0001). 90-day mortality was also reduced when PPIs were prescribed not until after discharge from the last recorded hip fracture-related hospital stay (OR 0.49; p < 0.0001) except for patients aged <70 years. In a sub-cohort of patients beginning PPIs during hospital stay, in-hospital mortality (0.2%) was substantially reduced relative to matched control patients (3.5%) (p < 0.0001). Longer-term mortality significantly increased after half a year post-fracture only among those who started PPI prescription before fracture. PPI use during and after hospital stay due to hip fracture is associated with a considerable decrease in mortality. These findings could have implications for hip fracture treatment.

Anesthesia-related mortality in pediatric patients: a systematic review.

PubMed

Gonzalez, Leopoldo Palheta; Pignaton, Wangles; Kusano, Priscila Sayuri; Módolo, Norma Sueli Pinheiro; Braz, José Reinaldo Cerqueira; Braz, Leandro Gobbo

2012-01-01

This systematic review of the Brazilian and worldwide literature aimed to evaluate the incidence and causes of perioperative and anesthesia-related mortality in pediatric patients. Studies were identified by searching EMBASE (1951-2011), PubMed (1966-2011), LILACS (1986-2011), and SciElo (1995-2011). Each paper was revised to identify the author(s), the data source, the time period, the number of patients, the time of death, and the perioperative and anesthesia-related mortality rates. Twenty trials were assessed. Studies from Brazil and developed countries worldwide documented similar total anesthesia-related mortality rates (<1 death per 10,000 anesthetics) and declines in anesthesia-related mortality rates in the past decade. Higher anesthesia-related mortality rates (2.4-3.3 per 10,000 anesthetics) were found in studies from developing countries over the same time period. Interestingly, pediatric perioperative mortality rates have increased over the past decade, and the rates are higher in Brazil (9.8 per 10,000 anesthetics) and other developing countries (10.7-15.9 per 10,000 anesthetics) compared with developed countries (0.41-6.8 per 10,000 anesthetics), with the exception of Australia (13.4 per 10,000 anesthetics). The major risk factors are being newborn or less than 1 year old, ASA III or worse physical status, and undergoing emergency surgery, general anesthesia, or cardiac surgery. The main causes of mortality were problems with airway management and cardiocirculatory events. Our systematic review of the literature shows that the pediatric anesthesia-related mortality rates in Brazil and in developed countries are similar, whereas the pediatric perioperative mortality rates are higher in Brazil compared with developed countries. Most cases of anesthesia-related mortality are associated with airway and cardiocirculatory events. The data regarding anesthesia-related and perioperative mortality rates may be useful in developing prevention strategies.

Cancer mortality in central Serbia.

PubMed

Markovic-Denic, Ljiljana; Cirkovic, Andia; Zivkovic, Snezana; Stanic, Danica; Skodric-Trifunovic, Vesna

2014-01-01

Cancer is the one of the leading cause of death worldwide. The aim of this study was to examine cancer mortality trends in the population of central Serbia in the period from 2002 to 2011. The descriptive epidemiological method was used. The mortality from all malignant tumors (code C00-C96 of the International Disease Classification) was registered. The source of mortality data was the published material of the Cancer Registry of Serbia. The source of population data was the census of 2002 and 2011 and the estimates for inter-census years. Non-standardized, age-adjusted and age-specific mortality rates were calculated. Age adjustment of mortality rates was performed by the direct method of standardization. Trend lines were estimated using linear regression. During 2002-2011, cancer caused about 20% of all deaths each year in central Serbia. More men (56.9%) than women (43.1%) died of cancer. The average mortality rate for men was 1.3 times higher compared to women. A significant trend of increase of the age-adjusted mortality rates was recorded both for males (p<0.001) and for females (p=0.02). Except gastric cancer, the age-adjusted mortality rates in men were significantly increased for lung cancer (p=0.02), colorectal cancer (p<0.05), prostate cancer (p=0.01) and pancreatic cancer (p=0.01). Age-adjusted mortality rates for breast cancer in females were remarkably increased (p=0.01), especially after 2007. In central Serbia during the period from 2002 to 2011, there was an increasing trend in mortality rates due to cancers in both sexes. Cancer mortality in males was 1.3-fold higher compared to females.

Mechanisms to explain purse seine bycatch mortality of coho salmon.

PubMed

Raby, Graham D; Hinch, Scott G; Patterson, David A; Hills, Jayme A; Thompson, Lisa A; Cooke, Steven J

2015-10-01

Research on fisheries bycatch and discards frequently involves the assessment of reflex impairment, injury, or blood physiology as means of quantifying vitality and predicting post-release mortality, but exceptionally few studies have used all three metrics concurrently. We conducted an experimental purse seine fishery for Pacific salmon in the Juan de Fuca Strait, with a focus on understanding the relationships between different sublethal indicators and whether mortality could be predicted in coho salmon (Oncorhynchus kisutch) bycatch. We monitored mortality using a ~24-h net pen experiment (N = 118) and acoustic telemetry (N = 50), two approaches commonly used to assess bycatch mortality that have rarely been directly compared. Short-term mortality was 21% in the net pen experiment (~24 h) and estimated at 20% for telemetry-tagged fish (~48-96 h). Mortality was predicted by injury and reflex impairment, but only in the net pen experiment. Higher reflex impairment was mirrored by perturbations to plasma ions and lactate, supporting the notion that reflex impairment can be used as a proxy for departure from physiological homeostasis. Reflex impairment also significantly correlated with injury scores, while injury scores were significantly correlated with plasma ion concentrations. The higher time-specific mortality rate in the net pen and the fact that reflexes and injury corresponded with mortality in that experiment, but not in the telemetry-tagged fish released into the wild could be explained partly by confinement stress. While holding experiments offer the potential to provide insights into the underlying causes of mortality, chronic confinement stress can complicate the interpretation of patterns and ultimately affect mortality rates. Collectively, these results help refine our understanding of the different sublethal metrics used to assess bycatch and the mechanisms that can lead to mortality.

Laboratory-based evaluation of MDR strains of Pseudomonas in patients with acute burn injuries

PubMed Central

Zhang, Hong-Tu; Liu, Hui

2015-01-01

Localization of burn was variable: head and face in 76 patients (29%), trunk in 58 (49%), upper limb in 37 (52%), lower limbs in 44 (41%), hands in 16 (15%), perinea area in 26 (5.5%) and whole body except perinea area in 10 (9%) patients. Inhalation syndrome was present in 56 (44%) patients. Ninety patients (82%) had indwelling venous catheters, 83 (75.5%) patients’ arterial catheter and 86 (78%) patients’ urinary catheters. By multivariate analysis: age ≤4 years, Garcés 4, colistin use in documented multiresistant infections, and mechanical ventilation were independent variables related with mortality and graft requirement was a protective factor for mortality. Despite advances in care, gram negative bacterial infections and infection with Pseudomonas aeruginosa remain the most common cause of bacteria related mortality early in the hospital course. Viral infections are also associated with mortality and numbers have remained stable when compared to data from prior years. PMID:26629178

Mortality in first generation white immigrants in California, 1989-1999.

PubMed

Nasseri, Kiumarss

2008-06-01

To identify mortality differentials in the first generation non-Hispanic White (NHW) immigrants in California for 1989 through 1999. First generation NHW immigrants (107,432) were identified in California Death Certificate files by place of birth outside the US and were grouped into Anglo-Saxon dominant, Northern, Western, Eastern, and Southern Europe, former USSR, Arabs and non-Arab Middle Eastern areas. US-born NHW (1,480,347) were used as standard to determine proportional mortality ratios (PMR) for major causes of death including: cancers, coronary heart disease, cerebrovascular accidents, chronic obstructive pulmonary disease (COPD), HIV/AIDS, accidents, diabetes, pneumonia, suicide, and homicide. All immigrants had significantly higher PMR for suicide and with few exceptions for cardiovascular diseases. Lower PMR was recorded for COPD and homicide. No difference was noticed for pneumonia and accidents. Cancer deaths were generally higher in European immigrants. Mortality patterns of NHW immigrants reflect the mixed impacts of acculturation, ethnic-specific characteristics, and psychological well being.

Estimates of cancer burden in Abruzzo and Molise.

PubMed

Foschi, Roberto; Viviano, Lorena; Rossi, Silvia

2013-01-01

Abruzzo and Molise are two regions located in the south of Italy, currently without population-based cancer registries. The aim of this paper is to provide estimates of cancer incidence, mortality and prevalence for the Abruzzo and Molise regions combined. The MIAMOD method, a back-calculation approach to estimate and project the incidence of chronic diseases from mortality and patient survival, was used for the estimation of incidence and prevalence by calendar year (from 1970 to 2015) and age (from 0 to 99). The survival estimates are based on cancer registry data of southern Italy. The most frequently diagnosed cancers were those of the colon and rectum, breast and prostate, with 1,394, 1,341 and 698 new diagnosed cases, respectively, estimated in 2012. Incidence rates were estimated to increase constantly for female breast cancer, colorectal cancer in men and melanoma in both sexes. For prostate cancer and male lung cancer, the incidence rates increased, reaching a peak, and then decreased. In women the incidence of colorectal and lung cancer stabilized after an initial increase. For stomach and cervical cancers, the incidence rates showed a constant decrease. Prevalence was increasing for all the considered cancer sites with the exception of the cervix uteri. The highest prevalence values were estimated for breast and colorectal cancer with about 12,300 and over 8,200 cases in 2012, respectively. In the 2000s the mortality rates declined for all cancers except skin melanoma and female lung cancer, for which the mortality was almost stable. This paper provides a description of the burden of the major cancers in Abruzzo and Molise until 2015. The increase in cancer survival, added to population aging, will inflate the cancer prevalence. In order to better evaluate the cancer burden in the two regions, it would be important to implement cancer registration.

Lethal and Sublethal Effects on Tamarixia triozae (Hymenoptera: Eulophidae), an Ectoparasitoid of Bactericera cockerelli (Hemiptera: Triozidae), of Three Insecticides Used on Solanaceous Crops.

PubMed

Morales, Sinue I; Martínez, Ana M; Viñuela, Elisa; Chavarrieta, Juan M; Figueroa, José I; Schneider, Marcela I; Tamayo, Fernando; Pineda, Samuel

2018-05-28

Lethal and sublethal effects of refined soybean oil, imidacloprid, and abamectin on Tamarixia triozae (Burks; Hymenoptera: Eulophidae) were assessed after exposure of the eggs, larvae, and pupae of this parasitoid to three concentrations of these active substances: the LC50 for fourth-instar Bactericera cockerelli (Sulc.; Hemiptera: Triozidae) and 50% and 100% of the minimum field-registered concentration (MiFRC). Soybean oil caused 26-61% mortality in T. triozae eggs and 6-19% in larvae; mortality in both eggs and larvae was ≤19% for imidacloprid and 4-100% for abamectin. All three compounds caused <18% mortality of T. triozae pupae, with the exception of the abamectin 50% (47%) and 100% (72%) MiFRC. The mortality of larvae and pupae derived from treated eggs was ≤39% for all three insecticides, and that of pupae derived from treated larvae was ≤10%. In general, emergence of adults developed from treated eggs, larvae, and pupae was affected more by abamectin than by the other treatments. The proportion of females derived from all three development stages was not affected by treatment with the compounds, except when the parasitoid was treated as larvae with the soybean oil 100 and 50% MiFRC (66 and 68%, respectively) or when treated as pupae with the imidacloprid LC50 and 100% MiFRC (~60%). Female longevity was generally higher than that of males. The use of imidacloprid, soybean oil, and abamectin in combination with T. triozae for pest control may be effective when the parasitoid is in the pupal stage because this stage is less susceptible than other immature stages.

Timber resource statistics for eastern Washington, 1995.

Treesearch

Neil McKay; Patricia M. Bassett; Colin D. MacLean

1995-01-01

This report summarizes a 1990-91 timber resource inventory of Washington east of the crest of the Cascade Range. The inventory was conducted on all private and public lands except National Forests. Timber resource statistics from National Forest inventories also are presented. Detailed tables provide estimates of forest area, timber volume, growth, mortality, and...

76 FR 15268 - Guidelines for Determining Probability of Causation Under the Energy Employees Occupational...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-21

... radiation exposure and CLL mortality.'' \\26\\ Another limitation stems from the low incidence of CLL... treat chronic lymphocytic leukemia (CLL) as a radiogenic cancer under the Energy Employees Occupational... regulations in 2002, all types of cancers except for CLL are treated as being potentially caused by radiation...

Predicting North American Scolytinae invasions in the Southern Hemisphere

Treesearch

Maria Victoria Lantschner; Thomas H. Atkinson; Juan C. Corley; Andrew M. Liebhold

2017-01-01

Scolytinae species are recognized as one of the most important tree mortality agents in coniferous forests worldwide, and many are known invaders because they are easily transported in wood products. Nonnative trees planted in novel habitats often exhibit exceptional growth, in part because they escape herbivore (such as Scolytinae) pressure from their native range....

Guidelines for regenerating southern pine beetle spots

Treesearch

J.C.G. Goelz; B.L. Strom; J.P. Barnett; M.A. Sword Sayer

2012-01-01

Southern pine forests are of exceptional commercial and ecological importance to the United States, and the southern pine beetle is their most serious insect pest. The southern pine beetle generally kills overstory pines, causing spots of tree mortality that are unpredictable in time and space and frequently disruptive to management activities and goals. The canopy...

When more is actually less-the tale of chronic ammonia toxicity

USDA-ARS?s Scientific Manuscript database

A commercial catfish producer submitted 7 food-sized fish from a pond that was experiencing mortalities on Jan 24, 2014. The ~ 2.64 acre pond was stocked with hybrid catfish. No gross external lesions were evident except for linear erosions (scratches) on the skin that were thought iatrogenic in or...

Trends in risk factors for coronary heart disease in the Netherlands.

PubMed

Koopman, C; Vaartjes, I; Blokstra, A; Verschuren, W M M; Visser, M; Deeg, D J H; Bots, M L; van Dis, I

2016-08-19

Favourable trends in risk factor levels in the general population may partly explain the decline in coronary heart disease (CHD) morbidity and mortality. Our aim was to present long-term national trends in established risk factors for CHD. Data were obtained from five data sources including several large scale population based surveys, cohort studies and general practitioner registers between 1988 and 2012. We applied linear regression models to age-standardized time trends to test for statistical significant trends. Analyses were stratified by sex and age (younger <65 and older ≥65 years adults). The results demonstrated favourable trends in smoking (except in older women) and physical activity (except in older men). Unfavourable trends were found for body mass index (BMI) and diabetes mellitus prevalence. Although systolic blood pressure (SBP) and total cholesterol trends were favourable for older persons, SBP and total cholesterol remained stable in younger persons. Four out of six risk factors for CHD showed a favourable or stable trend. The rise in diabetes mellitus and BMI is worrying with respect to CHD morbidity and mortality.

Investor Outlook: Gene Therapy Picking up Steam; At a Crossroads.

PubMed

Schimmer, Joshua; Breazzano, Steven

2016-09-01

The gene therapy field continues to pick up steam with recent successes in a number of different therapeutic indications that highlight the potential for the platform. As the field continues to make progress, a growing data set of long-term safety and efficacy data will continue to define gene therapy's role, determining ultimately how widely it may be used beyond rare, serious diseases with high unmet needs. New technologies often take unanticipated twists and turns as patient exposure accumulates, and gene therapy may be no exception. That said, with many diseases that have no other treatment options beyond gene therapy and that present considerable morbidity and mortality, the field appears poised to withstand some minor and even major bumps in the road should they emerge.

Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women.

PubMed

Ekelund, Ulf; Steene-Johannessen, Jostein; Brown, Wendy J; Fagerland, Morten Wang; Owen, Neville; Powell, Kenneth E; Bauman, Adrian; Lee, I-Min

2016-09-24

High amounts of sedentary behaviour have been associated with increased risks of several chronic conditions and mortality. However, it is unclear whether physical activity attenuates or even eliminates the detrimental effects of prolonged sitting. We examined the associations of sedentary behaviour and physical activity with all-cause mortality. We did a systematic review, searching six databases (PubMed, PsycINFO, Embase, Web of Science, Sport Discus, and Scopus) from database inception until October, 2015, for prospective cohort studies that had individual level exposure and outcome data, provided data on both daily sitting or TV-viewing time and physical activity, and reported effect estimates for all-cause mortality, cardiovascular disease mortality, or breast, colon, and colorectal cancer mortality. We included data from 16 studies, of which 14 were identified through a systematic review and two were additional unpublished studies where pertinent data were available. All study data were analysed according to a harmonised protocol, which categorised reported daily sitting time and TV-viewing time into four standardised groups each, and physical activity into quartiles (in metabolic equivalent of task [MET]-hours per week). We then combined data across all studies to analyse the association of daily sitting time and physical activity with all-cause mortality, and estimated summary hazard ratios using Cox regression. We repeated these analyses using TV-viewing time instead of daily sitting time. Of the 16 studies included in the meta-analysis, 13 studies provided data on sitting time and all-cause mortality. These studies included 1 005 791 individuals who were followed up for 2-18·1 years, during which 84 609 (8·4%) died. Compared with the referent group (ie, those sitting <4 h/day and in the most active quartile [>35·5 MET-h per week]), mortality rates during follow-up were 12-59% higher in the two lowest quartiles of physical activity (from HR=1·12, 95% CI 1·08-1·16, for the second lowest quartile of physical activity [<16 MET-h per week] and sitting <4 h/day; to HR=1·59, 1·52-1·66, for the lowest quartile of physical activity [<2·5 MET-h per week] and sitting >8 h/day). Daily sitting time was not associated with increased all-cause mortality in those in the most active quartile of physical activity. Compared with the referent (<4 h of sitting per day and highest quartile of physical activity [>35·5 MET-h per week]), there was no increased risk of mortality during follow-up in those who sat for more than 8 h/day but who also reported >35·5 MET-h per week of activity (HR=1·04; 95% CI 0·99-1·10). By contrast, those who sat the least (<4 h/day) and were in the lowest activity quartile (<2·5 MET-h per week) had a significantly increased risk of dying during follow-up (HR=1·27, 95% CI 1·22-1·31). Six studies had data on TV-viewing time (N=465 450; 43 740 deaths). Watching TV for 3 h or more per day was associated with increased mortality regardless of physical activity, except in the most active quartile, where mortality was significantly increased only in people who watched TV for 5 h/day or more (HR=1·16, 1·05-1·28). High levels of moderate intensity physical activity (ie, about 60-75 min per day) seem to eliminate the increased risk of death associated with high sitting time. However, this high activity level attenuates, but does not eliminate the increased risk associated with high TV-viewing time. These results provide further evidence on the benefits of physical activity, particularly in societies where increasing numbers of people have to sit for long hours for work and may also inform future public health recommendations. None. Copyright © 2016 Elsevier Ltd. All rights reserved.

Randomized trials of high-dose chemotherapy in breast cancer: fraud, the press and the data (or lessons learned in medical policy governing clinical research).

PubMed Central

Antman, Karen

2002-01-01

High dose therapy for breast cancer remains controversial. Of the 15 randomized trials of high dose therapy in breast cancer reported to date, two South African studies have been discredited leaving 13 remaining studies. Mortality was consistently low, in the 0 to 2.5% range, except for the BCNU containing American Intergroup study, which had a 7.4% toxic mortality rate. Seven of the remaining 13 studies randomized fewer than 200 patients. Three of these small studies have significant differences in disease free survival, and a fourth study has a trend in favor of high dose therapy. The other three small studies cannot exclude a survival difference of 20%. Of the 6 remaining moderately large trials of 219 to 885 randomized patients, 5 are adjuvant studies and one included patients with metastatic disease. Of the five adjuvant trials, four have significant differences in relapse rate favoring the high dose arm, and the remaining study has a trend (with a high dose sequential single agent design rather than combination therapy as in the other studies). A planned subset analysis of the first 284 patients in the largest study funded by the Dutch insurance industry showed a significant advantage for high dose therapy. Given the 2-year median time to relapse and an addition 2-year median to death after relapse, the follow up for survival of 3-5 years on these studies is still short. In the only moderately sized metastatic trial from the National Cancer Institute of Canada with a very short median follow-up of 19 months, a significant difference in disease free survival has emerged, with no difference in survival. PMID:12053718

Randomized trials of high-dose chemotherapy in breast cancer: fraud, the press and the data (or lessons learned in medical policy governing clinical research).

PubMed

Antman, Karen

2002-01-01

High dose therapy for breast cancer remains controversial. Of the 15 randomized trials of high dose therapy in breast cancer reported to date, two South African studies have been discredited leaving 13 remaining studies. Mortality was consistently low, in the 0 to 2.5% range, except for the BCNU containing American Intergroup study, which had a 7.4% toxic mortality rate. Seven of the remaining 13 studies randomized fewer than 200 patients. Three of these small studies have significant differences in disease free survival, and a fourth study has a trend in favor of high dose therapy. The other three small studies cannot exclude a survival difference of 20%. Of the 6 remaining moderately large trials of 219 to 885 randomized patients, 5 are adjuvant studies and one included patients with metastatic disease. Of the five adjuvant trials, four have significant differences in relapse rate favoring the high dose arm, and the remaining study has a trend (with a high dose sequential single agent design rather than combination therapy as in the other studies). A planned subset analysis of the first 284 patients in the largest study funded by the Dutch insurance industry showed a significant advantage for high dose therapy. Given the 2-year median time to relapse and an addition 2-year median to death after relapse, the follow up for survival of 3-5 years on these studies is still short. In the only moderately sized metastatic trial from the National Cancer Institute of Canada with a very short median follow-up of 19 months, a significant difference in disease free survival has emerged, with no difference in survival.

Wealth and mortality at older ages: a prospective cohort study

PubMed Central

Demakakos, Panayotes; Biddulph, Jane P; Bobak, Martin; Marmot, Michael G

2016-01-01

Background Despite the importance of socioeconomic position for survival, total wealth, which is a measure of accumulation of assets over the life course, has been underinvestigated as a predictor of mortality. We investigated the association between total wealth and mortality at older ages. Methods We estimated Cox proportional hazards models using a sample of 10 305 community-dwelling individuals aged ≥50 years from the English Longitudinal Study of Ageing. Results 2401 deaths were observed over a mean follow-up of 9.4 years. Among participants aged 50–64 years, the fully adjusted HRs for mortality were 1.21 (95% CI 0.92 to 1.59) and 1.77 (1.35 to 2.33) for those in the intermediate and lowest wealth tertiles, respectively, compared with those in the highest wealth tertile. The respective HRs were 2.54 (1.27 to 5.09) and 3.73 (1.86 to 7.45) for cardiovascular mortality and 1.36 (0.76 to 2.42) and 2.53 (1.45 to 4.41) for other non-cancer mortality. Wealth was not associated with cancer mortality in the fully adjusted model. Similar but less strong associations were observed among participants aged ≥65 years. The use of repeated measurements of wealth and covariates brought about only minor changes, except for the association between wealth and cardiovascular mortality, which became less strong in the younger participants. Wealth explained the associations between paternal occupation at age 14 years, education, occupational class, and income and mortality. Conclusions There are persisting wealth inequalities in mortality at older ages, which only partially are explained by established risk factors. Wealth appears to be more strongly associated with mortality than other socioeconomic position measures. PMID:26511887

Age and sex of surgeons and mortality of older surgical patients: observational study

PubMed Central

Jena, Anupam B; Orav, E John; Blumenthal, Daniel M; Tsai, Thomas C; Mehtsun, Winta T; Jha, Ashish K

2018-01-01

Abstract Objective To investigate whether patients’ mortality differs according to the age and sex of surgeons. Design Observational study. Setting US acute care hospitals. Participants 100% of Medicare fee-for-service beneficiaries aged 65-99 years who underwent one of 20 major non-elective surgeries between 2011 and 2014. Main outcome measure Operative mortality rate of patients, defined as death during hospital admission or within 30 days of the operative procedure, after adjustment for patients’ and surgeons’ characteristics and indicator variables for hospitals. Results 892 187 patients who were treated by 45 826 surgeons were included. Patients’ mortality was lower for older surgeons than for younger surgeons: the adjusted operative mortality rates were 6.6% (95% confidence interval 6.5% to 6.7%), 6.5% (6.4% to 6.6%), 6.4% (6.3% to 6.5%), and 6.3% (6.2% to 6.5%) for surgeons aged under 40 years, 40-49 years, 50-59 years, and 60 years or over, respectively (P for trend=0.001). There was no evidence that adjusted operative mortality differed between patients treated by female versus male surgeons (adjusted mortality 6.3% for female surgeons versus 6.5% for male surgeons; adjusted odds ratio 0.97, 95% confidence interval 0.93 to 1.01). After stratification by sex of surgeon, patients’ mortality declined with age of surgeon for both male and female surgeons (except for female surgeons aged 60 or older); female surgeons in their 50s had the lowest operative mortality. Conclusion Using national data on Medicare beneficiaries in the US, this study found that patients treated by older surgeons had lower mortality than patients treated by younger surgeons. There was no evidence that operative mortality differed between male and female surgeons. PMID:29695473

Economic downturns, universal health coverage, and cancer mortality in high-income and middle-income countries, 1990-2010: a longitudinal analysis.

PubMed

Maruthappu, Mahiben; Watkins, Johnathan; Noor, Aisyah Mohd; Williams, Callum; Ali, Raghib; Sullivan, Richard; Zeltner, Thomas; Atun, Rifat

2016-08-13

The global economic crisis has been associated with increased unemployment and reduced public-sector expenditure on health care (PEH). We estimated the effects of changes in unemployment and PEH on cancer mortality, and identified how universal health coverage (UHC) affected these relationships. For this longitudinal analysis, we obtained data from the World Bank and WHO (1990-2010). We aggregated mortality data for breast cancer in women, prostate cancer in men, and colorectal cancers in men and women, which are associated with survival rates that exceed 50%, into a treatable cancer class. We likewise aggregated data for lung and pancreatic cancers, which have 5 year survival rates of less than 10%, into an untreatable cancer class. We used multivariable regression analysis, controlling for country-specific demographics and infrastructure, with time-lag analyses and robustness checks to investigate the relationship between unemployment, PEH, and cancer mortality, with and without UHC. We used trend analysis to project mortality rates, on the basis of trends before the sharp unemployment rise that occurred in many countries from 2008 to 2010, and compared them with observed rates. Data were available for 75 countries, representing 2.106 billion people, for the unemployment analysis and for 79 countries, representing 2.156 billion people, for the PEH analysis. Unemployment rises were significantly associated with an increase in all-cancer mortality and all specific cancers except lung cancer in women. By contrast, untreatable cancer mortality was not significantly linked with changes in unemployment. Lag analyses showed significant associations remained 5 years after unemployment increases for the treatable cancer class. Rerunning analyses, while accounting for UHC status, removed the significant associations. All-cancer, treatable cancer, and specific cancer mortalities significantly decreased as PEH increased. Time-series analysis provided an estimate of more than 40,000 excess deaths due to a subset of treatable cancers from 2008 to 2010, on the basis of 2000-07 trends. Most of these deaths were in non-UHC countries. Unemployment increases are associated with rises in cancer mortality; UHC seems to protect against this effect. PEH increases are associated with reduced cancer mortality. Access to health care could underlie these associations. We estimate that the 2008-10 economic crisis was associated with about 260,000 excess cancer-related deaths in the Organisation for Economic Co-operation and Development alone. None. Copyright © 2016 Elsevier Ltd. All rights reserved.

Life cycle of lithobiidae - with a discussion of the r-and K-selection theory.

PubMed

Albert, Anke M

1983-02-01

The life cycle of two lithobiid species (Chilopoda: Lithobiidae) Lithobius mutabilis L. Koch and L. curtipes C.L. Koch in an old beech stand in the Solling is described. In addition to a main egg-laying period lithobiids are able to lay eggs continuously throughout the year. The reproductive potential is small, as only one egg is laid over several days. Most juveniles hatch in the spring and over-winter as L3 or L4 larvae. Epimorph development to attainment of sexual maturity takes nearly 2 years. Adult L. mutablilis live a further 2 years or more, adult L. curtipes about 1 year or more. Total life span is about 5-6 years for L. mutabilis and 4-5 years for L. curtipes. Egg development times and instar durations can be very different for different animals. Mortality is relatively high for eggs and small juveniles and low for post larval instars except the very old animals. A method is presented for construction of a survivorship curve from monthly abundance figures. Due to their slow development, late attainment of reproductive period, long reproductive phase, low reproductive potential, long life span, low mortality of post larval instars except very old animals, lithobiids can be regarded as K-strategists or, better, equilibrium species, among the arthropods. It is argued that the theory of r- and K-selection in its general use is not sufficient for a description of the ecological strategies of animals such as Lithobiomorpha. For lithobiids, variability in development time is a very important means of keeping population size at a constant level. The life cycle of the two lithobiid species is compared with ahat of Geophilomorpha and one henicopid species also occurring in the Solling.

Age structure and mortality of walleyes in Kansas reservoirs: Use of mortality caps to establish realistic management objectives

USGS Publications Warehouse

Quist, M.C.; Stephen, J.L.; Guy, C.S.; Schultz, R.D.

2004-01-01

Age structure, total annual mortality, and mortality caps (maximum mortality thresholds established by managers) were investigated for walleye Sander vitreus (formerly Stizostedion vitreum) populations sampled from eight Kansas reservoirs during 1991-1999. We assessed age structure by examining the relative frequency of different ages in the population; total annual mortality of age-2 and older walleyes was estimated by use of a weighted catch curve. To evaluate the utility of mortality caps, we modeled threshold values of mortality by varying growth rates and management objectives. Estimated mortality thresholds were then compared with observed growth and mortality rates. The maximum age of walleyes varied from 5 to 11 years across reservoirs. Age structure was dominated (???72%) by walleyes age 3 and younger in all reservoirs, corresponding to ages that were not yet vulnerable to harvest. Total annual mortality rates varied from 40.7% to 59.5% across reservoirs and averaged 51.1% overall (SE = 2.3). Analysis of mortality caps indicated that a management objective of 500 mm for the mean length of walleyes harvested by anglers was realistic for all reservoirs with a 457-mm minimum length limit but not for those with a 381-mm minimum length limit. For a 500-mm mean length objective to be realized for reservoirs with a 381-mm length limit, managers must either reduce mortality rates (e.g., through restrictive harvest regulations) or increase growth of walleyes. When the assumed objective was to maintain the mean length of harvested walleyes at current levels, the observed annual mortality rates were below the mortality cap for all reservoirs except one. Mortality caps also provided insight on management objectives expressed in terms of proportional stock density (PSD). Results indicated that a PSD objective of 20-40 was realistic for most reservoirs. This study provides important walleye mortality information that can be used for monitoring or for inclusion into population models; these results can also be combined with those of other studies to investigate large-scale differences in walleye mortality. Our analysis illustrates the utility of mortality caps for monitoring walleye populations and for establishing realistic management goals.

[Consanguineous marriage and morbi-mortality, short literature review based on an exceptional association: Usher syndrome and Von Recklinghausen neurofibromatosis].

PubMed

Atipo-Tsiba, Pépin-Williams

2016-01-01

Usher syndrome is defined by the association of a progressive or non-progressive congenital sensorineural hearing loss with variable severity and a gradually blinding pigmentary retinopathy. Von Recklinghausen neurofibromatosis or Neurofibromatosis type 1 is the major clinically form of neurofibromatosis which occurs in approximately 90% of cases. Both types of disease are genetic in origin with very low prevalence. The probability of co-occurrence of these diseases in a single individual is exceptional. Inbreeding, as well as all genetic diseases, increases quite significantly the probability of their occurrence. Consanguineous marriages are still widespread in Maghreb and in some regions of the western African. This observation reports an exceptional case of this association in a 40-year-old man of Mauritanian origin born from a consanguineous union.

CANCER HEALTH DISPARITIES PERSIST AMONG AFRICAN AMERICANS IN WISCONSIN

PubMed Central

Jones, Nathan R.; Williamson, Amy; Foote, Mary; Creswell, Paul; Strickland, Rick; Remington, Patrick; Cleary, James; Adams, Alexandra

2011-01-01

Background Cancer incidence and mortality rates have decreased over the last few decades, yet not all groups have benefited equally from these successes. This has resulted in increased disparities in cancer burden among various population groups. Objective This study examined trends in absolute and relative disparities in overall cancer incidence and mortality rates between African American and white residents of Wisconsin during 1995 to 2006. Methods Cancer incidence data were obtained from the Wisconsin Cancer Reporting System. Mortality data were accessed from the National Center for Health Statistics’ public use mortality file. Trends in incidence and mortality rates during 1995–2006 for African Americans and whites were calculated and changes in relative disparity were measured using rate ratios. Results With few exceptions, African American incidence and mortality rates were higher than white rates in every year of the period 1995–2006. Although cancer mortality and incidence declined for both groups over the period, relative racial disparities in rates persisted over the period and account for about a third of African American cancer deaths. Conclusions Elimination of cancer health disparities will require further research into the many contributing factors, as well as into effective interventions to address them. In Wisconsin, policy makers, health administrators, and healthcare providers need to balance resources carefully and set appropriate priorities to target racial inequities in cancer burden. PMID:21066932

A population-based analysis of increasing rates of suicide mortality in Japan and South Korea, 1985-2010.

PubMed

Jeon, Sun Y; Reither, Eric N; Masters, Ryan K

2016-04-23

In the past two decades, rates of suicide mortality have declined among most OECD member states. Two notable exceptions are Japan and South Korea, where suicide mortality has increased by 20 % and 280 %, respectively. Population and suicide mortality data were collected through national statistics organizations in Japan and South Korea for the period 1985 to 2010. Age, period of observation, and birth cohort membership were divided into five-year increments. We fitted a series of intrinsic estimator age-period-cohort models to estimate the effects of age-related processes, secular changes, and birth cohort dynamics on the rising rates of suicide mortality in the two neighboring countries. In Japan, elevated suicide rates are primarily driven by period effects, initiated during the Asian financial crisis of the late 1990s. In South Korea, multiple factors appear to be responsible for the stark increase in suicide mortality, including recent secular changes, elevated suicide risks at older ages in the context of an aging society, and strong cohort effects for those born between the Great Depression and the aftermath of the Korean War. In spite of cultural, demographic and geographic similarities in Japan and South Korea, the underlying causes of increased suicide mortality differ across these societies-suggesting that public health responses should be tailored to fit each country's unique situation.

Assessment of the 2010 global measles mortality reduction goal: results from a model of surveillance data.

PubMed

Simons, Emily; Ferrari, Matthew; Fricks, John; Wannemuehler, Kathleen; Anand, Abhijeet; Burton, Anthony; Strebel, Peter

2012-06-09

In 2008 all WHO member states endorsed a target of 90% reduction in measles mortality by 2010 over 2000 levels. We developed a model to estimate progress made towards this goal. We constructed a state-space model with population and immunisation coverage estimates and reported surveillance data to estimate annual national measles cases, distributed across age classes. We estimated deaths by applying age-specific and country-specific case-fatality ratios to estimated cases in each age-country class. Estimated global measles mortality decreased 74% from 535,300 deaths (95% CI 347,200-976,400) in 2000 to 139,300 (71,200-447,800) in 2010. Measles mortality was reduced by more than three-quarters in all WHO regions except the WHO southeast Asia region. India accounted for 47% of estimated measles mortality in 2010, and the WHO African region accounted for 36%. Despite rapid progress in measles control from 2000 to 2007, delayed implementation of accelerated disease control in India and continued outbreaks in Africa stalled momentum towards the 2010 global measles mortality reduction goal. Intensified control measures and renewed political and financial commitment are needed to achieve mortality reduction targets and lay the foundation for future global eradication of measles. US Centers for Disease Control and Prevention (PMS 5U66/IP000161). Copyright © 2012 Elsevier Ltd. All rights reserved.

The relationship between mortality and time since divorce, widowhood or remarriage in Norway.

PubMed

Berntsen, Kjersti Norgård; Kravdal, Oystein

2012-12-01

The chance of dying within any given year probably depends not only on marital status in that year but also on earlier partnership history. There is still not much knowledge about such effects, however. Our intention is to see how mortality is associated with time since divorce, bereavement and remarriage and time between marital disruption and remarriage. We use register data that include the entire Norwegian population aged 40-89 from 1970 to 2008 (70,701,767 person-years of exposure and 1,484,281 deaths). The excess mortality of divorced men compared to their married counterparts increases with time since divorce, while there is no such trend among divorced women. The pattern is opposite for the widowed, among whom there are indications of a more sharply positive association with time since bereavement for women than for men, though the association is rather weak for both sexes. The remarried have higher mortality than the first-time married, with one surprising exception: men who have remarried after a period of less than 10 years as divorced or widowed have the same mortality as the married. There is no clear association between mortality and time since remarriage. We discuss possible reasons for these patterns. Copyright © 2012 Elsevier Ltd. All rights reserved.

Monotherapy versus combination therapy against carbapenem-resistant Gram-negative bacteria: A retrospective observational study.

PubMed

Ghafur, A; Devarajan, V; Raja, T; Easow, J; Raja, M A; Sreenivas, S; Ramakrishnan, B; Raman, S G; Devaprasad, D; Venkatachalam, B; Nimmagadda, R

2016-01-01

Colistin-based combination therapy (CCT) is extensively used to treat infections due to carbapenem-resistant Gram-negative bacteria (CRGNB). There are no data available from India on the usefulness of combination therapy, especially in the oncology setup. The aim of this study was to analyze the clinical effectiveness of CCT over monotherapy in patients with CRGNB. We conducted a retrospective, observational study of patients with CRGNB bloodstream infections in our oncology and bone marrow transplant center. Over a 3-year study period (2011-2014), we could identify 91 patients satisfying study criteria. There was no statistically significant difference in the 28-day mortality between monotherapy and combination therapy arms (mono n = 26, mortality 10 (38.5%); combination n = 65, mortality 28 (40%); P = 0.886). Neutropenic patients with Enterobacteriaceae bloodstream infections performed better with combination therapy (mono n = 7, mortality 6 (85.7%); combination therapy n = 22, mortality 8 (36.4%); P = 0.035). There was no significant difference in the 28-day mortality between the two treatment arms in other subgroups. Our study did not find CCT superior to colistin monotherapy in patients with CRGNB blood stream infections; except in the subgroup of neutropenic patients with Enterobacteriaceae bloodstream infections, where combination therapy performed better.

[Burden of mortality due to diabetes mellitus in Latin America 2000-2011: the case of Argentina, Chile, Colombia, and Mexico.

PubMed

Agudelo-Botero, Marcela; Dávila-Cervantes, Claudio Alberto

2015-03-05

To analyze trends in mortality in Argentina, Chile, Colombia and Mexico, between 2000 and 2011, by sex and 5-year age groups (between 20 and 79 years of age). Mortality vital statistics and census data or projected population estimates were used for each country. Age-specific mortality rates and the years of life lost were calculated. Among the countries analyzed, Mexico had the highest mortality rate and lost the most years of life due to diabetes. Between 2000 and 2011, Mexicans lost an average of 1.13 years of life, while Colombia (0.24), Argentina (0.21) and Chile (0.18) lost considerably fewer life years. In general, deaths from diabetes were higher in men than in women except in Colombia. Nearly 80% of years of life lost due to diabetes occurred between 50 and 74 years of age in the four countries. Diabetes is a huge challenge for Latin America, especially in Mexico where mortality due to diabetes is accelerating. Even though the proportion of deaths due to diabetes in Argentina, Chile and Colombia is smaller, this disease figures among the main causes of death in these countries. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

Some aspects of social exclusion: do they influence suicide mortality?

PubMed

Yur'yev, Andriy; Värnik, Peeter; Sisask, Merike; Leppik, Lauri; Lumiste, Kaur; Värnik, Airi

2013-05-01

The current study is aimed to assess the relationship between the 'economic/employment' and 'social/welfare' dimensions of social exclusion and suicide mortality in Europe. Suicide rates for 26 countries were obtained from the WHO. Data on social expenditure were obtained from the OECD database. Employment rates and GDP were obtained from the Total Economy Database. Questions about citizens' attitudes towards different aspects of social exclusion were taken from the European Social Survey. Structural equation modelling was applied to research the theoretical structure of the variables. All variables are statistically significant in male and female models except of the relationships between 'economic/employment' and 'social/welfare' dimensions and female suicides; and the relationship between 'employment rates' and 'economic/employment' dimension. Suicide mortality rates among both males and females are influenced negatively by 'economic/employment' and 'social/welfare' dimensions. Among females, the influence of 'social/welfare' dimension is stronger compared to the 'economic/employment' dimension. The remaining influence of GDP is positive in both models. Both 'economic/employment' and 'social/welfare' dimensions of social exclusion significantly influence suicide mortality among males. The influence of 'economic/employment' and 'social/welfare' dimensions of social exclusion on female suicide mortality is controversial. Social exclusion might be considered as a risk factor for suicide mortality in Europe.

The Impact on Clients of a Community-Based Infant Mortality Reduction Program: The National Healthy Start Program Survey of Postpartum Women

PubMed Central

McCormick, Marie C.; Deal, Lisa W.; Devaney, Barbara L.; Chu, Dexter; Moreno, Lorenzo; Raykovich, Karen T.

2001-01-01

Objectives. This study assessed the effect of the national Healthy Start Program on its clients. Methods. We used a cross-sectional survey of a sample from Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) rosters of women less than 6 months postpartum who were residents of Healthy Start Program areas. Results. Healthy Start clients revealed higher sociodemographic risk, but not behavioral risk, for adverse pregnancy outcome than other area residents. They did not differ from other residents in receipt of services except for a greater likelihood of receiving case management, using birth control at the time of the interview, and rating their prenatal care more highly. Conclusions. The Healthy Start Program succeeded in enrolling women at high risk. It had little effect on the immediately concluded pregnancy, but it might influence future outcomes. PMID:11726379

[Maternal mortality rate in the Aurelio Valdivieso General Hospital: a ten years follow up].

PubMed

Noguera-Sánchez, Marcelo Fidias; Arenas-Gómez, Susana; Rabadán-Martínez, Cesar Esli; Antonio-Sánchez, Pedro

2013-01-01

In México, the maternal mortality rate has been diminishing in the country in the last decades, except in the state of Oaxaca. Oaxaca is located amongst the entities with the highest ratios of maternal mortality. To analyze the behavior and epidemiological tendencies of maternal mortality over 10 years at the Dr. Aurelio Valdivieso General Hospital. In a retrospective, descriptive, and transverse analysis, we reviewed the maternal mortality files from the gynecology and obstetrics division. Three sets of variables were designed: social, obstetrical and circumstantial. We used general and descriptive statistical tools. From January first to December 31th of 2009 there were registered 109 maternal deaths. Excluding 2 non-obstetrical deaths, ths results in 107 maternal deaths. Divided into 75 direct maternal deaths and 32 indirect maternal deaths, the maternal mortality rate was 172.14 × 100,000 livebirths. Eighty-nine maternal deaths were foreseeable (83%) and 18 were not foreseeable (17%) as was stated by the Ad Hoc Committee within the Dr. Aurelio Valdivieso General Hospital. Pregnancy-related hypertension accounts for the highest pathology in relation to maternal deaths, the low literacy and puerperium correlated to a higher risk. Low human development index and low literacy were the variables that accounted for higher mortality risk. Also, we found that the higher occurrence of maternal deaths appeared during the puerperium and within hospital wards. The maternal mortality rate founded was the higher amongst the various areas of the country.

Neonatal Mortality and Inequalities in Bangladesh: Differential Progress and Sub-national Developments.

