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Sample records for bac71-35 reduces mortality

  1. The host antimicrobial peptide Bac71-35 binds to bacterial ribosomal proteins and inhibits protein synthesis.

    Science.gov (United States)

    Mardirossian, Mario; Grzela, Renata; Giglione, Carmela; Meinnel, Thierry; Gennaro, Renato; Mergaert, Peter; Scocchi, Marco

    2014-12-18

    Antimicrobial peptides (AMPs) are molecules from innate immunity with high potential as novel anti-infective agents. Most of them inactivate bacteria through pore formation or membrane barrier disruption, but others cross the membrane without damages and act inside the cells, affecting vital processes. However, little is known about their intracellular bacterial targets. Here we report that Bac71-35, a proline-rich AMP belonging to the cathelicidin family, can reach high concentrations (up to 340 μM) inside the E. coli cytoplasm. The peptide specifically and completely inhibits in vitro translation in the micromolar concentration range. Experiments of incorporation of radioactive precursors in macromolecules with E. coli cells confirmed that Bac71-35 affects specifically protein synthesis. Ribosome coprecipitation and crosslinking assays showed that the peptide interacts with ribosomes, binding to a limited subset of ribosomal proteins. Overall, these results indicate that the killing mechanism of Bac71-35 is based on a specific block of protein synthesis.

  2. Reducing Maternal Mortality from Unsafe Abortion among ...

    African Journals Online (AJOL)

    Reducing Maternal Mortality from Unsafe Abortion among Adolescents in Africa. ... including the provision of appropriate sexuality education and information as well as supportive services to allow adolescents to prevent unwanted pregnancy.

  3. Vitamin D with calcium reduces mortality

    DEFF Research Database (Denmark)

    Rejnmark, Lars; Avenell, Alison; Masud, Tahir

    2012-01-01

    Introduction:Vitamin D may affect multiple health outcomes. If so, an effect on mortality is to be expected. Using pooled data from randomized controlled trials, we performed individual patient data (IPD) and trial level meta-analyses to assess mortality among participants randomized to either...... vitamin D alone or vitamin D with calcium.Subjects and Methods:Through a systematic literature search, we identified 24 randomized controlled trials reporting data on mortality in which vitamin D was given either alone or with calcium. From a total of 13 trials with more than 1000 participants each, eight......,528 randomized participants (86.8% females) with a median age of 70 (interquartile range, 62-77) yr. Vitamin D with or without calcium reduced mortality by 7% [hazard ratio, 0.93; 95% confidence interval (CI), 0.88-0.99]. However, vitamin D alone did not affect mortality, but risk of death was reduced if vitamin...

  4. Can mass media interventions reduce child mortality?

    Science.gov (United States)

    Head, Roy; Murray, Joanna; Sarrassat, Sophie; Snell, Will; Meda, Nicolas; Ouedraogo, Moctar; Deboise, Laurent; Cousens, Simon

    2015-07-04

    Many people recognise that mass media is important in promoting public health but there have been few attempts to measure how important. An ongoing trial in Burkina Faso (ClinicalTrials.gov, NCT01517230) is an attempt to bring together the very different worlds of mass media and epidemiology: to measure rigorously, using a cluster-randomised design, how many lives mass media can save in a low-income country, and at what cost. Application of the Lives Saved Tool predicts that saturation-based media campaigns could reduce child mortality by 10-20%, at a cost per disability-adjusted life-year that is as low as any existing health intervention. In this Viewpoint we explain the scientific reasoning behind the trial, while stressing the importance of the media methodology used. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Mortality and reduced growth hormone secretion

    DEFF Research Database (Denmark)

    Stochholm, Kirstine; Christiansen, Jens; Laursen, Torben

    2007-01-01

    BACKGROUND: Data regarding the mortality rates of patients with growth hormone deficiency (GHD), whether or not treated with growth hormone (GH), are limited, but an increased mortality rate among hypopituitary patients compared with the general population has been documented. Cardiovascular...... disease has been suggested as a primary cause of death, whereas cancer statistics might be influenced by the number of malignancies causing the pituitary disease. Furthermore, differences in mortality rates in females and males have been reported. METHODS: Epidemiological studies of mortality......-onset GHD might also exist. Two studies showed a normal mortality rate in GHD patients treated with GH compared with the general population. CONCLUSIONS: Although an increased mortality rate in hypopituitary patients is well documented, further research is needed to provide more reliable estimates...

  6. [Plan to Reduce Bird Mortality : Rocky Mountain Arsenal : 1996

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This document includes a plan for vegetation management on the Rocky Mountain Arsenal to reduce bird mortalities from dieldrin poisoning by way of tree removal,...

  7. Malaria prevention with IPTp during pregnancy reduces neonatal mortality.

    Directory of Open Access Journals (Sweden)

    Clara Menéndez

    Full Text Available BACKGROUND: In the global context of a reduction of under-five mortality, neonatal mortality is an increasingly relevant component of this mortality. Malaria in pregnancy may affect neonatal survival, though no strong evidence exists to support this association. METHODS: In the context of a randomised, placebo-controlled trial of intermittent preventive treatment (IPTp with sulphadoxine-pyrimethamine (SP in 1030 Mozambican pregnant women, 997 newborns were followed up until 12 months of age. There were 500 live borns to women who received placebo and 497 to those who received SP. FINDINGS: There were 58 infant deaths; 60.4% occurred in children born to women who received placebo and 39.6% to women who received IPTp (p = 0.136. There were 25 neonatal deaths; 72% occurred in the placebo group and 28% in the IPTp group (p = 0.041. Of the 20 deaths that occurred in the first week of life, 75% were babies born to women in the placebo group and 25% to those in the IPTp group (p = 0.039. IPTp reduced neonatal mortality by 61.3% (95% CI 7.4%, 83.8%; p = 0.024]. CONCLUSIONS: Malaria prevention with SP in pregnancy can reduce neonatal mortality. Mechanisms associated with increased malaria infection at the end of pregnancy may explain the excess mortality in the malaria less protected group. Alternatively, SP may have reduced the risk of neonatal infections. These findings are of relevance to promote the implementation of IPTp with SP, and provide insights into the understanding of the pathophysiological mechanisms through which maternal malaria affects fetal and neonatal health. TRIAL REGISTRATION: ClinicalTrials.gov NCT00209781.