PubMed

Minnery, Mark; Firth, Sonja; Hodge, Andrew; Jimenez-Soto, Eliana

2015-09-01

A rapid reduction in under-five mortality has put Bangladesh on-track to reach Millennium Development Goal 4. Little research, however, has been conducted into neonatal reductions and sub-national rates in the country, with considerable disparities potentially masked by national reductions. The aim of this paper is to estimate national and sub-national rates of neonatal mortality to compute relative and absolute inequalities between sub-national groups and draw comparisons with rates of under-five mortality. Mortality rates for under-five children and neonates were estimated directly for 1980-1981 to 2010-2011 using data from six waves of the Demographic and Health Survey. Rates were stratified by levels of rural/urban location, household wealth and maternal education. Absolute and relative inequalities within these groups were measured by rate differences and ratios, and where possible, slope and relative indices of inequality. National mortality was shown to have decreased dramatically although at differential rates for under-fives and neonates. Across all equity markers, a general pattern of declining absolute but constant relative inequalities was found. For mortality rates stratified by education and wealth mixed evidence suggests that relative inequalities may have also fallen. Although disparities remain, Bangladesh has achieved a rare combination of substantive reductions in mortality levels without increases in relative inequalities. A coalescence of substantial increases in coverage and equitable distribution of key child and neonatal interventions with widespread health sectoral and policy changes over the last 30 years may in part explain this exceptional pattern.

Time trend in the impact of heat waves on daily mortality in Spain for a period of over thirty years (1983-2013).

PubMed

Díaz, J; Carmona, R; Mirón, I J; Luna, M Y; Linares, C

2018-07-01

Many of the studies that analyze the future impact of climate change on mortality assume that the temperature that constitutes a heat wave will not change over time. This is unlikely, however, given the process of adapting to heat changes, prevention plans, and improvements in social and health infrastructure. The objective of this study is to analyze whether, during the 1983-2013 period, there has been a temporal change in the maximum daily temperatures that constitute a heat wave (T threshold ) in Spain, and to investigate whether there has been variation in the attributable risk (AR) associated with mortality due to high temperatures in this period. This study uses daily mortality data for natural causes except accidents CIEX: A00-R99 in municipalities of over 10,000 inhabitants in 10 Spanish provinces and maximum temperature data from observatories located in province capitals. The time series is divided into three periods: 1983-1992, 1993-2003 and 2004-2013. For each period and each province, the value of T threshold was calculated using scatter-plot diagram of the daily mortality pre-whitened series. For each period and each province capitals, it has been calculated the number of heat waves and quantifying the impact on mortality through generalized linear model (GLM) methodology with the Poisson regression link. These models permits obtained the relative risks (RR) and attributable risks (AR). Via a meta-analysis, using the Global RR and AR were calculated the heat impact for the total of the 10 provinces. The results show that in the first two periods RR remained constant RR: 1.14 (CI95%: 1.09 1.19) and RR: 1.14 (CI95%: 1.10 1.18), while the third period shows a sharp decrease with respect to the prior two periods RR: 1.01 (CI95%: 1.00 1.01); the difference is statistically significant. In Spain there has been a sharp decrease in mortality attributable to heat over the past 10 years. The observed variation in RR puts into question the results of numerous studies that analyze the future impact of heat on mortality in different temporal scenarios and show it to be constant over time. Copyright © 2018 Elsevier Ltd. All rights reserved.

High-Dose Daptomycin Therapy for Left-Sided Infective Endocarditis: a Prospective Study from the International Collaboration on Endocarditis

PubMed Central

Bayer, Arnold S.; Miró, Josè M.; Park, Lawrence P.; Guimarães, Armenio C.; Skoutelis, Athanasios; Fortes, Claudio Q.; Durante-Mangoni, Emanuele; Hannan, Margaret M.; Nacinovich, Francisco; Fernández-Hidalgo, Nuria; Grossi, Paolo; Tan, Ru-San; Holland, Thomas; Fowler, Vance G.; Corey, Ralph G.; Chu, Vivian H.

2013-01-01

The use of daptomycin in Gram-positive left-sided infective endocarditis (IE) has significantly increased. The purpose of this study was to assess the influence of high-dose daptomycin on the outcome of left-sided IE due to Gram-positive pathogens. This was a prospective cohort study based on 1,112 cases from the International Collaboration on Endocarditis (ICE)-Plus database and the ICE-Daptomycin Substudy database from 2008 to 2010. Among patients with left-sided IE due to Staphylococcus aureus, coagulase-negative staphylococci, and Enterococcus faecalis, we compared those treated with daptomycin (cohort A) to those treated with standard-of-care (SOC) antibiotics (cohort B). The primary outcome was in-hospital mortality. Time to clearance of bacteremia, 6-month mortality, and adverse events (AEs) ascribable to daptomycin were also assessed. There were 29 and 149 patients included in cohort A and cohort B, respectively. Baseline comorbidities did not differ between the two cohorts, except for a significantly higher prevalence of diabetes and previous episodes of IE among patients treated with daptomycin. The median daptomycin dose was 9.2 mg/kg of body weight/day. Two-thirds of the patients treated with daptomycin had failed a previous antibiotic regimen. In-hospital and 6-month mortalities were similar in the two cohorts. In cohort A, median time to clearance of methicillin-resistant S. aureus (MRSA) bacteremia was 1.0 day, irrespective of daptomycin dose, representing a significantly faster bacteremia clearance compared to SOC (1.0 versus 5.0 days; P < 0.01). Regimens with higher daptomycin doses were not associated with increased incidence of AEs. In conclusion, higher-dose daptomycin may be an effective and safe alternative to SOC in the treatment of left-sided IE due to common Gram-positive pathogens. PMID:24080644

Can High-flow Nasal Cannula Reduce the Rate of Endotracheal Intubation in Adult Patients With Acute Respiratory Failure Compared With Conventional Oxygen Therapy and Noninvasive Positive Pressure Ventilation?: A Systematic Review and Meta-analysis.

PubMed

Ni, Yue-Nan; Luo, Jian; Yu, He; Liu, Dan; Ni, Zhong; Cheng, Jiangli; Liang, Bin-Miao; Liang, Zong-An

2017-04-01

The effects of high-flow nasal cannula (HFNC) on adult patients with acute respiratory failure (ARF) are controversial. We aimed to further determine the effectiveness of HFNC in reducing the rate of endotracheal intubation in adult patients with ARF by comparison to noninvasive positive pressure ventilation (NIPPV) and conventional oxygen therapy (COT). The PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials databases, as well as the Information Sciences Institute Web of Science, were searched for all controlled studies that compared HFNC with NIPPV and COT in adult patients with ARF. The primary outcome was the rate of endotracheal intubation; the secondary outcomes were ICU mortality and length of ICU stay. Eighteen trials with a total of 3,881 patients were pooled in our final studies. Except for ICU mortality (I 2  = 67%, χ 2  = 12.21, P = .02) and rate of endotracheal intubation (I 2  = 63%, χ 2  = 13.51, P = .02) between HFNC and NIPPV, no significant heterogeneity was found in outcome measures. Compared with COT, HFNC was associated with a lower rate of endotracheal intubation (z = 2.55, P = .01) while no significant difference was found in the comparison with NIPPV (z = 1.40, P = .16). As for ICU mortality and length of ICU stay, HFNC did not exhibit any advantage over either COT or NIPPV. In patients with ARF, HFNC is a more reliable alternative than NIPPV to reduce the rate of endotracheal intubation than COT. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Predicting regional variations in mortality from motor vehicle crashes.

PubMed

Clark, D E; Cushing, B M

1999-02-01

To show that the previously-observed inverse relationship between population density and per-capita mortality from motor vehicle crashes can be derived from a simple mathematical model that can be used for prediction. The authors proposed models in which the number of fatal crashes in an area was directly proportional to the population and also to some power of the mean distance between hospitals. Alternatively, these can be parameterized as Weibull survival models. Using county and state data from the U.S. Census, the authors fitted linear regression equations on a logarithmic scale to test the validity of these models. The southern states conformed to a different model from the other states. If an indicator variable was used to distinguish these groups, the resulting model accounted for 74% of the variation from state to state (Alaska excepted). After controlling for mean inter-hospital distance, the southern states had a per-capita mortality 1.37 times that of the other states. Simply knowing the mean distance between hospitals in a region allows a fiarly accurate estimate of its per-capita mortality from vehicle crashes. After controlling for this factor, vehicle crash mortality per capita is higher in the southern states, for reasons yet to be explained.

Air pollution and nonmalignant respiratory mortality in 16 cohorts within the ESCAPE project.

PubMed

Dimakopoulou, Konstantina; Samoli, Evangelia; Beelen, Rob; Stafoggia, Massimo; Andersen, Zorana Jovanovic; Hoffmann, Barbara; Fischer, Paul; Nieuwenhuijsen, Mark; Vineis, Paolo; Xun, Wei; Hoek, Gerard; Raaschou-Nielsen, Ole; Oudin, Anna; Forsberg, Bertil; Modig, Lars; Jousilahti, Pekka; Lanki, Timo; Turunen, Anu; Oftedal, Bente; Nafstad, Per; Schwarze, Per E; Penell, Johanna; Fratiglioni, Laura; Andersson, Niklas; Pedersen, Nancy; Korek, Michal; De Faire, Ulf; Eriksen, Kirsten Thorup; Tjønneland, Anne; Becker, Thomas; Wang, Meng; Bueno-de-Mesquita, Bas; Tsai, Ming-Yi; Eeftens, Marloes; Peeters, Petra H; Meliefste, Kees; Marcon, Alessandro; Krämer, Ursula; Kuhlbusch, Thomas A J; Vossoughi, Mohammad; Key, Timothy; de Hoogh, Kees; Hampel, Regina; Peters, Annette; Heinrich, Joachim; Weinmayr, Gudrun; Concin, Hans; Nagel, Gabriele; Ineichen, Alex; Jacquemin, Bénédicte; Stempfelet, Morgane; Vilier, Alice; Ricceri, Fulvio; Sacerdote, Carlotta; Pedeli, Xanthi; Katsoulis, Michalis; Trichopoulou, Antonia; Brunekreef, Bert; Katsouyanni, Klea

2014-03-15

Prospective cohort studies have shown that chronic exposure to particulate matter and traffic-related air pollution is associated with reduced survival. However, the effects on nonmalignant respiratory mortality are less studied, and the data reported are less consistent. We have investigated the relationship of long-term exposure to air pollution and nonmalignant respiratory mortality in 16 cohorts with individual level data within the multicenter European Study of Cohorts for Air Pollution Effects (ESCAPE). Data from 16 ongoing cohort studies from Europe were used. The total number of subjects was 307,553. There were 1,559 respiratory deaths during follow-up. Air pollution exposure was estimated by land use regression models at the baseline residential addresses of study participants and traffic-proximity variables were derived from geographical databases following a standardized procedure within the ESCAPE study. Cohort-specific hazard ratios obtained by Cox proportional hazard models from standardized individual cohort analyses were combined using metaanalyses. We found no significant associations between air pollution exposure and nonmalignant respiratory mortality. Most hazard ratios were slightly below unity, with the exception of the traffic-proximity indicators. In this study of 16 cohorts, there was no association between air pollution exposure and nonmalignant respiratory mortality.

European seasonal mortality and influenza incidence due to winter temperature variability

NASA Astrophysics Data System (ADS)

Rodó, X.; Ballester, J.; Robine, J. M.; Herrmann, F. R.

2017-12-01

Recent studies have vividly emphasized the lack of consensus on the degree of vulnerability (sensu IPCC) of European societies to current and future winter temperatures. Here we consider several climate factors, influenza incidence and daily numbers of deaths to characterize the relationship between winter temperature and mortality in a very large ensemble of European regions representing more than 400 million people. Analyses highlight the strong association between the year-to-year fluctuations in winter mean temperature and mortality, with higher seasonal cases during harsh winters, in all of the countries except the United Kingdom, the Netherlands and Belgium. This spatial distribution contrasts with the well-documented latitudinal orientation of the dependency between daily temperature and mortality within the season. A theoretical framework is proposed to reconcile the apparent contradictions between recent studies, offering an interpretation to regional differences in the vulnerability to daily, seasonal and long-term winter temperature variability. Despite the lack of a strong year-to-year association between winter mean values in some countries, it can be concluded that warmer winters will contribute to the decrease in winter mortality everywhere in Europe. More information in Ballester J, et al. (2016) Nature Climate Change 6, 927-930, doi:10.1038/NCLIMATE3070.

Use of a seismic air gun to reduce survival of nonnative lake trout embryos: A tool for conservation?

USGS Publications Warehouse

Cox, B.S.; Dux, A.M.; Quist, M.C.; Guy, C.S.

2012-01-01

The detrimental impacts of nonnative lake trout Salvelinus namaycush in the western USA have prompted natural resource management agencies in several states to implement lake trout suppression programs. Currently, these programs rely on mechanical removal methods (i.e., gill nets, trap nets, and angling) to capture subadult and adult lake trout. We conducted a study to explore the potential for using high-intensity sound from a relatively small (655.5 cm3 [40 in3]) seismic air gun to reduce survival of lake trout embryos. Lake trout embryos at multiple stages of development were exposed to a single discharge of the seismic air gun at two depths (5 and 15 m) and at two distances from the air gun (0.1 and 2.7 m). Control groups for each developmental stage, distance, and depth were treated identically except that the air gun was not discharged. Mortality in lake trout embryos treated at 0.1 m from the air gun was 100% at 74 daily temperature units in degrees Celsius (TU°C) at both depths. Median mortality in lake trout embryos treated at 0.1 m from the air gun at 207 TU°C (93%) and 267 °C (78%) appeared to be higher than that of controls (49% and 48%, respectively) at 15-m depth. Among the four lake trout developmental stages, exposure to the air gun at 0.1 m resulted in acute mortality up to 60% greater than that of controls. Mortality at a distance of 2.7 m did not appear to differ from that of controls at any developmental stage or at either depth. Our results indicate that seismic air guns have potential as an alternative tool for controlling nonnative lake trout, but further investigation is warranted.

Climate change and heat waves in Paris and London metropolitan areas

NASA Astrophysics Data System (ADS)

Dousset, B.

2010-12-01

Summer warming trends in Western and Central Europe and in Mediterranean regions are increasing the incidence, intensity, and duration of heat waves. Those extreme events are especially deadly in large cities, owing to high population densities, surface characteristics, heat island effects, anthropogenic heat and pollutants. In August 2003, a persistent anticyclone over Western Europe generated a heat wave of exceptional strength and duration with an estimated death toll of 70,000, including 4678 in the Paris region. A series of NOAA-AVHRR satellite thermal images over the Paris and London metropolitan areas, were used to analyze Land Surface Temperature (LST) and its related mortality. In the Paris region, LSTs were merged with land use and cover data to identify risk areas, and thermal indicators were produced at the addresses of ~ 500 elderly people to assess diurnal heat exposure. Results indicate: (i) contrasting night time and daytime heat island patterns related to land use and surface characteristics; (ii) the relation between night-time heat islands and heat waves intensity; (iii) the impact of elevated minimal temperatures on excess mortality, with a 0.5 °C increase doubling the risk of death, (in the temperature range of the heatwave); iv) the correlation between the spatial distribution of highest night-time LSTs and that of highest mortality ratios; and v) the significant impact of urban parks in the partitioning between latent and sensible surface heat fluxes, despite a prior warm and dry spring. Near-real time satellite monitoring of heat waves in urban areas improve our understanding of the LST processes and spatial variability, and of the related heat stress and mortality. These observations provide criteria for warning systems, contingency policies and planning, and climate adaptation and mitigation strategies.

Epidemiology and risk factors for mortality in bloodstream infection by CP-Kp, ESBL-E, Candida and CDI: A single center retrospective study.

PubMed

Corcione, Silvia; Angilletta, Roberto; Raviolo, Stefania; Filippini, Claudia; Fossati, Lucina; Di Perri, Giovanni; Cavallo, Rossana; De Rosa, Francesco Giuseppe

2018-02-01

The incidence of C. difficile infection (CDI) and of bloodstream infection (BSI) caused by Candida spp., ESBL-E-producing Enterobacteriaceae (ESBL-E) and carbapenemase-producing K. pneumoniae (CP-Kp) is associated with high mortality. We conducted a single centre retrospective study on patients admitted to Molinette Hospital, Turin, Italy, from January 2013 to April 2015 with CDI or BSI caused by Candida, ESBL-E or CP-Kp. For each patient demographic, clinical and microbiological data were collected. Aims of this study were to describe epidemiology and to evaluate risk factors for in-hospital mortality in this group of patients. Seven hundred-eighty six cases were analyzed: 398 CDI, 137 candidemia, 125 ESBL-E BSI and 126 CP-Kp BSI. CDI, candidemia and ESBL-E BSI were more frequently reported in internal medicine wards (IMW), whilst CP-Kp were more described in intensive care unit (ICU). Sixty-six percent of patients had a previous hospitalization and the majority of patients had several medical comorbidities. In-hospital death occurred in 23.4%. Independent risk factors for mortality were antibiotic therapy before hospital admission, cardiovascular diseases, neutropenia, urinary catheter, total parenteral nutrition, SIRS and higher creatinine levels at diagnosis. Previous abdominal surgery, inflammatory bowel disease, higher serum albumin levels at the admission and fever at diagnosis were significantly associated with survival. Our data showed that CDI, ESBL-E BSI and candidemia are more frequent in frail patients, admitted to IMW, with chronic comorbidities and broad exposure to antibiotic therapies, with the exception for CP-Kp BSI, still more common in the ICU. Copyright © 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

The Impact of Hospital’s Cardiac Specialization on Outcomes after Coronary Artery Bypass Graft Surgery: Analysis of Medicare Claims Data

PubMed Central

Girotra, Saket; Lu, Xin; Popescu, Ioana; Vaughan-Sarrazin, Mary; Horwitz, Phillip A.; Cram, Peter

2011-01-01

Background Hospital volume has been widely embraced as a proxy measure for hospital quality; little attention has been focused on an alternative quality measure-hospital specialization. Even though specialization occurs on a continuum, previous studies have only focused on a small number of highly specialized hospitals (single-specialty hospitals). Studies on the broad relationship between hospital specialization and outcomes after coronary artery bypass grafting (CABG) are limited. Methods and Results We conducted a retrospective cohort study of 705,084 Medicare patients (1130 hospitals) who underwent CABG during 2001-2005. We stratified hospitals into quintiles based on their degree of cardiac specialization (proportion of a hospital’s Medicare discharges classified as Major Diagnostic Category 5 – cardiovascular diseases). We compared patient and hospital characteristics and outcomes across quintiles of cardiac specialization. Patient characteristics were generally similar across quintiles, but mean annual CABG volume increased progressively from quintile 1 (least-specialized) to quintile 5 (most-specialized). Unadjusted 30-day mortality was similar at hospitals in quintiles 1-4 (4.8%), except quintile 5 where mortality was lower (4.3%). A strong inverse association was seen between hospital cardiac specialization and 30-day mortality after adjustment for patient characteristics (P trend=0.001). However, this was no longer significant after additional adjustment for CABG volume (P trend=0.65). Results were similar for other mortality outcomes and length of stay. Conclusions After accounting for patient characteristics and CABG volume, greater cardiac specialization was not associated with clinically significant improvement in patient outcomes. This study calls into question the benefit of cardiac specialization for the vast majority of CABG-performing U.S. hospitals. PMID:20923993

Patient-reported Symptom Burden, Rate of Completion of Palliative Radiotherapy and 30-day Mortality in Two Groups of Cancer Patients Managed With or Without Additional Care by a Multidisciplinary Palliative Care Team.

PubMed

Nieder, Carsten; Dalhaug, Astrid; Haukland, Ellinor; Engljähringer, Kirsten

2018-04-01

The aim of this study was to analyze differences in symptom burden, baseline and outcome parameters, including completion of palliative radiotherapy and 30-day mortality, between patients treated with palliative radiotherapy (RT) who were managed exclusively by regular oncology staff or a multidisciplinary palliative care team (MPCT) in addition. This was a retrospective single-institution analysis. Comparison of two groups of patients: MPCT versus none (n=36 and 65, respectively). All patients provided Edmonton symptom assessment system (ESAS) data before RT. The MPCT group included significantly more patients with reduced performance status. Furthermore, these patients had higher ESAS symptom scores, except for two items (dyspnea, sleep). The largest differences were observed for pain, fatigue, anxiety and depression. The significant difference in pain scores was also reflected in different opioid medication rates. Failure to complete radiotherapy was more common in the MPCT group (11 and 2%, respectively, p=0.05). Thirty-day mortality was different, too (28 and 2%, respectively, p=0.0001). The Kaplan-Meier survival curves were not significantly different (1-year survival rates 21 and 25%, respectively, p=0.27). The MPCT group was characterized by a higher symptom burden. Prognostic factors such as performance status were not balanced between the two groups. Despite this fact, actuarial overall survival was comparable. Given the high rate of 30-day mortality in the MPCT group, efforts to optimize criteria for initiation of radiotherapy are warranted. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Structure of the New England herring gull population

USGS Publications Warehouse

Kadlec, J.A.; Drury, W.H.

1968-01-01

Measurements of the rates of population increase, reproduction, and mortality together with an observed age ratio, were used to analyze the population of the Herring Gull in New England. Data from sporadic censuses prior to this study, aerial censuses by the authors, and National Audubon Society Christmas Bird Count indicated that the New England breeding population has been doubling every 12 to 15 years since the early 1900's. This increase has involved founding new colonies and expanding the breeding range There is evidence that 15 to 30% of the adults do not breed in any given year. Sixty-one productivity measurements on 43 islands from 1963 through 1966, involving almost 13,000 nests, showed that from 0.8 to 1.4 young/breeding pair/year is the usual range of rate of production. The age distribution in the population was determined by classifying Herring Gulls by plumage category on an aerial census of the coast from Tampico, Mexico, to Cape Sable, Nova Scotia. Of the 622,000 gulls observed, 68% were adults, 17% were second- and third-year birds, and 15% were first-year birds. Mortality rates derived from band recovery data were too high to be consistent with the observed rate of population growth, productivity, and age structure. Loss of bands increasing to the rate of about 20%/year 5 years after banding eliminates most of the discrepancy. The age structure and rate of population increase indicate a mortality rate of 4 to 9% for gulls 2 years old or older, compared with the 25 to 30% indicated by band recoveries. The population structure we have developed fits everything we have observed about Herring Gull population dynamics, except mortality based on band recoveries.

Fire effects on basal area, tiller production, and mortality of the C4 Bunchgrass, Purple Threeawn

USDA-ARS?s Scientific Manuscript database

Fire behavior associated with wild and prescribed fires is variable, but plays a vital role in how a plant responds to fire. The relationship of fire behavior to rangeland plant community response has not been investigated, with a few exceptions, until recently. Fire is an important ecological pro...

Comparison of Geriatric Nutritional Risk Index scores on physical performance among elderly patients with chronic obstructive pulmonary disease.

PubMed

Matsumura, Takuro; Mitani, Yuji; Oki, Yutaro; Fujimoto, Yukari; Ohira, Mineko; Kaneko, Hiromi; Kawashima, Tsunehiro; Nishio, Masato; Ishikawa, Akira

2015-01-01

The Geriatric Nutritional Risk Index (GNRI) is a new prognostic indicator for nutritional status-related complications and mortality among the elderly. Here we aimed to compare 6-min walk distance (6MWD) between high and low GNRI groups for patients with COPD. We enrolled 63 elderly men with COPD. These subjects were divided into two groups based on their GNRI scores: high GNRI group (≥92 points; n = 44) and low GNRI group (n = 19); we compared 6MWD between these groups. The subjects' characteristics between the high and the low GNRI groups were similar, except for BMI and serum albumin levels. 6MWD were significantly lower in the low GNRI group (279.5 ± 112.3 m versus 211.1 ± 125.3 m; p = 0.03). The GNRI has a more close relation with exercise tolerance and may be a useful nutritional assessment scale for elderly patients with COPD. Copyright © 2015 Elsevier Inc. All rights reserved.

Losses of seabirds in gill nets in the North Pacific

USGS Publications Warehouse

DeGange, Anthony R.; Day, Robert H.; Takekawa, Jean E.; Mendenhall, Vivian M.; Vermeer, Kees; Briggs, K.T.; Morgan, K.H.; Siegel-Causey, D.

1993-01-01

Existing knowledge on high-seas and coastal gillnet fisheries known to kill seabirds in the North Pacific is summarized. Recent estimates suggest that high-seas gillnet fisheries may have taken more than 500,000 seabirds in 1990. The majority of birds taken in those fisheries were Sooty Puffinus griseus or Short-tailed P. tenuirostris shearwaters. A recent analysis of impacts of those fisheries suggests that both shearwater populations may be declining slightly, although overall populations remain large. Impacts on seabirds of gillnet fishing in coastal waters are poorly known, except in California. Incidental mortality of seabirds in coastal gillnet fisheries may be adding additional stress to populations already compromised by habitat destruction and oil spills. Local populations of Marbled Murrelets Brachyramphus marmoratus, Common Murres Uria aalge, and Japanese Murrelets Synthliboramphus wumizusume may be particularly vulnerable to coastal gillnet fisheries. United National General Assembly Resolution 44/225 called for a moratorium on high-seas gillnet fishing by 30 June 1992. Japan has complied and Korea and Taiwan will comply with the moratorium.

Relationship between Subclinical Thyroid Dysfunction and the Risk of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

PubMed Central

Sun, Jing; Yao, Liang; Fang, Yuan; Yang, Ruifei; Chen, Yaolong

2017-01-01

Background Evidence on the association between subclinical thyroid dysfunction and the risk of cardiovascular outcomes are conflicting. Methods and Results PubMed, EMbase, Web of Science, Cochrane Library, and China Biology Medicine (CBM) databases were searched from inception to July 10, 2016. A total of 16 studies were included for meta-analysis. We found that subclinical hypothyroidism was not correlated with coronary heart disease (CHD) (RR = 1.17; 95% CI, 0.91–1.52), total mortality (RR = 1.02; 95% CI, 0.93–1.13), cardiovascular mortality (RR = 1.06; 95% CI, 0.77–1.45), heart failure (RR = 1.17; 95% CI, 0.87–1.57), and atrial fibrillation (RR = 1.05; 95% CI, 0.91–1.21), except CHD mortality (RR = 1.37; 95% CI, 1.03–1.84). Subgroup analysis indicated a higher estimation risk in CHD (RR = 1.54; 95% CI, 1.00–2.39), cardiovascular mortality (RR = 2.14; 95% CI, 1.43–3.22), and CHD mortality (RR = 1.54; 95% CI, 1.11–2.15) among participants < 65 years. Furthermore, subclinical hyperthyroidism was found to be associated with CHD (RR = 1.20; 95% CI, 1.02–1.42), total mortality (RR = 1.27; 95% CI, 1.07–1.51), and CHD mortality (RR = 1.45; 95% CI, 1.12–1.86). Conclusions Subclinical hypothyroidism is likely associated with an increased risk of CHD mortality, and subclinical hyperthyroidism is likely associated with increased risk of CHD, CHD mortality, and total mortality. PMID:29081800

Conifer Decline and Mortality in Siberia

NASA Astrophysics Data System (ADS)

Kharuk, V.; Im, S.; Ranson, K.

2015-12-01

"Dark needle conifer" (DNC: Abies sibirica, Pinus sibirica and Picea obovata) decline and mortality increase were documented in Russia during recent decades. Here we analyzed causes and scale of Siberian pine and fir mortality in Altai-Sayan and Baikal Lake Regions and West Siberian Plane based on in situdata and remote sensing (QuickBird, Landsat, GRACE). Geographically, mortality began on the margins of the DNC range (i.e., within the forest-steppe and conifer-broadleaf ecotones) and on terrain features with maximal water stress risk (narrow-shaped hilltops, convex steep south facing slopes, shallow well-drained soils). Within ridges, mortality occurred mainly along mountain passes, where stands faced drying winds. Regularly mortality was observed to decrease with elevation increase with the exception of Baikal Lake Mountains, where it was minimal near the lake shore and increased with elevation (up to about 1000 m a.s.l.). Siberian pine and fir mortality followed a drying trend with consecutive droughts since the 1980s. Dendrochronology analysis showed that mortality was correlated with vapor pressure deficit increase, drought index, soil moisture decrease and occurrence of late frosts. In Baikal region Siberian pine mortality correlated with Baikal watershed meteorological variables. An impact of previous year climate conditions on the current growth was found (r2 = 0.6). Thus, water-stressed trees became sensitive to bark beetles and fungi impact (including Polygraphus proximus and Heterobasidion annosum). At present, an increase in mortality is observed within the majority of DNC range. Results obtained also showed a primary role of water stress in that phenomenon with a secondary role of bark beetles and fungi attacks. In future climate with increased drought severity and frequency Siberian pine and fir will partly disappear from its current range, and will be substituted by drought-tolerant species (e.g., Pinus silvestris, Larix sibirica).

Evaluation of climate-related carbon turnover processes in global vegetation models for boreal and temperate forests.

PubMed

Thurner, Martin; Beer, Christian; Ciais, Philippe; Friend, Andrew D; Ito, Akihiko; Kleidon, Axel; Lomas, Mark R; Quegan, Shaun; Rademacher, Tim T; Schaphoff, Sibyll; Tum, Markus; Wiltshire, Andy; Carvalhais, Nuno

2017-08-01

Turnover concepts in state-of-the-art global vegetation models (GVMs) account for various processes, but are often highly simplified and may not include an adequate representation of the dominant processes that shape vegetation carbon turnover rates in real forest ecosystems at a large spatial scale. Here, we evaluate vegetation carbon turnover processes in GVMs participating in the Inter-Sectoral Impact Model Intercomparison Project (ISI-MIP, including HYBRID4, JeDi, JULES, LPJml, ORCHIDEE, SDGVM, and VISIT) using estimates of vegetation carbon turnover rate (k) derived from a combination of remote sensing based products of biomass and net primary production (NPP). We find that current model limitations lead to considerable biases in the simulated biomass and in k (severe underestimations by all models except JeDi and VISIT compared to observation-based average k), likely contributing to underestimation of positive feedbacks of the northern forest carbon balance to climate change caused by changes in forest mortality. A need for improved turnover concepts related to frost damage, drought, and insect outbreaks to better reproduce observation-based spatial patterns in k is identified. As direct frost damage effects on mortality are usually not accounted for in these GVMs, simulated relationships between k and winter length in boreal forests are not consistent between different regions and strongly biased compared to the observation-based relationships. Some models show a response of k to drought in temperate forests as a result of impacts of water availability on NPP, growth efficiency or carbon balance dependent mortality as well as soil or litter moisture effects on leaf turnover or fire. However, further direct drought effects such as carbon starvation (only in HYBRID4) or hydraulic failure are usually not taken into account by the investigated GVMs. While they are considered dominant large-scale mortality agents, mortality mechanisms related to insects and pathogens are not explicitly treated in these models. © 2017 The Authors. Global Change Biology Published by John Wiley & Sons Ltd.

Effect of dialyzer membrane materials on survival in chronic hemodialysis patients: Results from the annual survey of the Japanese Nationwide Dialysis Registry

PubMed Central

Hamano, Takayuki; Wada, Atsushi; Nakai, Shigeru; Masakane, Ikuto

2017-01-01

Background Little information is available regarding which type of dialyzer membrane results in good prognosis in patients on chronic hemodialysis. Therefore, we conducted a cohort study from a nationwide registry of hemodialysis patients in Japan to establish the association between different dialyzer membranes and mortality rates. Methods We followed 142,412 patients on maintenance hemodialysis (female, 39.1%; mean age, 64.8 ± 12.3 years; median dialysis duration, 7 [4–12] years) for a year from 2008 to 2009. We included patients treated with seven types of high-flux dialyzer membranes at baseline, including cellulose triacetate (CTA), ethylene vinyl alcohol (EVAL), polyacrylonitrile (PAN), polyester polymer alloy (PEPA), polyethersulfone (PES), polymethylmethacrylate (PMMA), and polysulfone (PS). Cox regression was used to estimate the association between baseline dialyzers and all-cause mortality as hazard ratios (HRs) and 95% confidence intervals for 1-year mortality adjusting for potential confounders, and propensity score matching analysis was performed. Results The distribution of patients treated with each membrane was as follows: PS (56.0%), CTA (17.3%), PES (12.0%), PEPA (7.5%), PMMA (4.9%), PAN (1.2%), and EVAL (1.1%). When data were adjusted using basic factors, with PS as a reference group, the mortality rate was significantly higher in all groups except for the PES group. When data were further adjusted for dialysis-related factors, HRs were significantly higher for the CTA, EVAL, and PEPA groups. When the data were further adjusted for nutrition-and inflammation-related factors, HRs were significantly lower for the PMMA and PES groups compared with the PS group. After propensity score matching, HRs were significantly lower for the PMMA group than for the PS group. Conclusion The results suggest that the use of different membrane types may affect mortality in hemodialysis patients. However, further long-term prospective studies are needed to clarify these findings, including whether the use of the PMMA membrane can improve prognosis. PMID:28910324

Effect of dialyzer membrane materials on survival in chronic hemodialysis patients: Results from the annual survey of the Japanese Nationwide Dialysis Registry.

PubMed

Abe, Masanori; Hamano, Takayuki; Wada, Atsushi; Nakai, Shigeru; Masakane, Ikuto

2017-01-01

Little information is available regarding which type of dialyzer membrane results in good prognosis in patients on chronic hemodialysis. Therefore, we conducted a cohort study from a nationwide registry of hemodialysis patients in Japan to establish the association between different dialyzer membranes and mortality rates. We followed 142,412 patients on maintenance hemodialysis (female, 39.1%; mean age, 64.8 ± 12.3 years; median dialysis duration, 7 [4-12] years) for a year from 2008 to 2009. We included patients treated with seven types of high-flux dialyzer membranes at baseline, including cellulose triacetate (CTA), ethylene vinyl alcohol (EVAL), polyacrylonitrile (PAN), polyester polymer alloy (PEPA), polyethersulfone (PES), polymethylmethacrylate (PMMA), and polysulfone (PS). Cox regression was used to estimate the association between baseline dialyzers and all-cause mortality as hazard ratios (HRs) and 95% confidence intervals for 1-year mortality adjusting for potential confounders, and propensity score matching analysis was performed. The distribution of patients treated with each membrane was as follows: PS (56.0%), CTA (17.3%), PES (12.0%), PEPA (7.5%), PMMA (4.9%), PAN (1.2%), and EVAL (1.1%). When data were adjusted using basic factors, with PS as a reference group, the mortality rate was significantly higher in all groups except for the PES group. When data were further adjusted for dialysis-related factors, HRs were significantly higher for the CTA, EVAL, and PEPA groups. When the data were further adjusted for nutrition-and inflammation-related factors, HRs were significantly lower for the PMMA and PES groups compared with the PS group. After propensity score matching, HRs were significantly lower for the PMMA group than for the PS group. The results suggest that the use of different membrane types may affect mortality in hemodialysis patients. However, further long-term prospective studies are needed to clarify these findings, including whether the use of the PMMA membrane can improve prognosis.

Socioeconomic factors and all cause and cause-specific mortality among older people in Latin America, India, and China: a population-based cohort study.

PubMed

Ferri, Cleusa P; Acosta, Daisy; Guerra, Mariella; Huang, Yueqin; Llibre-Rodriguez, Juan J; Salas, Aquiles; Sosa, Ana Luisa; Williams, Joseph D; Gaona, Ciro; Liu, Zhaorui; Noriega-Fernandez, Lisseth; Jotheeswaran, A T; Prince, Martin J

2012-02-01

Even in low and middle income countries most deaths occur in older adults. In Europe, the effects of better education and home ownership upon mortality seem to persist into old age, but these effects may not generalise to LMICs. Reliable data on causes and determinants of mortality are lacking. The vital status of 12,373 people aged 65 y and over was determined 3-5 y after baseline survey in sites in Latin America, India, and China. We report crude and standardised mortality rates, standardized mortality ratios comparing mortality experience with that in the United States, and estimated associations with socioeconomic factors using Cox's proportional hazards regression. Cause-specific mortality fractions were estimated using the InterVA algorithm. Crude mortality rates varied from 27.3 to 70.0 per 1,000 person-years, a 3-fold variation persisting after standardisation for demographic and economic factors. Compared with the US, mortality was much higher in urban India and rural China, much lower in Peru, Venezuela, and urban Mexico, and similar in other sites. Mortality rates were higher among men, and increased with age. Adjusting for these effects, it was found that education, occupational attainment, assets, and pension receipt were all inversely associated with mortality, and food insecurity positively associated. Mutually adjusted, only education remained protective (pooled hazard ratio 0.93, 95% CI 0.89-0.98). Most deaths occurred at home, but, except in India, most individuals received medical attention during their final illness. Chronic diseases were the main causes of death, together with tuberculosis and liver disease, with stroke the leading cause in nearly all sites. Education seems to have an important latent effect on mortality into late life. However, compositional differences in socioeconomic position do not explain differences in mortality between sites. Social protection for older people, and the effectiveness of health systems in preventing and treating chronic disease, may be as important as economic and human development.

Rare fungal infectious agents: a lurking enemy

PubMed Central

Skiada, Anna; Pavleas, Ioannis; Drogari-Apiranthitou, Maria

2017-01-01

In the expanding population of immunocompromised patients and those treated in intensive care units, rare fungal infectious agents have emerged as important pathogens, causing invasive infections associated with high morbidity and mortality. These infections may present either as de novo or as breakthrough invasive infections in high-risk patients with hematologic malignancies receiving prophylactic or empirical antifungal therapy or in patients with central venous catheters. Diagnosis and treatment are challenging. Physicians should have a high index of suspicion because early diagnosis is of paramount importance. Conventional diagnostic methods such as cultures and histopathology are still essential, but rapid and more specific molecular techniques for both detection and identification of the infecting pathogens are being developed and hopefully will lead to early targeted treatment. The management of invasive fungal infections is multimodal. Reversal of risk factors, if feasible, should be attempted. Surgical debridement is recommended in localized mold infections. The efficacy of various antifungal drugs is not uniform. Amphotericin B is active against most yeasts, except Trichosporon, as well as against Mucorales, Fusarium, and some species of Paecilomyces and dimorphic fungi. The use of voriconazole is suggested for the treatment of trichosporonosis and scedosporiosis. Combination treatment, though recommended as salvage therapy in some infections, is controversial in most cases. Despite the use of available antifungals, mortality remains high. The optimization of molecular-based techniques, with expansion of reference libraries and the possibility for direct detection of resistance mechanisms, is awaited with great interest in the near future. Further research is necessary, however, in order to find the best ways to confront and destroy these lurking enemies. PMID:29152230

Gene-by-Environment Interactions in Pancreatic Cancer: Implications for Prevention

PubMed Central

Jansen, Rick J.; Tan, Xiang-Lin; Petersen, Gloria M.

2015-01-01

Pancreatic cancer (PC) has been estimated to have higher incidence and correspondingly higher mortality rates in more developed regions worldwide. Overall, the age-adjusted incidence rate is 4.9/105 and age-adjusted mortality rate is at 4.8/105. We review here our current knowledge of modifiable risk factors (cigarette smoking, obesity, diet, and alcohol) for PC, genetic variants implicated by genome-wide association studies, possible genetic interactions with risk factors, and prevention strategies to provide future research directions that may further our understanding of this complex disease. Cigarette smoking is consistently associated with a two-fold increased PC risk. PC associations with dietary intake have been largely inconsistent, with the potential exception of certain unsaturated fatty acids decreasing risk and well-done red meat or meat mutagens increasing risk. There is strong evidence to support that obesity (and related measures) increase risk of PC. Only the heaviest alcohol drinkers seem to be at an increased risk of PC. Currently, key prevention strategies include avoiding tobacco and excessive alcohol consumption and adopting a healthy lifestyle. Screening technologies and PC chemoprevention are likely to become more sophisticated, but may only apply to those at high risk. Risk stratification may be improved by taking into account gene environment interactions. Research on these modifiable risk factors is key to reducing the incidence of PC and understanding who in the population can be considered high risk. PMID:26029010

Acaricidal effect and chemical composition of essential oils extracted from Cuminum cyminum, Pimenta dioica and Ocimum basilicum against the cattle tick Rhipicephalus (Boophilus) microplus (Acari: Ixodidae).

PubMed

Martinez-Velazquez, Moises; Castillo-Herrera, Gustavo Adolfo; Rosario-Cruz, Rodrigo; Flores-Fernandez, Jose Miguel; Lopez-Ramirez, Julisa; Hernandez-Gutierrez, Rodolfo; Lugo-Cervantes, Eugenia del Carmen

2011-02-01

Acaricidal activity of essential oils extracted from cumin seeds (Cuminum cyminum), allspice berries (Pimenta dioica) and basil leaves (Ocimum basilicum) were tested on 10-day-old Rhipicephalus (Boophilus) microplus tick larvae using the LPT. Two-fold dilutions of the three essential oils were tested from a starting dilution of 20% down to 1.25%. Results showed a high toxicological effect for cumin, producing 100% mortality in all tested concentrations on R. microplus larvae. Similarly, allspice essential oil produced 100% mortality at all concentrations with the exception of a dramatic decrease at 1.25% concentration. Conversely, basil essential oil was not shown to be toxic against R. microplus larvae. The most common compounds detected by gas chromatography-mass spectrometry were as follows: cumin: cuminaldehyde (22.03%), γ-terpinene (15.69%) and 2-caren-10-al (12.89%); allspice: methyl eugenol (62.7%) and eugenol (8.3%); basil: linalool (30.61%) and estragole (20.04%). Results clearly indicate that C. cyminum and P. dioica essential oils can be used as an effective alternative for R. microplus tick control, and there is a high probability they can be used for other ticks affecting cattle in Mexico and throughout the world, thereby reducing the necessity for traditional and unfriendly synthetic acaricides.

Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy.

PubMed

Ahn, Dong-Won; Park, Young Soo; Lee, Sang Hyub; Shin, Cheol Min; Hwang, Jin-Hyeok; Kim, Jin-Wook; Jeong, Sook-Hyang; Kim, Nayoung; Lee, Dong Ho

2016-05-01

This study was performed to investigate the clinical role of urgent esophagogastroduodenoscopy (EGD) for acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) performed by experienced endoscopists after hours. A retrospective analysis was performed for consecutively collected data of patients with ANVUGIB between January 2009 and December 2010. A total of 158 patients visited the emergency unit for ANVUGIB after hours. Among them, 60 underwent urgent EGD (within 8 hours) and 98 underwent early EGD (8 to 24 hours) by experienced endoscopists. The frequencies of hemodynamic instability, fresh blood aspirate on the nasogastric tube, and high-risk endoscopic findings were significantly higher in the urgent EGD group. Primary hemostasis was achieved in all except two patients. There were nine cases of recurrent bleeding, and 30-day mortality occurred in three patients. There were no significant differences between the two groups in primary hemostasis, recurrent bleeding, and 30-day mortality. In a multiple linear regression analysis, urgent EGD significantly reduced the hospital stay compared with early EGD. In patients with a high clinical Rockall score (more than 3), urgent EGD tended to decrease the hospital stay, although this was not statistically significant (7.7 days vs. 12.0 days, p > 0.05). Urgent EGD after hours by experienced endoscopists had an excellent endoscopic success rate. However, clinical outcomes were not significantly different between the urgent and early EGD groups.

Comparative study of bacteremias caused by Enterococcus spp. with and without high-level resistance to gentamicin. The Grupo Andaluz para el estudio de las Enfermedades Infecciosas.

PubMed

Caballero-Granado, F J; Cisneros, J M; Luque, R; Torres-Tortosa, M; Gamboa, F; Díez, F; Villanueva, J L; Pérez-Cano, R; Pasquau, J; Merino, D; Menchero, A; Mora, D; López-Ruz, M A; Vergara, A

1998-02-01

A prospective, multicenter study was carried out over a period of 10 months. All patients with clinically significant bacteremia caused by Enterococcus spp. were included. The epidemiological, microbiological, clinical, and prognostic features and the relationship of these features to the presence of high-level resistance to gentamicin (HLRG) were studied. Ninety-three patients with enterococcal bacteremia were included, and 31 of these cases were caused by HLRG (33%). The multivariate analysis selected chronic renal failure, intensive care unit stay, previous use of antimicrobial agents, and Enterococcus faecalis species as the independent risk factors that influenced the development of HLRG. The strains with HLRG showed lower levels of susceptibility to penicillin and ciprofloxacin. Clinical features (except for chronic renal failure) were similar in both groups of patients. HLRG did not influence the prognosis for patients with enterococcal bacteremia in terms of either the crude mortality rate (29% for patients with bacteremia caused by enterococci with HLRG and 28% for patients not infected with strains with HLRG) or the hospital stay after the acquisition of enterococcal bacteremia. Hemodynamic compromise, inappropriate antimicrobial therapy, and mechanical ventilation were revealed in the multivariate analysis to be the independent risk factors for mortality. Prolonged hospitalization was associated with the nosocomial acquisition of bacteremia and polymicrobial infections.

Experimental transmission and tissue tropism of white spot syndrome virus (WSSV) in two species of lobsters, Panulirus homarus and Panulirus ornatus.

PubMed

Syed Musthaq, S; Sudhakaran, R; Balasubramanian, G; Sahul Hameed, A S

2006-10-01

The susceptibility of two species of lobsters, Panulirus homarus and Panulirus ornatus to white spot syndrome virus (WSSV) was tested by oral route and intramuscular injection. The results revealed that these lobsters were as highly susceptible as marine shrimp when the WSSV was administered intramuscularly. The WSSV caused 100% mortality in both Panulirus homarus and Panulirus ornatus, at 168 and 120 h, respectively, after intramuscular injection and failed to cause mortality when given orally. The presence of WSSV in moribund lobsters was confirmed by single-step and nested PCR, Western blot, histology, and bioassay test. It was found in eyestalk, gill, head muscle, tail muscle, hemolymph, appendages, and stomach. In lobsters with oral route infection, all tested organs except stomach and head muscle was negative for WSSV by nested PCR at 120 h post-inoculation. The stomach and head muscle was positive by nested PCR at 120 h p.i., but negative at 168 h p.i. Western blot analysis was negative in all the tested organs of both species of lobster at 120 h post-inoculation by oral route.

Temporomandibular joint involvement as a positive clinical prognostic factor in necrotising external otitis.

PubMed

Yeheskeli, E; Eta, R Abu; Gavriel, H; Kleid, S; Eviatar, E

2016-05-01

Necrotising otitis externa is associated with high morbidity and mortality rates. This study investigated whether temporomandibular joint involvement had any prognostic effect on the course of necrotising otitis externa in patients who had undergone hyperbaric oxygen therapy after failed medical and sometimes surgical therapy. A retrospective case series was conducted of patients in whom antibiotic treatment and surgery had failed, who had been hospitalised for further treatment and hyperbaric oxygen therapy. Twenty-three patients with necrotising otitis externa were identified. The temporomandibular joint was involved in four patients (17 per cent); these patients showed a constant gradual improvement in C-reactive protein and were eventually discharged free of disease, except one patient who was lost to follow up. Four patients (16 per cent) without temporomandibular joint involvement died within 90 days of discharge, while all patients with temporomandibular joint involvement were alive. Three patients (13 per cent) without temporomandibular joint involvement needed recurrent hospitalisation including further hyperbaric oxygen therapy; no patients with temporomandibular joint involvement required such treatment. Patients with temporomandibular joint involvement had lower rates of recurrent disease and no mortality. Therefore, we suggest considering temporomandibular joint involvement as a positive prognostic factor in necrotising otitis externa management.

The age structure of selected countries in the ESCAP region.

PubMed

Hong, S

1982-01-01

The study objective was to examine the age structure of selected countries in the Economic and Social Commission for Asia and the Pacific (ESCAP) region, using available data and frequently applied indices such as the population pyramid, aged-child ratio, and median age. Based on the overall picture of the age structure thus obtained, age trends and their implication for the near future were arrived at. Countries are grouped into 4 types based on the fertility and mortality levels. Except for Japan, Hong Kong, and Singapore, the age structure in the 18 ESCAP region countries changed comparatively little over the 1950-80 period. The largest structural change occurred in Singapore, where the proportion of children under age 15 in the population declined significantly from 41-27%, while that of persons 65 years and older more than doubled. This was due primarily to the marked decline in fertility from a total fertility rate (TFR) of 6.7-1.8 during the period. Hong Kong also had a similar major transformation during the same period: the proportion of the old age population increased 2 1/2 times, from 2.5-6.3%. The age structures of the 18 ESCAP countries varied greatly by country. 10 countries of the 2 high fertility and mortality types showed a similar young age structural pattern, i.e., they have higher dependency ratios, a higher proportion of children under 15 years, a lower proportion of population 65 years and older, lower aged-child ratios, and younger median ages than the average countries in the less developed regions of the world. With minimal changes over the 1950-80 period, the gap between these countries and the average of the less developed regions widened. Unlike these 10 (mostly South Asian) countries, moderately low fertility and mortality countries (China, Korea, and Sri Lanka) are located between the world average and the less developed region in most of the indices, particularly during the last decade. Although their rate of population aging is not rapid, they are moving toward it. 5 countries of the low fertility and mortality group basically showed an age structure in between the world average and that of the more developed region. Notable exceptions were Singapore and Hong Kong, which showed younger age structures than the less developed regions in terms of dependency ratios during 1950-60. On an average, the majority of ESCAP countries still have a young population.

Surgical management of giant posterior communicating artery aneurysms.

PubMed

Velat, Gregory J; Zabramski, Joseph M; Nakaji, Peter; Spetzler, Robert F

2012-09-01

Giant posterior communicating artery (PCoA) aneurysms (> 25 mm) are rare lesions associated with a poor prognosis and high rates of morbidity and mortality. To review the clinical results of giant PCoA aneurysms surgically treated at our institution, focusing on operative nuances. All cases of giant PCoA aneurysms treated surgically at our institution were identified from a prospectively maintained patient database. Patient demographic factors, medical comorbidities, rupture status, neurological presentation, clinical outcomes, and surgical records were critically reviewed. From 1989 to 2010, 11 patients (10 women) underwent surgical clipping of giant PCoA aneurysms. Presenting signs and symptoms included cranial nerve palsies, diminished mental status, headache, visual changes, and seizures. Five aneurysms were ruptured on admission. All aneurysms were clipped primarily except 1, which was treated by parent artery sacrifice and extracranial-to-intracranial bypass after intraoperative aneurysm rupture. Perioperative morbidity and mortality rates were 36% (4 of 11) and 18.3% (2 of 11), respectively. Excellent or good clinical outcomes, defined as modified Rankin Scale scores ≤ 2, were achieved in 86% (5 of 6) of patients available for long-term clinical follow-up (mean, 12.5 ± 13.6 months). Giant PCoA aneurysms are rare vascular lesions that may present with a variety of neurological signs and symptoms. These lesions can be successfully managed surgically with satisfactory morbidity and mortality rates. To the best of our knowledge, this is the largest surgical series of giant PCoA aneurysms published to date.

Introduction of a second dose of measles in national immunization program in India: a major step towards eradication.

PubMed

Verma, Ramesh; Khanna, Pardeep; Bairwa, Mohan; Chawla, Suraj; Prinja, Shankar; Rajput, Meena

2011-10-01

Measles is a highly infectious, acute respiratory illness that is caused by a virus of the genus Morbillivirus. The disease infects nearly 30 million children each year, and deaths usually occur from complications related to pneumonia, diarrhea and malnutrition. A systematic review of published Indian literature depicts the median case fatality ratio (CFR) of measles to be 1.6%. Through immunization, measles deaths dropped a remarkable 78% from 733,000 in 2000 to 164,000 in 2008. As of 2008, 192 of 193 Member States of WHO use 2 doses of measles vaccine in their national immunization programs, India being the only exception. The Millennium Development Goal (MDG) 4 aims to reduce by two-thirds between 1990 and 2015 the under-five mortality rate (U5MR) in the world. Per the draft comprehensive Multi Year Strategic Plan (cMYP, 2010–17) for immunization of India, the country aims to reduce measles-related mortality by 90% by 2013 when compared to 2000. As recommended by the National Technical Advisory Group on Immunization (NTAGI), the implementation strategy of the second dose of measles vaccine at the state level is determined by the underlying performance of the routine immunization program. The second dose in the national immunization schedule gives extra immunity against measles infection that renders children more susceptible to secondary pneumonia and diarrheal diseases, which are the primary causes of under-5 child mortality in India.

West Nile virus transmission and ecology in birds

USGS Publications Warehouse

McLean, R.G.; Ubico, S.R.; Docherty, D.E.; Hansen, W.R.; Sileo, L.; Mcnamara, T.S.

2001-01-01

The ecology of the strain of West Nile virus (WNV) introduced into the United States in 1999 has similarities to the native flavivirus, St. Louis encephalitis (SLE) virus, but has unique features not observed with SLE virus or with WNV in the old world. The primary route of transmission for most of the arboviruses in North America is by mosquito, and infected native birds usually do not suffer morbidity or mortality. An exception to this pattern is eastern equine encephalitis virus, which has an alternate direct route of transmission among nonnative birds, and some mortality of native bird species occurs. The strain of WNV circulating in the northeastern United States is unique in that it causes significant mortality in exotic and native bird species, especially in the American crow (Corvus brachyrhynchos). Because of the lack of information on the susceptibility and pathogenesis of WNV for this species, experimental studies were conducted at the USGS National Wildlife Health Center. In two separate studies, crows were inoculated with a 1999 New York strain of WNV, and all experimentally infected crows died. In one of the studies, control crows in regular contact with experimentally inoculated crows in the same room but not inoculated with WNV succumbed to infection. The direct transmission between crows was most likely by the oral route. Inoculated crows were viremic before death, and high titers of virus were isolated from a variety of tissues. The significance of the experimental direct transmission among captive crows is unknown.

Assessing the efficacy of corn-based bait containing antimycin-a to control common carp populations using laboratory and pond experiments

USGS Publications Warehouse

Poole, Joshua R.; Sauey, Blake W.; Amberg, Jon J.; Bajer, Przemyslaw G.

2018-01-01

Strategic use of oral toxicants could allow for practical and sustainable control schemes for the invasive common carp (Cyprinus carpio, or ‘carp’) if a toxicant selectively targeted carp and not native species. In this study, we incorporated antimycin-a (ANT-A), a known fish toxicant, into a corn-based bait and conducted a series of experiments to determine its toxicity, leaching rate, and species-specificity. Our results showed that ANT-A was lethal to carp at doses ≥ 4 mg/kg and that the amount of ANT-A that leached out of the bait in 72 h was not lethal to carp or bluegill (Lepomis macrochirus). Species-specificity trials were conducted in 227 L tanks, in which carp were stocked with three native species representing families that occur sympatrically with carp in our study region: the fathead minnow (Pimephales promelas), yellow perch (Perca flavescens) and bluegill. These trials showed high mortality of carp (46%) and fathead minnows (76%) but no significant mortality of perch or bluegill. Finally, a pond study, which used the same species composition except for fathead minnows, resulted in 37% morality among adult carp and no mortality among perch or bluegill. Our results suggest that corn-based bait that contains ANT-A could be used to selectively control carp in ecosystems dominated by percids or centrarchids, such as lakes across the Great Plains ecoregion of North America, where carp are especially problematic.

Cardiovascular disease mortality in the Americas: current trends and disparities.

PubMed

de Fatima Marinho de Souza, Maria; Gawryszewski, Vilma Pinheiro; Orduñez, Pedro; Sanhueza, Antonio; Espinal, Marcos A

2012-08-01

To describe the current situation and trends in mortality due to cardiovascular disease (CVD) in the Americas and explore their association with economic indicators. This time series study analysed mortality data from 21 countries in the region of the Americas from 2000 to the latest available year. Age-adjusted death rates, annual variation in death rates. Regression analysis was used to estimate the annual variation and the association between age-adjusted rates and country income. Currently, CVD comprised 33.7% of all deaths in the Americas. Rates were higher in Guyana (292/100 000), Trinidad and Tobago (289/100 000) and Venezuela (246/100 000), and lower in Canada (108/100 000), Puerto Rico (121/100 000) and Chile (125/100 000). Male rates were higher than female rates in all countries. The trend analysis showed that CVD death rates in the Americas declined -19% overall (-20% among women and -18% among men). Most countries had a significant annual decline, except Guatemala, Guyana, Suriname, Paraguay and Panama. The largest annual declines were observed in Canada (-4.8%), the USA (-3.9%) and Puerto Rico (-3.6%). Minor declines were in Mexico (-0.8%) and Cuba (-1.1%). Compared with high-income countries the difference between the median of death rates in lower middle-income countries was 56.7% higher and between upper middle-income countries was 20.6% higher. CVD death rates have been decreasing in most countries in the Americas. Considerable disparities still remain in the current rates and trends.

New evidence suggests pyroclastic flows are responsible for the remarkable preservation of the Jehol biota

NASA Astrophysics Data System (ADS)

Jiang, Baoyu; Harlow, George E.; Wohletz, Kenneth; Zhou, Zhonghe; Meng, Jin

2014-02-01

The lower Cretaceous Yixian and Jiufotang formations contain numerous exceptionally well-preserved invertebrate, vertebrate and plant fossils that comprise the Jehol Biota. Freshwater and terrestrial fossils of the biota usually occur together within some horizons and have been interpreted as deposits of mass mortality events. The nature of the events and the mechanisms behind the exceptional preservation of the fossils, however, are poorly understood. Here, after examining and analysing sediments and residual fossils from several key horizons, we postulate that the causal events were mainly phreatomagmatic eruptions. Pyroclastic density currents were probably responsible for the major causalities and for transporting the bulk of the terrestrial vertebrates from different habitats, such as lizards, birds, non-avian dinosaurs and mammals, into lacustrine environments for burial. Terrestrial vertebrate carcasses transported by and sealed within the pyroclastic flows were clearly preserved as exceptional fossils through this process.

Cancer mortality by country of birth, sex, and socioeconomic position in Sweden, 1961-2009.

PubMed

Abdoli, Gholamreza; Bottai, Matteo; Moradi, Tahereh

2014-01-01

In 2010, cancer deaths accounted for more than 15% of all deaths worldwide, and this fraction is estimated to rise in the coming years. Increased cancer mortality has been observed in immigrant populations, but a comprehensive analysis by country of birth has not been conducted. We followed all individuals living in Sweden between 1961 and 2009 (7,109,327 men and 6,958,714 women), and calculated crude cancer mortality rates and age-standardized rates (ASRs) using the world population for standardization. We observed a downward trend in all-site ASRs over the past two decades in men regardless of country of birth but no such trend was found in women. All-site cancer mortality increased with decreasing levels of education regardless of sex and country of birth (p for trend <0.001). We also compared cancer mortality rates among foreign-born (13.9%) and Sweden-born (86.1%) individuals and determined the effect of education level and sex estimated by mortality rate ratios (MRRs) using multivariable Poisson regression. All-site cancer mortality was slightly higher among foreign-born than Sweden-born men (MRR = 1.05, 95% confidence interval 1.04-1.07), but similar mortality risks was found among foreign-born and Sweden-born women. Men born in Angola, Laos, and Cambodia had the highest cancer mortality risk. Women born in all countries except Iceland, Denmark, and Mexico had a similar or smaller risk than women born in Sweden. Cancer-specific mortality analysis showed an increased risk for cervical and lung cancer in both sexes but a decreased risk for colon, breast, and prostate cancer mortality among foreign-born compared with Sweden-born individuals. Further studies are required to fully understand the causes of the observed inequalities in mortality across levels of education and countries of birth.

A benefit-risk assessment of class III antiarrhythmic agents.

PubMed

Brendorp, Bente; Pedersen, Oledyg; Torp-Pedersen, Christian; Sahebzadah, Naji; Køber, Lars

2002-01-01

With beta-blockers as the exception, increasing doubt is emerging on the value of antiarrhythmic drug therapy following a series of trials that have either shown no mortality benefit or even an excess mortality. Vaughan Williams class I drugs are generally avoided in patients with structural heart disease, and class IV drugs are avoided in heart failure. Unfortunately, arrhythmias are a growing problem due to an increase in the incidence of atrial fibrillation and sudden death. The population is becoming older and more patients survive for a longer time period with congestive heart failure, which again increases the frequency of both supraventricular as well as ventricular arrhythmias. Class III antiarrhythmic drugs act by blocking repolarising currents and thereby prolong the effective refractory period of the myocardium. This is believed to facilitate termination of re-entry tachyarrhythmias. This class of drugs is developed for treatment of both supraventricular and ventricular arrhythmias. Amiodarone, sotalol, dofetilide, and ibutilide are examples of class III drugs that are currently available. Amiodarone and sotalol have other antiarrhythmic properties in addition to pure class III action, which differentiates them from the others. However, all have potential serious adverse events. Proarrhythmia, especially torsade de pointes, is a common problem making the benefit-risk ratio of these drugs a key question. Class III drugs have been evaluated in different settings: primary and secondary prevention of ventricular arrhythmias and in treatment of atrial fibrillation or flutter. Based on existing evidence there is no routine indication for antiarrhythmic drug therapy other than beta-blockers in patients at high risk of sudden death. Subgroup analyses of trials with amiodarone and dofetilide suggest that patients with atrial fibrillation may have a mortality reduction with these drugs. However, this needs to be tested in a prospective trial. Similarly, subgroups that will benefit from prophylactic treatment with class III antiarrhythmic drugs may be found based on QT-intervals or - in the future - from genetic testing. Class III drugs are effective in converting atrial fibrillation to sinus rhythm and for the maintenance of sinus rhythm after conversion. This is currently by far the most important indication for this class of drugs. As defined by recent guidelines, amiodarone and dofetilide have their place as second-line therapy except for patients with heart failure where they are first line therapy being the only drugs where the safety has been documented for this group of high risk patients.

Chapter 5 - Tree Mortality

Treesearch

Mark J. Ambrose

2018-01-01

Tree mortality is a natural process in all forest ecosystems. High mortality can be an indicator of forest health problems. On aregional scale, high mortality levels may indicate widespread insect or disease impacts. High mortality may also occur if a large proportion of the forest in a particular region is made up of older, senescent stands. The approach...

Tree Mortality

Treesearch

Mark J. Ambrose

2012-01-01

Tree mortality is a natural process in all forest ecosystems. However, extremely high mortality also can be an indicator of forest health issues. On a regional scale, high mortality levels may indicate widespread insect or disease problems. High mortality may also occur if a large proportion of the forest in a particular region is made up of older, senescent stands....

Analysis of childhood leukemia mortality trends in Brazil, from 1980 to 2010.

PubMed

Silva, Franciane F; Zandonade, Eliana; Zouain-Figueiredo, Glaucia P

2014-01-01

Leukemias comprise the most common group of cancers in children and adolescents. Studies conducted in other countries and Brazil have observed a decrease in their mortality.This study aimed to evaluate the trend of mortality from leukemia in children under 19 years of age in Brazil, from 1980 to 2010. This was an ecological study, using retrospective time series data from the Mortality Information System, from 1980 to 2010. Calculations of mortality rates were performed, including gross, gender-specific, and age-based. For trend analysis, linear and semi-log regression models were used. The significance level was 5%. Mortality rates for lymphoid and myeloid leukemias presented a growth trend, with the exception of lymphoid leukemia among children under 4 years of age (percentage decrease: 1.21% annually), while in the sub-group "Other types of leukemia", a downward trend was observed. Overall, mortality from leukemia tended to increase for boys and girls, especially in the age groups 10-14 years (annual percentage increase of 1.23% for males and 1.28% for females) and 15-19 years (annual percentage increase of 1.40% for males and 1.62% for females). The results for leukemia generally corroborate the results of other similar studies. A detailed analysis by subgroup of leukemia, age, and gender revealed no trends shown in other studies, thus indicating special requirements for each variable in the analysis. Copyright © 2014 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

A Typology for Charting Socioeconomic Mortality Gradients: "Go Southwest".

PubMed

Blakely, Tony; Disney, George; Atkinson, June; Teng, Andrea; Mackenbach, Johan P

2017-07-01

Holistic depiction of time-trends in average mortality rates, and absolute and relative inequalities, is challenging. We outline a typology for situations with falling average mortality rates (m↓; e.g., cardiovascular disease), rates stable over time (m-; e.g., some cancers), and increasing average mortality rates (m↑; e.g., suicide in some contexts). If we consider inequality trends on both the absolute (a) and relative (r) scales, there are 13 possible combination of m, a, and r trends over time. They can be mapped to graphs with relative inequality (log relative index of inequality [RII]; r) on the y axis, log average mortality rate on the x axis (m), and absolute inequality (slope index of inequality; SII; a) as contour lines. We illustrate this by plotting adult mortality trends: (1) by household income from 1981 to 2011 for New Zealand, and (2) by education for European countries. Types range from the "best" m↓a↓r↓ (average, absolute, and relative inequalities all decreasing; southwest movement in graphs) to the "worst" m↑a↑r↑ (northeast). Mortality typologies in New Zealand (all-cause, cardiovascular disease, nonlung cancer, and unintentional injury) were all m↓r↑ (northwest), but variable with respect to absolute inequality. Most European typologies were m↓r↑ types (northwest; e.g., Finland), but with notable exceptions of m-a↑r↑ (north; e.g., Hungary) and "best" or southwest m↓a↓r↓ for Spain (Barcelona) females. Our typology and corresponding graphs provide a convenient way to summarize and understand past trends in inequalities in mortality, and hold potential for projecting future trends and target setting.

Update of a cohort mortality study of workers exposed to methylene chloride employed at a plant producing cellulose triacetate film base.

PubMed

Tomenson, John A

2011-12-01

To update the mortality experience of employees of a factory that produced cellulose triacetate film base at Brantham in the United Kingdom and generate information on the effects of exposure to methylene chloride, in particular, mortality from cardiovascular disease and cancers of the lung, liver and biliary tract, pancreas and brain. All 1,785 male employees with a record of employment at the film factory in 1946-1988 were followed through 2006, including 1,473 subjects exposed to methylene chloride on average for 9 years at a concentration of 19 ppm (8 h time-weighted average). A total of 559 deaths occurred during the follow-up period. In the subcohort of workers exposed to methylene chloride, substantially reduced mortalities compared with national and local rates were found for all causes, all cancers, and all the principal cancer sites of interest except for brain cancer. There was a small excess of brain cancer deaths (8 observed and 4.4 expected), but no evidence of an association with exposure to methylene chloride. Lung cancer mortality was significantly reduced in exposed workers, even compared to the low mortality rate in the local population (SMR 55). In contrast, mortality from ischaemic heart disease in exposed workers was slightly increased compared with local rates (SMR 102), but was lower in active employees (SMR 94; local rates), where a direct effect of exposure to methylene chloride should be concentrated. The study provided no indication that employment at the plant, or exposure to methylene chloride, had adversely affected the mortalities of workers.

The discomfort index, mortality and the London summers of 1976 and 1978

NASA Astrophysics Data System (ADS)

Tout, D. G.

1980-12-01

The Discomfort Index (DI), and its associated heat load categories as worked out for conditions in Israel, was used in a study of the summer months of 1976 and 1978 in London. The cool summer of 1978 presented no heat load problems but the exceptionally warm summer of 1976, especially the period between 22 June and 9 July, produced several days of moderate heat load conditions. During this hot spell mortality from ischaemic heart disease, cerebrovascular accidents and respiratory disease all increased substantially. It is suggested that the heat load categories, although rarely attained, would be useful in predicting danger periods during heatwave conditions in the United Kingdom.

Exercise, APOE genotype, and the evolution of the human lifespan

PubMed Central

Raichlen, David A.; Alexander, Gene E.

2014-01-01

Humans have exceptionally long lifespans compared with other mammals. However, our longevity evolved when our ancestors had two copies of the apolipoprotein E (APOE) ε4 allele, a genotype that leads to a high risk of Alzheimer’s disease (AD), cardiovascular disease, and increased mortality. How did human aging evolve within this genetic constraint? Drawing from neuroscience, anthropology, and brain-imaging research, we propose the hypothesis that the evolution of increased physical activity approximately 2 million years ago served to reduce the amyloid plaque and vascular burden of APOE ε4, relaxing genetic constraints on aging. This multidisciplinary approach links human evolution with health and provides a complementary perspective on aging and neurodegenerative disease that may help identify key mechanisms and targets for intervention. PMID:24690272

[Microbiological diagnosis of bacterial infection associated with delivery and postpartum].

PubMed

Padilla-Ortega, Belén; Delgado-Palacio, Susana; García-Garrote, Fernando; Rodríguez-Gómez, Juan Miguel; Romero-Hernández, Beatriz

2016-05-01

The newborn may acquire infections during delivery due to maternal colonization of the birth canal, by microorganisms such as Streptococcus agalactiae that caused early neonatal infection, or acquisition through the placenta, amniotic fluid or birth products. After birth, the newborn that needs hospitalization can develop nosocomial infections during their care and exceptionally through lactation by infectious mastitis or incorrect handling of human milk, which does not require to stop breastfeeding in most cases. It is important and necessary to perform microbiological diagnosis for the correct treatment of perinatal infections, especially relevant in preterm infants with low or very low weight with high mortality rates. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Giant Cell Arteritis Presenting as Scalp Necrosis

PubMed Central

Maidana, Daniel E.; Muñoz, Silvia; Acebes, Xènia; Llatjós, Roger; Jucglà, Anna; Álvarez, Alba

2011-01-01

The differential of scalp ulceration in older patients should include several causes, such as herpes zoster, irritant contact dermatitis, ulcerated skin tumors, postirradiation ulcers, microbial infections, pyoderma gangrenosum, and giant cell arteritis. Scalp necrosis associated with giant cell arteritis was first described in the 1940s. The presence of this dermatological sign within giant cell arteritis represents a severity marker of this disease, with a higher mean age at diagnosis, an elevated risk of vision loss and tongue gangrene, as well as overall higher mortality rates, in comparison to patients not presenting this manifestation. Even though scalp necrosis due to giant cell arteritis is exceptional, a high level of suspicion must be held for this clinical finding, in order to initiate prompt and proper treatment and avoid blindness. PMID:21789466

Performance of Prognostic Risk Scores in Chronic Heart Failure Patients Enrolled in the European Society of Cardiology Heart Failure Long-Term Registry.

PubMed

Canepa, Marco; Fonseca, Candida; Chioncel, Ovidiu; Laroche, Cécile; Crespo-Leiro, Maria G; Coats, Andrew J S; Mebazaa, Alexandre; Piepoli, Massimo F; Tavazzi, Luigi; Maggioni, Aldo P

2018-06-01

This study compared the performance of major heart failure (HF) risk models in predicting mortality and examined their utilization using data from a contemporary multinational registry. Several prognostic risk scores have been developed for ambulatory HF patients, but their precision is still inadequate and their use limited. This registry enrolled patients with HF seen in participating European centers between May 2011 and April 2013. The following scores designed to estimate 1- to 2-year all-cause mortality were calculated in each participant: CHARM (Candesartan in Heart Failure-Assessment of Reduction in Mortality), GISSI-HF (Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico-Heart Failure), MAGGIC (Meta-analysis Global Group in Chronic Heart Failure), and SHFM (Seattle Heart Failure Model). Patients with hospitalized HF (n = 6,920) and ambulatory HF patients missing any variable needed to estimate each score (n = 3,267) were excluded, leaving a final sample of 6,161 patients. At 1-year follow-up, 5,653 of 6,161 patients (91.8%) were alive. The observed-to-predicted survival ratios (CHARM: 1.10, GISSI-HF: 1.08, MAGGIC: 1.03, and SHFM: 0.98) suggested some overestimation of mortality by all scores except the SHFM. Overprediction occurred steadily across levels of risk using both the CHARM and the GISSI-HF, whereas the SHFM underpredicted mortality in all risk groups except the highest. The MAGGIC showed the best overall accuracy (area under the curve [AUC] = 0.743), similar to the GISSI-HF (AUC = 0.739; p = 0.419) but better than the CHARM (AUC = 0.729; p = 0.068) and particularly better than the SHFM (AUC = 0.714; p = 0.018). Less than 1% of patients received a prognostic estimate from their enrolling physician. Performance of prognostic risk scores is still limited and physicians are reluctant to use them in daily practice. The need for contemporary, more precise prognostic tools should be considered. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Changing Susceptibility to Non-Optimum Temperatures in Japan, 1972-2012: The Role of Climate, Demographic, and Socioeconomic Factors.

PubMed

Chung, Yeonseung; Yang, Daewon; Gasparrini, Antonio; Vicedo-Cabrera, Ana M; Fook Sheng Ng, Chris; Kim, Yoonhee; Honda, Yasushi; Hashizume, Masahiro

2018-05-02

Previous studies have shown that population susceptibility to non-optimum temperatures has changed over time, but little is known about the related time-varying factors that underlie the changes. Our objective was to investigate the changing population susceptibility to non-optimum temperatures in 47 prefectures of Japan over four decades from 1972 to 2012, addressing three aspects: minimum mortality temperature (MMT) and heat- and cold-related mortality risks. In addition, we aimed to examine how these aspects of susceptibility were associated with climate, demographic, and socioeconomic variables. We first used a two-stage time-series design with a time-varying distributed lag nonlinear model and multivariate meta-analysis to estimate the time-varying MMT, heat- and cold-related mortality risks. We then applied linear mixed effects models to investigate the association between each of the three time-varying aspects of susceptibility and various time-varying factors. MMT increased from 23.2 [95% confidence interval (CI): 23, 23.6] to 28.7 (27.0, 29.7) °C. Heat-related mortality risk [relative risk (RR) for the 99th percentile of temperature vs. the MMT] decreased from 1.18 (1.15, 1.21) to 1.01 (0.98, 1.04). Cold-related mortality risk (RR for the first percentile vs. the MMT) generally decreased from 1.48 (1.41, 1.54) to 1.35 (1.32, 1.40), with the exception of a few eastern prefectures that showed increased risk. The changing patterns in all three aspects differed by region, sex, and causes of death. Higher mean temperature was associated ( p <0.01) with lower heat risk, whereas higher humidity was associated with higher cold risk. A higher percentage of elderly people was associated with a higher cold risk, whereas higher economic strength of the prefecture was related to lower cold risk. Population susceptibility to heat has decreased over the last four decades in Japan. Susceptibility to cold has decreased overall except for several eastern prefectures where it has either increased or remained unchanged. Certain climate, demographic, and socioeconomic factors explored in the current study might underlie this changing susceptibility. https://doi.org/10.1289/EHP2546.

Does the presence of desert dust modify the effect of PM10 on mortality in Athens, Greece?

PubMed

Samoli, Evangelia; Kougea, Evgenia; Kassomenos, Pavlos; Analitis, Antonis; Katsouyanni, Klea

2011-05-01

Recent reports investigate whether windblown desert dust may exacerbate the short-term health effects associated with particulate pollution in urban centers. We have tested this hypothesis by using daily air pollution and mortality data for Athens, Greece during the period 2001-2006. We investigated the effects of exposure to particulate matter with aerodynamic diameter <0μg/m(3) (PM(10)) on total and cause specific mortality, during days with and without windblown desert dust, for all ages, stratified by age groups and by sex. We identified 141 dust days between 2001 and 2006. We used Poisson regression models with penalized splines to control for possible confounding by season, meteorology, day of the week and holiday effect. A 10μg/m(3) increase in PM(10) was associated with a 0.71% (95% confidence interval (CI): 0.42% to 0.99%) increase in all deaths. The effects for total and cause specific mortality were greater for those ≥ 75years of age, while for total mortality higher effects were observed among females. The main effect of desert dust days and its interaction with PM(10) concentrations were significant in all cases except for respiratory mortality and cardiovascular mortality among those < 75years. The negative interaction pointed towards lower particle effects on mortality during dust events. We found evidence of modification of the adverse health effects of PM(10) on mortality in Athens, Greece with desert dust events: the particle effects were significantly higher during non-desert dust days. Our analyses indicate that traffic related particles, which prevail on non-desert dust days, have more toxic effects than the ones originating from long-range transport, such as Sahara dust. Copyright © 2011 Elsevier B.V. All rights reserved.

Cancer mortality inequalities in urban areas: a Bayesian small area analysis in Spanish cities

PubMed Central

2011-01-01

Background Intra-urban inequalities in mortality have been infrequently analysed in European contexts. The aim of the present study was to analyse patterns of cancer mortality and their relationship with socioeconomic deprivation in small areas in 11 Spanish cities. Methods It is a cross-sectional ecological design using mortality data (years 1996-2003). Units of analysis were the census tracts. A deprivation index was calculated for each census tract. In order to control the variability in estimating the risk of dying we used Bayesian models. We present the RR of the census tract with the highest deprivation vs. the census tract with the lowest deprivation. Results In the case of men, socioeconomic inequalities are observed in total cancer mortality in all cities, except in Castellon, Cordoba and Vigo, while Barcelona (RR = 1.53 95%CI 1.42-1.67), Madrid (RR = 1.57 95%CI 1.49-1.65) and Seville (RR = 1.53 95%CI 1.36-1.74) present the greatest inequalities. In general Barcelona and Madrid, present inequalities for most types of cancer. Among women for total cancer mortality, inequalities have only been found in Barcelona and Zaragoza. The excess number of cancer deaths due to socioeconomic deprivation was 16,413 for men and 1,142 for women. Conclusion This study has analysed inequalities in cancer mortality in small areas of cities in Spain, not only relating this mortality with socioeconomic deprivation, but also calculating the excess mortality which may be attributed to such deprivation. This knowledge is particularly useful to determine which geographical areas in each city need intersectorial policies in order to promote a healthy environment. PMID:21232096

Continuous decline in mortality from coronary heart disease in Japan despite a continuous and marked rise in total cholesterol: Japanese experience after the Seven Countries Study.

PubMed

Sekikawa, Akira; Miyamoto, Yoshihiro; Miura, Katsuyuki; Nishimura, Kunihiro; Willcox, Bradley J; Masaki, Kamal H; Rodriguez, Beatriz; Tracy, Russell P; Okamura, Tomonori; Kuller, Lewis H

2015-10-01

The Seven Countries Study in the 1960s showed very low mortality from coronary heart disease (CHD) in Japan, which was attributed to very low levels of total cholesterol. Studies of migrant Japanese to the USA in the 1970s documented increase in CHD rates, thus CHD mortality in Japan was expected to increase as their lifestyle became Westernized, yet CHD mortality has continued to decline since 1970. This study describes trends in CHD mortality and its risk factors since 1980 in Japan, contrasting those in other selected developed countries. We selected Australia, Canada, France, Japan, Spain, Sweden, the UK and the USA. CHD mortality between 1980 and 2007 was obtained from WHO Statistical Information System. National data on traditional risk factors during the same period were obtained from literature and national surveys. Age-adjusted CHD mortality continuously declined between 1980 and 2007 in all these countries. The decline was accompanied by a constant fall in total cholesterol except Japan where total cholesterol continuously rose. In the birth cohort of individuals currently aged 50-69 years, levels of total cholesterol have been higher in Japan than in the USA, yet CHD mortality in Japan remained the lowest: >67% lower in men and > 75% lower in women compared with the USA. The direction and magnitude of changes in other risk factors were generally similar between Japan and the other countries. Decline in CHD mortality despite a continuous rise in total cholesterol is unique. The observation may suggest some protective factors unique to Japanese. © The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Six-Year Effects of Two Late Spring Frosts on Appalachian Hardwoods

Treesearch

Everette D. Rast; Robert L. Brisbin; Robert L. Brisbin

1987-01-01

Severe late spring frosts can kill new shoots and leaves on commercial tree species at higher elevations. A previous short-term study has shown that the resulting defoliation and dieback does not seriously affect the radial growth or mortality of most species except American beech. In this study we found that defoliation, dieback, and radial growth increment were...

Mortality from duck plague virus in immunosuppressed adult mallard ducks

USGS Publications Warehouse

Goldberg, Diana R.; Yuill, Thomas M.; Burgess, E.C.

1990-01-01

Environmental contaminants contain chemicals that, if ingested, could affect the immunological status of wild birds, and in particular, their resistance to infectious disease. Immunosuppression caused by environmental contaminants, could have a major impact on waterfowl populations, resulting in increased susceptibility to contagious disease agents. Duck plague virus has caused repeated outbreaks in waterfowl resulting in mortality. In this study, several doses of cyclophosphamide (CY), a known immunosuppressant, were administered to adult mallards (Anas platyrhynchos) to determine if a resultant decrease in resistance to a normally sub-lethal strain of duck plague virus would occur, and induce mortality in these birds. Death occurred in birds given CY only, and in birds given virus and CY, but not in those given virus only. There was significantly greater mortality and more rapid deaths in the duck plague virus-infected groups than in groups receiving only the immunosuppressant. A positively correlated dose-response effect was observed with CY mortalities, irrespective of virus exposure. A fuel oil and a crude oil, common environmental contaminants with immunosuppressive capabilities, were tested to determine if they could produce an effect similar to that of CY. Following 28 days of oral oil administration, the birds were challenged with a sub-lethal dose of duck plague virus. No alteration in resistance to the virus (as measured by mortality) was observed, except in the positive CY control group.

Mortality from duck plague virus in immunosuppressed adult mallard ducks

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goldberg, D.R.; Yuill, T.M.; Burgess, E.C.

Environmental contaminants contain chemicals that, if ingested, could affect the immunological status of wild birds, and in particular, their resistance to infectious disease. Immunosuppression caused by environmental contaminants, could have a major impact on waterfowl populations, resulting in increased susceptibility to contagious disease agents. Duck plague virus has caused repeated outbreaks in waterfowl resulting in mortality. In this study, several doses of cyclophosphamide (CY), a known immunosuppressant, were administered to adult mallards (Anas platyrhynchos) to determine if a resultant decrease in resistance to a normally sub-lethal strain of duck plague virus would occur, and induce mortality in these birds. Deathmore » occurred in birds given CY only, and in birds given virus and CY, but not in those given virus only. There was significantly greater mortality and more rapid deaths in the duck plague virus-infected groups than in groups receiving only the immunosuppressant. A positively correlated dose-response effect was observed with CY mortalities, irrespective of virus exposure. A fuel oil and a crude oil, common environmental contaminants with immunosuppressive capabilities, were tested to determine if they could produce an effect similar to that of CY. Following 28 days of oral oil administration, the birds were challenged with a sub-lethal dose of duck plague virus. No alteration in resistance to the virus (as measured by mortality) was observed, except in the positive CY control group.« less

Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program-Pediatrics.

PubMed

Kuo, Benjamin J; Vissoci, Joao Ricardo N; Egger, Joseph R; Smith, Emily R; Grant, Gerald A; Haglund, Michael M; Rice, Henry E

2017-03-01

OBJECTIVE Existing studies have shown a high overall rate of adverse events (AEs) following pediatric neurosurgical procedures. However, little is known regarding the morbidity of specific procedures or the association with risk factors to help guide quality improvement (QI) initiatives. The goal of this study was to describe the 30-day mortality and AE rates for pediatric neurosurgical procedures by using the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatrics (NSQIP-Peds) database platform. METHODS Data on 9996 pediatric neurosurgical patients were acquired from the 2012-2014 NSQIP-Peds participant user file. Neurosurgical cases were analyzed by the NSQIP-Peds targeted procedure categories, including craniotomy/craniectomy, defect repair, laminectomy, shunts, and implants. The primary outcome measure was 30-day mortality, with secondary outcomes including individual AEs, composite morbidity (all AEs excluding mortality and unplanned reoperation), surgical-site infection, and unplanned reoperation. Univariate analysis was performed between individual AEs and patient characteristics using Fischer's exact test. Associations between individual AEs and continuous variables (duration from admission to operation, work relative value unit, and operation time) were examined using the Student t-test. Patient characteristics and continuous variables associated with any AE by univariate analysis were used to develop category-specific multivariable models through backward stepwise logistic regression. RESULTS The authors analyzed 3383 craniotomy/craniectomy, 242 defect repair, 1811 laminectomy, and 4560 shunt and implant cases and found a composite overall morbidity of 30.2%, 38.8%, 10.2%, and 10.7%, respectively. Unplanned reoperation rates were highest for defect repair (29.8%). The mortality rate ranged from 0.1% to 1.2%. Preoperative ventilator dependence was a significant predictor of any AE for all procedure groups, whereas admission from outside hospital transfer was a significant predictor of any AE for all procedure groups except craniotomy/craniectomy. CONCLUSIONS This analysis of NSQIP-Peds, a large risk-adjusted national data set, confirms low perioperative mortality but high morbidity for pediatric neurosurgical procedures. These data provide a baseline understanding of current expected clinical outcomes for pediatric neurosurgical procedures, identify the need for collecting neurosurgery-specific risk factors and complications, and should support targeted QI programs and clinical management interventions to improve care of children.

Re-Evaluating the Possible Increased Risk of HIV Acquisition With Progestin-Only Injectables Versus Maternal Mortality and Life Expectancy in Africa: A Decision Analysis.

PubMed

Rodriguez, Maria Isabel; Gaffield, Mary E; Han, Leo; Caughey, Aaron B

2017-12-28

The association between increased risk of HIV acquisition and use of progestin-only injectables (POIs) is controversial. We sought to compare the competing risks of maternal mortality and HIV acquisition with use of POIs using updated data on this association and considering an expanded number of African countries. We designed a decision-analytic model to compare the benefits and risks of POIs on the competing risks of maternal mortality and HIV acquisition on life expectancy for women in 9 African countries. For the purposes of this analysis, we assumed that POIs were associated with an increased risk of HIV acquisition (hazards ratio of 1.4). Our primary outcome was life-years and the population was women of reproductive age (15-49 years) in these countries, who did not have HIV infection and were not currently planning a pregnancy. Probabilities for each variable included in the model, such as HIV incidence, access to antiretroviral therapy, and contraceptive prevalence, were obtained from the literature. Univariate and multivariate sensitivity analyses were performed to check model assumptions and explore how uncertainty in estimates would affect the model results. In all countries, discontinuation of POIs without replacement with an equally effective contraceptive method would result in decreased life expectancy due to a significant increase in maternal deaths. While the removal of POIs from the market would result in the prevention of some new cases of HIV, the life-years gained from this are mitigated due to the marked increase in neonatal HIV cases and maternal mortality with associated life-years lost. In all countries, except South Africa, typical-use contraceptive failure rates with POIs would need to exceed 39%, and more than half of women currently using POIs would have to switch to another effective method, for the removal of POIs to demonstrate an increase in total life-years. Women living in sub-Saharan Africa cope with both high rates of HIV infection and high rates of pregnancy-related maternal death relative to the rest of the world. Based on the most current estimates, our model suggests that removal of POI contraception from the market without effective and acceptable contraception replacement would have a net negative effect on maternal health, life expectancy, and mortality under a variety of scenarios. © Rodriguez et al.

Spatial-temporal patterns in Mediterranean carnivore road casualties: Consequences for mitigation

USGS Publications Warehouse

Grilo, C.; Bissonette, J.A.; Santos-Reis, M.

2009-01-01

Many carnivores have been seriously impacted by the expansion of transportation systems and networks; however we know little about carnivore response to the extent and magnitude of road mortality, or which age classes may be disproportionately impacted. Recent research has demonstrated that wildlife-vehicle-collisions (WVC) involving carnivores are modulated by temporal and spatial factors. Thus, we investigated road mortality on a guild of small and medium-sized carnivores in southern Portugal using road-kill data obtained from a systematic 36 months monitoring period along highways (260 km) and national roads (314 km) by addressing the following questions: (a) which species and age class are most vulnerable to WVC? (b) are there temporal and/or spatial patterns in road-kill? and (c) which life-history and/or spatial factors influence the likelihood of collisions? We recorded a total of 806 carnivore casualties, which represented an average of 47 ind./100 km/year. Red fox and stone marten had the highest mortality rates. Our findings highlight three key messages: (1) the majority of road-killed individuals were adults of common species; (2) all carnivores, except genets, were more vulnerable during specific life-history phenological periods: higher casualties were observed when red fox and stone marten were provisioning young, Eurasian badger casualties occurred more frequently during dispersal, and higher Egyptian mongoose mortality occurred during the breeding period; and (3) modeling demonstrated that favorable habitat, curves in the road, and low human disturbance were major contributors to the deadliest road segments. Red fox carcasses were more likely to be found on road sections with passages distant from urban areas. Conversely, stone marten mortalities were found more often on national roads with high of cork oak woodland cover; Egyptian mongoose and genet road-kills were found more often on road segments close to curves. Based on our results, two key mitigation measures should help to reduce WVC in Portugal. The first involves the improvement of existing crossings with buried and small mesh size fence to guide the individuals towards to the passages, in road segments with high traffic volume (>1200 vehicles/night) and located in preferred carnivore habitats. The second mitigation involves cutting or removal of dense vegetation in verges of road segments with curves to aid motorists in seeing animals about to cross. ?? 2008 Elsevier Ltd.