  8. Tetanus toxoid immunization to reduce mortality from neonatal tetanus.

    Science.gov (United States)

    Blencowe, Hannah; Lawn, Joy; Vandelaer, Jos; Roper, Martha; Cousens, Simon

    2010-04-01

    Neonatal tetanus remains an important and preventable cause of neonatal mortality globally. Large reductions in neonatal tetanus deaths have been reported following major increases in the coverage of tetanus toxoid immunization, yet the level of evidence for the mortality effect of tetanus toxoid immunization is surprisingly weak with only two trials considered in a Cochrane review. To review the evidence for and estimate the effect on neonatal tetanus mortality of immunization with tetanus toxoid of pregnant women, or women of childbearing age. We conducted a systematic review of multiple databases. Standardized abstraction forms were used. Individual study quality and the overall quality of evidence were assessed using an adaptation of the GRADE approach. Meta-analyses were performed. Only one randomised controlled trial (RCT) and one well-controlled cohort study were identified, which met inclusion criteria for meta-analysis. Immunization of pregnant women or women of childbearing age with at least two doses of tetanus toxoid is estimated to reduce mortality from neonatal tetanus by 94% [95% confidence interval (CI) 80-98%]. Additionally, another RCT with a case definition based on day of death, 3 case-control studies and 1 before-and-after study gave consistent results. Based on the consistency of the mortality data, the very large effect size and that the data are all from low/middle-income countries, the overall quality of the evidence was judged to be moderate. This review uses a standard approach to provide a transparent estimate of the high impact of tetanus toxoid immunization on neonatal tetanus.

  9. Child mortality estimation: accelerated progress in reducing global child mortality, 1990-2010.

    Directory of Open Access Journals (Sweden)

    Kenneth Hill

    Full Text Available Monitoring development indicators has become a central interest of international agencies and countries for tracking progress towards the Millennium Development Goals. In this review, which also provides an introduction to a collection of articles, we describe the methodology used by the United Nations Inter-agency Group for Child Mortality Estimation to track country-specific changes in the key indicator for Millennium Development Goal 4 (MDG 4, the decline of the under-five mortality rate (the probability of dying between birth and age five, also denoted in the literature as U5MR and (5q(0. We review how relevant data from civil registration, sample registration, population censuses, and household surveys are compiled and assessed for United Nations member states, and how time series regression models are fitted to all points of acceptable quality to establish the trends in U5MR from which infant and neonatal mortality rates are generally derived. The application of this methodology indicates that, between 1990 and 2010, the global U5MR fell from 88 to 57 deaths per 1,000 live births, and the annual number of under-five deaths fell from 12.0 to 7.6 million. Although the annual rate of reduction in the U5MR accelerated from 1.9% for the period 1990-2000 to 2.5% for the period 2000-2010, it remains well below the 4.4% annual rate of reduction required to achieve the MDG 4 goal of a two-thirds reduction in U5MR from its 1990 value by 2015. Thus, despite progress in reducing child mortality worldwide, and an encouraging increase in the pace of decline over the last two decades, MDG 4 will not be met without greatly increasing efforts to reduce child deaths.

  10. A "preamputation care pathway" reduces mortality for lower limb amputation.

    Science.gov (United States)

    Lewis, Jason; Dindyal, Shiva; Raynor, Hannah; Abidia, Ahmed; Refson, Jonathan

    2016-06-01

    Lower limb amputation due to peripheral arterial disease is common. The comorbid nature of this patient group makes management challenging. The aims of the study were 1) to introduce a novel "preamputation care pathway" to facilitate perioperative care and 2) to evaluate whether such a pathway is able to reduce morbidity and mortality. All patients undergoing lower limb amputation over 12 months were prospectively identified. Patient demographics were recorded before statistical analysis was performed. Twelve limbs were amputated (mean age, 69 years; mean American Association of Anesthesiologists score, 3.36). The mean time from presentation to amputation was 16.83 days. Eighty percent of patients were admitted to a critical care bed postoperatively. The mean time that patients stayed in a critical care environment was 2.62 days (range, 0-6 days). After a stay in the critical care unit, 90% of patients were stepped down to a health care of the elderly ward. One patient died in less than 30 days, representing a 10% 30-day mortality rate. The mean inpatient stay was 47 days (range, 19-121 days). Eighty percent of patients who underwent amputation in less than 10 days survived to discharge. In contrast, only 25% of patients who underwent amputation after day 11 survived to discharge (P = .0384). In conclusion, the implementation of the "preamputation care pathway" has reduced the 30-day mortality rate to 10%. A similar model of care currently exists for fractured neck of femur patients and is outlined by the care standards into "Best Practice Tariff" for the care of fractured neck of femur. A similar model should be implemented for patients undergoing lower limb amputation. Copyright © 2016 Society for Vascular Nursing, Inc. Published by Elsevier Inc. All rights reserved.