Predictors of death and production performance of layer chickens in opened and sealed pens in a tropical savannah environment.

PubMed

Shittu, Aminu; Raji, Abdullahi Abdullahi; Madugu, Shuaibu A; Hassan, Akinola Waheed; Fasina, Folorunso Oludayo

2014-09-12

Layer chickens are exposed to high risks of production losses and mortality with impact on farm profitability. The harsh tropical climate and severe disease outbreaks, poor biosecurity, sub-minimal vaccination and treatment protocols, poor management practices, poor chick quality, feed-associated causes, and unintended accidents oftentimes aggravate mortality and negatively affect egg production. The objectives of this study were to estimate the probability of survival and evaluate risk factors for death under different intensive housing conditions in a tropical climate, and to assess the production performance in the housing systems. Daily mean mortality percentages and egg production figures were significantly lower and higher in the sealed pens and open houses (P < 0. 001) respectively. The total mean feed consumption/bird/day was similar for the open sided and sealed pens but the mean feed quantity per egg produce was significantly lower in the sealed pens ((P < 0.005). Seasons differently impacted on mortality with the hot-dry season producing significantly higher risk of mortality (61 times) and reduced egg production. Other parameters also differed except the egg production during the cold-dry season. Layers in sealed pens appear to have higher probability of survival and the Kaplan-Meir survival curves differed for each pen; ≥ 78 weeks old layer have higher probability of survival compared with the younger chickens and the 19-38 weeks age category are at highest risk of death (P < 0.001). The hazard-ratio for mortality of layers raised in sealed pens was 0.568 (56.8%). Reasons for spiked mortality in layer chickens may not always be associated with disease. Hot-dry climatic environment is associated with heat stress, waning immunity and inefficient feed usage and increase probability of death with reduced egg production; usage of environmentally controlled building in conditions where environmental temperature may rise significantly above 25°C will reduce this impact. Since younger birds (19-38 weeks) are at higher risk of death due to stress of coming into production, management changes and diseases, critical implementation of protocols that will reduce death at this precarious period becomes mandatory. Whether older chickens' better protection from death is associated with many prophylactic and metaphylactic regimen of medications/vaccination will need further investigation.

Entrenched geographical and socioeconomic disparities in child mortality: trends in absolute and relative inequalities in Cambodia.

PubMed

Jimenez-Soto, Eliana; Durham, Jo; Hodge, Andrew

2014-01-01

Cambodia has made considerable improvements in mortality rates for children under the age of five and neonates. These improvements may, however, mask considerable disparities between subnational populations. In this paper, we examine the extent of the country's child mortality inequalities. Mortality rates for children under-five and neonates were directly estimated using the 2000, 2005 and 2010 waves of the Cambodian Demographic Health Survey. Disparities were measured on both absolute and relative scales using rate differences and ratios, and where applicable, slope and relative indices of inequality by levels of rural/urban location, regions and household wealth. Since 2000, considerable reductions in under-five and to a lesser extent in neonatal mortality rates have been observed. This mortality decline has, however, been accompanied by an increase in relative inequality in both rates of child mortality for geography-related stratifying markers. For absolute inequality amongst regions, most trends are increasing, particularly for neonatal mortality, but are not statistically significant. The only exception to this general pattern is the statistically significant positive trend in absolute inequality for under-five mortality in the Coastal region. For wealth, some evidence for increases in both relative and absolute inequality for neonates is observed. Despite considerable gains in reducing under-five and neonatal mortality at a national level, entrenched and increased geographical and wealth-based inequality in mortality, at least on a relative scale, remain. As expected, national progress seems to be associated with the period of political and macroeconomic stability that started in the early 2000s. However, issues of quality of care and potential non-inclusive economic growth might explain remaining disparities, particularly across wealth and geography markers. A focus on further addressing key supply and demand side barriers to accessing maternal and child health care and on the social determinants of health will be essential in narrowing inequalities.

Wealth and mortality at older ages: a prospective cohort study.

PubMed

Demakakos, Panayotes; Biddulph, Jane P; Bobak, Martin; Marmot, Michael G

2016-04-01

Despite the importance of socioeconomic position for survival, total wealth, which is a measure of accumulation of assets over the life course, has been underinvestigated as a predictor of mortality. We investigated the association between total wealth and mortality at older ages. We estimated Cox proportional hazards models using a sample of 10,305 community-dwelling individuals aged ≥ 50 years from the English Longitudinal Study of Ageing. 2401 deaths were observed over a mean follow-up of 9.4 years. Among participants aged 50-64 years, the fully adjusted HRs for mortality were 1.21 (95% CI 0.92 to 1.59) and 1.77 (1.35 to 2.33) for those in the intermediate and lowest wealth tertiles, respectively, compared with those in the highest wealth tertile. The respective HRs were 2.54 (1.27 to 5.09) and 3.73 (1.86 to 7.45) for cardiovascular mortality and 1.36 (0.76 to 2.42) and 2.53 (1.45 to 4.41) for other non-cancer mortality. Wealth was not associated with cancer mortality in the fully adjusted model. Similar but less strong associations were observed among participants aged ≥ 65 years. The use of repeated measurements of wealth and covariates brought about only minor changes, except for the association between wealth and cardiovascular mortality, which became less strong in the younger participants. Wealth explained the associations between paternal occupation at age 14 years, education, occupational class, and income and mortality. There are persisting wealth inequalities in mortality at older ages, which only partially are explained by established risk factors. Wealth appears to be more strongly associated with mortality than other socioeconomic position measures. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

[Start of PTB (Phthisis) mortality statistics in Japan (1)].

PubMed

Shimao, Tadao

2008-12-01

First "Statistics Annual", which included the population and vital statistics was published in Japan in 1882, and the numbers of death classified by major causes of death were tabulated by sex and age groups and by prefecture. Koch R reported the discovery of tubercle bacilli as the pathogen for TB in 1882, and since the latter half of 1883, the numbers of death due to PTB (Phthisis) were tabulated by prefecture, and by sex and age groups since 1884 annually except for 1885. Based on the population statistics and the numbers of PTB death, PTB (Phthisis) mortality was calculated by sex and age groups, and the results were shown in Table 1. PTB mortality per 100,000 increased from 78.2 in 1884 to 171.9 in 1899. Sex- and age-specific PTB mortality in 1884 showed a pattern increasing with age, and the PTB mortality of male was higher than that of female in adult as shown in Fig. 2. In 1889, low peak of mortality was seen in the age groups 15-19 and 20-29, and in these age groups, the PTB mortality was higher in female than in male. Such trend was seen more markedly in 1894 and 1899, while the rate was higher in male than in female in the age groups over 40. Trend of PTB mortality by sex and age groups was shown in Fig. 3. Rapid increase of PTB mortality in the age groups 10-14 and 20-29 could be explained by the rapid increase of young women workers in fast growing silk and spinning industries, but how rapid increase of PTB mortality in infants be explained? In "Statistics Annual", PTB (Phthisis) mortality rate by prefecture was printed, and the summarized table was shown in Table 2. The rates in 1883 and 1884 were calculated from the numbers of PTB death and the B-type population shown in the "Statistics Annual", which will be described in the next issue of this paper.

Air Pollution and Nonmalignant Respiratory Mortality in 16 Cohorts within the ESCAPE Project

PubMed Central

Dimakopoulou, Konstantina; Samoli, Evangelia; Beelen, Rob; Stafoggia, Massimo; Andersen, Zorana Jovanovic; Hoffmann, Barbara; Fischer, Paul; Nieuwenhuijsen, Mark; Vineis, Paolo; Xun, Wei; Hoek, Gerard; Raaschou-Nielsen, Ole; Oudin, Anna; Forsberg, Bertil; Modig, Lars; Jousilahti, Pekka; Lanki, Timo; Turunen, Anu; Oftedal, Bente; Nafstad, Per; Schwarze, Per E.; Penell, Johanna; Fratiglioni, Laura; Andersson, Niklas; Pedersen, Nancy; Korek, Michal; De Faire, Ulf; Eriksen, Kirsten Thorup; Tjønneland, Anne; Becker, Thomas; Wang, Meng; Bueno-de-Mesquita, Bas; Tsai, Ming-Yi; Eeftens, Marloes; Peeters, Petra H.; Meliefste, Kees; Marcon, Alessandro; Krämer, Ursula; Kuhlbusch, Thomas A.J.; Vossoughi, Mohammad; Key, Timothy; de Hoogh, Kees; Hampel, Regina; Peters, Annette; Heinrich, Joachim; Weinmayr, Gudrun; Concin, Hans; Nagel, Gabriele; Ineichen, Alex; Jacquemin, Bénédicte; Stempfelet, Morgane; Vilier, Alice; Ricceri, Fulvio; Sacerdote, Carlotta; Pedeli, Xanthi; Katsoulis, Michalis; Trichopoulou, Antonia; Brunekreef, Bert

2014-01-01

Rationale: Prospective cohort studies have shown that chronic exposure to particulate matter and traffic-related air pollution is associated with reduced survival. However, the effects on nonmalignant respiratory mortality are less studied, and the data reported are less consistent. Objectives: We have investigated the relationship of long-term exposure to air pollution and nonmalignant respiratory mortality in 16 cohorts with individual level data within the multicenter European Study of Cohorts for Air Pollution Effects (ESCAPE). Methods: Data from 16 ongoing cohort studies from Europe were used. The total number of subjects was 307,553. There were 1,559 respiratory deaths during follow-up. Measurements and Main Results: Air pollution exposure was estimated by land use regression models at the baseline residential addresses of study participants and traffic-proximity variables were derived from geographical databases following a standardized procedure within the ESCAPE study. Cohort-specific hazard ratios obtained by Cox proportional hazard models from standardized individual cohort analyses were combined using metaanalyses. We found no significant associations between air pollution exposure and nonmalignant respiratory mortality. Most hazard ratios were slightly below unity, with the exception of the traffic-proximity indicators. Conclusions: In this study of 16 cohorts, there was no association between air pollution exposure and nonmalignant respiratory mortality. PMID:24521254

Political party affiliation, political ideology and mortality

PubMed Central

Pabayo, Roman; Kawachi, Ichiro; Muennig, Peter

2018-01-01

Background Ecological and cross-sectional studies have indicated that conservative political ideology is associated with better health. Longitudinal analyses of mortality are needed because subjective assessments of ideology may confound subjective assessments of health, particularly in cross-sectional analyses. Methods Data were derived from the 2008 General Social Survey-National Death Index data set. Cox proportional analysis models were used to determine whether political party affiliation or political ideology was associated with time to death. Also, we attempted to identify whether self-reported happiness and self-rated health acted as mediators between political beliefs and time to death. Results In this analysis of 32 830 participants and a total follow-up time of 498 845 person-years, we find that political party affiliation and political ideology are associated with mortality. However, with the exception of independents (adjusted HR (AHR)=0.93, 95% CI 0.90 to 0.97), political party differences are explained by the participants’ underlying sociodemographic characteristics. With respect to ideology, conservatives (AHR=1.06, 95% CI 1.01 to 1.12) and moderates (AHR=1.06, 95% CI 1.01 to 1.11) are at greater risk for mortality during follow-up than liberals. Conclusions Political party affiliation and political ideology appear to be different predictors of mortality. PMID:25631861

The demography of menopause.

PubMed

Hill, K

1996-03-01

Menopause marks a time of dramatic hormonal and often social change for women. Both risk factors and health needs are likely to change as women pass through menopause. This paper examines the demographic characteristics of the world population of menopausal and post-menopausal women, and also examines the implication of menopause for mortality risks. The numbers of women involved are large. Using age 50 as a proxy for menopause, about 25 million women pass through menopause each year, and we estimate that in 1990 there were 467 million post-menopausal women in the world, with an average age of about 60 years. By 2030, the world population of menopausal and postmenopausal women is projected to increase to 1.2 billion, with 47 million new entrants each year. The mortality implications of menopause are also substantial. Ratios of female to male mortality risks from all causes and from all major cause groups except neoplasms decline to low levels around menopause or shortly thereafter, and then rise again to near unity. This pattern is taken as evidence that the female reproductive period is broadly protective of health, but that this protection disappears after menopause. The main protective effect is through reduced risk of cardiovascular disease mortality, partially offset by increased risks of cancer mortality, particularly of the breast and endometrium.

Vegetable and fruit intake and mortality from chronic disease in New Zealand.

PubMed

Tobias, Martin; Turley, Maria; Stefanogiannis, Niki; Vander Hoorn, Stephen; Lawes, Carlene; Mhurchu, Cliona Ni; Rodgers, Anthony

2006-02-01

To estimate mortality attributable to inadequate vegetable and fruit intake in New Zealand in 1997, and the burden of disease that could be avoided in 2011 if modest increases in vegetable and fruit intake were to occur. Comparative risk assessment methodology was used to estimate both attributable and avoidable mortality due to inadequate vegetable and fruit consumption (< 600 g/day). Vegetables and fruit were defined as all fresh, frozen, canned, dried or juiced vegetables and fruit, except potatoes, nuts, seeds and pulses. Disease outcomes assessed were mortality from ischaemic heart disease, ischaemic stroke, and lung, oesophageal, stomach and colorectal cancers. In 1997, mean vegetable and fruit intake was 420 g/day in males and 404 g/day in females. Inadequate vegetable and fruit intake is estimated to have contributed to 1,559 deaths (6% of all deaths) in that year, including 1,171 from ischaemic heart disease, 179 from ischaemic stroke and 209 from cancer. Modest increases in vegetable and fruit intake (40 g/day above the historic trend) could prevent 334 deaths each year from 2011, mostly from ischaemic heart disease. Inadequate vegetable and fruit intake is an important cause of mortality in New Zealand. Small increases in vegetable and fruit intake could have a major impact on population health within a decade.

Acute effects of air pollution on respiratory disease mortalities and outpatients in Southeastern China.

PubMed

Mo, Zhe; Fu, Qiuli; Zhang, Lifang; Lyu, Danni; Mao, Guangming; Wu, Lizhi; Xu, Peiwei; Wang, Zhifang; Pan, Xuejiao; Chen, Zhijian; Wang, Xiaofeng; Lou, Xiaoming

2018-02-22

The objective of this study was to investigate the potential association between air pollutants and respiratory diseases (RDs). Generalized additive models were used to analyze the effect of air pollutants on mortalities or outpatient visits. The average concentrations of air pollutants in Hangzhou (HZ) were 1.6-2.8 times higher than those in Zhoushan (ZS), except for O 3 . In a single pollutant model, the increased concentrations of PM 2.5 , NO 2 , and SO 2 were strongly associated with deaths caused by RD in HZ, while PM 2.5 and O 3 were associated with deaths caused by RD in ZS. All air pollutants (PM 2.5 , NO 2 , SO 2 , and O 3 ) were strongly associated with outpatient visits for RD in both HZ and ZS. In multiple pollutant models, a significant association was only observed between PM 2.5 and the mortality rate of RD patients in both HZ and in ZS. Moreover, strong associations between SO 2 , NO 2 , and outpatient visits for RD were observed in HZ and ZS. This study has provided evidence that both the mortality rates and outpatient visits for RD were significantly associated with air pollutants. Furthermore, the results showed that different air pollutant levels lead to regional differences between mortality rates and outpatient visits.

Global cardiovascular mortality risk in the adult Polish population: prospective assessment of the cohorts studied in multicentre national WOBASZ and WOBASZ Senior studies.

PubMed

Piotrowski, Walerian; Waśkiewicz, Anna; Cicha-Mikołajczyk, Alicja

2016-01-01

To develop a global cardiovascular disease (CVD) mortality risk model for the Polish population and to verify these data in the context of the SCORE risk algorithm. We analysed data obtained in two multicentre national population studies, the WOBASZ study which was conducted in 2003-2005 and included 14,769 subjects aged 20-74 years, and the WOBASZ Senior study which was conducted in 2007 and included 1096 subjects above 74 years of age. All these subjects were followed for survival status until 2012 and the cause of death was determined. The mean duration of follow-up was 8.2 years for WOBASZ study participants and about 5 years for WOBASZ Senior study participants. Overall, 1436 subjects died, including 568 due to CVD. For the purpose of our analysis of overall and CVD mortality, 15 established risk factors were selected. Survival was analysed separately in WOBASZ and WOBASZ Senior study participants. Statistical methods included descriptive statistics, Kaplan-Meier curves, Cox proportional hazard models, and the SCORE risk algorithm. Measure of incompatibility of the SCORE risk model to the Polish population was determined as the difference between mortality rates by the SCORE risk quartiles and the Cox approach. During the 8-year follow-up of the WOBASZ study population, mortality due to CVD was 38% among men and 31% among women. The most common causes of CVD mortality were ischaemic heart disease (IHD, 33%) followed by cerebro-vascular disease (17%) in men, and cerebrovascular disease (31%) followed by IHD (23%) in women. We found significant differences between men and women in regard to survival curves for both overall mortality and CVD mortality (p < 0.0001). For overall mortality among men and women, nearly all selected risk factors were shown to be significant in univariate analyses, except for high density lipoprotein cholesterol (HDL-C) level and the total cholesterol/HDL-C ratio in men, and smoking status in women. In multivariate analysis, independent predictors in men included age, glucose level, systolic blood pressure, and smoking status. In women, independent predictors were age, smoking status, and diabetes. During the 5-year follow-up of the WOBASZ Senior study population, mortality due to CVD was 48% among men and 58% among women. The most common cause of CVD mortality in both men and women was IHD (29% and 24%, respectively), followed by cerebrovascular disease (16% and 21%, respectively). We found significant differences between men and women in regard to survival curves for overall mortality (p < 0.0001) but not for CVD mortality (p = 0.0755). Due to the fact that survival curves for CVD mortality did not differ between men and women, we estimated the cut-off age for no survival difference in the WOBASZ study. By selecting the oldest patients and adding them to the WOBASZ Senior cohort, we obtained the cut-off age of 70 years above which the survival curves were not significantly different between men and women. In univariate analyses, independent predictors in men were age and creatinine level. These factors remained significant in multivariate analysis. In women above 74 years of age, independent predictors in univariate analyses included age, HDL-C level, creatinine level, total cholesterol/HDL-C ratio, and smoking status. Age, HDL-C level, creatinine level, and smoking status remained independent predictors of overall mortality in multivariate analysis. For CVD mortality, significant predictors were the same as for overall mortality. In women, significant predictors in uni- and multivariate analyses were age and smoking status. Overall disagreement between CVD mortality rates by the SCORE risk model and the Cox model was 5.7% in men and 2% in women. 1. Long-term follow-up of WOBASZ and WOBASZ Senior study participants allowed assessment of the inde-pendent association of the evaluated cardiovascular risk factors with CVD mortality in the Polish population. 2. Validation of the SCORE risk algorithm to estimate individual global CVD risk in the Polish population showed a high predictive value of this algorithm.

Impact of timing of birth and resident duty-hour restrictions on outcomes for small preterm infants.

PubMed

Bell, Edward F; Hansen, Nellie I; Morriss, Frank H; Stoll, Barbara J; Ambalavanan, Namasivayam; Gould, Jeffrey B; Laptook, Abbot R; Walsh, Michele C; Carlo, Waldemar A; Shankaran, Seetha; Das, Abhik; Higgins, Rosemary D

2010-08-01

The goal was to examine the impact of birth at night, on the weekend, and during July or August (the first months of the academic year) and the impact of resident duty-hour restrictions on mortality and morbidity rates for very low birth weight infants. Outcomes were analyzed for 11,137 infants with birth weights of 501 to 1250 g who were enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network registry in 2001-2005. Approximately one-half were born before the introduction of resident duty-hour restrictions in 2003. Follow-up assessments at 18 to 22 months were completed for 4508 infants. Mortality rate, short-term morbidities, and neurodevelopmental outcome were examined with respect to the timing of birth. There was no effect of the timing of birth on mortality rate and no impact on the risks of short-term morbidities except that the risk of retinopathy of prematurity (stage > or =2) was higher after the introduction of duty-hour restrictions and the risk of retinopathy of prematurity requiring operative treatment was lower for infants born during the late night than during the day. There was no impact of the timing of birth on neurodevelopmental outcome except that the risk of hearing impairment or death was slightly lower among infants born in July or August. In this network, the timing of birth had little effect on the risks of death and morbidity for very low birth weight infants, which suggests that staffing patterns were adequate to provide consistent care.

Estimates of cancer burden in Campania.

PubMed

Fusco, Mario; De Angelis, Roberta; Senatore, Gennaro; Zigon, Giulia; Rossi, Silvia

2013-01-01

In Campania two cancer registries have been operating since 1996, covering part of the province of Naples and the province of Salerno, and amounting to 29% of the regional population. The aim of this paper is to provide estimates of the incidence, mortality and prevalence of seven major cancers for the entire Campania region. The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence figures starting from mortality and relative survival data. Survival was modeled on the basis of published data from the Italian cancer registries. In 2012 the most frequent cancers were colorectal, breast and lung cancer with 3,969, 3,675 and 3,629 new diagnosed cases, respectively. The cancers with increasing incidence trends were breast cancer, lung cancer and skin melanoma in women, and colorectal cancer and skin melanoma in men. By contrast, the incidence rates of uterine cervix cancer and stomach cancer were decreasing. In men the lung and prostate cancer incidence rates increased, reaching a peak in different periods, and then decreased and stabilized, respectively. Prevalence was increasing for all considered cancers with the exception of cervical cancer. The highest values in 2012 were estimated for breast and colorectal cancer (34,000 and 22,000 prevalent cases, respectively). In the final period under study there was a decline in mortality for all cancers except female lung cancer. The highest crude mortality rates in 2012 were estimated for lung cancer in men and breast cancer in women: 80 and 31 per 100,000, respectively. This paper provides a description of the burden of the major cancers in Campania until 2015. The estimates highlight the need to reinforce organized screening, especially for breast and colorectal cancer, and to support evidence-based prevention campaigns against female smoking. All these aspects require continuous and updated monitoring of the main epidemiological indicators in the Campania population.

Phytoplankton and microzooplankton growth and grazing dynamics in Kaneohe Bay, Hawaii, a subtropical estuarine coastal embayment

NASA Astrophysics Data System (ADS)

Selph, K. E.; Jungbluth, M.; Goetze, E.; Chang, S.; Uchida, M.; Kolker, G.

2016-02-01

This presentation will describe growth and mortality rates of phytoplankton, and the response of their primary consumers, in Kaneohe Bay, Hawaii, a subtropical coastal embayment. This study includes data from both dry and wet conditions, the latter where local storms increase stream flow, which in turn introduces macronutrients to surface waters of the bay, resulting in phytoplankton blooms. Phytoplankton growth and mortality rates are estimated using the seawater dilution method in 9 experiments conducted over a range of initial fluorometric chlorophyll a (Chl) conditions (i.e., from 0.3 to >1 µg Chl/L). Samples were also collected for determining the population dynamics of ciliates, dinoflagellates, and metazoan nauplii. Net growth rates could always be described with a linear negative regression as a function of dilution factor. In 2 experiments, the assumption that adding nutrients only affected the growth, and not the mortality, rates of the phytoplankton was tested and confirmed. The dominant picophytoplankton, Synechococcus (SYN), had cell-specific growth rates of 0.4 - 1.7 d-1, and positive net growth in all but one experiment. With the exception of 2 experiments conducted during and just after a diatom bloom, other pico- and nano-eukaryotic phytoplankton had negative cell-based growth rates, and mortality varied widely, from -0.22 to 0.94 d-1. Most experiments (5/9) showed higher growth with added macronutrients (ammonium and phosphorus), suggesting nutrient limitation. Microzooplankton biomass was relatively evenly partitioned between ciliates and dinoflagellates, however abundance was dominated by 10-20 µm (length) aloricate oligotrich ciliates, except for during a diatom bloom, where large (>30 µm length) ciliate mixotrophs and gymnodinoid dinoflagellates contributed to a 7-fold increase in micrograzer biomass. Thus, during episodic storm events, microzooplankton have elevated biomass, suggesting that some fraction of the increased production is available for higher trophic levels.

Toxicological evaluation of hydroethanolic extract of Helicteres sacarolha A. St.- Hil. et al.

PubMed

Balogun, Sikiru Olaitan; da Silva, Iberê Ferreira; Colodel, Edson Moleta; de Oliveira, Ruberlei Godinho; Ascêncio, Sérgio Donizeti; Martins, Domingos Tabajara de Oliveira

2014-11-18

Helicteres sacarolha, popularly known in Brazil as 'rosquinha', 'sacarolhas', 'semente-de-macaco', is widely distributed in different phytogeographic zones in Brazil. Preparations from its roots and leaves are employed in popular Brazilian medicine in the treatments of ailments such as peptic ulcer, hypertension among others. Cytotoxicity, acute oral and subchronic toxicity of the hydroethanolic extract of Helicteres sacrolha was investigated as well as the classes of phytochemical present in the extract. Hydroethanolic (70%) extract of Helicteres sacarolha (HEHs) was prepared by maceration. Potential cytotoxicity was evaluated in CHO-k1 cells. Acute administration of HEHs was done in mice as a single dose up to 5000mg/kg and subchronic oral toxicity study for 30 days in Wistar rats at daily oral doses of 0, 250 and 750mg/kg b.w. Clinical observations and toxicological related parameters were determined every 6 days. Blood was collected for biochemical and hematological analyses, while histological examinations were performed on selected organs. Selected secondary metabolites detected were quantified by UV-spectrophotometry and high performance liquid chromatography (HPLC). The extract was non-cytotoxic to CHO-k1 cells. In acute oral toxicity, there was no mortality or clinical alterations in the female mice, at all doses, except for the transient diarrhea observed at 5000mg/kg acute. Doses up to 2000mg/kg caused no mortality or treatment-related clinical manifestations in the male mice, but treatment-related alterations were however observed at 4000mg/kg, with mortalities recorded at 5000mg/kg. During the subchronic oral toxicity study, no mortality or treatment-related clinical signs were observed. Differences in relative organ weight, hematological parameters and histopathology observations between the treated and the control groups were considered not to be treatment-related. Spectrophotometric analysis revealed the presence of relatively high content of phenolics and flavonoids in HEHs. HPLC analysis confirmed the presence of the quantified compounds and demonstrated the presence of ellagic acid, morin and naringin. Our results confirmed that HEHs have a broad safety margin for therapeutic use. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Why are women so intelligent? The effect of maternal IQ on childhood mortality may be a relevant evolutionary factor.

PubMed

Charlton, Bruce G

2010-03-01

Humans are an unusual species because they exhibit an economic division of labour. Most theories concerning the evolution of specifically human intelligence have focused either on economic problems or sexual selection mechanisms, both of which apply more to men than women. Yet while there is evidence for men having a slightly higher average IQ, the sexual dimorphism of intelligence is not obvious (except at unusually high and low levels). However, a more female-specific selection mechanism concerns the distinctive maternal role in child care during the offspring's early years. It has been reported that increasing maternal intelligence is associated with reducing child mortality. This would lead to a greater level of reproductive success for intelligent women, and since intelligence is substantially heritable, this is a plausible mechanism by which natural selection might tend to increase female intelligence in humans. Any effect of maternal intelligence on improving child survival would likely be amplified by assortative mating for IQ by which people tend to marry others of similar intelligence - combining female maternal and male economic or sexual selection factors. Furthermore, since general intelligence seems to have the functional attribute of general purpose problem-solving and more rapid learning, the advantages of maternal IQ are likely to be greater as the environment for child-rearing is more different from the African hunter-gatherer society and savannah environment in which ancestral humans probably evolved. However, the effect of maternal IQ on child mortality would probably only be of major evolutionary significance in environments where childhood mortality rates were high. The modern situation is that population growth is determined mostly by birth rates; so in modern conditions, maternal intelligence may no longer have a significant effect on reproductive success; the effect of female IQ on reproductive success is often negative. Nonetheless, in the past it is plausible that the link between maternal IQ and child survival constituted a strong selection pressure acting specifically on women. Copyright (c) 2009. Published by Elsevier Ltd.

Are life histories of Norwegian fjord herring populations of Pacific ancestry similar to those of Atlantic or Pacific herring?

NASA Astrophysics Data System (ADS)

Mikkelsen, Nina; Pedersen, Torstein; dos Santos Schmidt, Thassya Christina; Falk-Petersen, Inger-Britt; Slotte, Aril

2018-04-01

Herring from two unexploited fjord populations, Lake Rossfjord (LRH, n = 100) and Balsfjord (BFH, n = 420) in northern Norway, were sampled in 2014 and 2015. Life history characteristics were analysed and compared to the oceanic Norwegian spring-spawning herring (NSSH), and other Atlantic and Pacific herring stocks. Genetic studies have shown that LRH and BFH are ancestors evolved from Pacific herring that hybridized with Atlantic herring. This study shows that both LRH and BFH mature at a relatively early age, at 2-3 years and ca. 4 years respectively, compared to ca. 5 years for NSSH. The spawning stocks of LRH and BFH consist of small fish and contain relatively few age classes. Both fjord populations have slow growth after sexual maturity; LRH has a very low asymptotic length (L∞ = 19.8 cm), while that of BFH is higher (L∞ of 28.5 cm); both these values being lower than that of NSSH (L∞ of ca. 37 cm). The somatic relative fecundity of LRH is 176.6 oocytes g- 1, while the somatic relative fecundity of recruit and repeat BFH spawners is 152.4 and 183.1 oocytes g- 1, respectively. These estimates are lower than those for NSSH and other Atlantic herring fjord populations, but comparable with other Pacific herring. Due to the smaller body sizes of the spawners in the LRH and BFH populations, absolute fecundity is much lower than in NSSH. The gonadosomatic indices of prespawning fish are similar in LRH and BFH, being slightly higher compared to the NSSH, but lower than values reported for Pacific herring. The natural mortality rates of LRH and BFH (M = 0.64 year- 1 and M = 0.76 year- 1, respectively) are much higher than in NSSH (M = 0.15 year- 1) and most other Atlantic herring populations, except the Lusterfjord herring. However, these high mortality rates are similar to those of several Pacific herring populations. It is concluded that LRH and BFH show low somatic growth and high natural mortality rate. These life history characteristics differ from those of NSSH, but are similar to some Pacific herring populations adapted to a coastal high-mortality risk environment.

Maternal and newborn outcomes in Pakistan compared to other low and middle income countries in the Global Network’s Maternal Newborn Health Registry: an active, community-based, pregnancy surveillance mechanism

PubMed Central

2015-01-01

Background Despite global improvements in maternal and newborn health (MNH), maternal, fetal and newborn mortality rates in Pakistan remain stagnant. Using data from the Global Network’s Maternal Newborn Health Registry (MNHR) the objective of this study is to compare the rates of maternal mortality, stillbirth and newborn mortality and levels of putative risk factors between the Pakistani site and those in other countries. Methods Using data collected through a multi-site, prospective, ongoing, active surveillance system to track pregnancies and births in communities in discrete geographical areas in seven sites across six countries including Pakistan, India, Kenya, Zambia, Guatemala and Argentina from 2010 to 2013, the study compared MNH outcomes and risk factors. The MNHR captures more than 60,000 deliveries annually across all sites with over 10,000 of them in Thatta, Pakistan. Results The Pakistan site had a maternal mortality ratio almost three times that of the other sites (313/100,000 vs 116/100,000). Stillbirth (56.5 vs 22.9/1000 births), neonatal mortality (50.0 vs 20.7/1000 livebirths) and perinatal mortality rates (95.2/1000 vs 39.0/1000 births) in Thatta, Pakistan were more than twice those of the other sites. The Pakistani site is the only one in the Global Network where maternal mortality increased (from 231/100,000 to 353/100,000) over the study period and fetal and neonatal outcomes remained stagnant. The Pakistan site lags behind other sites in maternal education, high parity, and appropriate antenatal and postnatal care. However, facility delivery and skilled birth attendance rates were less prominently different between the Pakistani site and other sites, with the exception of India. The difference in the fetal and neonatal outcomes between the Pakistani site and the other sites was most pronounced amongst normal birth weight babies. Conclusions The increase in maternal mortality and the stagnation of fetal and neonatal outcomes from 2010 to 2013 indicates that current levels of antenatal and newborn care interventions in Thatta, Pakistan are insufficient to protect against poor maternal and neonatal outcomes. Delivery care in the Pakistani site, while appearing quantitatively equivalent to the care in sites in Africa, is less effective in saving the lives of women and their newborns. By the metrics available from this study, the quality of obstetric and neonatal care in the site in Pakistan is poor. Trial registration The study is registered at clinicaltrials.gov [NCT01073475]. PMID:26062610

Maternal and newborn outcomes in Pakistan compared to other low and middle income countries in the Global Network's Maternal Newborn Health Registry: an active, community-based, pregnancy surveillance mechanism.

PubMed

Pasha, Omrana; Saleem, Sarah; Ali, Sumera; Goudar, Shivaprasad S; Garces, Ana; Esamai, Fabian; Patel, Archana; Chomba, Elwyn; Althabe, Fernando; Moore, Janet L; Harrison, Margo; Berrueta, Mabel B; Hambidge, K; Krebs, Nancy F; Hibberd, Patricia L; Carlo, Waldemar A; Kodkany, Bhala; Derman, Richard J; Liechty, Edward A; Koso-Thomas, Marion; McClure, Elizabeth M; Goldenberg, Robert L

2015-01-01

Despite global improvements in maternal and newborn health (MNH), maternal, fetal and newborn mortality rates in Pakistan remain stagnant. Using data from the Global Network's Maternal Newborn Health Registry (MNHR) the objective of this study is to compare the rates of maternal mortality, stillbirth and newborn mortality and levels of putative risk factors between the Pakistani site and those in other countries. Using data collected through a multi-site, prospective, ongoing, active surveillance system to track pregnancies and births in communities in discrete geographical areas in seven sites across six countries including Pakistan, India, Kenya, Zambia, Guatemala and Argentina from 2010 to 2013, the study compared MNH outcomes and risk factors. The MNHR captures more than 60,000 deliveries annually across all sites with over 10,000 of them in Thatta, Pakistan. The Pakistan site had a maternal mortality ratio almost three times that of the other sites (313/100,000 vs 116/100,000). Stillbirth (56.5 vs 22.9/1000 births), neonatal mortality (50.0 vs 20.7/1000 livebirths) and perinatal mortality rates (95.2/1000 vs 39.0/1000 births) in Thatta, Pakistan were more than twice those of the other sites. The Pakistani site is the only one in the Global Network where maternal mortality increased (from 231/100,000 to 353/100,000) over the study period and fetal and neonatal outcomes remained stagnant. The Pakistan site lags behind other sites in maternal education, high parity, and appropriate antenatal and postnatal care. However, facility delivery and skilled birth attendance rates were less prominently different between the Pakistani site and other sites, with the exception of India. The difference in the fetal and neonatal outcomes between the Pakistani site and the other sites was most pronounced amongst normal birth weight babies. The increase in maternal mortality and the stagnation of fetal and neonatal outcomes from 2010 to 2013 indicates that current levels of antenatal and newborn care interventions in Thatta, Pakistan are insufficient to protect against poor maternal and neonatal outcomes. Delivery care in the Pakistani site, while appearing quantitatively equivalent to the care in sites in Africa, is less effective in saving the lives of women and their newborns. By the metrics available from this study, the quality of obstetric and neonatal care in the site in Pakistan is poor. The study is registered at clinicaltrials.gov [NCT01073475].

Human papillomavirus detection using the Abbott RealTime high-risk HPV tests compared with conventional nested PCR coupled to high-throughput sequencing of amplification products in cervical smear specimens from a Gabonese female population.

PubMed

Moussavou-Boundzanga, Pamela; Koumakpayi, Ismaël Hervé; Labouba, Ingrid; Leroy, Eric M; Belembaogo, Ernest; Berthet, Nicolas

2017-12-21

Cervical cancer is the fourth most common malignancy in women worldwide. However, screening with human papillomavirus (HPV) molecular tests holds promise for reducing cervical cancer incidence and mortality in low- and middle-income countries. The performance of the Abbott RealTime High-Risk HPV test (AbRT) was evaluated in 83 cervical smear specimens and compared with a conventional nested PCR coupled to high-throughput sequencing (HTS) to identify the amplicons. The AbRT assay detected at least one HPV genotype in 44.57% of women regardless of the grade of cervical abnormalities. Except for one case, good concordance was observed for the genotypes detected with the AbRT assay in the high-risk HPV category determined with HTS of the amplicon generated by conventional nested PCR. The AbRT test is an easy and reliable molecular tool and was as sensitive as conventional nested PCR in cervical smear specimens for detection HPVs associated with high-grade lesions. Moreover, sequencing amplicons using an HTS approach effectively identified the genotype of the hrHPV identified with the AbRT test.

Socioeconomic Factors and All Cause and Cause-Specific Mortality among Older People in Latin America, India, and China: A Population-Based Cohort Study

PubMed Central

Ferri, Cleusa P.; Acosta, Daisy; Guerra, Mariella; Huang, Yueqin; Llibre-Rodriguez, Juan J.; Salas, Aquiles; Sosa, Ana Luisa; Williams, Joseph D.; Gaona, Ciro; Liu, Zhaorui; Noriega-Fernandez, Lisseth; Jotheeswaran, A. T.; Prince, Martin J.

2012-01-01

Background Even in low and middle income countries most deaths occur in older adults. In Europe, the effects of better education and home ownership upon mortality seem to persist into old age, but these effects may not generalise to LMICs. Reliable data on causes and determinants of mortality are lacking. Methods and Findings The vital status of 12,373 people aged 65 y and over was determined 3–5 y after baseline survey in sites in Latin America, India, and China. We report crude and standardised mortality rates, standardized mortality ratios comparing mortality experience with that in the United States, and estimated associations with socioeconomic factors using Cox's proportional hazards regression. Cause-specific mortality fractions were estimated using the InterVA algorithm. Crude mortality rates varied from 27.3 to 70.0 per 1,000 person-years, a 3-fold variation persisting after standardisation for demographic and economic factors. Compared with the US, mortality was much higher in urban India and rural China, much lower in Peru, Venezuela, and urban Mexico, and similar in other sites. Mortality rates were higher among men, and increased with age. Adjusting for these effects, it was found that education, occupational attainment, assets, and pension receipt were all inversely associated with mortality, and food insecurity positively associated. Mutually adjusted, only education remained protective (pooled hazard ratio 0.93, 95% CI 0.89–0.98). Most deaths occurred at home, but, except in India, most individuals received medical attention during their final illness. Chronic diseases were the main causes of death, together with tuberculosis and liver disease, with stroke the leading cause in nearly all sites. Conclusions Education seems to have an important latent effect on mortality into late life. However, compositional differences in socioeconomic position do not explain differences in mortality between sites. Social protection for older people, and the effectiveness of health systems in preventing and treating chronic disease, may be as important as economic and human development. Please see later in the article for the Editors' Summary PMID:22389633

Socioeconomic inequalities in cause-specific mortality in 15 European cities.

PubMed

Marí-Dell'Olmo, Marc; Gotsens, Mercè; Palència, Laia; Burström, Bo; Corman, Diana; Costa, Giuseppe; Deboosere, Patrick; Díez, Èlia; Domínguez-Berjón, Felicitas; Dzúrová, Dagmar; Gandarillas, Ana; Hoffmann, Rasmus; Kovács, Katalin; Martikainen, Pekka; Demaria, Moreno; Pikhart, Hynek; Rodríguez-Sanz, Maica; Saez, Marc; Santana, Paula; Schwierz, Cornelia; Tarkiainen, Lasse; Borrell, Carme

2015-05-01

Socioeconomic inequalities are increasingly recognised as an important public health issue, although their role in the leading causes of mortality in urban areas in Europe has not been fully evaluated. In this study, we used data from the INEQ-CITIES study to analyse inequalities in cause-specific mortality in 15 European cities at the beginning of the 21st century. A cross-sectional ecological study was carried out to analyse 9 of the leading specific causes of death in small areas from 15 European cities. Using a hierarchical Bayesian spatial model, we estimated smoothed Standardized Mortality Ratios, relative risks and 95% credible intervals for cause-specific mortality in relation to a socioeconomic deprivation index, separately for men and women. We detected spatial socioeconomic inequalities for most causes of mortality studied, although these inequalities differed markedly between cities, being more pronounced in Northern and Central-Eastern Europe. In the majority of cities, most of these causes of death were positively associated with deprivation among men, with the exception of prostatic cancer. Among women, diabetes, ischaemic heart disease, chronic liver diseases and respiratory diseases were also positively associated with deprivation in most cities. Lung cancer mortality was positively associated with deprivation in Northern European cities and in Kosice, but this association was non-existent or even negative in Southern European cities. Finally, breast cancer risk was inversely associated with deprivation in three Southern European cities. The results confirm the existence of socioeconomic inequalities in many of the main causes of mortality, and reveal variations in their magnitude between different European cities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Race, exercise training, and outcomes in chronic heart failure: Findings from Heart Failure - A Controlled Trial Investigating Outcomes in Exercise TraiNing (HF-ACTION)

PubMed Central

Mentz, Robert J.; Bittner, Vera; Schulte, Phillip J.; Fleg, Jerome L.; Piña, Ileana L.; Keteyian, Steven J.; Moe, Gordon; Nigam, Anil; Swank, Ann M.; Onwuanyi, Anekwe E.; Fitz-Gerald, Meredith; Kao, Andrew; Ellis, Stephen J.; Kraus, William E.; Whellan, David J.; O'Connor, Christopher M.

2014-01-01

Background The strength of race as an independent predictor of long-term outcomes in a contemporary chronic heart failure (HF) population and its association with exercise training response have not been well established. We aimed to investigate the association between race and outcomes and to explore interactions with exercise training in patients with ambulatory HF. Methods We performed an analysis of HF-ACTION, which randomized 2331 patients with HF having an ejection fraction ≤35% to usual care with or without exercise training. We examined characteristics and outcomes (mortality/hospitalization, mortality, and cardiovascular mortality/HF hospitalization) by race using adjusted Cox models and explored an interaction with exercise training. Results There were 749 self-identified black patients (33%). Blacks were younger with significantly more hypertension and diabetes, less ischemic etiology, and lower socioeconomic status versus whites. Blacks had shorter 6-minute walk distance and lower peak VO2 at baseline. Over a median follow-up of 2.5 years, black race was associated with increased risk for all outcomes except mortality. After multivariable adjustment, black race was associated with increased mortality/hospitalization (hazard ratio [HR] 1.16, 95% CI 1.01–1.33) and cardiovascular mortality/HF hospitalization (HR 1.46, 95% CI 1.20–1.77). The hazard associated with black race was largely caused by increased HF hospitalization (HR 1.58, 95% CI 1.27–1.96), given similar cardiovascular mortality. There was no interaction between race and exercise training on outcomes (P >.5). Conclusions Black race in patients with chronic HF was associated with increased prevalence of modifiable risk factors, lower exercise performance, and increased HF hospitalization, but not increased mortality or a differential response to exercise training. PMID:24016498

Trends in cause specific mortality across occupations in Japanese men of working age during period of economic stagnation, 1980-2005: retrospective cohort study.

PubMed

Wada, Koji; Kondo, Naoki; Gilmour, Stuart; Ichida, Yukinobu; Fujino, Yoshihisa; Satoh, Toshihiko; Shibuya, Kenji

2012-03-06

To assess the temporal trends in occupation specific all causes and cause specific mortality in Japan between 1980 and 2005. Longitudinal analysis of individual death certificates by last occupation before death. Data on population by age and occupation were derived from the population census. Government records, Japan. Men aged 30-59. Age standardised mortality rate for all causes, all cancers, cerebrovascular disease, ischaemic heart disease, unintentional injuries, and suicide. Age standardised mortality rates for all causes and for the four leading causes of death (cancers, ischaemic heart disease, cerebrovascular disease, and unintentional injuries) steadily decreased from 1980 to 2005 among all occupations except for management and professional workers, for whom rates began to rise in the late 1990s (P<0.001). During the study period, the mortality rate was lowest in other occupations such as production/labour, clerical, and sales workers, although overall variability of the age standardised mortality rate across occupations widened. The rate for suicide rapidly increased since the late 1990s, with the greatest increase being among management and professional workers. Occupational patterns in cause specific mortality changed dramatically in Japan during the period of its economic stagnation and resulted in the reversal of occupational patterns in mortality that have been well established in western countries. A significant negative effect on the health of management and professional workers rather than clerks and blue collar workers could be because of increased job demands and more stressful work environments and could have eliminated or even reversed the health inequality across occupations that had existed previously.

Trends in Mortality from Cerebrovascular and Hypertensive Diseases in Brazil Between 1980 and 2012.

PubMed

Villela, Paolo Blanco; Klein, Carlos Henrique; Oliveira, Gláucia Maria Moraes de

2016-07-01

Cerebrovascular and hypertensive diseases are among the main causes of death worldwide. However, there are limited data about the trends of these diseases over the years. To evaluate the temporal trends in mortality rates and proportional mortality from cerebrovascular and hypertensive diseases according to sex and age in Brazil between 1980 and 2012. We evaluated the underlying causes of death between 1980 and 2012 in both sexes and by age groups for circulatory diseases (CD), cerebrovascular diseases (CBVD), and hypertensive diseases (HD). We also evaluated death due to all causes (AC), external causes (EC), and ill-defined causes of death (IDCD). Data on deaths and population were obtained from the Department of Information Technology of the Unified Health System (Departamento de Informática do Sistema Único de Saúde, DATASUS/MS). We estimated crude and standardized annual mortality rates per 100,000 inhabitants and percentages of proportional mortality rates. With the exception of EC, the mortality rates per 100,000 inhabitants of all other diseases increased with age. The proportional mortality of CD, CBVD, and HD increased up to the age range of 60-69 years in men and 70-79 years in women, and reached a plateau in both sexes after that. The standardized rates of CD and CBVD declined in both sexes. However, the HD rates showed the opposite trend and increased mildly during the study period. Despite the decline in standardized mortality rates due to CD and CBVD, there was an increase in deaths due to HD, which could be related to factors associated with the completion of the death certificates, decline in IDCD rates, and increase in the prevalence of hypertension.

Leading Causes of Death among Asian American Subgroups (2003-2011).

PubMed

Hastings, Katherine G; Jose, Powell O; Kapphahn, Kristopher I; Frank, Ariel T H; Goldstein, Benjamin A; Thompson, Caroline A; Eggleston, Karen; Cullen, Mark R; Palaniappan, Latha P

2015-01-01

Our current understanding of Asian American mortality patterns has been distorted by the historical aggregation of diverse Asian subgroups on death certificates, masking important differences in the leading causes of death across subgroups. In this analysis, we aim to fill an important knowledge gap in Asian American health by reporting leading causes of mortality by disaggregated Asian American subgroups. We examined national mortality records for the six largest Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) and non-Hispanic Whites (NHWs) from 2003-2011, and ranked the leading causes of death. We calculated all-cause and cause-specific age-adjusted rates, temporal trends with annual percent changes, and rate ratios by race/ethnicity and sex. Rankings revealed that as an aggregated group, cancer was the leading cause of death for Asian Americans. When disaggregated, there was notable heterogeneity. Among women, cancer was the leading cause of death for every group except Asian Indians. In men, cancer was the leading cause of death among Chinese, Korean, and Vietnamese men, while heart disease was the leading cause of death among Asian Indians, Filipino and Japanese men. The proportion of death due to heart disease for Asian Indian males was nearly double that of cancer (31% vs. 18%). Temporal trends showed increased mortality of cancer and diabetes in Asian Indians and Vietnamese; increased stroke mortality in Asian Indians; increased suicide mortality in Koreans; and increased mortality from Alzheimer's disease for all racial/ethnic groups from 2003-2011. All-cause rate ratios revealed that overall mortality is lower in Asian Americans compared to NHWs. Our findings show heterogeneity in the leading causes of death among Asian American subgroups. Additional research should focus on culturally competent and cost-effective approaches to prevent and treat specific diseases among these growing diverse populations.

Alcohol intake and mortality among survivors of colorectal cancer: The Cancer Prevention Study II Nutrition Cohort.

PubMed

Yang, Baiyu; Gapstur, Susan M; Newton, Christina C; Jacobs, Eric J; Campbell, Peter T

2017-06-01

Alcohol consumption is associated with a higher risk of colorectal cancer, but to the authors' knowledge its influence on survival after a diagnosis of colorectal cancer is unclear. The authors investigated associations between prediagnosis and postdiagnosis alcohol intake with mortality among survivors of colorectal cancer. The authors identified 2458 men and women who were diagnosed with invasive, nonmetastatic colorectal cancer between 1992 (enrollment into the Cancer Prevention Study II Nutrition Cohort) and 2011. Alcohol consumption was self-reported at baseline and updated in 1997, 1999, 2003, and 2007. Postdiagnosis alcohol data were available for 1599 participants. Of the 2458 participants diagnosed with colorectal cancer, 1156 died during follow-up through 2012. Prediagnosis and postdiagnosis alcohol consumption were not found to be associated with all-cause mortality, except for an association between prediagnosis consumption of <2 drinks per day and a slightly lower risk of all-cause mortality (relative risk [RR], 0.86; 95% confidence interval [95% CI], 0.74-1.00) compared with never drinking. Alcohol use was generally not associated with colorectal cancer-specific mortality, although there was some suggestion of increased colorectal cancer-specific mortality with postdiagnosis drinking (RR, 1.27 [95% CI, 0.87-1.86] for current drinking of <2 drinks/day and RR, 1.44 [95% CI, 0.80-2.60] for current drinking of ≥2 drinks/day). The results of the current study do not support an association between alcohol consumption and all-cause mortality among individuals with nonmetastatic colorectal cancer. The association between postdiagnosis drinking and colorectal cancer-specific mortality should be examined in larger studies of individuals diagnosed with nonmetastatic colorectal cancer. Cancer 2017;123:2006-2013. © 2017 American Cancer Society. © 2017 American Cancer Society.

National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014.

PubMed

Lecoffre, Camille; de Peretti, Christine; Gabet, Amélie; Grimaud, Olivier; Woimant, France; Giroud, Maurice; Béjot, Yannick; Olié, Valérie

2017-11-01

Stroke is the leading cause of death in women and the third leading cause in men in France. In young adults (ie, <65 years old), an increase in the incidence of ischemic stroke was observed at a local scale between 1985 and 2011. After the implementation of the 2010 to 2014 National Stroke Action Plan, this study investigates national trends in patients hospitalized by stroke subtypes, in-hospital mortality, and stroke mortality between 2008 and 2014. Hospitalization data were extracted from the French national hospital discharge databases and mortality data from the French national medical causes of death database. Time trends were tested using a Poisson regression model. From 2008 to 2014, the age-standardized rates of patients hospitalized for ischemic stroke increased by 14.3% in patients <65 years old and decreased by 1.5% in those aged ≥65 years. The rate of patients hospitalized for hemorrhagic stroke was stable (+2.0%), irrespective of age and sex. The proportion of patients hospitalized in stroke units substantially increased. In-hospital mortality decreased by 17.1% in patients with ischemic stroke. From 2008 to 2013, stroke mortality decreased, except for women between 45 and 64 years old and for people aged ≥85 years. An increase in cardiovascular risk factors and improved stroke management may explain the increase in the rates of patients hospitalized for ischemic stroke. The decrease observed for in-hospital stroke mortality may be because of recent improvements in acute-phase management. © 2017 American Heart Association, Inc.

Tuberculosis mortality trends in cuba, 1998 to 2007.

PubMed

González, Edilberto; Risco, Grisel E; Borroto, Susana; Perna, Abel; Armas, Luisa

2009-01-01

Introduction Tuberculosis (TB) is a major cause of illness and death throughout the world. The World Health Organization's Global Plan to Stop TB 2006-2015 proposes that countries cut TB mortality by half compared to 1990 rates. In Cuba, TB mortality declined steadily throughout the 20th century, particularly after 1960. Objective Describe TB mortality distribution and trends in Cuba from January 1998 to December 2007 by infection site, sex, age and province, and determine progress towards the WHO's 2015 target for TB mortality reduction. Methods A time series ecological study was conducted. Death certificates stating TB as cause of death were obtained from the Ministry of Public Health's National Statistics Division, and population data by age group, sex, and province were obtained from the National Statistics Bureau. Crude and specific death rate trends and variation were analyzed. Results TB mortality declined from 0.4 per 100,000 population in 1998 to 0.2 (under half the 1990 rate) in 2007. Clinical forms of the disease, both pulmonary and extrapulmonary, also declined. The highest mortality rates were found in males and in the group aged ≥ 65 years. Rates were also highest in the capital, Havana, with extreme values of 0.73 and 0.39 per 100,000 population at the beginning and end of the period, respectively. Conclusions Deaths from TB declined steadily compared to total deaths and deaths caused by infectious diseases. The Global Plan to Stop TB target was met well ahead of 2015. If this trend continues, TB is likely to become an exceptional cause of death in Cuba.

Mapping under-5 and neonatal mortality in Africa, 2000-15: a baseline analysis for the Sustainable Development Goals.

PubMed

Golding, Nick; Burstein, Roy; Longbottom, Joshua; Browne, Annie J; Fullman, Nancy; Osgood-Zimmerman, Aaron; Earl, Lucas; Bhatt, Samir; Cameron, Ewan; Casey, Daniel C; Dwyer-Lindgren, Laura; Farag, Tamer H; Flaxman, Abraham D; Fraser, Maya S; Gething, Peter W; Gibson, Harry S; Graetz, Nicholas; Krause, L Kendall; Kulikoff, Xie Rachel; Lim, Stephen S; Mappin, Bonnie; Morozoff, Chloe; Reiner, Robert C; Sligar, Amber; Smith, David L; Wang, Haidong; Weiss, Daniel J; Murray, Christopher J L; Moyes, Catherine L; Hay, Simon I

2017-11-11

During the Millennium Development Goal (MDG) era, many countries in Africa achieved marked reductions in under-5 and neonatal mortality. Yet the pace of progress toward these goals substantially varied at the national level, demonstrating an essential need for tracking even more local trends in child mortality. With the adoption of the Sustainable Development Goals (SDGs) in 2015, which established ambitious targets for improving child survival by 2030, optimal intervention planning and targeting will require understanding of trends and rates of progress at a higher spatial resolution. In this study, we aimed to generate high-resolution estimates of under-5 and neonatal all-cause mortality across 46 countries in Africa. We assembled 235 geographically resolved household survey and census data sources on child deaths to produce estimates of under-5 and neonatal mortality at a resolution of 5 × 5 km grid cells across 46 African countries for 2000, 2005, 2010, and 2015. We used a Bayesian geostatistical analytical framework to generate these estimates, and implemented predictive validity tests. In addition to reporting 5 × 5 km estimates, we also aggregated results obtained from these estimates into three different levels-national, and subnational administrative levels 1 and 2-to provide the full range of geospatial resolution that local, national, and global decision makers might require. Amid improving child survival in Africa, there was substantial heterogeneity in absolute levels of under-5 and neonatal mortality in 2015, as well as the annualised rates of decline achieved from 2000 to 2015. Subnational areas in countries such as Botswana, Rwanda, and Ethiopia recorded some of the largest decreases in child mortality rates since 2000, positioning them well to achieve SDG targets by 2030 or earlier. Yet these places were the exception for Africa, since many areas, particularly in central and western Africa, must reduce under-5 mortality rates by at least 8·8% per year, between 2015 and 2030, to achieve the SDG 3.2 target for under-5 mortality by 2030. In the absence of unprecedented political commitment, financial support, and medical advances, the viability of SDG 3.2 achievement in Africa is precarious at best. By producing under-5 and neonatal mortality rates at multiple levels of geospatial resolution over time, this study provides key information for decision makers to target interventions at populations in the greatest need. In an era when precision public health increasingly has the potential to transform the design, implementation, and impact of health programmes, our 5 × 5 km estimates of child mortality in Africa provide a baseline against which local, national, and global stakeholders can map the pathways for ending preventable child deaths by 2030. Bill & Melinda Gates Foundation. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Low oxygen saturation is associated with pre-hospital mortality among non-traumatic patients using emergency medical services: A national database of Thailand.

PubMed

Sittichanbuncha, Yuwares; Savatmongkorngul, Sorrawit; Jawroongrit, Puchong; Sawanyawisuth, Kittisak

2015-09-01

Pre-hospital emergency medical services are an important network for Emergency Medicine. It has been shown to reduce morbidity and mortality of patients by medical procedures. The Thai government established pre-hospital emergency medical services in 2008 to improve emergency medical care. Since then, there are limited data at the national level on mortality rates with pre-hospital care and the risk factors associated with mortality in non-traumatic patients. To study the pre-hospital mortality rate and factors associated with mortality in non-traumatic patients using the emergency medical service in Thailand. This study retrieved medical data from the National Institute for Emergency Medicine, NIEMS. The inclusion criteria were adult patients above the age of 15 who received medical services by the emergency medical services in Thailand (except Bangkok) from April 1st, 2011 to March 31st, 2012. Patients were excluded if there was no treatment during pre-hospital period, if they were trauma patients, or if their medical data was incomplete. Patients were categorized as either in the survival or non-survival group. Factors associated with mortality were examined by multivariate logistic regression analysis. During the study period, there were 127,602 non-traumatic patients who used pre-hospital emergency medical services in Thailand. Of those, 98,587 patients met the study criteria. For the statistical analyses, there were 66,760 patients who had complete clinical investigations. The mortality rate in this group was 1.89%. Only oxygen saturation was associated with mortality by multivariate logistic regression analysis. The adjusted OR was 0.922 (95% CI 0.8550.994). Low oxygen saturation is significantly associated with pre-hospital mortality in a national database of non-traumatic patients using emergency medical services in Thailand. During pre-hospital care, oxygen level should be monitored and promptly treated. Pulse oximetry devices should be available in all pre-hospital services.

Radiation modality use and cardiopulmonary mortality risk in elderly patients with esophageal cancer.

PubMed

Lin, Steven H; Zhang, Ning; Godby, Joy; Wang, Jingya; Marsh, Gary D; Liao, Zhongxing; Komaki, Ritsuko; Ho, Linus; Hofstetter, Wayne L; Swisher, Stephen G; Mehran, Reza J; Buchholz, Thomas A; Elting, Linda S; Giordano, Sharon H

2016-03-15

It is currently unclear whether the superior normal organ-sparing effect of intensity-modulated radiotherapy (IMRT) compared with 3-dimensional radiotherapy (3D) has a clinical impact on survival and cardiopulmonary mortality in patients with esophageal cancer (EC). The authors identified 2553 patients aged > 65 years from the Surveillance, Epidemiology, and End Results (SEER)-Medicare and Texas Cancer Registry-Medicare databases who had nonmetastatic EC diagnosed between 2002 and 2009 and were treated with either 3D (2240 patients) or IMRT (313 patients) within 6 months of diagnosis. The outcomes of the 2 cohorts were compared using inverse probability of treatment weighting adjustment. Except for marital status, year of diagnosis, and SEER region, both radiation cohorts were well balanced with regard to various patient, tumor, and treatment characteristics, including the use of IMRT versus 3D in urban/metropolitan or rural areas. IMRT use increased from 2.6% in 2002 to 30% in 2009, whereas the use of 3D decreased from 97.4% in 2002 to 70% in 2009. On propensity score inverse probability of treatment weighting-adjusted multivariate analysis, IMRT was not found to be associated with EC-specific mortality (hazard ratio [HR], 0.93; 95% confidence interval [95% CI], 0.80-1.10) or pulmonary mortality (HR, 1.11; 95% CI, 0.37-3.36), but was significantly associated with lower all-cause mortality (HR, 0.83; 95% CI, 0.72-0.95), cardiac mortality (HR, 0.18; 95% CI, 0.06-0.54), and other-cause mortality (HR, 0.54; 95% CI, 0.35-0.84). Similar associations were noted after adjusting for the type of chemotherapy, physician experience, and sensitivity analysis removing hybrid radiation claims. In this population-based analysis, the use of IMRT was found to be significantly associated with lower all-cause mortality, cardiac mortality, and other-cause mortality in patients with EC. © 2015 American Cancer Society.

Naked mole-rat mortality rates defy Gompertzian laws by not increasing with age

PubMed Central

Ruby, J Graham; Smith, Megan

2018-01-01

The longest-lived rodent, the naked mole-rat (Heterocephalus glaber), has a reported maximum lifespan of >30 years and exhibits delayed and/or attenuated age-associated physiological declines. We questioned whether these mouse-sized, eusocial rodents conform to Gompertzian mortality laws by experiencing an exponentially increasing risk of death as they get older. We compiled and analyzed a large compendium of historical naked mole-rat lifespan data with >3000 data points. Kaplan-Meier analyses revealed a substantial portion of the population to have survived at 30 years of age. Moreover, unlike all other mammals studied to date, and regardless of sex or breeding-status, the age-specific hazard of mortality did not increase with age, even at ages 25-fold past their time to reproductive maturity. This absence of hazard increase with age, in defiance of Gompertz’s law, uniquely identifies the naked mole-rat as a non-aging mammal, confirming its status as an exceptional model for biogerontology. PMID:29364116

[Suicide, antidepressant prescription and unemployment in Andalusia (Spain)].

PubMed

Alameda-Palacios, José; Ruiz-Ramos, Miguel; García-Robredo, Beatriz

2014-01-01

To analyze the trend in suicide mortality in Andalusia from 1975 to 2012 and its relationship with unemployment and the use of antidepressants. Poisson's segmented regression models were used to estimate changes over time. The association between suicide and the factors examined was measured using Spearman's correlation coefficient. Suicide mortality patterns in men and women are rising. The largest increase was found in people aged from 15 to 44 years, with an annual percentage rate change of 1.21 (95%CI: 0.7-1.7) for men and 0.93 (95%CI: 0.4-1.4) for women. Mortality by suicide has increased in Andalusia since 1975 in all age and gender groups except for women aged 65 years or above. During the last few decades, an upward trend has been observed in young people and a stable or falling trend in the remaining population. Temporary variations in suicide rates are not associated with unemployment rates or with changes in antidepressant prescription. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

Detection of Bordetella pertussis in Infants Suspected to have Whooping Cough.

PubMed

Hajia, Massoud; Rahbar, Mohammad; Fallah, Fatemeh; Safadel, Nooshafarin

2012-01-01

Even with high coverage of vaccination programs, Bordetella pertussis is still reported in various countries. It causes a high rate of mortality and morbidity in infants while it could be asymptomatic in adults. At the present study, we are going to evaluate the frequency of B. pertussis among received specimens. This cross-sectional study was performed on 138 children under one year who were suspected to have whooping cough from October 2008 to March in 2011. Nasopharyngeal dacron and rayon swabs and sera were used for PCR and serology respectively. The mean age of the subjects was 1.9± 0.9 months. PCR was positive in 12 cases; ELISA was in agreement with PCR results except in one case that showed the specific antibody at borderline limit. The rate of reported positive results showed that pertussis not only is still present in the community, but the number of the asymptomatic cases who are able to transmit the disease may be considerable.

Update in mild traumatic brain injury.

PubMed

Freire-Aragón, María Dolores; Rodríguez-Rodríguez, Ana; Egea-Guerrero, Juan José

2017-08-10

There has been concern for many years regarding the identification of patients with mild traumatic brain injury (TBI) at high risk of developing an intracranial lesion (IL) that would require neurosurgical intervention. The small percentage of patients with these characteristics and the exceptional mortality associated with mild TBI with IL have led to the high use of resources such as computerised tomography (CT) being reconsidered. The various protocols developed for the management of mild TBI are based on the identification of risk factors for IL, which ultimately allows more selective indication or discarding both the CT application and the hospital stay for neurological monitoring. Finally, progress in the study of brain injury biomarkers with prognostic utility in different clinical categories of TBI has recently been incorporated by several clinical practice guidelines, which has allowed, together with clinical assessment, a more accurate prognostic approach for these patients to be established. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Rapid detection of single bacteria in unprocessed blood using Integrated Comprehensive Droplet Digital Detection

PubMed Central

Kang, Dong-Ku; Ali, M. Monsur; Zhang, Kaixiang; Huang, Susan S.; Peterson, Ellena; Digman, Michelle A.; Gratton, Enrico; Zhao, Weian

2014-01-01

Blood stream infection or sepsis is a major health problem worldwide, with extremely high mortality, which is partly due to the inability to rapidly detect and identify bacteria in the early stages of infection. Here we present a new technology termed ‘Integrated Comprehensive Droplet Digital Detection’ (IC 3D) that can selectively detect bacteria directly from milliliters of diluted blood at single-cell sensitivity in a one-step, culture- and amplification-free process within 1.5–4 h. The IC 3D integrates real-time, DNAzyme-based sensors, droplet microencapsulation and a high-throughput 3D particle counter system. Using Escherichia coli as a target, we demonstrate that the IC 3D can provide absolute quantification of both stock and clinical isolates of E. coli in spiked blood within a broad range of extremely low concentration from 1 to 10,000 bacteria per ml with exceptional robustness and limit of detection in the single digit regime. PMID:25391809

The burden of culture? Health outcomes among immigrants from the former Soviet Union in the United States.

PubMed

Hofmann, Erin Trouth

2012-04-01

Immigrants in the U.S. often experience better health than the native-born, and many explanations for this phenomenon center around the positive health behaviors that immigrants bring from their home cultures. Immigrants from the former Soviet Union may be an exception; because they come from societies where unhealthy lifestyles and high mortality are common, they are often expected to experience worse health than the native population. Using data from the Integrated Health Interview Series, I compare FSU immigrants with U.S.-born, non-Hispanic whites on several health measures. FSU immigrants are twice as likely as native whites to report fair or poor health, but they are less likely to smoke or drink, and are less likely to report a functional limitation. FSU immigrants' advantage in functional limitation is largely explained by their very high levels of education and marriage, indicating that selectivity is important to understanding the health of this population.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ying, Tianlei; Prabakaran, Ponraj; Du, Lanying

The MERS-CoV is an emerging virus, which already infected more than 1,300 humans with high (~36%) mortality. Here, we show that m336, an exceptionally potent human anti-MERS-CoV antibody, is almost germline with only one somatic mutation in the heavy chain. The structure of Fab m336 in complex with the MERS-CoV receptor-binding domain reveals that its IGHV1-69-derived heavy chain provides more than 85% binding surface and that its epitope almost completely overlaps with the receptor-binding site. Analysis of antibodies from 69 healthy humans suggests an important role of the V(D)J recombination-generated junctional and allele-specific residues for achieving high affinity of bindingmore » at such low levels of somatic hypermutation. Our results also have important implications for development of vaccine immunogens based on the newly identified m336 epitope as well as for elucidation of mechanisms of neutralization by m336-like antibodies and their elicitation in vivo.« less

Life Expectancy Among U.S.-born and Foreign-born Older Adults in the United States: Estimates From Linked Social Security and Medicare Data.

PubMed

Mehta, Neil K; Elo, Irma T; Engelman, Michal; Lauderdale, Diane S; Kestenbaum, Bert M

2016-08-01

In recent decades, the geographic origins of America's foreign-born population have become increasingly diverse. The sending countries of the U.S. foreign-born vary substantially in levels of health and economic development, and immigrants have arrived with distinct distributions of socioeconomic status, visa type, year of immigration, and age at immigration. We use high-quality linked Social Security and Medicare records to estimate life tables for the older U.S. population over the full range of birth regions. In 2000-2009, the foreign-born had a 2.4-year advantage in life expectancy at age 65 relative to the U.S.-born, with Asian-born subgroups displaying exceptionally high longevity. Foreign-born individuals who migrated more recently had lower mortality compared with those who migrated earlier. Nonetheless, we also find remarkable similarities in life expectancy among many foreign-born subgroups that were born in very different geographic and socioeconomic contexts (e.g., Central America, western/eastern Europe, and Africa).

Acute and long-term effects of irradiation on pine (Pinus silvestris) strands post-Chernobyl.

PubMed

Arkhipov, N P; Kuchma, N D; Askbrant, S; Pasternak, P S; Musica, V V

1994-12-11

The effect of ionizing irradiation on the viability of pine stands after the fallout from the damaged nuclear energy plant at Chernobyl (ChNPP) was shown within the territory of the 10-km zone. During the period 1986-1991, irradiated and damaged forest stands, so-called 'red forest', located in this area were systematically classified by observation. Mortality rate, re-establishment, development of tree canopies, reproduction anomalies and stand viability were shown to be dependent on absorbed irradiation dose, on the age of the stand and on forest composition. For pine stands in the acutely affected zone, doses of more than 60 Gy resulted in a massive mortality and no regeneration of pine trees since 1987. The injured trees had burned or had dried-up. The drying process was accelerated by a massive production of pathogenic insects invading the dying trees. Specifically, irradiation doses of 10-60 Gy, 1-10 Gy and 0.1-1 Gy caused high, medium and low injury to the forest stands, respectively. Doses of less than 0.1 Gy did not cause any visible damage to the trees. In 1987, repair processes were displayed by the tree canopies and practically the entire viability of the forest stands had recovered except for trees in the acute and highly affected zones. The young forest was reestablished in the same place as the perished trees and new pine saplings were planted on the reclaimed areas.

Towards improving cervical cancer screening in Nigeria: a review of the basics of cervical neoplasm and cytology.

PubMed

Dim, C C

2012-01-01

Cervical cancer screening is the key to reducing the incidence and mortality of cervical cancer in developing countries. In the absence of a national screening program, healthcare givers in Nigeria are encouraged to routinely inform and screen eligible women. This review aims at equipping health workers for this task by re-educating them on the basics of the disease and its screening by cytology. Relevant texts and online databases including Pubmed, African Journal Online, and Google Scholar, were searched for relevant literature on the subject area. Persistent infection by a high-risk human papilloma virus, especially types 16 and 18, is necessary for the development of cervical cancer. The exfoliation of cells from the metaplastic squamous cells of transformation zone of the cervix is the basis of cervical cytology. Organized Pap screening reduces the incidence and mortality of cervical cancer, but screening protocols vary. Nevertheless, annual screening is not recommended except for high-risk women such as HIV-positive women. Abnormal Pap smear results are currently reported using either the Bethesda System or the British Society for Clinical Cytology classification, and colposcopy with or without biopsy are necessary when indicated. In conclusion, the use of cervical cytology to detect pre-cancerous lesions followed by an appropriate treatment when necessary is the key to reducing invasive cervical cancer. The task of provider-initiated counseling and testing for cervical cancer by health practitioners requires update on the current etio-pathology of cervical cancer, and its screening as reviewed.

Severe Fever with Thrombocytopenia Syndrome in South Korea, 2013-2015.

PubMed

Choi, Seong Jin; Park, Sang-Won; Bae, In-Gyu; Kim, Sung-Han; Ryu, Seong Yeol; Kim, Hyun Ah; Jang, Hee-Chang; Hur, Jian; Jun, Jae-Bum; Jung, Younghee; Chang, Hyun-Ha; Kim, Young Keun; Yi, Jongyoun; Kim, Kye-Hyung; Hwang, Jeong-Hwan; Kim, Yeon-Sook; Jeong, Hye Won; Song, Kyoung-Ho; Park, Wan Beom; Kim, Eu Suk; Oh, Myoung-Don

2016-12-01

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that was recently identified in China, South Korea and Japan. The objective of the study was to evaluate the epidemiologic and clinical characteristics of SFTS in South Korea. SFTS is a reportable disease in South Korea. We included all SFTS cases reported to the Korea Centers for Disease Control and Prevention (KCDC) from January 2013 to December 2015. Clinical information was gathered by reviewing medical records, and epidemiologic characteristics were analyzed using both KCDC surveillance data and patient medical records. Risk factors for mortality in patients with SFTS were assessed. A total of 172 SFTS cases were reported during the study period. SFTS occurred throughout the country, except in urban areas. Hilly areas in the eastern and southeastern regions and Jeju island (incidence, 1.26 cases /105 person-years) were the main endemic areas. The yearly incidence increased from 36 cases in 2013 to 81 cases in 2015. Most cases occurred from May to October. The overall case fatality ratio was 32.6%. The clinical progression was similar to the 3 phases reported in China: fever, multi-organ dysfunction, and convalescence. Confusion, elevated C-reactive protein, and prolonged activated partial thromboplastin times were associated with mortality in patients with SFTS. Two outbreaks of nosocomial SFTS transmission were observed. SFTS is an endemic disease in South Korea, with a nationwide distribution and a high case-fatality ratio. Confusion, elevated levels of C-reactive protein, and prolonged activated partial thromboplastin times were associated with mortality in patients with SFTS.

Cancer incidence and mortality: A cohort study in China, 2008-2013.

PubMed

Pan, Rui; Zhu, Meng; Yu, Canqing; Lv, Jun; Guo, Yu; Bian, Zheng; Yang, Ling; Chen, Yiping; Hu, Zhibin; Chen, Zhengming; Li, Liming; Shen, Hongbing

2017-10-01

The National Central Cancer Registry of China (NCCR) was the only available source of cancer monitoring in China, even though only about 70% of cancer registration sites were qualified by now. In this study, based on a national large prospective cohort-the China Kadoorie Biobank (CKB), we aimed to provide additional cancer statistics and compare the difference of cancer burden between urban and rural areas of China. A total of 497,693 cancer-free participants aged 35-74 years were recruited and successfully followed up from 2004 to 2013 in 5 urban and 5 rural areas across China. Except for traditional registration systems, the national health insurance system and active follow-up were used to determine new cancer incidents and related deaths. The mortality-to-incidence ratio (MIR) was used to compare the differences of cancer burden between urban and rural areas of China. We found that cancer mortality coincided well between our cohort and NCCR, while the incidence was much higher in our cohort. Based on CKB, we found the MIR of all cancers was 0.54 in rural areas, which was approximately one-third higher than that in urban areas with 0.39. Cancer profiles in urban areas were transiting to Western distributions, which were characterized with high incidences of breast cancer and colorectal cancer; while cancers of the esophagus, liver and cervix uteri were still common in rural areas of China. Our results provide additional cancer statistics of China and demonstrate the differences of cancer burden between urban and rural areas of China. © 2017 UICC.

Psoriasis and Cardiovascular Risk: Strength in Numbers Part II

PubMed Central

Gelfand, Joel M.; Mehta, Nehal N.; Langan, Sinéad M.

2012-01-01

Summary The Psoralen plus Ultraviolet-A (PUVA) cohort study has been a tremendous success in determining how a novel treatment (i.e. PUVA) impacts the long-term risk of keratinocyte carcinoma. The ability to follow patients from the initial multi-center clinical trial for over three decades has been a remarkable achievement in dermatoepidemiology. In this issue, Stern and Huibregste report results from the PUVA follow-up study and conclude that only patients with exceptionally severe psoriasis have an increased overall mortality risk and that there is no significant risk of cardiovascular mortality associated with psoriasis. The results are in contrast to a large and growing body of literature that suggests patients with more severe psoriasis have a clinically significant increased risk of mortality in general, and cardiovascular disease in particular. In addition, the authors found no association between severe psoriasis and obesity or between obesity and cardiovascular mortality, despite extensive literature establishing these associations. Basic principles of epidemiological study design may explain these discrepancies. Ultimately, however, , randomized clinical trials will be necessary to determine whether severe psoriasis is in fact a “visible killer”, as four decades ago (after many years of controversy), hypertension was recognized to be a “silent killer”. PMID:21494241

Ambient PM2.5 exposure and expected premature mortality to 2100 in India under climate change scenarios.

PubMed

Chowdhury, Sourangsu; Dey, Sagnik; Smith, Kirk R

2018-01-22

Premature mortality from current ambient fine particulate (PM 2.5 ) exposure in India is large, but the trend under climate change is unclear. Here we estimate ambient PM 2.5 exposure up to 2100 by applying the relative changes in PM 2.5 from baseline period (2001-2005) derived from Coupled Model Inter-comparison Project 5 (CMIP5) models to the satellite-derived baseline PM 2.5 . We then project the mortality burden using socioeconomic and demographic projections in the Shared Socioeconomic Pathway (SSP) scenarios. Ambient PM 2.5 exposure is expected to peak in 2030 under the RCP4.5 and in 2040 under the RCP8.5 scenario. Premature mortality burden is expected to be 2.4-4 and 28.5-38.8% higher under RCP8.5 scenario relative to the RCP4.5 scenario in 2031-2040 and 2091-2100, respectively. Improved health conditions due to economic growth are expected to compensate for the impact of changes in population and age distribution, leading to a reduction in per capita health burden from PM 2.5 for all scenarios except the combination of RCP8.5 exposure and SSP3.

Blunt hepatic trauma: comparison between surgical and nonoperative treatment.

PubMed

Zago, Thiago Messias; Pereira, Bruno Monteiro; Calderan, Thiago Rodrigues Araujo; Hirano, Elcio Shiyoiti; Rizoli, Sandro; Fraga, Gustavo Pereira

2012-01-01

To examine the outcomes of blunt hepatic trauma, and compare surgical and non-surgical treatment in patients admitted with hemodynamic stability and with no obvious indications of laparotomy. This is a retrospective study of cases admitted to a university teaching hospital between the years 2000 and 2010. Patients undergoing surgical treatment were divided into two groups: (a) all patients undergoing surgical treatment, and (b) patients with obvious need for surgery. In this period, 120 patients were admitted with blunt hepatic trauma. Sixty five patients (54.1%) were treated non-operatively and fifty five patients were operated upon. Patients treated non-operatively had better physiologic conditions on admission, demonstrated less severe injuries (except the grade of hepatic injury), received less blood components and had lower morbidity and mortality than the patients operated upon. Patients who underwent non-operative treatment had a lower need for blood transfusion but higher rates of complications and mortality than the patients operated upon. Patients who were operated upon, with no obvious indications for surgery, had higher rates of complication and mortality than patients not operated upon. A non-operative approach resulted in lower complications, a lower need for blood transfusions and lower mortality.

Habitat use by Swainson's Hawks on their austral winter grounds in Argentina

USGS Publications Warehouse

Canavelli, Sonia B.; Bechard, Marc J.; Woodbridge, B.; Kochert, Michael N.; Maceda, Juan J.; Zaccagnini, Maria E.

2003-01-01

We examined the use of agricultural habitats by Swainson's Hawks (Buteo swainsoni)in La Pampa and Santa Fe provinces, Argentina. We found an association of foraging Swainson's Hawks with permanent pastures such as fallow, natural, and alfalfa fields. The hawks also used plowed fields for sunning, resting, and preening. Fields planted with annual crops and pastures were used very little, except when they were cut for hay, plowed, and harvested, or when low crop height and cover allowed the hawks to land in fields. The availability of abundant, yet widely-spaced and transient food-sources, such as insect outbreaks, appeared to be the principal factor influencing habitat use by the hawks. Their reliance on agricultural habitats makes Swainson's Hawks highly vulnerable to pesticide contamination and has contributed to the occurrence of significant mortality events on their wintering grounds.

Ambient air pollution and cancer in California Seventh-day Adventists.

PubMed

Mills, P K; Abbey, D; Beeson, W L; Petersen, F

1991-01-01

Cancer incidence and mortality in a cohort of 6,000 Seventh-day Adventist nonsmokers who were residents of California were monitored for a 6-y period, and relationships with long-term ambient concentrations of total suspended particulates (TSPs) and ozone (O3) were studied. Ambient concentrations were expressed as mean concentrations and exceedance frequencies, which are the number of hours during which concentrations exceeded specified cutoffs (e.g., federal and California air quality standards). Risk of malignant neoplasms in females increased concurrently with exceedance frequencies for all TSP cutoffs, except the lowest, and these increased risks were highly statistically significant. An increased risk of respiratory cancers was associated with only one cutoff of O3, and this result was of borderline significance. These results are presented in the context of setting standards for these two air pollutants.

The effects of plague on the distribution of property: Ivrea, Northern Italy 1630.

PubMed

Alfani, Guido

2010-03-01

The demographic effects of the epidemics of plague in Early Modern Europe and their economic consequences illuminate the evolution of property structures and of wealth distribution during and after a mortality crisis. An analysis of the high-quality data available for the Italian city of Ivrea at the time of the 1630 plague shows the exceptional resilience of property structures. Like the social structures of the period, property structures were able to recover quickly, informed as they were by the lessons learnt by trial and error by the patrician families of the late Middle Ages, whose patrimonies had been badly damaged by the Black Death. In a period of recurrent catastrophes that struck European populations during the Old Demographic Regime, apparently 'inegalitarian' institutions seem to have had long-term 'egalitarian' effects.

[When thinking to scleroderma?].

PubMed

Cogan, E

2007-09-01

Scleroderma encompasses an heterogeneous group of autoimmune disorders characterized by an hidebound thickened skin involvement. When the changes are limited to the skin, localized scleroderma is suspected. Although the latter is most often a benign disease, it may be exceptionally associated with involvement of multiple organs, mainly the neurological system. At the opposite, systemic sclerosis is a serious disorder associated with high morbidity and even mortality and defined by an extended skin sclerosis, multiple organ involvement and general symptoms. Raynaud phenomena is nearly always present at the beginning of the disease. Identifying initial manifestations of the disease (Raynaud phenomena, diffuse non pitting edema, symmetrical polyarthritis with tendon friction rubs, dysphagia associated with mucosal telangiectasia) may allow the clinician to rapidly transfer the patient to a specialized reference center in order to organize a multidisciplinary approach and to prompt optimum therapy.

Educational Differences in U.S. Adult Mortality: A Cohort Perspective*

PubMed Central

Masters, Ryan K.; Hummer, Robert A.; Powers, Daniel A.

2014-01-01

We use hierarchical cross-classified random-effects models to simultaneously measure age, period, and cohort patterns of mortality risk between 1986 and 2006 for non-Hispanic white and non-Hispanic black men and women with less than a high school education, a high school education, and more than a high school education. We examine all-cause mortality risk and mortality risk from heart disease, lung cancer, and unpreventable cancers. Findings reveal that temporal reductions in black and white men’s and women’s mortality rates were driven entirely by cohort changes in mortality. Findings also demonstrate that disparate cohort effects between education groups widened the education gap in all-cause mortality risk and mortality risk from heart disease and lung cancer across this time period. Educational disparities in mortality risk from unpreventable cancers, however, did not change. This research uncovers widening educational differences in adult mortality and demonstrates that a cohort perspective provides valuable insights for understanding recent temporal changes in U.S. mortality risk. PMID:25346542

[Mortality in the tire plant workers].

PubMed

Wilczyńska, U; Szadkowska-Stańczyk, I; Szeszenia-Dabrowska, N; Sobala, W; Strzelecka, A

2000-01-01

This paper describes a cohort study of the mortality among workers employed in one of Polish tyre plants. The scope of the study was limited to the analysis of mortality from main disease categories. Mortality from particular cancer sites will be discussed in a separate publication. The cohort comprised 17,747 workers (11,660 men and 6,087 women) employed during the years 1950-95 for at least three months in the tyre plant. As of 31 December 1995, the follow-up of the cohort was completed. A detailed analysis of mortality by causes was carried out using standardised mortality ratio (SMR) calculated by the person-years method. The general population of Poland was used as the reference. The results indicated general mortality significantly lower in the cohort (men: SMR = 72; women: SMR = 62), than in the reference population. The number of observed deaths from main disease categories was also lower than those expected. The analysis by specific causes revealed significant excess of deaths, due to hypertensive disease among men (36 deaths, SMR = 142; 95% CI: 99-197). SMRs were also calculated in sub-cohorts identified by activities performed (preparatory works: production of tyres and inner tubes; maintenance; storage; others). General mortality in sub-cohorts was similar to that in the total cohort. After analysis by causes of death, some non-significant excess mortality could be observed. It was very small or it applied only to single cases of death. Excess mortality from hypertensive disease in male maintenance workers (21 deaths, SMR = 262; 95% CI: 162-400) was the only exception. The absence of adverse health effects pronounced by significant excess mortality should be attributed to a relatively short period of exposure among the majority of the followed-up workers (over 58% of workers in the cohort employed in the plant for a period shorter than five years) and to their young age. Almost 56% of workers in the cohort were born in the 1950s or later which means that at the end of the follow-up they were not older than 45 years. In order to complete the final mortality assessment the follow-up should continue.

The effect of simulated field storage conditions on the accuracy of rapid user-friendly blood pathogen detection kits.

PubMed

Bienek, Diane R; Charlton, David G

2012-05-01

Being able to test for the presence of blood pathogens at forward locations could reduce morbidity and mortality in the field. Rapid, user-friendly blood typing kits for detecting Human Immunodeficiency Virus (HIV), Hepatitis C Virus (HCV), and Hepatitis B Virus (HBV) were evaluated to determine their accuracy after storage at various temperatures/humidities. Rates of positive tests of control groups, experimental groups, and industry standards were compared (Fisher's exact chi2, p < or = 0.05). Compared to the control group, 2 of 10 HIV detection devices were adversely affected by exposure to high temperature/high humidity or high temperature/low humidity. With one exception, none of the environmentally exposed HCV or HBV detection devices exhibited significant differences compared to those stored under control conditions. For HIV, HCV, and HBV devices, there were differences compared to the industry standard. Collectively, this evaluation of pathogen detection kits revealed that diagnostic performance varies among products and storage conditions, and that the tested products cannot be considered to be approved for use to screen blood, plasma, cell, or tissue donors.

Evidence of correlated evolution of hypsodonty and exceptional longevity in endemic insular mammals.

PubMed

Jordana, Xavier; Marín-Moratalla, Nekane; DeMiguel, Daniel; Kaiser, Thomas M; Köhler, Meike

2012-08-22

Here, we test whether the increase in tooth height in insular endemics results from the expansion of the dietary niche under resource limitation, as widely considered, or whether it represents an investment in dental durability in response to the selection for extended longevity under low levels of extrinsic mortality. We tested these hypotheses in the extremely hypsodont fossil bovid Myotragus balearicus from the Balearic Islands, an ideal model to study the evolutionary trends on islands. Dental abrasion was significantly lower in the insular bovid than in highly hypsodont continental artiodactyls, suggesting that feeding habits are not the sole driving force behind increased crown height. However, the estimated longevity for M. balearicus based on dental durability was two times that predicted from body mass. Survivorship curves confirm that an extraordinarily large number of individuals approached the longevity of the species. Our results, hence, provide evidence that hypsodonty in insular endemics is the outcome of selection for increased durability of the permanent dentition in association with an extended lifespan. In the context of insularity, our results lend additional support to the disposable soma theory of ageing confirming the dependency of somatic maintenance and repair on lifespan, and its control by resource availability and extrinsic mortality.

First isolation of hirame rhabdovirus from freshwater fish in Europe.

PubMed

Borzym, E; Matras, M; Maj-Paluch, J; Baud, M; De Boisséson, C; Talbi, C; Olesen, N J; Bigarré, L

2014-05-01

A rhabdovirus was isolated in cell culture inoculated with tissue material from diseased grayling, Thymallus thymallus (L.), originating from a fish farm affected by a mortality episode in Poland. Diagnostics tests showed that the virus was not related to novirhabdoviruses known in Europe, nor to vesiculovirus-like species, except perch rhabdovirus (PRhV) with which it shared moderate serological relations. However, RT-PCR with PRhV probes gave negative results. To identify the virus, a random-priming sequence-independent single primer amplification was adopted. Surprisingly, two of the obtained sequences exhibited a high identity (>99%) with hirame rhabdovirus (HIRRV), a novirhabdovirus usually found in fish in marine Asiatic countries, for instance Japan, China and Korea. The full-length sequence of the phosphoprotein gene (P) demonstrated a higher identity of the present isolate with HIRRV from China compared with the Korean isolate. An identical viral sequence was also found in brown trout, Salmo trutta trutta L., affected by mortalities in a second farm in the same region, after a likely contamination from the grayling farm. To our knowledge, this is the first report of HIRRV in Europe, and in two hosts from fresh water that have not been described before as susceptible species. © 2013 John Wiley & Sons Ltd.