  11. Growth hormone reduces mortality and bacterial translocation in irradiated rats

    Energy Technology Data Exchange (ETDEWEB)

    Gomez-de-Segura, I.A.; Miguel, E. de [`La Paz` Hospital, Madrid (Spain). Dept. of Experimental Surgery; Prieto, I. [`La Paz` Hospital, Madrid (Spain). Dept. of General and Digestive Surgery; Grande, A.G. [`La Paz` Hospital, Madrid (Spain). Dept. of Oncology Radiotherapy; Garcia, P.; Mendez, J. [`La Paz` Hospital, Madrid (Spain). Dept. of Clinical Biochemistry; Guerra, A. [`La Paz` Hospital, Madrid (Spain). Dept. of Microbiology

    1998-09-01

    Growth hormone stimulates the growth of intestinal mucosa and may reduce the severity of injury caused by radiation. Male Wistar rats underwent abdominal irradiation (12 Gy) and were treated with either human growth hormone (hGH) or saline, and sacrificed at day 4 or 7 post-irradiation. Bacterial translocation, and the ileal mucosal thickness, proliferation, and disaccharidase activity were assessed. Mortality was 65% in irradiated animals, whereas hGH caused a decrement (29%, p<0.05). Bacterial translocation was also reduced by hGH (p<0.05). Treating irradiated rats with hGH prevented body weight loss (p<0.05). Mucosal thickness increased faster in irradiated hGH-treated animals. The proliferative index showed an increment in hGH-treated animals (p<0.05). Giving hGH to irradiated rats prevented decrease in sucrose activity, and increment in lactase activity. In conclusion, giving hGH to irradiated rats promotes the adaptative process of the intestine and acute radiation-related negative effects, including mortality, bacterial translocation, and weight loss. (orig.)

  12. Health actions in primary care to reduce child mortality

    Directory of Open Access Journals (Sweden)

    Camila Marques Careti

    2016-02-01

    Full Text Available Objective: to identify the health actions aimed at reducing child mortality in primary care in a county of São Paulo, Brazil. Methods: an exploratory study with a quantitative approach. 54 health professionals (nurses, doctors and community health agents participated in this study in three health units selected. Results: most participants reported to develop actions to encourage breast-feeding; of the children assisted, 59.3% had their vaccination updated; 72.2% of doctors and nurses confirmed that the children have at least one appointment in their first week of life. For planning in health care, 51.9% reported that sometimes there is health team participation in the meetings. Conclusion: several actions correspond to those recommended by the child-care public policies. However, there are weaknesses pointing at the need to enhance the vision of the health professionals for greater planning, adapting to the needs of the child population in order to reduce the deaths.

  13. Strategies to reduce infant mortality rate in India.

    Science.gov (United States)

    Ghai, O P

    1985-01-01

    As a systems approach is needed to develop strategies to reduce the infant mortality rate (IMR), it is appropriate to analyze the present situation in India, reasons for low IMR in some Indian states vis-a-vis others, the status in some neighboring countries, and the cost effectiveness of various available technological interventions and their organizational constraints. A 1981 survey revealed 1) a low IMR for the state of Kerala, one which was comparable with Western nations, despite the fact that nearly half of the population in Kerala lived below the poverty line; 2) a very high IMR for the state of Uttar Pradesh, even though the number of people living below the poverty line was not significantly by different from the state of Kerala; and a moderate IMR reduction in the state of Punjab, even though only 15% of the population was below the poverty line. Favorable factors for low IMR appear to be a high female literacy rate, good medical and educational facilities close to the place of residence, and an excellent transportation and communication system. To significantly reduce IMR in a short period of time, it is necessary to adopt certain immediate measures. Nearly 55% of infant deaths occur in the 1st month of life, and these generally are not amenable to general measures and technological interventions. The problem is difficult, but a solution can be found by reaching a broad consensus among professionals and administrators. The major recommendations of a seminar on the Strategies for Reducing infant Mortality in India, held during January 1984, were: provide antenatal care to 100% of pregnant women; work for early registration of pregnancy and identification of high risk pregnancies; immunize 100% of pregnant women with tetanus toxoid; make available intrapartum care for all pregnant women; delineate anticipated job requirements, duties, and functions of village level health workers; make presterilized packaged delivery kits available to all female health

  14. Addressing the sluggish progress in reducing maternal mortality in India.

    Science.gov (United States)

    Rai, Rajesh Kumar; Tulchinsky, Theodore Herzl

    2015-03-01

    Although some progress has been made in India, achievement of the Fifth Millennium Development Goal (MDG5; ie, 75% reduction in maternal mortality ratio [MMR] from 1990 by 2015) target seems to be unattainable by 2015. Failure of the National Population Policy, 2000, and the National Health Policy, 2002, to reduce the MMR demanded a new direction, leading to the establishment of a National Rural Health Mission in 2005. This commentary addresses both the real achievements and the hurdles faced in India's stagnating progress in maternal health. Promotion of maternal nutrition and health education, with greater attention to emergency obstetrical care at the district subcenter and primary health care center levels, must be prioritized. These changes of focus are vital to make prenatal, delivery, and postnatal care safer with increased resources allotted to adolescents, the poor, and women living in rural areas in order to enhance maternal health and achieve the MDG target.

  15. Reducing maternal mortality from ruptured uterus--the Sokoto initiative.

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    Ahmed, Y; Shehu, C E; Nwobodo, E I; Ekele, B A

    2004-06-01

    Uterine rupture is the most common cause of maternal mortality in our institution. Case fatality for the year 2001 was 47%. Health care including emergency obstetric care (EmOC) is not free, hence, delays in receiving care could occur in patients with limited resources. The objectives of the study were to promote access to emergency obstetric care through a loan scheme for indigent patients with ruptured uterus and determine the success or otherwise of the scheme. The scheme was initiated in January 2002, with the sum of thirty eight Thousand Naira (about 300 US dollars) by consultant obstetricians in the department. Funds were released to the patient only after assessment of her financial capability to enable her get emergency surgical packs. All that was required was a promise to pay back the loan before discharge. Following resuscitation, surgery was performed by one of the consultants. Eighteen cases of ruptured uterus have been managed. Treatment was initiated within 30 minutes of admission. Admission-laparotomy interval averaged 3.5 hours (+/-1.2). There were two maternal deaths, giving a case fatality of 11% (2/ 18). The case fatality from a previous study from the same centre was 38% (16/42). There was a significant difference in case fatality between the two studies (Ploan before discharge (94% loan recovery). Only one patient defaulted with five thousand Naira (40 US dollars). A loan scheme for indigent patients with ruptured uterus that enabled them receive emergency obstetric care reduced case fatality. Loan recovery was good. In our quest to reduce maternal mortality in low-income countries without health insurance policies, there might be a need to extend similar initiative to other obstetric emergencies.