Evidence of correlated evolution of hypsodonty and exceptional longevity in endemic insular mammals

PubMed Central

Jordana, Xavier; Marín-Moratalla, Nekane; DeMiguel, Daniel; Kaiser, Thomas M.; Köhler, Meike

2012-01-01

Here, we test whether the increase in tooth height in insular endemics results from the expansion of the dietary niche under resource limitation, as widely considered, or whether it represents an investment in dental durability in response to the selection for extended longevity under low levels of extrinsic mortality. We tested these hypotheses in the extremely hypsodont fossil bovid Myotragus balearicus from the Balearic Islands, an ideal model to study the evolutionary trends on islands. Dental abrasion was significantly lower in the insular bovid than in highly hypsodont continental artiodactyls, suggesting that feeding habits are not the sole driving force behind increased crown height. However, the estimated longevity for M. balearicus based on dental durability was two times that predicted from body mass. Survivorship curves confirm that an extraordinarily large number of individuals approached the longevity of the species. Our results, hence, provide evidence that hypsodonty in insular endemics is the outcome of selection for increased durability of the permanent dentition in association with an extended lifespan. In the context of insularity, our results lend additional support to the disposable soma theory of ageing confirming the dependency of somatic maintenance and repair on lifespan, and its control by resource availability and extrinsic mortality. PMID:22535784

Antibiotic therapy of fulminant E. coli K1 sepsis in infant rabbits.

PubMed

Law, B J; Rettig, P J; Marks, M I

1984-04-01

A model of overwhelming E. coli K1 sepsis and early meningitis was developed in infant rabbits and used to compare clinical and bacteriologic efficacy of ampicillin, moxalactam, cephalothin and chloramphenicol. Intraperitoneal injection of 10(7) E. coli K1 into 1- or 2-wk-old rabbits produced a rapidly progressive infection which, if left untreated, produced bacteremia in 100% of animals, meningitis in 78%, and mortality in 100%. Therapy was initiated 4 h after ip infection at which time mean bacterial concentration (log10 CFU/ml) ranged from 4.4-4.8 in the blood and from 1.8-2.3 in the cerebral spinal fluid (CSF). Pre-treatment frequency of bacteremia (100%) and meningitis (17-23%) was similar for all experimental groups. Antibiotic concentrations in blood and CSF 2 h after a dose exceeded the E. coli minimum inhibitory concentration with the exception of CSF cephalothin, which was undetectable. Moxalactam, ampicillin, and chloramphenicol significantly reduced the incidence of bacteremia and meningitis relative to cephalothin or saline controls (P less than 0.02). Mortality rates among the former three groups were high (64-82%) but significantly less than in saline or cephalothin-treated rabbits (100%). In this neonatal model of fulminant sepsis with early meningitis, moxalactam provided no therapeutic advantage over ampicillin or chloramphenicol.

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.

The Bangladesh paradox: exceptional health achievement despite economic poverty.

PubMed

Chowdhury, A Mushtaque R; Bhuiya, Abbas; Chowdhury, Mahbub Elahi; Rasheed, Sabrina; Hussain, Zakir; Chen, Lincoln C

2013-11-23

Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the first paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country's success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing women-centred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households. Government and non-governmental organisations have pioneered many innovations that have been scaled up nationally. However, these remarkable achievements in equity and coverage are counterbalanced by the persistence of child and maternal malnutrition and the low use of maternity-related services. The Bangladesh paradox shows the net outcome of successful direct health action in both positive and negative social determinants of health--ie, positives such as women's empowerment, widespread education, and mitigation of the effect of natural disasters; and negatives such as low gross domestic product, pervasive poverty, and the persistence of income inequality. Bangladesh offers lessons such as how gender equity can improve health outcomes, how health innovations can be scaled up, and how direct health interventions can partly overcome socioeconomic constraints. Copyright © 2013 Elsevier Ltd. All rights reserved.

77 FR 71259 - Taking of Marine Mammals Incidental to Commercial Fishing Operations; False Killer Whale Take...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-29

... December 31, 2012, except for the addition of Sec. Sec. 229.3(v) and 229.37(c), which are effective... factor (MMPA Sec. 3(20), 16 U.S.C. 1362). The PBR level for the Hawaii Insular false killer whale stock... ``strategic'' (i.e., the level of human-caused mortality exceeds the stock's PBR level; 16 U.S.C. 1362(19)(A...

Experiments with classes of stock suitable for forest planting in the northern Rocky Mountains

Treesearch

W. G. Wahlenberg

1928-01-01

Except in unusually moist years the survival of planted stock in the northern Rocky Mountains, even on favorable slopes, has not been satisfactory. On good and poor sites alike, the principal cause of the unusual degree of mortality has been the combination of dry soil and dry winds during the hot days of July and August. The results have made it clear that the most...

Demographic and circumstantial accounts of burn mortality in Cape Town, South Africa, 2001-2004: An observational register based study

PubMed Central

Van Niekerk, A; Laubscher, R; Laflamme, L

2009-01-01

Background Burns are a persisting public health problem in low- and middle-income countries; however, epidemiologic data for these settings is scarce. South Africa is no exception although there is an emerging knowledge base, especially for paediatric burns. The current study describes the epidemiology of burn mortality across the lifespan in Cape Town (2.9 million inhabitants in 2001), one of the six South African metropolitan centres. Methods The distribution of burn mortality across socio-demographic groups and also their circumstances of occurrence were investigated using four year (2001 to 2004) surveillance data from the National Injury Mortality Surveillance System (n = 1024 cases). Results Burn mortality occurred at a rate of 7.9 per 100 000 person-years (95% CI: 7.3-8.3). Males sustained fatal rates 2.2 times more than that for females (p < 0.001), with rates significantly higher in the 25 to 38 and 39 to 50 age groups than at other ages (p < 0.001). The greatest difference between male and female deaths was observed in the 25 to 38 year age group, when almost three male deaths occurred for every female one. The vast majority of fatal burns were registered as accidental and occurred in the home, either over the cold and wet months or during recreational periods over weekends and across the year. Alcohol intoxication was reported for the majority of those adults whose alcohol blood levels were tested (i.e. 52.6% of cases aged 16+ years). Conclusion Besides paediatric burns, the high prevalence and circumstances of occurrence of burns among middle age men are a source of concern. There are reasons to believe that this over-representation is a reflection of detrimental living conditions, life-style and poor socio-economic status. It is recommended that there be greater prioritisation of prevention activities that involve the control or management of kerosene heat sources, the provision of alternatives to flammable housing materials, and the implementation of strategies to reduce harmful drinking practices. PMID:19804652

Comparison of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on cardiovascular outcomes in hypertensive patients with type 2 diabetes mellitus: A PRISMA-compliant systematic review and meta-analysis.

PubMed

Lv, Xiaodan; Zhang, Yingshi; Niu, Yixuan; Song, Qi; Zhao, Qingchun

2018-04-01

Previous studies seem to show different effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) on cardiovascular (CV) events in hypertensive patients with type 2 diabetes mellitus (T2DM). Our objective was to analyze which are preferable on the incidence of all-cause mortality, CV death, and major CV events in hypertensive patients with T2DM. PubMed, MEDLINE, and EMBASE were searched for randomized controlled trials (RCTs) published up to June 2016 with ACEI or ARBs as the intervention for hypertensive patients with T2DM. The primary end points were all-cause mortality and CV death. The secondary end points were myocardial infarction (MI), stroke, heart failure (HF), and CV events. Two investigators extracted the information independently. Data were pooled using a fixed-effects model or a random-effects model if significant heterogeneity was present. A total of 13 trials were included for analysis, 5 ACEI trials (24,976 patients) and 8 ARB trials (22,032 patients) followed for a mean of 3.8 years. Treatment with ACEI was associated with significantly reduction in all-cause mortality [odds ratio (OR) 0.87; 95% confidence interval (95% CI), 0.80-0.94], CV death (OR 0.81; 95% CI, 0.68-0.98), and other CV outcomes such as MI (0R 0.77; 95% CI, 0.66-0.90), stroke (OR 0.88; 95% CI, 0.78-0.99), HF (OR 0.65; 95% CI, 0.47-0.90), and CV events (OR 0.83; 95% CI, 0.73-0.95), whereas ARBs therapy had no significant reduction in the results of many primary and secondary outcomes. This meta-analysis suggests that treatment with ACEI showed a significant CV protection for all-cause mortality, CV death, and major CV events, whereas ARBs had no benefits on these outcomes except MI. In consideration of high mortality and morbidity, ACEI was preferable than ARBs on patients with hypertension and T2DM.

Failure to Clear Elevated Lactate Predicts 24-Hour Mortality in Trauma Patients

PubMed Central

Dezman, Zachary D.W.; Comer, Angela C.; Smith, Gordon S.; Narayan, Mayur; Scalea, Thomas M.; Hirshon, Jon Mark

2015-01-01

Background Lactate clearance is a standard resuscitation goal in patients in non-traumatic shock but has not been investigated adequately as a tool to identify trauma patients at risk of dying. Our objective was to determine if trauma patients with impaired lactate clearance have a higher 24-hour mortality rate than patients whose lactate concentration normalizes. Methods A retrospective chart review identified patients who were admitted directly from the scene of injury to an urban trauma center between 2010 and 2013 and who had at least one lactate concentration measurement within 24 hours. Transfers, patients without lactate measurement, and those who were dead on arrival were excluded. Of the 26,545 screened patients, 18,304 constituted the initial lactate measurement population and 3,887 were the lactate clearance cohorts. Results Initial lactate had an area-under-the-receiver operating curve of 0.86 and 0.73 for mortality at 24 hours and in-hospital, respectively. An initial concentration ≥3 mmol/L had sensitivity of 0.86 and specificity of 0.73 for mortality at 24 hours. The mortality rate among patients with elevated lactate concentrations (n=2381, 5.6±2.8 mmol/L) that did not decline to <2.0 mmol/L in response to resuscitative efforts (mean second measurement, 3.7±1.9 mmol/L) was nearly seven times higher (4.1% vs 0.6% [p<0.001]) than among those with an elevated concentration (n=1506, 5.3±2.7 mmol/L) that normalized (1.4±0.4 mmol/L). Logistic regression analysis showed that failure to clear lactate was associated with death more than any other feature (OR=7.4; CI, 1.5–35.5), except having an Injury Severity Score >25 (OR=8.2; CI, 2.7–25.2). Conclusions Failure to clear lactate is a strong negative prognostic marker after injury. An initial lactate measurement combined with a second measurement for high-risk individuals might constitute a useful method of risk-stratifying injured patients. PMID:26402531

[Population dynamics and development in the Caribbean].

PubMed

Boland, B

1995-12-01

The impact is examined of socioeconomic factors on Caribbean population dynamics. This work begins by describing the socioeconomic context of the late 1980s and early 1990s, under the influence of the economic changes and crises of the 1980s. The small size, openness, dependency, and lack of diversification of the Caribbean economies have made them vulnerable to external pressures. The Bahamas and Belize had economic growth rates exceeding 5% annually during 1981-90, but most of the countries had low or negative growth. Unemployment, poverty, the structural adjustment measures adopted in the mid-1980s, and declines in social spending exacerbated general economic conditions. In broad terms, the population situation of the Caribbean is marked by diversity of sizes and growth rates. A few countries oriented toward services and tourism had demographic growth rates exceeding 3%, while at least 7 had almost no growth or negative growth. Population growth rates reflected different combinations of natural increase and migration. Crude death rates ranged from around 5/1000 to 11/1000, except in Haiti, and all countries of the region except Haiti had life expectancies of 70 years or higher. Despite fertility decline, the average crude birth rate was still relatively high at 26/1000, and the rate of natural increase was 1.8% annually for the region. Nearly half of the regional population was under 15 or over 65 years old. The body of this work provides greater detail on mortality patterns, variations by sex, infant mortality, causes of death, and implications for policy. The discussion of fertility includes general patterns and trends, age specific fertility rates, contraceptive prevalence, levels of adolescent fertility and age factors in adolescent sexual behavior, characteristics of adolescent unions, contraceptive usage, health and social consequences of adolescent childbearing, and the search for solutions. The final section describes the magnitude and causes of emigration from the Caribbean and the impact of emigration on population composition, with attention to intraregional and return migration.

Effects of severe obstetric complications on women’s health and infant mortality in Benin

PubMed Central

Filippi, Véronique; Goufodji, Sourou; Sismanidis, Charalambos; Kanhonou, Lydie; Fottrell, Edward; Ronsmans, Carine; Alihonou, Eusèbe; Patel, Vikram

2010-01-01

Summary Objective To document the impact of severe obstetric complications on post-partum health in mothers and mortality in babies over 12 months in Benin and to assess whether severe complications associated with perinatal death are particularly likely to lead to adverse health consequences. Methods Cohort study which followed women and their babies after a severe complication or an uncomplicated childbirth. Women were selected in hospitals and interviewed at home at discharge, and at 6 and 12 months post-partum. Women were invited for a medical check-up at 6 months and 12 months. Results The cohort includes 205 women with severe complications and a live birth, 64 women with severe complications and perinatal death and 440 women with uncomplicated delivery. Women with severe complications and a live birth were not dissimilar to women with a normal delivery in terms of post-partum health, except for hypertension [adjusted OR = 5.8 (1.9–17.0)], fever [adjusted OR = 1.71 (1.1–2.8)] and infant mortality [adjusted OR = 11.0 (0.8–158.2)]. Women with complications and perinatal death were at increased risk of depression [adjusted OR = 3.4 (1.3–9.0)], urine leakages [adjusted OR = 2.7 (1.2–5.8)], and to report poor health [adjusted OR = 5.27 (2.2–12.4)] and pregnancy’s negative effects on their life [adjusted OR = 4.11 (1.9–9.0)]. Uptake of post-natal services was poor in all groups. Conclusion Women in developing countries face a high risk of severe complications during pregnancy and delivery. These can lead to adverse consequences for their own health and that of their offspring. Resources are needed to ensure that pregnant women receive adequate care before, during and after discharge from hospital. Near-miss women with a perinatal death appear a particularly high-risk group. PMID:20406426

Effects of severe obstetric complications on women's health and infant mortality in Benin.

PubMed

Filippi, Véronique; Goufodji, Sourou; Sismanidis, Charalambos; Kanhonou, Lydie; Fottrell, Edward; Ronsmans, Carine; Alihonou, Eusèbe; Patel, Vikram

2010-06-01

To document the impact of severe obstetric complications on post-partum health in mothers and mortality in babies over 12 months in Benin and to assess whether severe complications associated with perinatal death are particularly likely to lead to adverse health consequences. Cohort study which followed women and their babies after a severe complication or an uncomplicated childbirth. Women were selected in hospitals and interviewed at home at discharge, and at 6 and 12 months post-partum. Women were invited for a medical check-up at 6 months and 12 months. The cohort includes 205 women with severe complications and a live birth, 64 women with severe complications and perinatal death and 440 women with uncomplicated delivery. Women with severe complications and a live birth were not dissimilar to women with a normal delivery in terms of post-partum health, except for hypertension [adjusted OR = 5.8 (1.9-17.0)], fever [adjusted OR = 1.71 (1.1-2.8)] and infant mortality [adjusted OR = 11.0 (0.8-158.2)]. Women with complications and perinatal death were at increased risk of depression [adjusted OR = 3.4 (1.3-9.0)], urine leakages [adjusted OR = 2.7 (1.2-5.8)], and to report poor health [adjusted OR = 5.27 (2.2-12.4)] and pregnancy's negative effects on their life [adjusted OR = 4.11 (1.9-9.0)]. Uptake of post-natal services was poor in all groups. Women in developing countries face a high risk of severe complications during pregnancy and delivery. These can lead to adverse consequences for their own health and that of their offspring. Resources are needed to ensure that pregnant women receive adequate care before, during and after discharge from hospital. Near-miss women with a perinatal death appear a particularly high-risk group.

Patterns of Cancer in Kurdistan - Results of Eight Years Cancer Registration in Sulaymaniyah Province-Kurdistan-Iraq.

PubMed

Khoshnaw, Najmaddin; Mohammed, Hazha A; Abdullah, Dana A

2015-01-01

Cancer has become a major health problem associated with high mortality worldwide, especially in developing countries. The aim of our study was to evaluate the incidence rates of different types of cancer in Sulaymaniyah from January-2006 to January-2014. The data were compared with those reported for other middle east countries. This retrospective study depended on data collected from Hiwa hospital cancer registry unit, death records and histopathology reports in all Sulaymaniyah teaching hospitals, using international classification of diseases. A total of 8,031 cases were registered during the eight year period, the annual incidence rate in all age groups rose from 38 to 61.7 cases/100,000 population/year, with averages over 50 in males and 50.7 in females. The male to female ratio in all age groups were 0.98, while in the pediatric age group it was 1.33. The hematological malignancies in all age groups accounted for 20% but in the pediatric group around half of all cancer cases. Pediatric cancers were occluding 7% of total cancers with rates of 10.3 in boys and 8.7 in girls. The commonest malignancies by primary site were leukemia, lymphoma, brain, kidney and bone. In males in all age groups they were lung, leukaemia, lymphoma, colorectal, prostate, bladder, brain, stomach, carcinoma of unknown primary (CUP) and skin, while in females they were breast, leukaemia, lymphoma, colorectal, ovary, lung, brain, CUP, and stomach. Most cancers were increased with increasing age except breast cancer where decrease was noted in older ages. High mortality rates were found with leukemia, lung, lymphoma, colorectal, breast and stomach cancers. We here found an increase in annual cancer incidence rates across the period of study, because of increase of cancer with age and higher rates of hematological malignancies. Our study is valuable for Kurdistan and Iraq because it provides more accurate data about the exact patterns of cancer and mortality in our region.

Breast cancer statistics, 2011.

PubMed

DeSantis, Carol; Siegel, Rebecca; Bandi, Priti; Jemal, Ahmedin

2011-01-01

In this article, the American Cancer Society provides an overview of female breast cancer statistics in the United States, including trends in incidence, mortality, survival, and screening. Approximately 230,480 new cases of invasive breast cancer and 39,520 breast cancer deaths are expected to occur among US women in 2011. Breast cancer incidence rates were stable among all racial/ethnic groups from 2004 to 2008. Breast cancer death rates have been declining since the early 1990s for all women except American Indians/Alaska Natives, among whom rates have remained stable. Disparities in breast cancer death rates are evident by state, socioeconomic status, and race/ethnicity. While significant declines in mortality rates were observed for 36 states and the District of Columbia over the past 10 years, rates for 14 states remained level. Analyses by county-level poverty rates showed that the decrease in mortality rates began later and was slower among women residing in poor areas. As a result, the highest breast cancer death rates shifted from the affluent areas to the poor areas in the early 1990s. Screening rates continue to be lower in poor women compared with non-poor women, despite much progress in increasing mammography utilization. In 2008, 51.4% of poor women had undergone a screening mammogram in the past 2 years compared with 72.8% of non-poor women. Encouraging patients aged 40 years and older to have annual mammography and a clinical breast examination is the single most important step that clinicians can take to reduce suffering and death from breast cancer. Clinicians should also ensure that patients at high risk of breast cancer are identified and offered appropriate screening and follow-up. Continued progress in the control of breast cancer will require sustained and increased efforts to provide high-quality screening, diagnosis, and treatment to all segments of the population. Copyright © 2011 American Cancer Society, Inc.

Treating childhood pneumonia in hard-to-reach areas: a model-based comparison of mobile clinics and community-based care.

PubMed

Pitt, Catherine; Roberts, Bayard; Checchi, Francesco

2012-01-10

Where hard-to-access populations (such as those living in insecure areas) lack access to basic health services, relief agencies, donors, and ministries of health face a dilemma in selecting the most effective intervention strategy. This paper uses a decision mathematical model to estimate the relative effectiveness of two alternative strategies, mobile clinics and fixed community-based health services, for antibiotic treatment of childhood pneumonia, the world's leading cause of child mortality. A "Markov cycle tree" cohort model was developed in Excel with Visual Basic to compare the number of deaths from pneumonia in children aged 1 to 59 months expected under three scenarios: 1) No curative services available, 2) Curative services provided by a highly-skilled but intermittent mobile clinic, and 3) Curative services provided by a low-skilled community health post. Parameter values were informed by literature and expert interviews. Probabilistic sensitivity analyses were conducted for several plausible scenarios. We estimated median pneumonia-specific under-5 mortality rates of 0.51 (95% credible interval: 0.49 to 0.541) deaths per 10,000 child-days without treatment, 0.45 (95% CI: 0.43 to 0.48) with weekly mobile clinics, and 0.31 (95% CI: 0.29 to 0.32) with CHWs in fixed health posts. Sensitivity analyses found the fixed strategy superior, except when mobile clinics visited communities daily, where rates of care-seeking were substantially higher at mobile clinics than fixed posts, or where several variables simultaneously differed substantially from our baseline assumptions. Current evidence does not support the hypothesis that mobile clinics are more effective than CHWs. A CHW strategy therefore warrants consideration in high-mortality, hard-to-access areas. Uncertainty remains, and parameter values may vary across contexts, but the model allows preliminary findings to be updated as new or context-specific evidence becomes available. Decision analytic modelling can guide needed field-based research efforts in hard-to-access areas and offer evidence-based insights for decision-makers.

Perioperative Management of Pregnant Women With Idiopathic Pulmonary Arterial Hypertension: An Observational Case Series Study From China.

PubMed

Zhang, Jinglan; Lu, Jiakai; Zhou, Xiaorui; Xu, Xuefeng; Ye, Qing; Ou, Qitan; Li, Yanna; Huang, Jiapeng

2018-03-07

The mortality of pregnant women with idiopathic pulmonary arterial hypertension (PAH) is very high. There are limited data on the management of idiopathic PAH during pregnancy. The authors aimed to examine systematically the characteristics of parturient women with idiopathic PAH, to explore the adverse effects of idiopathic PAH on pregnancy outcomes, and to report the multidisciplinary perioperative management strategy from the largest comprehensive cardiac hospital in China. Observational case series study. Tertiary referral acute care hospital in Beijing, China. The cases of 17 consecutive pregnant idiopathic PAH patients undergoing abortion or parturition at Anzhen Hospital were reviewed retrospectively. Preoperative characteristics, anesthesia method, intensive care management, PAH-specific therapy, and maternal and neonatal outcomes were analyzed in this case series study. Maternal and neonatal outcomes were the main measures. The mean ages of the 17 parturient women with idiopathic PAH were 28.3 ± 5.4 years, and the mean systolic pulmonary arterial pressure was 97.9 ± 18.6 mmHg. Fifteen patients (88.2%) received PAH-specific therapy before delivery, including sildenafil, iloprost, and treprostinil. All except 1 parturient received epidural anesthesia for surgery due to an emergency Caesarean section. Three patients experienced pulmonary hypertension crisis that necessitated conversion to general anesthesia. Ten parturients underwent Caesarean delivery at a median gestational age of 31 weeks. Three patients developed acute pulmonary hypertensive crisis intraoperatively. Two patients underwent cardiopulmonary resuscitation and extracorporeal membrane oxygenation support. The maternal mortality was 17.6% (3/17). Of the 10 delivered neonates, 9 (90.0%) survived. The maternal mortality of the idiopathic PAH parturient was high in this case series from China. The authors applied epidural anesthesia, early management with multidisciplinary approaches, PAH-specific therapy, avoidance of oxytocin, and timely delivery or pregnancy termination to improve maternal and neonatal outcomes. Copyright © 2018 Elsevier Inc. All rights reserved.

Ingestion of Fireworks: Rare Cause of Poisoning in Children.

PubMed

Yuksekkaya, Hasan; Gumus, Meltem; Yucel, Aylin; Energin, Meltem; Demirci, Serafettin

2018-03-12

Mistaken ingestion of all manner of toxic matter is common in childhood, but poisoning with fireworks and matchsticks is rare. Fireworks usually contain 10% yellow phosphorus and 50% potassium chlorate. Potassium chlorate is an extremely reactive and toxic agent that is used in fireworks and matchstick heads. Eleven cases (7 females and 5 males; median age, 36 months [ranging from 24 to 48 months]) of poisoning after ingestion of fireworks and matchstick(s), between February 2008 and June 2014, were reviewed. The most common initial symptom was vomiting except for 2 cases in this group. Biochemical tests indicated that hyperphosphatemia was present in all patients, 8 patients (72.7%) had subclinical hepatic injury, 1 (9%) had acute hepatic failure, and 2 patients had no clinical or biochemical evidence of hepatic damage. Three patients had renal impairment, but none of them required dialysis. All of the patients recovered with supportive therapy except for 2 cases. One patient underwent cadaveric liver transplantation, whereas the other died because of circulatory dysfunction and respiratory failure due to pulmonary alveolar hemorrhage. Without prompt intervention, poisoning with fireworks carries high morbidity and mortality in children. It can cause pulmonary hemorrhage, in addition to other organ damage, including liver and kidney. Hyperphosphatemia is common, as it was seen in all of the study patients.

Political party affiliation, political ideology and mortality.

PubMed

Pabayo, Roman; Kawachi, Ichiro; Muennig, Peter

2015-05-01

Ecological and cross-sectional studies have indicated that conservative political ideology is associated with better health. Longitudinal analyses of mortality are needed because subjective assessments of ideology may confound subjective assessments of health, particularly in cross-sectional analyses. Data were derived from the 2008 General Social Survey-National Death Index data set. Cox proportional analysis models were used to determine whether political party affiliation or political ideology was associated with time to death. Also, we attempted to identify whether self-reported happiness and self-rated health acted as mediators between political beliefs and time to death. In this analysis of 32,830 participants and a total follow-up time of 498,845 person-years, we find that political party affiliation and political ideology are associated with mortality. However, with the exception of independents (adjusted HR (AHR)=0.93, 95% CI 0.90 to 0.97), political party differences are explained by the participants' underlying sociodemographic characteristics. With respect to ideology, conservatives (AHR=1.06, 95% CI 1.01 to 1.12) and moderates (AHR=1.06, 95% CI 1.01 to 1.11) are at greater risk for mortality during follow-up than liberals. Political party affiliation and political ideology appear to be different predictors of mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Prediction of cancer incidence and mortality in Korea, 2014.

PubMed

Jung, Kyu-Won; Won, Young-Joo; Kong, Hyun-Joo; Oh, Chang-Mo; Lee, Duk Hyoung; Lee, Jin Soo

2014-04-01

We studied and reported on cancer incidence and mortality rates as projected for the year 2014 in order to estimate Korea's current cancer burden. Cancer incidence data from 1999 to 2011 were obtained from the Korea National Cancer Incidence Database, and cancer mortality data from 1993 to 2012 were acquired from Statistics Korea. Cancer incidence in 2014 was projected by fitting a linear regression model to observed age-specific cancer incidence rates against observed years, then multiplying the projected age-specific rates by the age-specific population. For cancer mortality, a similar procedure was employed, except that a Joinpoint regression model was used to determine at which year the linear trend changed significantly. A total of 265,813 new cancer cases and 74,981 cancer deaths are expected to occur in Korea in 2014. Further, the crude incidence rate per 100,000 of all sites combined will likely reach 524.7 and the age-standardized incidence rate, 338.5. Meanwhile, the crude mortality rate of all sites combined and age-standardized rate are projected to be 148.0 and 84.6, respectively. Given the rapid rise in prostate cancer cases, it is anticipated to be the fourth most frequently occurring cancer site in men for the first time. Cancer has become the most prominent public health concern in Korea, and as the population ages, the nation's cancer burden will continue to increase.

Impact of diurnal temperature range on mortality in a high plateau area in southwest China: A time series analysis.

PubMed

Ding, Zan; Guo, Pi; Xie, Fang; Chu, Huifang; Li, Kun; Pu, Jingbo; Pang, Shaojie; Dong, Hongli; Liu, Yahui; Pi, Fuhua; Zhang, Qingying

2015-09-01

Diurnal temperature range (DTR) is an important meteorological indicator that reflects weather stability and is associated with global climate change and urbanization. Previous studies have explored the effect of DTR on human health in coastal cities with small daily temperature variations, but we have little evidence for high plateau regions where large DTRs usually occur. Using daily mortality data (2007-2013), we conducted a time-series analysis to assess the effect of DTR on daily mortality in Yuxi, a high plateau city in southwest China. Poisson regression with distributed lag non-linear model was used to estimate DTR effects on daily mortality, controlling for daily mean temperature, relative humidity, sunshine duration, wind speed, atmospheric pressure, day of the week, and seasonal and long-term trends. The cumulative effects of DTR were J-shaped curves for non-accidental, cardiorespiratory and cardiovascular mortality, with a U-shaped curve for respiratory mortality. Risk assessments showed strong monotonic increases in mortality starting at a DTR of approximately 16 °C. The relative risk of non-accidental morality with extreme high DTR at lag 0 and 0-21 days was 1.03 (95% confidence interval: 0.95-1.11) and 1.33 (0.94-1.89), respectively. The risk of mortality with extreme high DTR was greater for males and age <75 years than females and age ≥75 years. The effect of DTR on mortality was non-linear, with high DTR associated with increased mortality. A DTR of 16 °C may be a cut-off point for mortality prognosis and has implications for developing intervention strategies to address high DTR exposure. Copyright © 2015 Elsevier B.V. All rights reserved.

Tetanus antibody titers and duration of immunity to clinical tetanus infections in free-ranging rhesus monkeys (Macaca mulatta).

PubMed

Kessler, Matthew J; Berard, John D; Rawlins, Richard G; Bercovitch, Fred B; Gerald, Melissa S; Laudenslager, Mark L; Gonzalez-Martinez, Janis

2006-07-01

Prior to 1985 tetanus was a major cause of mortality in the free-ranging colony of rhesus monkeys on Cayo Santiago, accounting for almost a quarter of annual deaths. In 1985 and 1986 all animals (except infants) received primary and booster doses, respectively, of tetanus toxoid. In subsequent years primary immunizations were given to all yearlings, and boosters were administered to all 2-year-old animals during the annual capture of the colony. The main objectives of the tetanus immunization program were to reduce the pain and suffering caused by tetanus infections and to decrease mortality in the colony. Other objectives were to evaluate the efficacy of the two-dose tetanus toxoid immunization protocol and to determine whether additional boosters might be required to provide adequate long-term protection against tetanus infections. The immediate effect of the mass immunization program was the elimination of clinical tetanus infections in the population and a 42.2% reduction in the overall mortality rate. Since the immunization program began, no cases of tetanus have been observed in the colony, except in two unimmunized infants, and it has not been necessary to give tertiary injections of tetanus toxoid to maintain protection against infection. A sample collected in 2004 of the original cohort of monkeys immunized in 1985 and 1986 showed that 93.3% (14/15) had protective tetanus antibody titers (>0.01 IU/ml) at the ages of 20-23 years, which is close to the life expectancy of the Cayo Santiago rhesus macaques. Two intramuscular doses of tetanus toxoid provided long-term, if not lifelong, protection against tetanus for rhesus monkeys living in a tropical clime where tetanus is enzootic and the risk of infection is great. (c) 2005 Wiley-Liss, Inc.

Impact of type 2 diabetes mellitus on in-hospital-mortality after major cardiovascular events in Spain (2002-2014).

PubMed

de Miguel-Yanes, José M; Jiménez-García, Rodrigo; Hernández-Barrera, Valentín; Méndez-Bailón, Manuel; de Miguel-Díez, Javier; Lopez-de-Andrés, Ana

2017-10-10

Diabetes mellitus has long been associated with cardiovascular events. Nevertheless, the higher burden of traditional cardiovascular risk factors reported in high-income countries is offset by a more widespread use of preventive measures and revascularization or other invasive procedures. The aim of this investigation is to describe trends in number of cases and outcomes, in-hospital mortality (IHM) and length of hospital stay (LHS), of hospital admissions for major cardiovascular events between type 2 diabetes (T2DM) and matched non-diabetes patients. Retrospective study using National Hospital Discharge Database, analyzed in 4 years 2002, 2006, 2010, 2014, in Spain. We included patients (≥ 40 years old) with a primary diagnosis of myocardial infarction, ischemic and hemorrhagic stroke, aortic aneurysm and dissection and acute lower limb ischemia in people with T2DM. Cases were matched with controls (without T2DM) by ICD-9-CM codes, sex, age, province of residence and year. We selected 130,011 matched couples (50,427 with myocardial infarction, 60,236 with stroke, 2599 with aortic aneurysm and dissection and 16,749 with acute lower limb ischemia. Among T2DM patients we found increasing numbers of admissions overtime for stroke (10,794 in 2002 vs 17,559 in 2014), aortic aneurysm and dissection (390 vs 841) and acute lower limb ischemia (3854 vs. 4548). People were progressively older (except for myocardial infarction), had more comorbidities (especially T2DM patients), and were more frequently coded overtime for cardiovascular risk factors (smoking, obesity, hypertension, lipid disorders) and renal diseases. LHS and IHM declined overtime, though IHM only did it significantly in T2DM patients. Multivariable adjustment showed that T2DM patients had a significantly 15% higher mortality rate during admission for myocardial infarction, a 6% higher mortality for stroke, and a 6% higher mortality rate for "all cardiovascular events combined", than non-diabetic matched controls. The number of hospital admissions for stroke, aortic aneurysm and dissection and acute lower limb ischemia increased overtime, but remained stable for myocardial infarction. T2DM is associated to higher IHM after major cardiovascular events. Further research is needed to help us understand the reasons for an apparently increased mortality in T2DM patients when admitted to hospital for some major cardiovascular events.

Gestational Age Patterns of Fetal and Neonatal Mortality in Europe: Results from the Euro-Peristat Project

PubMed Central

Mohangoo, Ashna D.; Buitendijk, Simone E.; Szamotulska, Katarzyna; Chalmers, Jim; Irgens, Lorentz M.; Bolumar, Francisco; Nijhuis, Jan G.; Zeitlin, Jennifer

2011-01-01

Background The first European Perinatal Health Report showed wide variability between European countries in fetal (2.6–9.1‰) and neonatal (1.6–5.7‰) mortality rates in 2004. We investigated gestational age patterns of fetal and neonatal mortality to improve our understanding of the differences between countries with low and high mortality. Methodology/Principal Findings Data on 29 countries/regions participating in the Euro-Peristat project were analyzed. Most European countries had no limits for the registration of live births, but substantial variations in limits for registration of stillbirths before 28 weeks of gestation existed. Country rankings changed markedly after excluding deaths most likely to be affected by registration differences (22–23 weeks for neonatal mortality and 22–27 weeks for fetal mortality). Countries with high fetal mortality ≥28 weeks had on average higher proportions of fetal deaths at and near term (≥37 weeks), while proportions of fetal deaths at earlier gestational ages (28–31 and 32–36 weeks) were higher in low fetal mortality countries. Countries with high neonatal mortality rates ≥24 weeks, all new member states of the European Union, had high gestational age-specific neonatal mortality rates for all gestational-age subgroups; they also had high fetal mortality, as well as high early and late neonatal mortality. In contrast, other countries with similar levels of neonatal mortality had varying levels of fetal mortality, and among these countries early and late neonatal mortality were negatively correlated. Conclusions For valid European comparisons, all countries should register births and deaths from at least 22 weeks of gestation and should be able to distinguish late terminations of pregnancy from stillbirths. After excluding deaths most likely to be influenced by existing registration differences, important variations in both levels and patterns of fetal and neonatal mortality rates were found. These disparities raise questions for future research about the effectiveness of medical policies and care in European countries. PMID:22110575

CO2 and N-fertilization effects on fine-root length, production, and mortality: a 4-year ponderosa pine study.

PubMed

Phillips, Donald L; Johnson, Mark G; Tingey, David T; Storm, Marjorie J; Ball, J Timothy; Johnson, Dale W

2006-06-01

We conducted a 4-year study of juvenile Pinus ponderosa fine root (< or =2 mm) responses to atmospheric CO2 and N-fertilization. Seedlings were grown in open-top chambers at three CO2 levels (ambient, ambient+175 mumol/mol, ambient+350 mumol/mol) and three N-fertilization levels (0, 10, 20 g m(-2) year(-1)). Length and width of individual roots were measured from minirhizotron video images bimonthly over 4 years starting when the seedlings were 1.5 years old. Neither CO2 nor N-fertilization treatments affected the seasonal patterns of root production or mortality. Yearly values of fine-root length standing crop (m m(-2)), production (m m(-2) year(-1)), and mortality (m m(-2) year(-1)) were consistently higher in elevated CO2 treatments throughout the study, except for mortality in the first year; however, the only statistically significant CO2 effects were in the fine-root length standing crop (m m(-2)) in the second and third years, and production and mortality (m m(-2) year(-1)) in the third year. Higher mortality (m m(-2) year(-1)) in elevated CO2 was due to greater standing crop rather than shorter life span, as fine roots lived longer in elevated CO2. No significant N effects were noted for annual cumulative production, cumulative mortality, or mean standing crop. N availability did not significantly affect responses of fine-root standing crop, production, or mortality to elevated CO2. Multi-year studies at all life stages of trees are important to characterize belowground responses to factors such as atmospheric CO2 and N-fertilization. This study showed the potential for juvenile ponderosa pine to increase fine-root C pools and C fluxes through root mortality in response to elevated CO2.

The relationship between fermented food intake and mortality risk in the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort.

PubMed

Praagman, Jaike; Dalmeijer, Geertje W; van der Schouw, Yvonne T; Soedamah-Muthu, Sabita S; Monique Verschuren, W M; Bas Bueno-de-Mesquita, H; Geleijnse, Johanna M; Beulens, Joline W J

2015-02-14

The objective of the present study was to investigate the relationship between total and subtypes of bacterial fermented food intake (dairy products, cheese, vegetables and meat) and mortality due to all causes, total cancer and CVD. From the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort, 34 409 Dutch men and women, aged 20-70 years who were free from CVD or cancer at baseline, were included. Baseline intakes of total and subtypes of fermented foods were measured with a validated FFQ. Data on the incidence and causes of death were obtained from the national mortality register. Cox proportional hazards models were used to analyse mortality in relation to the quartiles of fermented food intake. After a mean follow-up of 15 (sd 2·5) years, 2436 deaths occurred (1216 from cancer and 727 from CVD). After adjustment for age, sex, total energy intake, physical activity, education level, hypertension, smoking habit, BMI, and intakes of fruit, vegetables and alcohol, total fermented food intake was not found to be associated with mortality due to all causes (hazard ratio upper v. lowest quartile (HR(Q4 v. Q1)) 1·00, 95% CI 0·88, 1·13), cancer (HR(Q4 v. Q1) 1·02, 95% CI 0·86, 1·21) or CVD (HR(Q4 v. Q1) 1·04, 95 % CI 0·83, 1·30). Bacterial fermented foods mainly consisted of fermented dairy foods (78 %) and cheese (16%). None of the subtypes of fermented foods was consistently related to mortality, except for cheese which was moderately inversely associated with CVD mortality, and particularly stroke mortality (HR(Q4 v. Q1) 0·59, 95% CI 0·38, 0·92, P trend= 0·046). In conclusion, the present study provides no strong evidence that intake of fermented foods, particularly fermented dairy foods, is associated with mortality.

Total and cause-specific mortality of U.S. nurses working rotating night shifts.

PubMed

Gu, Fangyi; Han, Jiali; Laden, Francine; Pan, An; Caporaso, Neil E; Stampfer, Meir J; Kawachi, Ichiro; Rexrode, Kathryn M; Willett, Walter C; Hankinson, Susan E; Speizer, Frank E; Schernhammer, Eva S

2015-03-01

Rotating night shift work imposes circadian strain and is linked to the risk of several chronic diseases. To examine associations between rotating night shift work and all-cause; cardiovascular disease (CVD); and cancer mortality in a prospective cohort study of 74,862 registered U.S. nurses from the Nurses' Health Study. Lifetime rotating night shift work (defined as ≥3 nights/month) information was collected in 1988. During 22 years (1988-2010) of follow-up, 14,181 deaths were documented, including 3,062 CVD and 5,413 cancer deaths. Cox proportional hazards models estimated multivariable-adjusted hazard ratios (HRs) and 95% CIs. All-cause and CVD mortality were significantly increased among women with ≥5 years of rotating night shift work, compared to women who never worked night shifts. Specifically, for women with 6-14 and ≥15 years of rotating night shift work, the HRs were 1.11 (95% CI=1.06, 1.17) and 1.11 (95% CI=1.05, 1.18) for all-cause mortality and 1.19 (95% CI=1.07, 1.33) and 1.23 (95% CI=1.09, 1.38) for CVD mortality. There was no significant association between rotating night shift work and all-cancer mortality (HR≥15years=1.08, 95% CI=0.98, 1.19) or mortality of any individual cancer, with the exception of lung cancer (HR≥15years=1.25, 95% CI=1.04, 1.51). Women working rotating night shifts for ≥5 years have a modest increase in all-cause and CVD mortality; those working ≥15 years of rotating night shift work have a modest increase in lung cancer mortality. These results add to prior evidence of a potentially detrimental effect of rotating night shift work on health and longevity. Copyright © 2015 American Journal of Preventive Medicine. All rights reserved.

Pre-diagnostic 25-Hydroxyvitamin D, VDR and CASR Polymorphisms, and Survival in Patients with Colorectal Cancer in Western European Populations

PubMed Central

Fedirko, Veronika; Riboli, Elio; Tjønneland, Anne; Ferrari, Pietro; Olsen, Anja; Bueno-de-Mesquita, H. Bas; van Duijnhoven, Fränzel J.B.; Norat, Teresa; Jansen, Eugène H.J.M.; Dahm, Christina C; Overvad, Kim; Boutron-Ruault, Marie-Christine; Clavel-Chapelon, Françoise; Racine, Antoine; Lukanova, Annekatrin; Teucher, Birgit; Boeing, Heiner; Aleksandrova, Krasimira; Trichopoulou, Antonia; Benetou, Vassiliki; Trichopoulos, Dimitrios; Grioni, Sara; Vineis, Paolo; Panico, Salvatore; Palli, Domenico; Tumino, Rosario; Siersema, Peter D.; Peeters, Petra HM; Skeie, Guri; Brustad, Magritt; Chirlaque, Maria-Dolores; Gurrea, Aurelio Barricarte; Garcia, Jose Ramón Quirós; Pérez, Maria José Sánchez; Dorronsoro, Miren; Bonet, Catalina; Palmqvist, Richard; Hallmans, Göran; Key, Timothy J.; Crowe, Francesca; Khaw, Kay-Tee; Wareham, Nick; Romieu, Isabelle; McKay, James; Wark, Petra A.; Romaguera, Dora; Jenab, Mazda

2012-01-01

Background Individuals with higher blood 25-hydroxy-vitamin D [25(OH)D] levels have a lower risk of developing colorectal cancer (CRC), but the influence of 25(OH)D on mortality after CRC diagnosis is unknown. Methods The association between pre-diagnostic 25(OH)D levels and CRC-specific (N=444) and overall mortality (N=541) was prospectively examined among 1,202 participants diagnosed with CRC between 1992-2003 in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) according to 25(OH)D quintiles and genetic variation within the VDR and CASR genes. Potential dietary, lifestyle and metabolic effect modifiers were also investigated. Results There were 541 deaths, 444 (82%) due to CRC. Mean follow-up was 73 months. In multivariable analysis, higher 25(OH)D levels were associated with a statistically significant reduction in CRC-specific (Ptrend=0.04) and overall mortality (Ptrend=0.01). Participants with 25(OH)D levels in the highest quintile had an adjusted HR of 0.69 (95%CI: 0.50-0.93) for CRC-specific and 0.67 (95%CI: 0.50-0.88) for overall mortality, compared to the lowest quintile. Except for a possible interaction by pre-diagnostic dietary calcium intake (Pinteraction=0.01), no other potential modifying factors related to CRC survival were noted. The VDR (FokI and BsmI) and CASR (rs1801725) genotypes were not associated with survival. Conclusions High pre-diagnostic 25(OH)D levels are associated with improved survival of patients with CRC. Impact Our findings may stimulate further research directed at investigating the effects of blood vitamin D levels before, at, and after CRC diagnosis on outcomes in CRC patients. PMID:22278364

An Alternative to NOx Cap-and-Trade Programs: An Exploratory Analysis of Charging NOx Emitters for Health Damages

NASA Astrophysics Data System (ADS)

Mauzerall, D. L.; Sultan, B.; Kim, N.; Bradford, D.