  16. Screening for reducing morbidity and mortality in malignant melanoma

    DEFF Research Database (Denmark)

    Johansson, Minna; Brodersen, John; Gøtzsche, Peter C.

    2016-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects on morbidity and mortality of screening for malignant melanoma in the general population.......This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects on morbidity and mortality of screening for malignant melanoma in the general population....

  17. Orthogeriatric Service Reduces Mortality in Patients With Hip Fracture

    DEFF Research Database (Denmark)

    Stenqvist, Charlotte; Madsen, Christian Medom; Riis, Troels

    2016-01-01

    INTRODUCTION: Orthogeriatric service has been shown to improve outcomes in patients with hip fracture. The purpose of this study is to evaluate the effect of orthogeriatrics at Bispebjerg University Hospital, Denmark. The primary outcome is mortality inhospital and after 1, 3, and 12 months for p......, and ASA score. Future trials should include frail patients with other fracture types who can benefit from orthogeriatrics.......INTRODUCTION: Orthogeriatric service has been shown to improve outcomes in patients with hip fracture. The purpose of this study is to evaluate the effect of orthogeriatrics at Bispebjerg University Hospital, Denmark. The primary outcome is mortality inhospital and after 1, 3, and 12 months...... for patients with hip fracture. The secondary outcome is mortality for home dwellers and nursing home inhabitants. MATERIALS AND METHODS: This is a retrospective clinical cohort study with an historic control group including all patients with hip fracture admitted from 2007 to 2011. Patients with hip fracture...

  18. A comprehensive hip fracture program reduces complication rates and mortality

    DEFF Research Database (Denmark)

    Pedersen, Susanne Juhl; Moltke, Finn Borgbjerg; Schousboe, B.

    2008-01-01

    OBJECTIVES: To evaluate the rate of postoperative complications, length of stay, and 1-year mortality before and after introduction of a comprehensive Multidisciplinary fast-track treatment and care program for hip fracture patients (the optimized program). DESIGN: Retrospective chart review...... with historical control. SETTING: Orthopedic ward (110 beds) at a university hospital (700 beds). PARTICIPANTS: Five hundred thirty-five consecutive patients aged 40 and older (94% >= 60) hospitalized for hip fracture between January 1, 2003, and March 3 1, 2004. Three hundred and thirty-six patients (70.3%) were...... tract infection (P mortality was 23% in the control group versus 12% in the intervention...

  19. Success in reducing maternal and child mortality in Afghanistan.

    Science.gov (United States)

    Rasooly, Mohammad Hafiz; Govindasamy, Pav; Aqil, Anwer; Rutstein, Shea; Arnold, Fred; Noormal, Bashiruddin; Way, Ann; Brock, Susan; Shadoul, Ahmed

    2014-01-01

    After the collapse of the Taliban regime in 2002, Afghanistan adopted a new development path and billions of dollars were invested in rebuilding the country's economy and health systems with the help of donors. These investments have led to substantial improvements in maternal and child health in recent years and ultimately to a decrease in maternal and child mortality. The 2010 Afghanistan Mortality Survey (AMS) provides important new information on the levels and trends in these indicators. The AMS estimated that there are 327 maternal deaths for every 100,000 live births (95% confidence interval = 260-394) and 97 deaths before the age of five years for every 1000 children born. Decreases in these mortality rates are consistent with changes in key determinants of mortality, including an increasing age at marriage, higher contraceptive use, lower fertility, better immunisation coverage, improvements in the percentage of women delivering in health facilities and receiving antenatal and postnatal care, involvement of community health workers and increasing access to the Basic Package of Health Services. Despite the impressive gains in these areas, many challenges remain. Further improvements in health services in Afghanistan will require sustained efforts on the part of both the Government of Afghanistan and international donors.

  20. Mobile phone intervention reduces perinatal mortality in Zanzibar

    DEFF Research Database (Denmark)

    Lund, Stine; Rasch, Vibeke; Hemed, Maryam

    2014-01-01

    BACKGROUND: Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies......, evidence for its role in health care is sparse. OBJECTIVE: We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting. METHODS: This study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities...... care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text message and voucher component. Secondary outcome measures included stillbirth, perinatal mortality, and death of a child within 42 days after birth...

  1. Reducing mortality for high risk surgical patients in the UK.

    Science.gov (United States)

    Rogers, B A; Carrothers, A D; Jones, Chris

    2012-06-01

    Over 40 million surgical procedures are performed per annum in the USA and Europe, including several million patients who are considered to be high risk (Bennett-Guerrero et al 2003). Overall, the risk of death or major complications after surgery in the general surgical patient population is low, with a post-operative mortality rate of less than1% during the same hospital admission (Niskanen et al 2001).

  2. Zero in on postpartum hemorrhage to reduce Cuba's maternal mortality.

    Science.gov (United States)

    Águila, Sonia

    2015-01-01

    Postpartum hemorrhage (PPH) is the most frequent cause of severe maternal morbidity (SMM) and the first direct cause of maternal death in most countries. In Africa and Asia, it accounts for about one third of all maternal deaths. Put more graphically: worldwide, one woman dies every minute from PPH. Defined as blood loss of ≥500 mL after vaginal birth or ≥1000 mL after cesarean delivery, PPH can be fatal in just two hours. In Cuba, between 2000 and 2012, maternal deaths directly related to obstetric causes totaled 410, 24.1% of which occurred postpartum, with PPH the leading cause.[1] While Cuba is among the Latin American countries with lowest maternal mortality, the decline has been slow over the last 20 years: in 1998, direct maternal mortality was 26.5 per 100,000 live births and in 2012, the rate was 21.5. This is troubling and deserves careful study, especially given that Cuba has a single, unified health system supported by significant political will-determining factors in important advances made in maternal-child health on par with wealthier countries.

  3. Laparoscopic colectomy reduces morbidity and mortality in obese patients.

    Science.gov (United States)

    Hardiman, Karin; Chang, Eric T; Diggs, Brian S; Lu, Kim C

    2013-08-01

    Obesity is a growing epidemic in the US and increases the difficulty of laparoscopic surgery. Randomized, controlled trials of laparoscopic vs. open colectomy have shown equivalence but often exclude obese patients thus not answering whether obese patients may specifically benefit from laparoscopy. We hypothesized that obese patients would benefit from use of laparoscopy for colectomy. We used the National Surgical Quality Improvement Program database from 2005 to 2009 and chose elective laparoscopic and open segmental colectomy and ileocecal resections. We compared patients' demographics, comorbidities, and outcomes. We used multivariate models to assess for predictors of complications in obese patients. These models included demographics, comorbidities, and outcomes. 35,998 patients were identified who underwent elective colectomy with primary anastomosis. Forty-four percent of the included cases were laparoscopic and 31 % of patients had a BMI greater than 30 (obese). Obese patients were more likely to have diabetes, hypertension, prior percutaneous coronary intervention, and dyspnea on exertion. We constructed a new variable called any complication that included all complications except 30-day mortality. In our multivariate analysis, laparoscopic approach in obese patients independently decreased the relative risk of superficial (odds ratio (OR) 0.72, 95 % confidence interval (CI) 0.63-0.82) and deep (OR 0.44, CI 0.31-0.61) surgical site infections, intra-abdominal infection (OR 0.61, CI 0.49-0.78), dehiscence (OR 0.50, CI 0.35-0.69), pneumonia (OR 0.60, CI 0.44-0.81), failure to wean from the ventilator (OR 0.64, CI 0.47-0.87), renal failure (OR 0.58, CI 0.35-0.96), urinary tract infection (OR 0.62, CI 0.49-0.79), sepsis (OR 0.53, CI 0.43-0.66), septic shock (OR 0.65, CI 0.47-0.90), any complication (OR 0.61, CI 0.55-0.67) and 30-day mortality (OR 0.56, CI 0.31-0.98). Due to the significant decrease in the risk of morbidity and mortality, laparoscopic

  4. Reducing maternal mortality in the eastern Mediterranean region.

    Science.gov (United States)

    Mahaini, R; Mahmoud, H

    2005-07-01

    Current efforts in some countries of the Eastern Mediterranean Region are still insufficient to achieve the fifth Millennium Development Goal on improving maternal health. Strong commitment, intensive efforts and effective national policies and strategies are now urgently required in order to translate vision into action. Such efforts and plans should target the strengthening of health systems, the expansion in the coverage of effective integrated interventions, and the recognition of the essential role of individuals, families and communities in making pregnancy safer. This article provides a background on the current situation of maternal health in the Eastern Mediterranean Region, including underlying causes and contributing factors, and describes strategic directions aimed at accelerating the reduction of maternal mortality in the Region and moving closer to the achievement of the Millennium Development Goals.

  5. Medication review in hospitalised patients to reduce morbidity and mortality

    DEFF Research Database (Denmark)

    Christensen, Mikkel; Lundh, Andreas

    2016-01-01

    : We searched the Specialised Register of the Cochrane Effective Practice and Organisation of Care (EPOC) Group; the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) to November 2014, as well......BACKGROUND: Pharmacotherapy in the elderly population is complicated by several factors that increase the risk of drug-related harms and less favourable effectiveness. The concept of medication review is a key element in improving the quality of prescribing and in preventing adverse drug events...... CRITERIA: We included randomised controlled trials (RCTs) of medication review in hospitalised adult patients. We excluded trials of outclinic and paediatric patients. Our primary outcome was all-cause mortality, and secondary outcomes included hospital readmissions, emergency department contacts...

  6. Pneumonia research to reduce childhood mortality in the developing world

    OpenAIRE

    Scott, JA; Brooks, WA; Peiris, JS; Holtzman, D.; Mulholland, EK

    2010-01-01

    Pneumonia is an illness, usually caused by infection, in which the lungs become inflamed and congested, reducing oxygen exchange and leading to cough and breathlessness. It affects individuals of all ages but occurs most frequently in children and the elderly. Among children, pneumonia is the most common cause of death worldwide. Historically, in developed countries, deaths from pneumonia have been reduced by improvements in living conditions, air quality, and nutrition. In the developing wor...

  7. Targeting the Mevalonate Pathway to Reduce Mortality from Ovarian Cancer

    Science.gov (United States)

    2015-10-01

    2015 Clinical Cancer Research4658 cancer cell morphogenesis, motility, and migration. Rab GTPases control membrane and vesicle trafficking ...effects of a brief, psychosexual intervention. J Sex Med 2015;12:189–97. 7. Moldovan R, Keating S, Clancy T. The impact of risk-reducing gynaecolo

  8. Low Nonfasting Triglycerides and Reduced All-Cause Mortality: A Mendelian Randomization Study

    DEFF Research Database (Denmark)

    Thomsen, Mette; Varbo, Anette; Tybjærg-Hansen, Anne;

    2014-01-01

    Increased nonfasting plasma triglycerides marking increased amounts of cholesterol in remnant lipoproteins are important risk factors for cardiovascular disease, but whether lifelong reduced concentrations of triglycerides on a genetic basis ultimately lead to reduced all-cause mortality is unknown....... We tested this hypothesis.METHODS: Using individuals from the Copenhagen City Heart Study in a Mendelian randomization design, we first tested whether low concentrations of nonfasting triglycerides were associated with reduced all-cause mortality in observational analyses (n = 13 957); second......, whether genetic variants in the triglyceride-degrading enzyme lipoprotein lipase, resulting in reduced nonfasting triglycerides and remnant cholesterol, were causally associated with reduced all-cause mortality (n = 10 208).RESULTS: During a median 24 and 17 years of 100% complete follow-up, 9991 and 4005...