2003-12-01

To address the problem of elevated O3 concentrations throughout the northeastern United States in summer, a NOx cap-and-trade program was implemented that reduced NOx emissions from large point sources by nearly 50%. To determine whether this program has been successful, we examine O3, NO and temperature measurements collected in the EPA-AIRS network prior to and after the cap-and-trade program went into effect in 1999. Ambient NO concentrations as measured in the EPA-AIRS network are lower in the post-cap period in all months except July. We find that the upper half of the distribution of O3 concentrations within the region is essentially unchanged (or slightly higher) in May and June, modestly reduced in July and August (except the highest concentrations which are larger in August), and significantly lower in September (ranging from 0-20 ppb lower between the mean and highest concentrations) in the 1999-2001 post-cap period relative to the 1995-1998 pre-cap period. Except for September, the frequency with which the 80ppb 8-hour NAAQS standard for O3 is exceeded has not decreased. Temperatures during the post-cap period were slightly higher in June, July and August, and slightly lower in September - likely contributing to reduced O3 levels during September in the post-cap period. To explore the possibility that trading, or selective emissions over the course of the summer, could influence regional O3 concentrations, we conduct chemical transport modeling experiments using the CAMx regional model. Even within May-September for a single year, demands for electrical power and hence NOx emissions are greater during hot than cool periods. We demonstrate that substantially more O3 is produced from identical NOx emissions from a single power plant on high temperature than on low temperature days in July 1995. Thus a lack of temporal restrictions on when in a single summer month NOx emissions may occur can result in higher O3 levels. We also demonstrate that identical NOx emissions in regions of high (low) isoprene emission result in greater (lesser) O3 production. This indicates that NOx trades from locations with low to high isoprene emissions likely result in increases in O3 production. Since the objective of reducing O3 concentrations is to reduce the impact elevated O3 has on human health and welfare, we examine the mortalities that result from the O3 produced from a fixed NOx emission in the two cases described above as well as in regions of high and low population. We estimate substantially higher mortality rates from a unit NOx emission as a result of elevated O3 concentrations for high temperature days, in regions of high isoprene emissions, and for emissions occurring upwind of large populations. We attempt to assign a monetary value to the loss of life resulting from the enhanced O3 concentrations that result from these NOx emissions. We propose, as an alternative to NOx emissions cap and trade programs, a system by which NOx emitters are charged for the marginal damage they cause as a result of the O3 produced from the NOx they emit. Rather than resulting in a reduction in total NOx emissions without necessarily reducing O3 concentrations (as a cap-and-trade program does), this alternative system provides a direct incentive to reduce NOx emissions at times and places where they cause the most harm.

Racial and ethnic disparities in pneumonia treatment and mortality.

PubMed

Hausmann, Leslie R M; Ibrahim, Said A; Mehrotra, Ateev; Nsa, Wato; Bratzler, Dale W; Mor, Maria K; Fine, Michael J

2009-09-01

The extent to which racial/ethnic disparities in pneumonia care occur within or between hospitals is unclear. Examine within and between-hospital racial/ethnic disparities in quality indicators and mortality for patients hospitalized for pneumonia. Retrospective cohort study. A total of 1,183,753 non-Hispanic white, African American, and Hispanic adults hospitalized for pneumonia between January 2005 and June 2006. Eight pneumonia care quality indicators and in-hospital mortality. Performance rates for the 8 quality indicators ranged from 99.4% (oxygenation assessment within 24 hours) to 60.2% (influenza vaccination). Overall hospital mortality was 4.1%. African American and Hispanic patients were less likely to receive pneumococcal and influenza vaccinations, smoking cessation counseling, and first dose of antibiotic within 4 hours than white patients at the same hospital (ORs = 0.65-0.95). Patients at hospitals with the racial composition of those attended by average African Americans and Hispanics were less likely to receive all indicators except blood culture within 24 hours than patients at hospitals with the racial composition of those attended by average whites. Hospital mortality was higher for African Americans (OR = 1.05; 95% CI = 1.02, 1.09) and lower for Hispanics (OR = 0.85; 95% CI = 0.81, 0.89) than for whites within the same hospital. Mortality for patients at hospitals with the racial composition of those attended by average African Americans (OR = 1.21; 95% CI = 1.18, 1.25) or Hispanics (OR = 1.18; 95% CI = 1.14, 1.23) was higher than for patients at hospitals with the racial composition of those attended by average whites. Racial/ethnic disparities in pneumonia treatment and mortality are larger and more consistent between hospitals than within hospitals.

Metabolically healthy obesity and risk of mortality: does the definition of metabolic health matter?

PubMed

Hinnouho, Guy-Marino; Czernichow, Sébastien; Dugravot, Aline; Batty, G David; Kivimaki, Mika; Singh-Manoux, Archana

2013-08-01

To assess the association of a "metabolically healthy obese" phenotype with mortality using five definitions of metabolic health. Adults (n = 5,269; 71.7% men) aged 39-62 years in 1991 through 1993 provided data on BMI and metabolic health, defined using data from the Adult Treatment Panel-III (ATP-III); criteria from two studies; and the Matsuda and homeostasis model assessment (HOMA) indices. Cross-classification of BMI categories and metabolic status (healthy/unhealthy) created six groups. Cox proportional hazards regression models were used to analyze associations with all-cause and cardiovascular disease (CVD) mortality during a median follow-up of 17.7 years. A total of 638 individuals (12.1% of the cohort) were obese, of whom 9-41% were metabolically healthy, depending on the definition. Regardless of the definition, compared with metabolically healthy, normal-weight individuals, both the metabolically healthy obese (hazard ratios [HRs] ranged from 1.81 [95% CI 1.16-2.84] for ATP-III to 2.30 [1.13-4.70] for the Matsuda index) and the metabolically abnormal obese (HRs ranged from 1.57 [1.08-2.28] for the Matsuda index to 2.05 [1.44-2.92] for criteria defined in a separate study) had an increased risk of mortality. The only exception was the lack of excess risk using the HOMA criterion for the metabolically healthy obese (1.08; 0.67-1.74). Among the obese, the risk of mortality did not vary as a function of metabolic health apart from when using the HOMA criterion (1.93; 1.15-3.22). Similar results were obtained for cardiovascular mortality. For most definitions of metabolic health, both metabolically healthy and unhealthy obese patients carry an elevated risk of mortality.

Older Age Confers a Higher Risk of 30-Day Morbidity and Mortality Following Laparoscopic Bariatric Surgery: an Analysis of the Metabolic and Bariatric Surgery Quality Improvement Program.

PubMed

Haskins, Ivy N; Ju, Tammy; Whitlock, Ashlyn E; Rivas, Lisbi; Amdur, Richard L; Lin, Paul P; Vaziri, Khashayar

2018-04-17

There is a paucity of literature describing the association of age with the risk of adverse events following bariatric surgery. The purpose of this study is to investigate the association of age with 30-day morbidity and mortality following laparoscopic bariatric surgery using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. All adult patients undergoing laparoscopic Roux-en-Y gastric bypass (RNGYB) or sleeve gastrectomy (SG) were identified within the MBSAQIP database. Patients were divided into five equal age quintiles. Binary outcomes of interest, including cardiac, pulmonary, wound, septic, clotting, and renal events, in addition to the incidence of related 30-day unplanned reintervention, related 30-day mortality, and a composite morbidity and mortality outcome were compared across the age quintiles and procedures. A total of 266,544 patients met inclusion criteria. Older age was associated with an increased risk of all morbidity outcomes except venous thromboembolism events, 30-day mortality, and the composite morbidity and mortality outcome. Patients who underwent Roux-en-Y gastric bypass had worse outcomes per quintile for almost every outcome of interest when compared to patients who underwent sleeve gastrectomy. Older patients and patients who undergo Roux-en-Y gastric bypass are at an increased risk of perioperative morbidity and mortality following laparoscopic bariatric surgery. Additional studies are needed to determine the association of age with long-term weight loss and cardiometabolic comorbidity resolution following bariatric surgery in order to determine if the increased perioperative risk is offset by improved long-term outcomes in older patients undergoing bariatric surgery.

Life expectancy and death by diseases of the circulatory system in patients with bipolar disorder or schizophrenia in the Nordic countries.

PubMed

Laursen, Thomas Munk; Wahlbeck, Kristian; Hällgren, Jonas; Westman, Jeanette; Ösby, Urban; Alinaghizadeh, Hassan; Gissler, Mika; Nordentoft, Merete

2013-01-01

Excess mortality from diseases and medical conditions (natural death) in persons with psychiatric disorders has been extensively reported. Even in the Nordic countries with well-developed welfare systems, register based studies find evidence of an excess mortality. In recent years, cardiac mortality and death by diseases of the circulatory system has seen a decline in all the Nordic countries, but a recent paper indicates that women and men in Denmark, Finland, and Sweden, who had been hospitalised for a psychotic disorder, had a two to three-fold increased risk of dying from a cardiovascular disease. The aim of this study was to compare the mortality by diseases of the circulatory system among patients with bipolar disorder or schizophrenia in the three Nordic countries Denmark, Sweden, and Finland. Furthermore, the aim was to examine and compare life expectancy among these patients. Cause specific Standardized Mortality Rates (SMRs) were calculated for each specific subgroup of mortality. Life expectancy was calculated using Wiesler's method. The SMR for bipolar disorder for diseases of the circulatory system was approximately 2 in all countries and both sexes. SMR was slightly higher for people with schizophrenia for both genders and in all countries, except for men in Denmark. Overall life expectancy was much lower among persons with bipolar disorder or schizophrenia, with life expectancy being from 11 to 20 years shorter. Our data show that persons in the Nordic countries with schizophrenia or bipolar disorder have a substantially reduced life expectancy. An evaluation of the reasons for these increased mortality rates should be prioritized when planning healthcare in the coming years.

Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries

PubMed Central

Laursen, Thomas Munk; Wahlbeck, Kristian; Hällgren, Jonas; Westman, Jeanette; Ösby, Urban; Alinaghizadeh, Hassan; Gissler, Mika; Nordentoft, Merete

2013-01-01

Objective Excess mortality from diseases and medical conditions (natural death) in persons with psychiatric disorders has been extensively reported. Even in the Nordic countries with well-developed welfare systems, register based studies find evidence of an excess mortality. In recent years, cardiac mortality and death by diseases of the circulatory system has seen a decline in all the Nordic countries, but a recent paper indicates that women and men in Denmark, Finland, and Sweden, who had been hospitalised for a psychotic disorder, had a two to three-fold increased risk of dying from a cardiovascular disease. The aim of this study was to compare the mortality by diseases of the circulatory system among patients with bipolar disorder or schizophrenia in the three Nordic countries Denmark, Sweden, and Finland. Furthermore, the aim was to examine and compare life expectancy among these patients. Cause specific Standardized Mortality Rates (SMRs) were calculated for each specific subgroup of mortality. Life expectancy was calculated using Wiesler’s method. Results The SMR for bipolar disorder for diseases of the circulatory system was approximately 2 in all countries and both sexes. SMR was slightly higher for people with schizophrenia for both genders and in all countries, except for men in Denmark. Overall life expectancy was much lower among persons with bipolar disorder or schizophrenia, with life expectancy being from 11 to 20 years shorter. Conclusion Our data show that persons in the Nordic countries with schizophrenia or bipolar disorder have a substantially reduced life expectancy. An evaluation of the reasons for these increased mortality rates should be prioritized when planning healthcare in the coming years. PMID:23826212

Differential immune gene expression profiles in susceptible and resistant full-sibling families of Atlantic salmon (Salmo salar) challenged with infectious pancreatic necrosis virus (IPNV).

PubMed

Reyes-López, Felipe E; Romeo, Jose S; Vallejos-Vidal, Eva; Reyes-Cerpa, Sebastián; Sandino, Ana M; Tort, Lluis; Mackenzie, Simon; Imarai, Mónica

2015-11-01

This study aims to identify at the expression level the immune-related genes associated with IPN-susceptible and resistant phenotypes in Atlantic salmon full-sibling families. We have analyzed thirty full-sibling families infected by immersion with IPNV and then classified as resistant or susceptible using a multivariate survival analysis based on a gamma-Cox frailty model and the Kaplan-Meier mortality curves. In four families within each group head kidneys were pooled for real-time PCR and one-color salmon-specific oligonucleotide microarray (21K) analysis at day 1 and 5 post-infection. Transcripts involved in innate response (IL-6, IFN-α), antigen presentation (HSP-70, HSP-90, MHC-I), TH1 response (IL-12, IFN-γ, CRFB6), immunosuppression (IL-10, TGF-β1) and leukocyte activation and migration (CCL-19, CD18) showed a differential expression pattern between both phenotypes, except in IL-6. In susceptible families, except for IFN-γ, the expressions dropped to basal values at day 5 post-infection. In resistant families, unlike susceptible families, levels remained high or increased (except for IL-6) at day 5. Transcriptomic analysis showed that both families have a clear differential expression pattern, resulting in a marked down-regulation in immune related genes involved in innate response, complement system, antigen recognition and activation of immune response in IPN-resistant. Down-regulation of genes, mainly related to tissue differentiation and protein degradation metabolism, was also observed in resistant families. We have identified an immune-related gene patterns associated with susceptibility and resistance to IPNV infection of Atlantic salmon. This suggests that a limited immune response is associated with resistant fish phenotype to IPNV challenge while a highly inflammatory but short response is associated with susceptibility. Copyright © 2015 Elsevier Ltd. All rights reserved.

All-cause mortality in adults with and without type 2 diabetes: findings from the national health monitoring in Germany

PubMed Central

Brinks, Ralph; Baumert, Jens; Paprott, Rebecca; Du, Yong; Heidemann, Christin; Scheidt-Nave, Christa

2017-01-01

Objective To estimate age-specific and sex-specific all-cause mortality among adults with and without type 2 diabetes (T2D) in Germany. Research design and methods The German National Health Interview and Examination Survey 1998 (GNHIES98) included a mortality follow-up (median follow-up time 12.0 years) of its nationwide sample representative of the population aged 18–79 years. After exclusion of participants with type 1 diabetes, age- and sex-stratified mortality rates (MR) were calculated for 330 GNHIES98 participants with diagnosed T2D (self-reported diagnosis or antidiabetic medication), 245 with undiagnosed T2D (no diagnosed T2D, glycated hemoglobin A1c ≥6.5% (≥48 mmol/mol)), and 5975 without T2D. Mortality rate ratios (MRR) comparing MR of persons with and without T2D were estimated. Age-/sex-standardized MR and MRR were calculated including persons aged 45 years or older. MRR were used to estimate the number of years of life lost (YLL) due to diagnosed diabetes in 2010. Results Over 75 994 person-years, 73 persons with undiagnosed T2D, 103 with diagnosed T2D, and 425 persons without T2D died. MRR were significantly higher in younger age groups, except for analyses limited to women or diagnosed T2D. Age- and sex-standardized MRR (95% CI) among persons aged 45 years or older were 1.96 (1.41 to 2.71) for undiagnosed, 1.68 (1.26 to 2.23) for diagnosed, and 1.82 (1.45 to 2.28) for total (undiagnosed or diagnosed) T2D. Sex-stratified analysis revealed similar age-standardized MRR for undiagnosed (1.56 (0.79 to 3.06)) and diagnosed T2D (1.56 (1.03 to 2.37)) among women, and a higher age-standardized MRR for undiagnosed (2.06 (1.43 to 2.97)) than diagnosed T2D (1.70 (1.10 to 2.63)) among men. YLL due to diagnosed diabetes in Germany in 2010 were 164 600 (35 000 to 279 300) among women and 169 900 (28 300 to 328 300) among men. Conclusions In Germany, age- and sex-standardized all-cause mortality is almost twice as high for adults with T2D as for adults without T2D. The T2D-associated excess risk of mortality appears to be most pronounced in younger adults and among men unaware of their T2D. PMID:29435349

[Brazilian medical literature about the white plague: 1870-1940].

PubMed

Sheppard, D S

2001-01-01

The Darwinian theories compound the paradigm adopted by the physicians in Southern United States, when they turned to the subject of the differences in morbidity and mortality among the races after abolition. These physicians engaged in thoughts about the health crisis that assaulted the African-American population on that region. The Brazilian physicians, on the other hand, would not try to understand or explain the health crisis that overtook the population descended from Africans on their country. Actually, not a single Brazilian medical journal, since the end of abolition to the 1930s, published an article where a physician indicated the morbidity and mortality of his negro patients, or of negroes in general, as caused by any source related to the racial paradigm. The psychiatrists and eugenicist doctors were exceptions.

Cerebral ischemia and neuroregeneration

PubMed Central

Lee, Reggie H. C.; Lee, Michelle H. H.; Wu, Celeste Y. C.; Couto e Silva, Alexandre; Possoit, Harlee E.; Hsieh, Tsung-Han; Minagar, Alireza; Lin, Hung Wen

2018-01-01

Cerebral ischemia is one of the leading causes of morbidity and mortality worldwide. Although stroke (a form of cerebral ischemia)-related costs are expected to reach 240.67 billion dollars by 2030, options for treatment against cerebral ischemia/stroke are limited. All therapies except anti-thrombolytics (i.e., tissue plasminogen activator) and hypothermia have failed to reduce neuronal injury, neurological deficits, and mortality rates following cerebral ischemia, which suggests that development of novel therapies against stroke/cerebral ischemia are urgently needed. Here, we discuss the possible mechanism(s) underlying cerebral ischemia-induced brain injury, as well as current and future novel therapies (i.e., growth factors, nicotinamide adenine dinucleotide, melatonin, resveratrol, protein kinase C isozymes, pifithrin, hypothermia, fatty acids, sympathoplegic drugs, and stem cells) as it relates to cerebral ischemia. PMID:29623912

A never-ending succession of epidemics? Mortality in early-modern York.

PubMed

Galley, C

1994-04-01

Early-modern cities are often perceived to be centres of high mortality and under constant siege from a barrage of epidemics. However, few urban mortality rates have been calculated and by employing parish register evidence from the regional capital of York, the thesis that the city was subjected to continual sudden increases in mortality can be firmly rejected. Infant mortality was high but remained virtually constant between 1561 and 1700. About a quarter of all infants did not survive to reach their first birthday and neonatal mortality was especially severe. From the mid-seventeenth century a series of epidemics increased child mortality although overall levels of mortality were not significantly affected. Relatively little can be said about adult mortality and apart from two periods of 'crisis' mortality there is little to suggest that adults were greatly affected by epidemics. Indeed, for many adults the urban environment appears to have posed no great threat to health and most could look forward to a relatively long life in the city. York's mortality regime was very similar to that of the smaller market town of Gainsborough where high levels of mortality remained stable throughout much of the early-modern period.

Mortality from ischaemic heart disease by country, region, and age: statistics from World Health Organisation and United Nations.

PubMed

Finegold, Judith A; Asaria, Perviz; Francis, Darrel P

2013-09-30

Ischaemic heart disease (IHD) is the leading cause of death worldwide. The World Health Organisation (WHO) collects mortality data coded using the International Statistical Classification of Diseases (ICD) code. We analysed IHD deaths world-wide between 1995 and 2009 and used the UN population database to calculate age-specific and directly and indirectly age-standardised IHD mortality rates by country and region. IHD is the single largest cause of death worldwide, causing 7,249,000 deaths in 2008, 12.7% of total global mortality. There is more than 20-fold variation in IHD mortality rates between countries. Highest IHD mortality rates are in Eastern Europe and Central Asian countries; lowest rates in high income countries. For the working-age population, IHD mortality rates are markedly higher in low-and-middle income countries than in high income countries. Over the last 25 years, age-standardised IHD mortality has fallen by more than half in high income countries, but the trend is flat or increasing in some low-and-middle income countries. Low-and-middle income countries now account for more than 80% of global IHD deaths. The global burden of IHD deaths has shifted to low-and-middle income countries as lifestyles approach those of high income countries. In high income countries, population ageing maintains IHD as the leading cause of death. Nevertheless, the progressive decline in age-standardised IHD mortality in high income countries shows that increasing IHD mortality is not inevitable. The 20-fold mortality difference between countries, and the temporal trends, may hold vital clues for handling IHD epidemic which is migratory, and still burgeoning. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Dual impact of temperature on growth and mortality of marine fish larvae in a shallow estuarine habitat

NASA Astrophysics Data System (ADS)

Arula, Timo; Laur, Kerli; Simm, Mart; Ojaveer, Henn

2015-12-01

High individual growth and mortality rates of herring Clupea harengus membras and goby Pomatoschistus spp. larvae were observed in the estuarine habitat of the Gulf of Riga, Baltic Sea. Both instantaneous mortality (0.76-1.05) as well as growth rate (0.41-0.82 mm day-1) of larval herring were amongst highest observed elsewhere previously. Mortality rates of goby larvae were also high (0.57-1.05), while first ever data on growth rates were provided in this study (0.23-0.35 mm day-1). Our study also evidenced that higher growth rate of marine fish larvae did not result in lower mortalities. We suggest that high growth and mortality rates primarily resulted from a rapidly increasing and high (>18 °C) water temperature that masked potential food-web effects. The explanation for observed patterns lies in the interactive manner temperature contributed: i) facilitating prey production, which supported high growth rate and decreased mortalities; ii) exceeding physiological thermal optimum of larvae, which resulted in decreased growth rate and generally high mortalities. Our investigation suggests that the projected climate warming may have significant effect on early life history stages of the dominating marine fish species inhabiting shallow estuaries.

Clinical Significance of the Edema Index in Incident Peritoneal Dialysis Patients.

PubMed

Kang, Seok Hui; Choi, Eun Woo; Park, Jong Won; Cho, Kyu Hyang; Do, Jun Young

2016-01-01

Proper monitoring for volume overload is important to improve prognosis in peritoneal dialysis (PD) patients. The association between volume status and residual renal function (RRF) remains an unresolved issue. The aim of the present study was to evaluate the association between the edema index and survival or RRF in incident PD patients. We identified all adults who underwent PD. The edema index was defined as the ratio of extracellular fluid to total body fluid. Participants with available data regarding survivorship or non-survivorship during the first year after PD initiation were included in the area under the receiver operating characteristic curve analysis. The cutoff value of the edema index for 1-year mortality was >0.371 in men and >0.372 in women. Participants were divided into two groups according to the cutoff value of their baseline edema indices: High (>cutoff value) and Low (≤ cutoff value). Survivors during the first year after PD initiation were divided into two groups according to the initial and 1-year edema index: Non-improvement (maintenance of criteria in the initial Low group during the year) and Other (all participants except those in the Non-improvement group). In total, 631 patients were enrolled in the present study. The cutoff value of the edema index for 1-year mortality was >0.371 in men and >0.372 in women. The respective mean initial RRF values (mL · min(-1) · 1.73 m(-2)) in the Low and High groups, respectively, were 4.88 ± 4.09 and 4.21 ± 3.28 in men (P = 0.108), and 3.19 ± 2.57 and 2.98 ± 2.70 in women (P = 0.531). There were no significant differences between groups in either sex. The respective mean RRF values at 1 year after PD initiation in the Low and High groups, respectively, were 3.56 ± 4.35 and 2.73 ± 2.53 in men, and 2.80 ± 2.36 and 1.85 ± 1.51 in women. RRF at 1 year after PD initiation was higher in the Low group than in the High group (men: P = 0.027; women: P = 0.001). In men, the cumulative 5-year survival rates were 78.7% and 46.2% in the Low and High groups, respectively, whereas in women, rates were 77.2% and 58.8% in the Low and High groups, respectively. For survivors during the first year after PD initiation, the Non-improvement group was associated with a poor survival rate compared with the Other group for both sexes. A high edema index was associated with mortality in incident PD patients at baseline and follow-up. The edema index may be used as a new marker for predicting mortality in PD patients.

Socioeconomic indicators in epidemiologic research: A practical example from the LIFEPATH study

PubMed Central

d’Errico, Angelo; Ricceri, Fulvio; Stringhini, Silvia; Carmeli, Cristian; Kivimaki, Mika; Bartley, Mel; McCrory, Cathal; Bochud, Murielle; Vollenweider, Peter; Tumino, Rosario; Goldberg, Marcel; Zins, Marie; Barros, Henrique; Giles, Graham; Severi, Gianluca

2017-01-01

Background Several social indicators have been used in epidemiological research to describe socioeconomic position (SEP) of people in societies. Among SEP indicators, those more frequently used are education, occupational class and income. Differences in the incidence of several health outcomes have been reported consistently, independently from the indicator employed. Main objectives of the study were to present the socioeconomic classifications of the social indicators which will be employed throughout the LIFEPATH project and to compare social gradients in all-cause mortality observed in the participating adult cohorts using the different SEP indicators. Methods Information on the available social indicators (education, own and father’s occupational class, income) from eleven adult cohorts participating in LIFEPATH was collected and harmonized. Mortality by SEP for each indicator was estimated by Poisson regression on each cohort and then evaluated using a meta-analytical approach. Results In the meta-analysis, among men mortality was significantly inversely associated with both occupational class and education, but not with father’s occupational class; among women, the increase in mortality in lower social strata was smaller than among men and, except for a slight increase in the lowest education category, no significant differences were found. Conclusions Among men, the proposed three-level classifications of occupational class and education were found to predict differences in mortality which is consistent with previous research. Results on women suggest that classifying them through their sole SEP, without considering that of their partners, may imply a misclassification of their social position leading to attenuation of mortality differences. PMID:28557991

[Occupational pesticide poisoning mortality, 2000-2009, Brazil].

PubMed

Santana, Vilma Sousa; Moura, Maria Claudia Peres; Ferreira e Nogueira, Flávia

2013-06-01

To estimate the mortality rate due to occupational pesticide poisoning in Brazil. Data on diagnoses of death from pesticide poisoning between 2000 and 2009 were obtained from the Mortality Information System. ICD-10 codes T60.0-T60.4, T60.8 and T60.9, Y18, X487 and Z578 as the main or secondary cause of death; data on work-related deaths were obtained from the death certificate, from the fields , and whether cases were agricultural workers. Homicides and suicides were excluded. To calculate mortality, the number of agricultural workers was obtained from the Brazilian Institute of Geography and Statistics, National System of Accounts estimates. There were 2,052 deaths recorded as caused by pesticide poisoning in Brazil, between 2000 and 2009, of which 36.2% (n = 743) had no occupation data. Of the remaining 1,309, 679 (51.9%) were agricultural workers. Mortality from occupational pesticide poisoning declined from 0.56/100.000 (2000-2001) to 0.39/100.000 (2008-2009) workers during the study period, and there was a larger decrease among men compared with women. Males had a higher mortality from this type of poisoning than women in all study years. Most deaths were caused by organophosphates and carbamate pesticides poisoning. During the study period the number of cases declined in all regions, except for the Northeast. Improvement in the quality of Death Certificate records is needed, particularly for occupation and the assessment of causes of death as work related, crucial for work injuries control and prevention programs. Special attention is required in the Northeast region.

Comparative mortality among US military personnel in the Persian Gulf region and worldwide during Operations Desert Shield and Desert Storm.

PubMed

Writer, J V; DeFraites, R F; Brundage, J F

1996-01-10

To determine cause-specific mortality rates among US troops stationed in the Persian Gulf region and compare them with those of US troops serving elsewhere during Operations Desert Shield and Desert Storm. Retrospective cohort. US men and women on active duty from August 1, 1990, through July 31, 1991. Deaths occurring among all active-duty US military persons during the 1-year study period. Age-adjusted mortality rates among US troops stationed in the Persian Gulf region were compared with rates projected from mortality rates among troops on active duty elsewhere. A total of 1769 active-duty persons died during the study period, 372 in the Persian Gulf region and 1397 elsewhere. Of the 372 deaths in the Persian Gulf region, 147 (39.5%) occurred as a direct result of combat during the war, 194 (52.2%) resulted from injuries not incurred in battle, and 30 (8%) resulted from illness. Twenty-three of the deaths due to illness were considered unexpected or cardiovascular deaths. Based on age-adjusted mortality rates observed among US troops on active duty outside the Persian Gulf region, 165 deaths from unintentional injury and 32 deaths from illness (20 of which were unexpected or cardiovascular) would have been anticipated among Persian Gulf troops. Except for deaths from unintentional injury, US troops in the Persian Gulf region did not experience significantly higher mortality rates than US troops serving elsewhere. There were no clusters of unexplained deaths. The number and circumstances of nonbattle deaths among Persian Gulf troops were typical for the US military population.

Stroke mortality variations in South-East Asia: empirical evidence from the field.

PubMed

Hoy, Damian G; Rao, Chalapati; Hoa, Nguyen Phuong; Suhardi, S; Lwin, Aye Moe Moe

2013-10-01

Stroke is a leading cause of death in Asia; however, many estimates of stroke mortality are based on epidemiological models rather than empirical data. Since 2005, initiatives have been undertaken in a number of Asian countries to strengthen and analyse vital registration data. This has increased the availability of empirical data on stroke mortality. The aim of this paper is to present estimates of stroke mortality for Indonesia, Myanmar, Viet Nam, Thailand, and Malaysia, which have been derived using these empirical data. Age-specific stroke mortality rates were calculated in each of the five countries, and adjusted for data completeness or misclassification where feasible. All data were age-standardized and the resulting rates were compared with World Health Organization estimates, which are largely based on epidemiological models. Using empirical data, stroke ranked as the leading cause of death in all countries except Malaysia, where it ranked as the second leading cause. Age-standardized rates for males ranged from 94 per 100,000 in Thailand, to over 300 per 100,000 in Indonesia. In all countries, rates were higher for males than for females, and those compiled from empirical data were generally higher than modelled estimates published by World Health Organization. This study highlights the extent of stroke mortality in selected Asian countries, and provides important baseline information to investigate the aetiology of stroke in Asia and design appropriate public health strategies to address the rapidly growing burden from stroke. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

TRENDS IN MORTALITY FROM OCCUPATIONAL HAZARDS AMONG MEN IN ENGLAND AND WALES DURING 1979-2010

PubMed Central

Harris, E Clare; Palmer, Keith T; Cox, Vanessa; Darnton, Andrew; Osman, John; Coggon, David

2016-01-01

Objectives To monitor the impact of health and safety provisions and inform future preventive strategies, we investigated trends in mortality from established occupational hazards in England and Wales. Methods We analysed data from death certificates on underlying cause of death and last full-time occupation for 3,688,916 deaths among men aged 20-74 years in England and Wales during 1979-2010 (excluding 1981 when records were incomplete). Proportional mortality ratios (PMRs), standardised for age and social class, were calculated for occupations at risk of specified hazards. Observed and expected numbers of deaths for each hazard were summed across occupations, and the differences summarised as average annual excesses. Results Excess mortality declined substantially for most hazards. For example, the annual excess of deaths from chronic bronchitis and emphysema fell from 170.7 during 1979-90 to 36.0 in 2001-10, and that for deaths from injury and poisoning from 237.0 to 87.5. In many cases the improvements were associated with falling PMRs (suggesting safer working practices), but they also reflected reductions in the numbers of men employed in more hazardous jobs, and declining mortality from some diseases across the whole population. Notable exceptions to the general improvement were diseases caused by asbestos, especially in some construction trades and sinonasal cancer in woodworkers. Conclusions The highest priority for future prevention of work-related fatalities is the minority of occupational disorders for which excess mortality remains static or is increasing, in particular asbestos-related disease among certain occupations in the construction industry and sinonasal cancer in woodworkers. PMID:26976946

Intra-annual growth and mortality of four Populus clones in pure and mixed plantings

Treesearch

Warren D. Devine; Constance A. Harrington; Dean S. DeBell

2010-01-01

Intra-annual growth rates were assessed during 3 years for four Populus clones grown in pure and mixed clonal stands at square spacings of 0.5, 1.0, and 1.5 m in western Washington, USA. Height growth rate peaked in August, except at the 0.5-m spacing where it peaked in July and June in years 2 and 3, respectively. Diameter growth rate generally...

High blood glucose independent of pre-existing diabetic status predicts mortality in patients initiating peritoneal dialysis therapy.

PubMed

Chung, Sung Hee; Han, Dong Cheol; Noh, Hyunjin; Jeon, Jin Seok; Kwon, Soon Hyo; Lindholm, Bengt; Lee, Hi Bahl

2015-06-01

Poor glycemic control associates with increased mortality in diabetic (DM) dialysis patients, but it is less well established whether high blood glucose (BG) independent of pre-existing diabetic status associates with mortality in dialysis patients. We assessed factors affecting BG at the start of peritoneal dialysis (PD) and its mortality-predictive impact in Korean PD patients. In 174 PD patients (55 % males, 56 % DM), BG, nutritional status, comorbidity (CMD), and residual renal function (RRF) were assessed in conjunction with dialysis initiation. Determinants of BG and its association with mortality after a mean follow-up period of 30 ± 24 months were analyzed. On Cox proportional hazards analysis comprising all patients, old age, high CMD score, presence of protein energy wasting, and low serum albumin (Salb) concentration were independent predictors of mortality but not a high-BG level, while in patients without pre-existing diabetic status, high BG, together with old age and high CMD score, was an independent predictor of mortality. After adjustment for age, CMD score, and Salb, the risk ratio for mortality increased by 12 % per 1 mg/dL increase in BG in the non-DM patients. Patient survival in patients without pre-existing diabetic status with high BG did not differ from DM patients, but the survival of patients with high BG was significantly lower than in patients with low BG. In patients without pre-existing diabetic status, in multiple regression analysis, high BG at initiation of PD associated with high age, high body mass index, and low RRF. High blood glucose at initiation of PD associated with an increased mortality risk in PD patients without pre-existing diabetic status suggesting that blood glucose monitoring and surveillance of factors contributing to poor glycemic control are warranted in patients initiating PD therapy.

Mortality Attributable to Low Levels of Education in the United States.

PubMed

Krueger, Patrick M; Tran, Melanie K; Hummer, Robert A; Chang, Virginia W

2015-01-01

Educational disparities in U.S. adult mortality are large and have widened across birth cohorts. We consider three policy relevant scenarios and estimate the mortality attributable to: (1) individuals having less than a high school degree rather than a high school degree, (2) individuals having some college rather than a baccalaureate degree, and (3) individuals having anything less than a baccalaureate degree rather than a baccalaureate degree, using educational disparities specific to the 1925, 1935, and 1945 cohorts. We use the National Health Interview Survey data (1986-2004) linked to prospective mortality through 2006 (N=1,008,949), and discrete-time survival models, to estimate education- and cohort-specific mortality rates. We use those mortality rates and data on the 2010 U.S. population from the American Community Survey, to calculate annual attributable mortality estimates. If adults aged 25-85 in the 2010 U.S. population experienced the educational disparities in mortality observed in the 1945 cohort, 145,243 deaths could be attributed to individuals having less than a high school degree rather than a high school degree, 110,068 deaths could be attributed to individuals having some college rather than a baccalaureate degree, and 554,525 deaths could be attributed to individuals having anything less than a baccalaureate degree rather than a baccalaureate degree. Widening educational disparities between the 1925 and 1945 cohorts result in a doubling of attributable mortality. Mortality attributable to having less than a high school degree is proportionally similar among women and men and among non-Hispanic blacks and whites, and is greater for cardiovascular disease than for cancer. Mortality attributable to low education is comparable in magnitude to mortality attributable to individuals being current rather than former smokers. Existing research suggests that a substantial part of the association between education and mortality is causal. Thus, policies that increase education could significantly reduce adult mortality.

Mortality Attributable to Low Levels of Education in the United States

PubMed Central

Krueger, Patrick M.; Tran, Melanie K.; Hummer, Robert A.; Chang, Virginia W.

2015-01-01

Background Educational disparities in U.S. adult mortality are large and have widened across birth cohorts. We consider three policy relevant scenarios and estimate the mortality attributable to: (1) individuals having less than a high school degree rather than a high school degree, (2) individuals having some college rather than a baccalaureate degree, and (3) individuals having anything less than a baccalaureate degree rather than a baccalaureate degree, using educational disparities specific to the 1925, 1935, and 1945 cohorts. Methods We use the National Health Interview Survey data (1986–2004) linked to prospective mortality through 2006 (N=1,008,949), and discrete-time survival models, to estimate education- and cohort-specific mortality rates. We use those mortality rates and data on the 2010 U.S. population from the American Community Survey, to calculate annual attributable mortality estimates. Results If adults aged 25–85 in the 2010 U.S. population experienced the educational disparities in mortality observed in the 1945 cohort, 145,243 deaths could be attributed to individuals having less than a high school degree rather than a high school degree, 110,068 deaths could be attributed to individuals having some college rather than a baccalaureate degree, and 554,525 deaths could be attributed to individuals having anything less than a baccalaureate degree rather than a baccalaureate degree. Widening educational disparities between the 1925 and 1945 cohorts result in a doubling of attributable mortality. Mortality attributable to having less than a high school degree is proportionally similar among women and men and among non-Hispanic blacks and whites, and is greater for cardiovascular disease than for cancer. Conclusions Mortality attributable to low education is comparable in magnitude to mortality attributable to individuals being current rather than former smokers. Existing research suggests that a substantial part of the association between education and mortality is causal. Thus, policies that increase education could significantly reduce adult mortality. PMID:26153885

Identifying and Targeting Mortality Disparities: A Framework for Sub-Saharan Africa Using Adult Mortality Data from South Africa

PubMed Central

Sartorius, Benn; Sartorius, Kurt

2013-01-01

Background Health inequities in developing countries are difficult to eradicate because of limited resources. The neglect of adult mortality in Sub-Saharan Africa (SSA) is a particular concern. Advances in data availability, software and analytic methods have created opportunities to address this challenge and tailor interventions to small areas. This study demonstrates how a generic framework can be applied to guide policy interventions to reduce adult mortality in high risk areas. The framework, therefore, incorporates the spatial clustering of adult mortality, estimates the impact of a range of determinants and quantifies the impact of their removal to ensure optimal returns on scarce resources. Methods Data from a national cross-sectional survey in 2007 were used to illustrate the use of the generic framework for SSA and elsewhere. Adult mortality proportions were analyzed at four administrative levels and spatial analyses were used to identify areas with significant excess mortality. An ecological approach was then used to assess the relationship between mortality “hotspots” and various determinants. Population attributable fractions were calculated to quantify the reduction in mortality as a result of targeted removal of high-impact determinants. Results Overall adult mortality rate was 145 per 10,000. Spatial disaggregation identified a highly non-random pattern and 67 significant high risk local municipalities were identified. The most prominent determinants of adult mortality included HIV antenatal sero-prevalence, low SES and lack of formal marital union status. The removal of the most attributable factors, based on local area prevalence, suggest that overall adult mortality could be potentially reduced by ∼90 deaths per 10,000. Conclusions The innovative use of secondary data and advanced epidemiological techniques can be combined in a generic framework to identify and map mortality to the lowest administration level. The identification of high risk mortality determinants allows health authorities to tailor interventions at local level. This approach can be replicated elsewhere. PMID:23967209

Tree Mortality

Treesearch

Mark J. Ambrose

2011-01-01

Tree mortality is a natural process in all forest ecosystems, but it can also be an indicator of forest health issues. On a regional scale, high-mortality levels may indicate widespread insect or disease problems. Regionally high mortality may also occur if a large proportion of the forests in an area are made up of older, senescent stands.

A surprising exception. Himachal's success in promoting female education.

PubMed

Dreze, J

1999-01-01

Gender inequalities in India are derived partly from the economic dependence of women on men. Low levels of formal education among women reinforce the asymmetry of power between the sexes. A general pattern of sharp gender bias in education levels is noted in most Indian states; however, in the small state of Himachal Pradesh, school participation rates are almost as high for girls as for boys. Rates of school participation for girls at the primary level is close to universal in this state, and while gender bias persists at higher levels of education, it is much lower than elsewhere in India and rapidly declining. This was not the case 50 years ago; educational levels in Himachal Pradesh were no higher than in Bihar or Uttar Pradesh. Today, the spectacular transition towards universal elementary education in Himachal Pradesh has contributed to the impressive reduction of poverty, mortality, illness, undernutrition, and related deprivations.

The economic impact of prospective population changes in advanced industrial countries: an historical perspective.

PubMed

Easterlin, R A

1991-11-01

Demographic projections to the year 2050 for advanced industrial nations, implying low or negative population growth and a sharp rise in old age dependency, have created concerns about the long-term economic outlook in these countries. An analysis of these projections in the light of the demographic and economic experience of the past century raises doubt about these concerns. There is little empirical evidence that declining population growth has slowed the rate of economic growth. Although the burden of aged dependents will reach a new high, the projected total dependency rate is not out of line with prior experience. Thus, the ability of the working population to shoulder the burden of higher taxes to support programs for older dependents will be greater because of reduced needs to support younger dependents. This conclusion holds for a number of variant projections, the only clear exception being one that implies a mortality revolution at older ages.

Experimental model to evaluate the human body louse as a vector of plague.

PubMed

Houhamdi, Linda; Lepidi, Hubert; Drancourt, Michel; Raoult, Didier

2006-12-01

Yersinia pestis has been found in human body lice during plague outbreaks. To evaluate the role that the human body louse plays as a vector of plague, we allowed lice to feed on rabbits made bacteremic by intravenous inoculation of 10(9) colony-forming units of 3 strains of Y. pestis. High mortality rates were observed in all lice 2 and 3 days after infection. The lice remained infected with the strains for their life span and excreted viable organisms in their feces from day 1, although they were unable to lay eggs. The lice infected with 2 virulent strains of Y. pestis transmitted the organisms during feeding to uninfected rabbits, which became septicemic and died of plague (with 1 exception) 1 day later. Infections were transmitted to naive lice that were fed on these rabbits, showing that lice can be vectors of Y. pestis in an experimental model.

A typical presentations of hypothyroidism and associated problems in Ibadan, Nigeria.

PubMed

Balogun, F M; Jarrett, O O

2015-06-01

Hypothyroidism can present atypically making its recognition difficult especially in resource limited settings. CASE PRESENTATION AND MANAGEMENT: Two children presented with atypical features of hypothyroidism with resultant delay in diagnosis. Patient I presented with persistent respiratory distress, facial swelling and recurrent syncopal attacks. Cardiovascular examination was normal except for pulmonary hypertension. He did not respond to conventional supportive therapy and hypothyroidism was discovered much later. Patient II was a seven month old male infant with abdominal swelling, bilateral pitting leg oedema, poor weight gain and delayed developmental milestones. Examination revealed ascites and pericardial effusion. He was being managed for protein energy malnutrition until he was found to have hypothyroidism and was successfully managed with L thyroxin. A typical presentations of hypothyroidism in resource limited settings can result in delay in diagnosis and treatment which can lead to unnecessary morbidity and mortality. High index of suspicion and expertise are therefore required.

Platelet count and total and cause-specific mortality in the Women's Health Initiative.