  9. Do seat belts and air bags reduce mortality and injury severity after car accidents?

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    Cummins, Justin S; Koval, Kenneth J; Cantu, Robert V; Spratt, Kevin F

    2011-03-01

    We studied National Trauma Data Bank data to determine the effectiveness of car safety devices in reducing mortality and injury severity in 184,992 patients between 1988 and 2004. Safety device variables were seat belt used plus air bag deployed; only seat belt used; only air bag deployed; and, as explicitly coded, no device used. Overall mortality was 4.17%. Compared with the no-device group, the seat-belt-plus-air-bag group had a 67% reduction in mortality (adjusted odds ratio [AOR], 0.33; 99% confidence interval [CI], 0.28-0.39), the seatbelt- only group had a 51% mortality reduction (AOR, 0.49; 99% CI, 0.45-0.52), and the air-bag-only group had a 32% mortality reduction (AOR, 0.68, 99% CI, 0.57-0.80). Injury Severity Scores showed a similar pattern.

  10. Sustainable Development Goals and the Ongoing Process of Reducing Maternal Mortality.

    Science.gov (United States)

    Callister, Lynn Clark; Edwards, Joan E

    2017-03-09

    Innovative programs introduced in response to the Millennium Development Goals show promise to reduce the global rate of maternal mortality. The Sustainable Development Goals, introduced in 2015, were designed to build on this progress. In this article, we describe the global factors that contribute to maternal mortality rates, outcomes of the implementation of the Millennium Development Goals, and the new, related Sustainable Development Goals. Implications for clinical practice, health care systems, research, and health policy are provided.

  11. Global progress and potentially effective policy responses to reduce maternal mortality.

    Science.gov (United States)

    Mbizvo, Michael T; Say, Lale

    2012-10-01

    Reducing maternal mortality within significant margins is a global imperative that reflects attainment of development goals. Progress in reducing maternal mortality, in particular among countries with notably high maternal mortality ratios (MMRs), has been substantially slower than the Millennium Development Goal target of an annual rate of 5.5% decline. The latest UN maternal mortality estimates show a reduction in MMR in a number of countries between 1990 and 2008. Understanding the factors associated with progress in countries that have reduced maternal mortality provides other countries and development partners with opportunities to consider and implement policies and interventions that could help accelerate progress. This paper reviews 6 countries that have demonstrated marked progress. The policies that have been effective include innovative financing measures; investment in human resources both in terms of strengthening pre-service education and emphasizing in-service training for healthcare providers; strengthening obstetric care by enhancing infrastructure and upgrading equipment, as well as improving quality of services; and investing in the broader determinants of maternal mortality, particularly family planning and women's education and socioeconomic empowerment. This range of actions, which includes a combination of facility and community-based approaches, provides a list of potentially effective strategies that could be considered when developing programs in other countries with slower progress. Strong political will and multistakeholder involvement and interventions are key in the development and implementation of these policies and actions.

  12. Low nonfasting triglycerides and reduced all-cause mortality: a mendelian randomization study.

    Science.gov (United States)

    Thomsen, Mette; Varbo, Anette; Tybjærg-Hansen, Anne; Nordestgaard, Børge G

    2014-05-01

    Increased nonfasting plasma triglycerides marking increased amounts of cholesterol in remnant lipoproteins are important risk factors for cardiovascular disease, but whether lifelong reduced concentrations of triglycerides on a genetic basis ultimately lead to reduced all-cause mortality is unknown. We tested this hypothesis. Using individuals from the Copenhagen City Heart Study in a mendelian randomization design, we first tested whether low concentrations of nonfasting triglycerides were associated with reduced all-cause mortality in observational analyses (n = 13 957); second, whether genetic variants in the triglyceride-degrading enzyme lipoprotein lipase, resulting in reduced nonfasting triglycerides and remnant cholesterol, were associated with reduced all-cause mortality (n = 10 208). During a median 24 and 17 years of 100% complete follow-up, 9991 and 4005 individuals died in observational and genetic analyses, respectively. In observational analyses compared to individuals with nonfasting plasma triglycerides of 266-442 mg/dL (3.00-4.99 mmol/L), multivariably adjusted hazard ratios for all-cause mortality were 0.89 (95% CI 0.78-1.02) for 177-265 mg/dL (2.00-2.99 mmol/L), 0.74 (0.65-0.84) for 89-176 mg/dL (1.00-1.99 mmol/L), and 0.59 (0.51-0.68) for individuals with nonfasting triglycerides triglycerides was 0.50 (0.30-0.82), with a corresponding observational hazard ratio of 0.87 (0.85-0.89). Also, the odds ratio for a genetically derived 50% lower concentration in nonfasting triglycerides was 0.43 (0.23-0.80), with a corresponding observational hazard ratio of 0.73 (0.70-0.77). Genetically reduced concentrations of nonfasting plasma triglycerides are associated with reduced all-cause mortality, likely through reduced amounts of cholesterol in remnant lipoproteins.

  13. Higher levels of serum lycopene are associated with reduced mortality in individuals with metabolic syndrome.

    Science.gov (United States)

    Han, Guang-Ming; Meza, Jane L; Soliman, Ghada A; Islam, K M Monirul; Watanabe-Galloway, Shinobu

    2016-05-01

    Metabolic syndrome increases the risk of mortality. Increased oxidative stress and inflammation may play an important role in the high mortality of individuals with metabolic syndrome. Previous studies have suggested that lycopene intake might be related to the reduced oxidative stress and decreased inflammation. Using data from the National Health and Nutrition Examination Survey, we examined the hypothesis that lycopene is associated with mortality among individuals with metabolic syndrome. A total of 2499 participants 20 years and older with metabolic syndrome were divided into 3 groups based on their serum concentration of lycopene using the tertile rank method. The National Health and Nutrition Examination Survey from years 2001 to 2006 was linked to the mortality file for mortality follow-up data through December 31, 2011, to determine the mortality rate and hazard ratios (HR) for the 3 serum lycopene concentration groups. The mean survival time was significantly higher in the group with the highest serum lycopene concentration (120.6 months; 95% confidence interval [CI], 118.8-122.3) and the medium group (116.3 months; 95% CI, 115.2-117.4), compared with the group with lowest serum lycopene concentration (107.4 months; 95% CI, 106.5-108.3). After adjusting for possible confounding factors, participants in the highest (HR, 0.61; P = .0113) and in the second highest (HR, 0.67; P = .0497) serum lycopene concentration groups showed significantly lower HRs of mortality when compared with participants in the lower serum lycopene concentration. The data suggest that higher serum lycopene concentration has a significant association with the reduced risk of mortality among individuals with metabolic syndrome.

  14. Comparing the effectiveness of competing tests for reducing colorectal cancer mortality: a network meta-analysis.

    Science.gov (United States)

    Elmunzer, B Joseph; Singal, Amit G; Sussman, Jeremy B; Deshpande, Amar R; Sussman, Daniel A; Conte, Marisa L; Dwamena, Ben A; Rogers, Mary A M; Schoenfeld, Philip S; Inadomi, John M; Saini, Sameer D; Waljee, Akbar K

    2015-03-01

    Comparative effectiveness data pertaining to competing colorectal cancer (CRC) screening tests do not exist but are necessary to guide clinical decision making and policy. To perform a comparative synthesis of clinical outcomes studies evaluating the effects of competing tests on CRC-related mortality. Traditional and network meta-analyses. Two reviewers identified studies evaluating the effect of guaiac-based fecal occult blood testing (gFOBT), flexible sigmoidoscopy (FS), or colonoscopy on CRC-related mortality. gFOBT, FS, colonoscopy. Traditional meta-analysis was performed to produce pooled estimates of the effect of each modality on CRC mortality. Bayesian network meta-analysis (NMA) was performed to indirectly compare the effectiveness of screening modalities. Multiple sensitivity analyses were performed. Traditional meta-analysis revealed that, compared with no intervention, colonoscopy reduced CRC-related mortality by 57% (relative risk [RR] 0.43; 95% confidence interval [CI], 0.33-0.58), whereas FS reduced CRC-related mortality by 40% (RR 0.60; 95% CI, 0.45-0.78), and gFOBT reduced CRC-related mortality by 18% (RR 0.82; 95% CI, 0.76-0.88). NMA demonstrated nonsignificant trends favoring colonoscopy over FS (RR 0.71; 95% CI, 0.45-1.11) and FS over gFOBT (RR 0.74; 95% CI, 0.51-1.09) for reducing CRC-related deaths. NMA-based simulations, however, revealed that colonoscopy has a 94% probability of being the most effective test for reducing CRC mortality and a 99% probability of being most effective when the analysis is restricted to screening studies. Randomized trials and observational studies were combined within the same analysis. Clinical outcomes studies demonstrate that gFOBT, FS, and colonoscopy are all effective in reducing CRC-related mortality. Network meta-analysis suggests that colonoscopy is the most effective test. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  15. Parathyroidectomy Is Associated with Reduced Mortality in Hemodialysis Patients with Secondary Hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Tsung-Liang Ma

    2015-01-01

    Full Text Available Secondary hyperparathyroidism increases morbidity and mortality in hemodialysis patients. The Kidney Disease Outcomes Quality Initiative Guidelines recommend parathyroidectomy for patients with chronic kidney disease and parathyroid hormone concentrations exceeding 800 pg/mL; however, this concentration represents an arbitrary cut-off value. The present study was conducted to identify factors influencing mortality in hemodialysis patients with parathyroid hormone concentrations exceeding 800 pg/mL and to evaluate the effects of parathyroidectomy on outcome for these patients. Two hundred twenty-one hemodialysis patients with parathyroid hormone concentrations > 800 pg/mL from July 2004 to June 2010 were identified. 21.1% of patients (n = 60 received parathyroidectomy and 14.9% of patients (n = 33 died during a mean follow-up of 36 months. Patients with parathyroidectomy were found to have lower all-cause mortality (adjusted hazard ratio [aHR]: 0.34. Other independent predictors included age ≥ 65 years (aHR: 2.11 and diabetes mellitus (aHR: 3.80. For cardiovascular mortality, parathyroidectomy was associated with lower mortality (HR = 0.31 but with a marginal statistical significance (p = 0.061. In multivariate analysis, diabetes was the only significant predictor (aHR: 3.14. It is concluded that, for hemodialysis patients with parathyroid hormone concentrations greater than 800 pg/mL, parathyroidectomy is associated with reduced all-cause mortality.

  16. General health checks in adults for reducing morbidity and mortality from disease

    DEFF Research Database (Denmark)

    Krogsbøll, Lasse T; Jørgensen, Karsten Juhl; Grønhøj Larsen, Christian

    2012-01-01

    General health checks are common elements of health care in some countries. These aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality. Most of the commonly used screening tests offered in general health checks have been incompletely studied. Also...

  17. A Strategy for the Evaluation of Activities to Reduce Maternal Mortality in Developing Countries.

    Science.gov (United States)

    Ward, Victoria M.; And Others

    1994-01-01

    An evaluation strategy in which a set of process indicators is applied to programs to reduce maternal mortality in developing countries is presented. The four-stage strategy is illustrated for three interventions: (1) providing safe abortion services; (2) increasing knowledge of obstetric complications; and (3) improving medical care quality. (SLD)

  18. Setting research priorities to reduce global mortality from preterm birth and low birth

    Directory of Open Access Journals (Sweden)

    Rajiv Bahl Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland

    2012-06-01

    Full Text Available This paper aims to identify health research priorities that could improve the rate of progress in reducing global neonatal mortality from preterm birth and low birth weight (PB/LBW, as set out in the UN's Millennium Development Goal 4.