PubMed

Kabat, Geoffrey C; Kim, Mimi Y; Verma, Amit K; Manson, JoAnn E; Lin, Juan; Lessin, Lawrence; Wassertheil-Smoller, Sylvia; Rohan, Thomas E

2017-04-01

We used data from the Women's Health Initiative to examine the association of platelet count with total mortality, coronary heart disease (CHD) mortality, cancer mortality, and non-CHD/noncancer mortality. Platelet count was measured at baseline in 159,746 postmenopausal women and again in year 3 in 75,339 participants. Participants were followed for a median of 15.9 years. Cox proportional hazards models were used to estimate the relative mortality hazards associated with deciles of baseline platelet count and of the mean of baseline + year 3 platelet count. Low and high deciles of both baseline and mean platelet count were positively associated with total mortality, CHD mortality, cancer mortality, and non-CHD/noncancer mortality. The association was robust and was not affected by adjustment for a number of potential confounding factors, exclusion of women with comorbidity, or allowance for reverse causality. Low- and high-platelet counts were associated with all four outcomes in never smokers, former smokers, and current smokers. In this large study of postmenopausal women, both low- and high-platelet counts were associated with total and cause-specific mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

Effects of diurnal temperature range on mortality in Hefei city, China

NASA Astrophysics Data System (ADS)

Tang, Jing; Xiao, Chang-chun; Li, Yu-rong; Zhang, Jun-qing; Zhai, Hao-yuan; Geng, Xi-ya; Ding, Rui; Zhai, Jin-xia

2017-12-01

Although several studies indicated an association between diurnal temperature range (DTR) and mortality, the results about modifiers are inconsistent, and few studies were conducted in developing inland country. This study aims to evaluate the effects of DTR on cause-specific mortality and whether season, gender, or age might modify any association in Hefei city, China, during 2007-2016. Quasi-Poisson generalized linear regression models combined with a distributed lag non-linear model (DLNM) were applied to evaluate the relationships between DTR and non-accidental, cardiovascular, and respiratory mortality. We observed a J-shaped relationship between DTR and cause-specific mortality. With a DTR of 8.3 °C as the reference, the cumulative effects of extremely high DTR were significantly higher for all types of mortality than effects of lower or moderate DTR in full year. When stratified by season, extremely high DTR in spring had a greater impact on all cause-specific mortality than other three seasons. Male and the elderly (≥ 65 years) were consistently more susceptible to extremely high DTR effect than female and the youth (< 65 years) for non-accidental and cardiovascular mortality. To the contrary, female and the youth were more susceptible to extremely high DTR effect than male and the elderly for respiratory morality. The study suggests that extremely high DTR is a potential trigger for non-accidental mortality in Hefei city, China. Our findings also highlight the importance of protecting susceptible groups from extremely high DTR especially in the spring.

Effects of diurnal temperature range on mortality in Hefei city, China

NASA Astrophysics Data System (ADS)

Tang, Jing; Xiao, Chang-chun; Li, Yu-rong; Zhang, Jun-qing; Zhai, Hao-yuan; Geng, Xi-ya; Ding, Rui; Zhai, Jin-xia

2018-05-01

Although several studies indicated an association between diurnal temperature range (DTR) and mortality, the results about modifiers are inconsistent, and few studies were conducted in developing inland country. This study aims to evaluate the effects of DTR on cause-specific mortality and whether season, gender, or age might modify any association in Hefei city, China, during 2007-2016. Quasi-Poisson generalized linear regression models combined with a distributed lag non-linear model (DLNM) were applied to evaluate the relationships between DTR and non-accidental, cardiovascular, and respiratory mortality. We observed a J-shaped relationship between DTR and cause-specific mortality. With a DTR of 8.3 °C as the reference, the cumulative effects of extremely high DTR were significantly higher for all types of mortality than effects of lower or moderate DTR in full year. When stratified by season, extremely high DTR in spring had a greater impact on all cause-specific mortality than other three seasons. Male and the elderly (≥ 65 years) were consistently more susceptible to extremely high DTR effect than female and the youth (< 65 years) for non-accidental and cardiovascular mortality. To the contrary, female and the youth were more susceptible to extremely high DTR effect than male and the elderly for respiratory morality. The study suggests that extremely high DTR is a potential trigger for non-accidental mortality in Hefei city, China. Our findings also highlight the importance of protecting susceptible groups from extremely high DTR especially in the spring.

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

[Completeness of mortality statistics in Navarra, Spain].

PubMed

Moreno-Iribas, Conchi; Guevara, Marcela; Díaz-González, Jorge; Álvarez-Arruti, Nerea; Casado, Itziar; Delfrade, Josu; Larumbe, Emilia; Aguirre, Jesús; Floristán, Yugo

2013-01-01

Women in the region of Navarra, Spain, have one of the highest life expectancies at birth in Europe. The aim of this study is to assess the completeness of the official mortality statistics of Navarra in 2009 and the impact of the under-registration of deaths on life expectancy estimates. Comparison of the number of deaths in Navarra using the official statistics from the Instituto Nacional de Estadística (INE) and the data derived from a multiple-source case-finding: the electronic health record, Instituto Navarro de Medicina Legal and INE including data that they received late. 5,249 deaths were identified, of which 103 were not included in the official mortality statistics. Taking into account only deaths that occurred in Spain, which are the only ones considered for the official statistics, the completeness was 98.4%. Estimated life expectancy at birth in 2009 descended from 86.6 years to 86.4 in women and from 80.0 to 79.6 years in men, after correcting for undercount. The results of this study ruled out the existence of significant under-registration of the official mortality statistics, confirming the exceptional longevity of women in Navarra, who are in the top position in Europe with a life expectancy at birth of 86.4 years.

The state of the art in raptor electrocution research: A global review

USGS Publications Warehouse

Lehman, Robert N.; Kennedy, P.L.; Savidge, J.A.

2007-01-01

We systematically reviewed the raptor electrocution literature to evaluate study designs and methods used in raptor electrocution research, mitigation, and monitoring, emphasizing original research published in English. Specifically, we wondered if three decades of effort to reduce raptor electrocutions has had positive effects. The majority of literature examined came from North America, western Europe, and South Africa. In spite of intensive and often sustained effort by industry and governments across three continents for 30 years, reductions in the incidence of electrocution have been demonstrated in only a few studies. Reliable rate estimates of electrocution mortality generally are unavailable, with some exceptions. Nearly half of 110 studies we analyzed in detail were retrospective reviews of historical mortality records, banding data, or results of necropsies on dead birds received at pathology and veterinary facilities. Among prospective studies, less than half used unbiased approaches to sampling and many did not provide enough detail to assess the sampling design used. At this time, few researchers can demonstrate the reliability of standardized retrofitting procedures or the effectiveness of monitoring techniques. Future progress in reducing raptor mortalities on power lines will benefit from properly designed studies that generate rate estimates of mortality, address biasing factors, and include predictions concerning risk and techniques to reduce risk that can be tested in the field or laboratory.

Do socioeconomic inequalities in mortality vary between different Spanish cities? a pooled cross-sectional analysis

PubMed Central

2013-01-01

Background The relationship between deprivation and mortality in urban settings is well established. This relationship has been found for several causes of death in Spanish cities in independent analyses (the MEDEA project). However, no joint analysis which pools the strength of this relationship across several cities has ever been undertaken. Such an analysis would determine, if appropriate, a joint relationship by linking the associations found. Methods A pooled cross-sectional analysis of the data from the MEDEA project has been carried out for each of the causes of death studied. Specifically, a meta-analysis has been carried out to pool the relative risks in eleven Spanish cities. Different deprivation-mortality relationships across the cities are considered in the analysis (fixed and random effects models). The size of the cities is also considered as a possible factor explaining differences between cities. Results Twenty studies have been carried out for different combinations of sex and causes of death. For nine of them (men: prostate cancer, diabetes, mental illnesses, Alzheimer’s disease, cerebrovascular disease; women: diabetes, mental illnesses, respiratory diseases, cirrhosis) no differences were found between cities in the effect of deprivation on mortality; in four cases (men: respiratory diseases, all causes of mortality; women: breast cancer, Alzheimer’s disease) differences not associated with the size of the city have been determined; in two cases (men: cirrhosis; women: lung cancer) differences strictly linked to the size of the city have been determined, and in five cases (men: lung cancer, ischaemic heart disease; women: ischaemic heart disease, cerebrovascular diseases, all causes of mortality) both kinds of differences have been found. Except for lung cancer in women, every significant relationship between deprivation and mortality goes in the same direction: deprivation increases mortality. Variability in the relative risks across cities was found for general mortality for both sexes. Conclusions This study provides a general overview of the relationship between deprivation and mortality for a sample of large Spanish cities combined. This joint study allows the exploration of and, if appropriate, the quantification of the variability in that relationship for the set of cities considered. PMID:23679869

An evaluation of the impact of a large reduction in alcohol prices on alcohol-related and all-cause mortality: time series analysis of a population-based natural experiment

PubMed Central

Herttua, Kimmo; Mäkelä, Pia; Martikainen, Pekka

2011-01-01

Background We examined the effect of a large reduction in the price of alcohol that occurred in Finland in 2004 on alcohol-related and all-cause mortality, and mortality due to cardiovascular diseases (CVDs) from which alcohol-attributable cases were excluded. Methods Time series intervention analysis modelling was applied to the monthly aggregations of deaths in Finland for the period 1996–2006 to assess the impact of the reduction in alcohol prices. Alcohol-related mortality was defined using information on both underlying and contributory causes of death. Analyses were carried out for men and women aged 15–39, 40–49, 50–69 and >69 years. Results Alcohol-related deaths increased in men aged 40–49 years, and in men and women aged 50–69 years, after the price reduction when trends and seasonal variation were taken into account: the mean rate of alcohol-related mortality increased by 17% [95% confidence interval (CI) 1.5, 33.7], 14% (95% CI 1.1, 28.0) and 40% (95% CI) 7.1, 81.7), respectively, which implies 2.5, 2.9 and 1.6 additional monthly deaths per 100 000 person-years following the price reduction. In contrast to alcohol-related mortality, CVD and all-cause mortality decreased: among men and women aged >69 years a decrease of 7 and 10%, respectively, in CVD mortality implied 19 and 25 fewer monthly deaths per 100 000 person-years, and a decrease of 7 and 14%, respectively, in all-cause mortality similarly implied 42 and 69 fewer monthly deaths. Conclusion These results obtained from the time series analyses suggest that the reduction in alcohol prices led to an increase in alcohol-related mortality, except in persons <40 years of age. However, it appears that beneficial effects in older age, when CVD deaths are prevalent, counter-balance these adverse effects, at least to some extent. PMID:19995860

Do socioeconomic inequalities in mortality vary between different Spanish cities? a pooled cross-sectional analysis.

PubMed

Martinez-Beneito, Miguel A; Zurriaga, Oscar; Botella-Rocamora, Paloma; Marí-Dell'Olmo, Marc; Nolasco, Andreu; Moncho, Joaquín; Daponte, Antonio; Domínguez-Berjón, M Felicitas; Gandarillas, Ana; Martos, Carmen; Montoya, Imanol; Sánchez-Villegas, Pablo; Taracido, Margarita; Borrell, Carme

2013-05-16

The relationship between deprivation and mortality in urban settings is well established. This relationship has been found for several causes of death in Spanish cities in independent analyses (the MEDEA project). However, no joint analysis which pools the strength of this relationship across several cities has ever been undertaken. Such an analysis would determine, if appropriate, a joint relationship by linking the associations found. A pooled cross-sectional analysis of the data from the MEDEA project has been carried out for each of the causes of death studied. Specifically, a meta-analysis has been carried out to pool the relative risks in eleven Spanish cities. Different deprivation-mortality relationships across the cities are considered in the analysis (fixed and random effects models). The size of the cities is also considered as a possible factor explaining differences between cities. Twenty studies have been carried out for different combinations of sex and causes of death. For nine of them (men: prostate cancer, diabetes, mental illnesses, Alzheimer's disease, cerebrovascular disease; women: diabetes, mental illnesses, respiratory diseases, cirrhosis) no differences were found between cities in the effect of deprivation on mortality; in four cases (men: respiratory diseases, all causes of mortality; women: breast cancer, Alzheimer's disease) differences not associated with the size of the city have been determined; in two cases (men: cirrhosis; women: lung cancer) differences strictly linked to the size of the city have been determined, and in five cases (men: lung cancer, ischaemic heart disease; women: ischaemic heart disease, cerebrovascular diseases, all causes of mortality) both kinds of differences have been found. Except for lung cancer in women, every significant relationship between deprivation and mortality goes in the same direction: deprivation increases mortality. Variability in the relative risks across cities was found for general mortality for both sexes. This study provides a general overview of the relationship between deprivation and mortality for a sample of large Spanish cities combined. This joint study allows the exploration of and, if appropriate, the quantification of the variability in that relationship for the set of cities considered.

Causes of death in people with liver cirrhosis in England compared with the general population: a population-based cohort study.

PubMed

Ratib, Sonia; Fleming, Kate M; Crooks, Colin J; Walker, Alex J; West, Joe

2015-08-01

There is a need for unbiased estimates of cause-specific mortality by etiology in patients with liver cirrhosis. The aim of this study is to use nationwide linked electronic routine healthcare data from primary and secondary care alongside the national death registry data to report such estimates. We identified from the linked Clinical Practice Research Datalink (CPRD) and English Hospital Episode Statistics adults with an incident diagnosis of liver cirrhosis linked to the Office for National Statistics between 1998 and 2009. Age-matched controls from the CPRD general population were selected. We calculated the cumulative incidence (adjusting for competing risks) and excess risk of death by 5 years from diagnosis for different causes of death, stratified by etiology and stage of disease. Five thousand one hundred and eighteen patients with cirrhosis were matched to 152,903 controls. Among compensated patients, the 5-year excess risk of liver-related death was higher than that of any other cause of death for all patients, except those of unspecified etiology. For example, those of alcohol etiology had 30.8% excess risk of liver-related death (95% confidence interval (CI): 27.9%, 33.1%) compared with 9.9% excess risk of non-liver-related death. However, patients of unspecified etiology had a higher excess risk of non-liver-related compared with liver-related death (10.7% vs. 6.7%). This was due to a high excess risk of non-liver neoplasm death (7.7%, 95% CI: 5.9%, 9.5%). All decompensated patients had a higher excess of liver-related mortality than any other cause. In order to reduce associated mortality among people with liver cirrhosis, patients' care pathways need to be tailored depending on the etiology and stage of the disease.

Is there a trade-off between fertility and longevity? A comparative study of women from three large historical databases accounting for mortality selection.

PubMed

Gagnon, Alain; Smith, Ken R; Tremblay, Marc; Vézina, Hélène; Paré, Paul-Philippe; Desjardins, Bertrand

2009-01-01

Frontier populations provide exceptional opportunities to test the hypothesis of a trade-off between fertility and longevity. In such populations, mechanisms favoring reproduction usually find fertile ground, and if these mechanisms reduce longevity, demographers should observe higher postreproductive mortality among highly fertile women. We test this hypothesis using complete female reproductive histories from three large demographic databases: the Registre de la population du Québec ancien (Université de Montréal), which covers the first centuries of settlement in Quebec; the BALSAC database (Université du Québec à Chicoutimi), including comprehensive records for the Saguenay-Lac-St-Jean (SLSJ) in Quebec in the nineteenth and twentieth centuries; and the Utah Population Database (University of Utah), including all individuals who experienced a vital event on the Mormon Trail and their descendants. Together, the three samples allow for comparisons over time and space, and represent one of the largest set of natural fertility cohorts used to simultaneously assess reproduction and longevity. Using survival analyses, we found a negative influence of parity and a positive influence of age at last child on postreproductive survival in the three populations, as well as a significant interaction between these two variables. The effect sizes of all these parameters were remarkably similar in the three samples. However, we found little evidence that early fertility affects postreproductive survival. The use of Heckman's procedure assessing the impact of mortality selection during reproductive ages did not appreciably alter these results. We conclude our empirical investigation by discussing the advantages of comparative approaches. 2009 Wiley-Liss, Inc.

Self-rated health and its association with mortality in older adults in China, India and Latin America—a 10/66 Dementia Research Group study

PubMed Central

Falk, Hanna; Skoog, Ingmar; Johansson, Lena; Guerchet, Maëlenn; Mayston, Rosie; Hörder, Helena; Prince, Martin; Prina, A Matthew

2017-01-01

Abstract Background empirical evidence from high-income countries suggests that self-rated health (SRH) is useful as a brief and simple outcome measure in public health research. However, in many low- and middle-income countries (LMIC) there is a lack of evaluation and the cross-cultural validity of SRH remains largely untested. This study aims to explore the prevalence of SRH and its association with mortality in older adults in LMIC in order to cross-culturally validate the construct of SRH. Methods population-based cohort studies including 16,940 persons aged ≥65 years in China, India, Cuba, Dominican Republic, Peru, Venezuela, Mexico and Puerto Rico in 2003. SRH was assessed by asking ‘how do you rate your overall health in the past 30 days’ with responses ranging from excellent to poor. Covariates included socio-demographic characteristics, use of health services and health factors. Mortality was ascertained through a screening of all respondents until 2007. Results the prevalence of good SRH was higher in urban compared to rural sites, except in China. Men reported higher SRH than women, and depression had the largest negative impact on SRH in all sites. Without adjustment, those with poor SRH showed a 142% increase risk of dying within 4 years compared to those with moderate SRH. After adjusting for all covariates, those with poor SRH still showed a 43% increased risk. Conclusion our findings support the use of SRH as a simple measure in survey settings to identify vulnerable groups and evaluate health interventions in resource-scares settings. PMID:28985329

Exposure of the grass shrimp, Palaemonetes pugio, to antimicrobial compounds affects associated Vibrio bacterial density and development of antibiotic resistance.

PubMed

DeLorenzo, M E; Brooker, J; Chung, K W; Kelly, M; Martinez, J; Moore, J G; Thomas, M

2016-04-01

Antimicrobial compounds are widespread, emerging contaminants in the aquatic environment and may threaten ecosystem and human health. This study characterized effects of antimicrobial compounds common to human and veterinary medicine, aquaculture, and consumer personal care products [erythromycin (ERY), sulfamethoxazole (SMX), oxytetracycline (OTC), and triclosan (TCS)] in the grass shrimp Palaemonetes pugio. The effects of antimicrobial treatments on grass shrimp mortality and lipid peroxidation activity were measured. The effects of antimicrobial treatments on the bacterial community of the shrimp were then assessed by measuring Vibrio density and testing bacterial isolates for antibiotic resistance. TCS (0.33 mg/L) increased shrimp mortality by 37% and increased lipid peroxidation activity by 63%. A mixture of 0.33 mg/L TCS and 60 mg/L SMX caused a 47% increase in shrimp mortality and an 88% increase in lipid peroxidation activity. Exposure to SMX (30 mg/L or 60 mg/L) alone and to a mixture of SMX/ERY/OTC did not significantly affect shrimp survival or lipid peroxidation activity. Shrimp exposure to 0.33 mg/L TCS increased Vibrio density 350% as compared to the control whereas SMX, the SMX/TCS mixture, and the mixture of SMX/ERY/OTC decreased Vibrio density 78-94%. Increased Vibrio antibiotic resistance was observed for all shrimp antimicrobial treatments except for the mixture of SMX/ERY/OTC. Approximately 87% of grass shrimp Vibrio isolates displayed resistance to TCS in the control treatment suggesting a high level of TCS resistance in environmental Vibrio populations. The presence of TCS in coastal waters may preferentially increase the resistance and abundance of pathogenic bacteria. These results indicate the need for further study into the potential interactions between antimicrobials, aquatic organisms, and associated bacterial communities. © 2014 Wiley Periodicals, Inc.

Decreased early mortality associated with the treatment of acute myeloid leukemia at National Cancer Institute-designated cancer centers in California.

PubMed

Ho, Gwendolyn; Wun, Ted; Muffly, Lori; Li, Qian; Brunson, Ann; Rosenberg, Aaron S; Jonas, Brian A; Keegan, Theresa H M

2018-05-01

To the authors' knowledge, few population-based studies to date have evaluated the association between location of care, complications with induction therapy, and early mortality in patients with acute myeloid leukemia (AML). Using linked data from the California Cancer Registry and Patient Discharge Dataset (1999-2014), the authors identified adult (aged ≥18 years) patients with AML who received inpatient treatment within 30 days of diagnosis. A propensity score was created for treatment at a National Cancer Institute-designated cancer center (NCI-CC). Inverse probability-weighted, multivariable logistic regression models were used to determine associations between location of care, complications, and early mortality (death ≤60 days from diagnosis). Of the 7007 patients with AML, 1762 (25%) were treated at an NCI-CC. Patients with AML who were treated at NCI-CCs were more likely to be aged ≤65 years, live in higher socioeconomic status neighborhoods, have fewer comorbidities, and have public health insurance. Patients treated at NCI-CCs had higher rates of renal failure (23% vs 20%; P = .010) and lower rates of respiratory failure (11% vs 14%; P = .003) and cardiac arrest (1% vs 2%; P = .014). After adjustment for baseline characteristics, treatment at an NCI-CC was associated with lower early mortality (odds ratio, 0.46; 95% confidence interval, 0.38-0.57). The impact of complications on early mortality did not differ by location of care except for higher early mortality noted among patients with respiratory failure treated at non-NCI-CCs. The initial treatment of adult patients with AML at NCI-CCs is associated with a 53% reduction in the odds of early mortality compared with treatment at non-NCI-CCs. Lower early mortality may result from differences in hospital or provider experience and supportive care. Cancer 2018;124:1938-45. © 2018 American Cancer Society. © 2018 American Cancer Society.

Association of Race With Mortality and Cardiovascular Events in a Large Cohort of US Veterans.

PubMed

Kovesdy, Csaba P; Norris, Keith C; Boulware, L Ebony; Lu, Jun L; Ma, Jennie Z; Streja, Elani; Molnar, Miklos Z; Kalantar-Zadeh, Kamyar

2015-10-20

In the general population, blacks experience higher mortality than their white peers, attributed in part to their lower socioeconomic status, reduced access to care, and possibly intrinsic biological factors. Patients with kidney disease are a notable exception, among whom blacks experience lower mortality. It is unclear if similar differences affecting outcomes exist in patients with no kidney disease but with equal or similar access to health care. We compared all-cause mortality, incident coronary heart disease, and incident ischemic stroke using multivariable-adjusted Cox models in a nationwide cohort of 547 441 black and 2 525 525 white patients with baseline estimated glomerular filtration rate ≥ 60 mL·min⁻¹·1.73 m⁻² receiving care from the US Veterans Health Administration. In parallel analyses, we compared outcomes in black versus white individuals in the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004. After multivariable adjustments in veterans, black race was associated with 24% lower all-cause mortality (adjusted hazard ratio, 0.76; 95% confidence interval, 0.75-0.77; P<0.001) and 37% lower incidence of coronary heart disease (adjusted hazard ratio, 0.63; 95% confidence interval, 0.62-0.65; P<0.001) but a similar incidence of ischemic stroke (adjusted hazard ratio, 0.99; 95% confidence interval, 0.97-1.01; P=0.3). Black race was associated with a 42% higher adjusted mortality among individuals with estimated glomerular filtration rate ≥ 60 mL·min⁻¹·1.73 m⁻² in NHANES (adjusted hazard ratio, 1.42; 95% confidence interval, 1.09-1.87). Black veterans with normal estimated glomerular filtration rate and equal access to healthcare have lower all-cause mortality and incidence of coronary heart disease and a similar incidence of ischemic stroke. These associations are in contrast to the higher mortality experienced by black individuals in the general US population. © 2015 American Heart Association, Inc.

Air pollutants and health outcomes: Assessment of confounding by influenza

NASA Astrophysics Data System (ADS)

Thach, Thuan-Quoc; Wong, Chit-Ming; Chan, King-Pan; Chau, Yuen-Kwan; Neil Thomas, G.; Ou, Chun-Quan; Yang, Lin; Peiris, Joseph S. M.; Lam, Tai-Hing; Hedley, Anthony J.

2010-04-01

We assessed confounding of associations between short-term effects of air pollution and health outcomes by influenza using Hong Kong mortality and hospitalization data for 1996-2002. Three measures of influenza were defined: (i) intensity: weekly proportion of positive influenza viruses, (ii) epidemic: weekly number of positive influenza viruses ≥4% of the annual number for ≥2 consecutive weeks, and (iii) predominance: an epidemic period with co-circulation of respiratory syncytial virus <2% of the annual positive isolates for ≥2 consecutive weeks. We examined effects of influenza on associations between nitrogen dioxide (NO 2), sulfur dioxide (SO 2), particulate matter with aerodynamic diameter ≤10 μm (PM 10) and ozone (O 3) and health outcomes including all natural causes mortality, cardiorespiratory mortality and hospitalization. Generalized additive Poisson regression model with natural cubic splines was fitted to control for time-varying covariates to estimate air pollution health effects. Confounding with influenza was assessed using an absolute difference of >0.1% between unadjusted and adjusted excess risks (ER%). Without adjustment, pollutants were associated with positive ER% for all health outcomes except asthma and stroke hospitalization with SO 2 and stroke hospitalization with O 3. Following adjustment, changes in ER% for all pollutants were <0.1% for all natural causes mortality, but >0.1% for mortality from stroke with NO 2 and SO 2, cardiac or heart disease with NO 2, PM 10 and O 3, lower respiratory infections with NO 2 and O 3 and mortality from chronic obstructive pulmonary disease with all pollutants. Changes >0.1% were seen for acute respiratory disease hospitalization with NO 2, SO 2 and O 3 and acute lower respiratory infections hospitalization with PM 10. Generally, influenza does not confound the observed associations of air pollutants with all natural causes mortality and cardiovascular hospitalization, but for some pollutants and subgroups of cardiorespiratory mortality and respiratory hospitalization there was evidence to suggest confounding by influenza.

Total and Cause-Specific Mortality of U.S. Nurses Working Rotating Night Shifts

PubMed Central

Gu, Fangyi; Han, Jiali; Laden, Francine; Pan, An; Caporaso, Neil E.; Stampfer, Meir J.; Kawachi, Ichiro; Rexrode, Kathryn M.; Willett, Walter C.; Hankinson, Susan E.; Speizer, Frank; Schernhammer, Eva S.

2014-01-01

Background Rotating night shift work imposes circadian strain and is linked to the risk of several chronic diseases. Purpose To examine associations between rotating night shift work and all-cause, cardiovascular disease (CVD), and cancer mortality in a prospective cohort study of 74,862 registered U.S. nurses from the Nurses’ Health Study. Methods Lifetime rotating night shift work (defined as ≥3 nights/month) information was collected in 1988. During 22 years (1988–2010) of follow-up, 14,181 deaths were documented, including 3,062 CVD and 5,413 cancer deaths. Cox proportional hazards models (2013) estimated multivariable-adjusted hazard ratios (HRs) and 95% CIs. Results All-cause and CVD mortality were significantly increased among women with ≥5 years of rotating night shift work, compared to women who never worked night shifts. Specifically, for women with 6–14 and ≥15 years of rotating night shift work, the HRs were 1.11 (95% CI=1.06, 1.17) and 1.11 (95% CI=1.05, 1.18) for all-cause mortality and 1.19 (95% CI=1.07, 1.33) and 1.23 (95% CI=1.09, 1.38) for CVD mortality. There was no association between rotating night shift work and all-cancer mortality (HR≥15years=1.08, 95% CI=0.89, 1.19) or any other cancer, with the exception of lung cancer (HR≥15years=1.25, 95% CI=1.04, 1.51). Conclusions Women working rotating night shifts for ≥5 five years have a modest increase in all-cause and CVD mortality; those working ≥15 years of rotating night shift work have a modest increase in lung cancer mortality. These results add to prior evidence of a potentially detrimental effect of rotating night shift work on health and longevity. PMID:25576495

Association of Race with Mortality and Cardiovascular Events in a Large Cohort of US Veterans

PubMed Central

Kovesdy, Csaba P.; Norris, Keith C.; Boulware, L. Ebony; Lu, Jun L.; Ma, Jennie Z.; Streja, Elani; Molnar, Miklos Z.; Kalantar-Zadeh, Kamyar

2015-01-01

Background In the general population African-Americans experience higher mortality than their white peers, attributed, in part, to their lower socio-economic status, reduced access to care and possibly intrinsic biologic factors. A notable exception are patients with kidney disease, among whom African-Americans experience lower mortality. It is unclear if similar differences affecting outcomes exist in patients with no kidney disease but with similar access to health care. Methods and Results We compared all-cause mortality, incident coronary heart disease (CHD) and incident ischemic stroke using multivariable adjusted Cox models in a nationwide cohort of 547,441 African-American and 2,525,525 white patients with baseline estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73m2 receiving care from the US Veterans Health Administration. In parallel analyses we compared outcomes in African-American vs. white individuals in the National Health and Nutrition Examination Survey 1999–2004 (NHANES). After multivariable adjustments in veterans, African-American race was associated with 24% lower all-cause mortality (adjusted hazard ratio (aHR), 95% confidence interval (CI): 0.76, 0.75–0.77, p<0.001) and 37% lower incidence of CHD (aHR, 95%CI: 0.63, 0.62–0.65, p<0.001), but similar incidence of ischemic stroke (aHR, 95%CI: 0.99, 0.97–1.01, p=0.3). African-American race was associated with a 42% higher adjusted mortality among individuals with eGFR≥60 ml/min/1.73m2 in NHANES (aHR, 95%CI: 1.42 (1.09–1.87)). Conclusions African-American veterans with normal eGFR have lower all-cause mortality and incidence of CHD, and similar incidence of ischemic stroke. These associations are in contrast with the higher mortality experienced by African-American individuals in the general US population. PMID:26384521

Regional Variation in Disparities in Breast Cancer Specific Mortality Due to Race/Ethnicity, Socioeconomic Status, and Urbanization.

PubMed

Parise, Carol A; Caggiano, Vincent

2017-08-01

Disparities in breast cancer mortality due to race/ethnicity, area socioeconomic status (SES), and urbanization have been documented. This study examined if disparities in the risk of breast cancer specific mortality due to race/ethnicity, SES, and urbanization varied within diverse regions of California. We identified 163,569 cases of first primary female invasive breast cancer from the California Cancer Registry diagnosed between January, 2000 and December, 2013. Cox regression was used to compute hazard ratios (HR) and 95 % confidence intervals for race/ethnicity, SES, and urbanization within eight regions of California. Blacks had an increased risk of mortality in the San Francisco Bay Area (SFBA) (HR = 1.37; 1.22-1.55), Desert Sierra (HR = 1.27; 1.08-1.49), San Diego/Orange (HR = 1.43; 1.19-1.71), and Los Angeles (LA) (HR = 1.31; 1.20-1.44). Japanese (HR = 0.62; 0.47-0.81), Chinese (HR = 0.71; 0.58-0.87), and Filipino (HR = 0.81; 0.69-0.95) women had a decreased risk of mortality in LA. Southeast Asians had a decreased risk in San Diego/Orange (HR = 0.72; 0.57-0.90) and in the SFBA (HR = 0.81; 0.67-0.98). Hispanics had a decreased risk (HR = 0.73; 0.57-0.93) and American Indians had an increased risk (HR = 2.32; 1.08-4.98) in the Tri-County region. SES was a significant risk factor for mortality in all regions except the North and Tri-County. Urbanization was a statistically significant factor for mortality only in LA (HR = 1.32; 1.08-1.60). Disparities in breast cancer mortality, due to race/ethnicity, SES, and urbanization vary by region which suggests that further research is warranted concerning the role of geographic regions and neighborhoods in cancer outcomes.

[Social capital, violent deaths, and cancer mortality in Colombia: a population approach].

PubMed

Idrovo, Alvaro Javier

2006-01-01

In Colombia there are evidences that social capital (SC) is associated with greater rates of violent crime ("perverse" SC). This study explores the relation between SC, violent deaths (1973-1996), and the accumulated occurrence of cancer deaths (1990-1996). An ecologic study with the 33 Colombian departments was carried out. Correlations between violent deaths (inverse proxy of SC), the internal displacement ratio, and the mortality rates by each type of cancer. With robust regressions the effect of violent deaths ("perverse" SC) on the occurrence of mortality cancer were explored, adjusting by economic convergence or polarization (1960-1995), and the internal displacement ratio until 1996. Positive correlations (p < 0.05) between violent deaths ("perverse "CS) and all types of cancer, except breast and lung among men, were observed. In all the cases statistically significant associations were observed, after adjust by departments' economic convergence/polarization and internal displacement. This study shows a direct relation between violent deaths on the occurrence of cancer. The findings obtained here suggest an inverted U shape relation between SC and disease occurrence.

Cervical carcinoma in the European Union: an update on disease burden, screening program state of activation, and coverage as of March 2014.

PubMed

Altobelli, Emma; Lattanzi, Amedeo

2015-03-01

Cervical cancer (CC) is defined as a disease of disparity. This is due to marked differences in CC incidence and mortality between developed and developing countries. As a continent, Europe is no exception. This study examines the state of activation of CC screening in the European Union as of March 2014, reviews CC incidence and mortality data, and highlights the initiatives adopted to extend program coverage to nonresponders. The present study is based on the most recent data available from PubMed-indexed journals, the Web sites of the health ministries of each member state, and the Web sites of national cancer observatories; failing these sources, information was sought in scientific journals published in the local language. In 2003, the European Council recommended that priority be given to organized screening program activation. Nonetheless, a number of European Union member states still lack population-based organized screening programs, and few have implemented programs directed at disadvantaged populations. Several investigations have demonstrated that the women at higher CC risk are unscreened and underscreened ones. Since then, several member states have made significant efforts to set up effective prevention programs by adopting international quality standards and centralizing screening organization and result evaluation. Several developed countries and some new central-eastern European member states have poorly organized prevention programs that result in poor women's health. Diagnosis of CC is emotionally traumatic, but it is highly preventable. When CC is found early, it is highly treatable and associated with long survival and good quality of life.

Climate Change and water in Southwestern North America special feature: water, climate change, and sustainability in the southwest.

PubMed

MacDonald, Glen M

2010-12-14

The current Southwest drought is exceptional for its high temperatures and arguably the most severe in history. Coincidentally, there has been an increase in forest and woodland mortality due to fires and pathogenic outbreaks. Although the high temperatures and aridity are consistent with projected impacts of greenhouse warming, it is unclear whether the drought can be attributed to increased greenhouse gases or is a product of natural climatic variability. Climate models indicate that the 21st century will be increasingly arid and droughts more severe and prolonged. Forest and woodland mortality due to fires and pathogens will increase. Demography and food security dictate that water demand in the Southwest will remain appreciable. If projected population growth is twinned with suburb-centered development, domestic demands will intensify. Meeting domestic demands through transference from agriculture presents concerns for rural sustainability and food security. Environmental concerns will limit additional transference from rivers. It is unlikely that traditional supply-side solutions such as more dams will securely meet demands at current per-capita levels. Significant savings in domestic usage can be realized through decreased applications of potable water to landscaping, but this is a small fraction of total regional water use, which is dominated by agriculture. Technical innovations, policy measures, and market-based solutions that increase supply and decrease water demand are all needed. Meeting 21st-century sustainability challenges in the Southwest will also require planning, cooperation, and integration that surpass 20th-century efforts in terms of geographic scope, jurisdictional breadth, multisectoral engagement, and the length of planning timelines.

Why does society accept a higher risk for alcohol than for other voluntary or involuntary risks?

PubMed

Rehm, Jürgen; Lachenmeier, Dirk W; Room, Robin

2014-10-21

Societies tend to accept much higher risks for voluntary behaviours, those based on individual decisions (for example, to smoke, to consume alcohol, or to ski), than for involuntary exposure such as exposure to risks in soil, drinking water or air. In high-income societies, an acceptable risk to those voluntarily engaging in a risky behaviour seems to be about one death in 1,000 on a lifetime basis. However, drinking more than 20 g pure alcohol per day over an adult lifetime exceeds a threshold of one in 100 deaths, based on a calculation from World Health Organization data of the odds in six European countries of dying from alcohol-attributable causes at different levels of drinking. The voluntary mortality risk of alcohol consumption exceeds the risks of other lifestyle risk factors. In addition, evidence shows that the involuntary risks resulting from customary alcohol consumption far exceed the acceptable threshold for other involuntary risks (such as those established by the World Health Organization or national environmental agencies), and would be judged as not acceptable. Alcohol's exceptional status reflects vagaries of history, which have so far resulted in alcohol being exempted from key food legislation (no labelling of ingredients and nutritional information) and from international conventions governing all other psychoactive substances (both legal and illegal). This is along with special treatment of alcohol in the public health field, in part reflecting overestimation of its beneficial effect on ischaemic disease when consumed in moderation. A much higher mortality risk from alcohol than from other risk factors is currently accepted by high income countries.

Water, climate change, and sustainability in the southwest

PubMed Central

2010-01-01

The current Southwest drought is exceptional for its high temperatures and arguably the most severe in history. Coincidentally, there has been an increase in forest and woodland mortality due to fires and pathogenic outbreaks. Although the high temperatures and aridity are consistent with projected impacts of greenhouse warming, it is unclear whether the drought can be attributed to increased greenhouse gasses or is a product of natural climatic variability. Climate models indicate that the 21st century will be increasingly arid and droughts more severe and prolonged. Forest and woodland mortality due to fires and pathogens will increase. Demography and food security dictate that water demand in the Southwest will remain appreciable. If projected population growth is twinned with suburb-centered development, domestic demands will intensify. Meeting domestic demands through transference from agriculture presents concerns for rural sustainability and food security. Environmental concerns will limit additional transference from rivers. It is unlikely that traditional supply-side solutions such as more dams will securely meet demands at current per-capita levels. Significant savings in domestic usage can be realized through decreased applications of potable water to landscaping, but this is a small fraction of total regional water use, which is dominated by agriculture. Technical innovations, policy measures, and market-based solutions that increase supply and decrease water demand are all needed. Meeting 21st-century sustainability challenges in the Southwest will also require planning, cooperation, and integration that surpass 20th-century efforts in terms of geographic scope, jurisdictional breadth, multisectoral engagement, and the length of planning timelines. PMID:21149704

The Economic Burden of Hepatitis A, B, and C in South Korea.

PubMed

Shon, Changwoo; Choi, Hyung-Yun; Shim, Jae-Jun; Park, So-Youn; Lee, Kyung Suk; Yoon, Seok-Jun; Oh, In-Hwan

2016-01-01

The prevalence of hepatitis in South Korea is relatively high compared to that in other high-income countries. For this reason, viral hepatitis infection not only affects the population's health, but also impacts national healthcare costs. This study was performed in order to estimate the individual economic costs of the hepatitis A, B, and C viruses as well as to determine, using nationally representative data, the trends in South Korea with respect to these viruses during the 2008-2011 period. The study found that the prevalence of hepatitis A had decreased, but those of hepatitis B and C had increased overall. The mortality rate of hepatitis C was higher than that of the other two types. The mortality rate of hepatitis B had changed little, whereas that of hepatitis C had risen. The total cost of hepatitis A had decreased, from US $62.2 million to US $45.7 million, although a notable exception occurred in 2009, when the cost was US $126.6 million. Conversely, the total cost of hepatitis B had increased rapidly during the same period, from US $501.4 million to US $607.8 million. Finally, the total cost of hepatitis C had also increased from US $63.9 million to US $90.7 million. The direct costs of hepatitis A, B, and C were estimated to account for approximately 35.5%, 46.6%, and 58.0% of the total, respectively. These findings demonstrate the economic burden associated with hepatitis A, B, and C, and demonstrate the need to establish an effective prevention and management policy for future planning in South Korea.

Variation in mortality of ischemic and hemorrhagic strokes in relation to high temperature.

PubMed

Lim, Youn-Hee; Kim, Ho; Hong, Yun-Chul

2013-01-01

Outdoor temperature has been reported to have a significant influence on the seasonal variations of stroke mortality, but few studies have investigated the effect of high temperature on the mortality of ischemic and hemorrhagic strokes. The main study goal was to examine the effect of temperature, particularly high temperature, on ischemic and hemorrhagic strokes. We investigated the association between outdoor temperature and stroke mortality in four metropolitan cities in Korea during 1992-2007. We used time series analysis of the age-adjusted mortality rate for ischemic and hemorrhagic stroke deaths by using generalized additive and generalized linear models, and estimated the percentage change of mortality rate associated with a 1°C increase of mean temperature. The temperature-responses for the hemorrhagic and ischemic stroke mortality differed, particularly in the range of high temperature. The estimated percentage change of ischemic stroke mortality above a threshold temperature was 5.4 % (95 % CI, 3.9-6.9 %) in Seoul, 4.1 % (95 % CI, 1.6-6.6 %) in Incheon, 2.3 % (-0.2 to 5.0 %) in Daegu and 3.6 % (0.7-6.6 %) in Busan, after controlling for daily mean humidity, mean air pressure, day of the week, season, and year. Additional adjustment of air pollution concentrations in the model did not change the effects. Hemorrhagic stroke mortality risk significantly decreased with increasing temperature without a threshold in the four cities after adjusting for confounders. These findings suggest that the mortality of hemorrhagic and ischemic strokes show different patterns in relation to outdoor temperature. High temperature was harmful for ischemic stroke but not for hemorrhagic stroke. The risk of high temperature to ischemic stroke did not differ by age or gender.

Variation in mortality of ischemic and hemorrhagic strokes in relation to high temperature

NASA Astrophysics Data System (ADS)

Lim, Youn-Hee; Kim, Ho; Hong, Yun-Chul

2013-01-01

Outdoor temperature has been reported to have a significant influence on the seasonal variations of stroke mortality, but few studies have investigated the effect of high temperature on the mortality of ischemic and hemorrhagic strokes. The main study goal was to examine the effect of temperature, particularly high temperature, on ischemic and hemorrhagic strokes. We investigated the association between outdoor temperature and stroke mortality in four metropolitan cities in Korea during 1992-2007. We used time series analysis of the age-adjusted mortality rate for ischemic and hemorrhagic stroke deaths by using generalized additive and generalized linear models, and estimated the percentage change of mortality rate associated with a 1°C increase of mean temperature. The temperature-responses for the hemorrhagic and ischemic stroke mortality differed, particularly in the range of high temperature. The estimated percentage change of ischemic stroke mortality above a threshold temperature was 5.4 % (95 % CI, 3.9-6.9 %) in Seoul, 4.1 % (95 % CI, 1.6-6.6 %) in Incheon, 2.3 % (-0.2 to 5.0 %) in Daegu and 3.6 % (0.7-6.6 %) in Busan, after controlling for daily mean humidity, mean air pressure, day of the week, season, and year. Additional adjustment of air pollution concentrations in the model did not change the effects. Hemorrhagic stroke mortality risk significantly decreased with increasing temperature without a threshold in the four cities after adjusting for confounders. These findings suggest that the mortality of hemorrhagic and ischemic strokes show different patterns in relation to outdoor temperature. High temperature was harmful for ischemic stroke but not for hemorrhagic stroke. The risk of high temperature to ischemic stroke did not differ by age or gender.

Life and death during the Great Depression

PubMed Central

Tapia Granados, José A.; Diez Roux, Ana V.

2009-01-01

Recent events highlight the importance of examining the impact of economic downturns on population health. The Great Depression of the 1930s was the most important economic downturn in the U.S. in the twentieth century. We used historical life expectancy and mortality data to examine associations of economic growth with population health for the period 1920–1940. We conducted descriptive analyses of trends and examined associations between annual changes in health indicators and annual changes in economic activity using correlations and regression models. Population health did not decline and indeed generally improved during the 4 years of the Great Depression, 1930–1933, with mortality decreasing for almost all ages, and life expectancy increasing by several years in males, females, whites, and nonwhites. For most age groups, mortality tended to peak during years of strong economic expansion (such as 1923, 1926, 1929, and 1936–1937). In contrast, the recessions of 1921, 1930–1933, and 1938 coincided with declines in mortality and gains in life expectancy. The only exception was suicide mortality which increased during the Great Depression, but accounted for less than 2% of deaths. Correlation and regression analyses confirmed a significant negative effect of economic expansions on health gains. The evolution of population health during the years 1920–1940 confirms the counterintuitive hypothesis that, as in other historical periods and market economies, population health tends to evolve better during recessions than in expansions. PMID:19805076