  19. Ecological investigations to select mitigation options to reduce vehicle-caused mortality of a threatened butterfly

    Science.gov (United States)

    Sara B. Zielin; Jalene Littlejohn; Catherine E. de Rivera; Winston P. Smith; Sandra L. Jacobson

    2016-01-01

    Whereas roads that bisect habitat are known to decrease population size through animal-vehicle collisions or interruption of key life history events, it is not always obvious how to reduce such impacts, especially for flying organisms. We needed a quick, cost-efficient and effective way to determine how best to decrease vehicle-caused mortality while maintaining...

  20. Confinement of lactating sows in crates for 4 days after farrowing reduces piglet mortality.

    Science.gov (United States)

    Moustsen, V A; Hales, J; Lahrmann, H P; Weber, P M; Hansen, C F

    2013-04-01

    To reduce mortality among suckling piglets, lactating sows are traditionally housed in farrowing crates. Alternatively, lactating sows can be housed in farrowing pens where the sow is loose to ensure more behavioural freedom and consequently a better welfare for the sow, although under commercial conditions, farrowing pens have been associated with increased piglet mortality. Most suckling piglets that die do so within the first week of life, so potentially lactating sows do not have to be restrained during the entire lactation period. Therefore, the aim of the current study was to investigate whether confinement of the sow for a limited number of days after farrowing would affect piglet mortality. A total of 210 sows (Danish Landrace × Danish Yorkshire) were farrowed in specially designed swing-aside combination farrowing pens measuring 2.6 m × 1.8 m (combi-pen), where the sows could be kept loose or in a crate. The sows were either: (a) loose during the entire experimental period, (b) crated from days 0 to 4 postpartum, (c) crated from days 0 to 7 postpartum or (d) crated from introduction to the farrowing pen to day 7 postpartum. The sows and their subsequent litters were studied from introduction to the combi-pen ∼1 week before expected farrowing and until 10 days postpartum. Confinement period of the sow failed to affect the number of stillborn piglets; however, sows that were crated after farrowing had fewer live-born mortality deaths (P piglet mortality among the loose sows was because of higher mortality in the first 4 days after farrowing. In conclusion, the current study demonstrated that crating the sow for 4 days postpartum was sufficient to reduce piglet mortality.

  1. Temporary confinement of loose-housed hyperprolific sows reduces piglet mortality.

    Science.gov (United States)

    Hales, J; Moustsen, V A; Nielsen, M B F; Hansen, C F

    2015-08-01

    The objective of this study was to investigate piglet mortality in a commercial setting where sows were accommodated in a loose-housed system with an option to confine the sow for a few days around farrowing and during early lactation. The study was conducted in a Danish piggery where records were obtained from 2,139 farrowings. Sows were randomly allocated to 1 of 3 treatments: loose-loose (LL), loose-confined (LC), and confined-confined (CC). In LL, sows were loose housed from the time they entered the farrowing pens to weaning. In LC, sows were loose housed until farrowing was finished and then confined to d 4 after farrowing. In CC, sows were confined at d 114 of gestation to d 4 after farrowing. All sows were loose housed from d 5 to weaning. Total piglet mortality was analyzed at batch level to include piglets fostered by nurse sows and at sow level to analyze the effects of confinement during different time periods. Total piglet mortality was greater in LL (26.0%) and LC (25.4%) compared with CC (22.1%; sows in CC were classified as "low mortality" compared with LL and LC both before ( < 0.001) and after ( = 0.002) litter equalization. The results in this study emphasize that the period of time from the birth of the first piglet to litter equalization is important in relation to piglet mortality. The results also suggest that confinement for 4 d after farrowing can reduce mortality in this specific period, but only confinement from d 114 of gestation to d 4 after farrowing reduced total piglet mortality.

  2. Reducing mortality with device therapy in heart failure patients without ventricular arrhythmias.

    Science.gov (United States)

    Chapa, Deborah W; Lee, Hyeon-Joo; Kao, Chi-Wen; Friedmann, Erika; Thomas, Sue A; Anderson, Jill; Bardy, Gust H

    2008-09-01

    Use of device therapy to prevent sudden cardiac death in patients with heart failure is expanding on the basis of evidence from recent clinical trials. Three multicenter prospective clinical trials-Sudden Cardiac Death in Heart Failure (SCD-HeFT); Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION); and Cardiac Resynchronization-Heart Failure (CARE-HF)-were conducted to determine the effectiveness of devices in reducing mortality in patients with heart failure who did not have a history of ventricular arrhythmias. The 3 trials varied in the devices used, the population of patients included, and the study designs. In SCD-HeFT, implantable cardioverter defibrillators were more effective than pharmacological therapy in preventing mortality among patients with mild to moderate heart failure. In COMPANION, cardiac resynchronization therapy alone and cardiac resynchronization therapy plus an implantable cardioverter defibrillator were more effective than optimal drug treatment in reducing morbidity and all-cause mortality in patients with moderate to severe heart failure. In CARE-HF, cardiac resynchronization therapy alone was more effective than optimal drug treatment in reducing all-cause mortality in patients with moderate to severe heart failure. No direct comparison of the devices used has been done. These 3 clinical trials provide clear evidence that device therapy is beneficial for some patients with heart failure, even patients who do not have a history of ventricular arrhythmia.

  3. Mediation pathways and effects of green structures on respiratory mortality via reducing air pollution

    Science.gov (United States)

    Shen, Yu-Sheng; Lung, Shih-Chun Candice

    2017-01-01

    Previous studies have shown both health and environmental benefits of green spaces, especially in moderating temperature and reducing air pollution. However, the characteristics of green structures have been overlooked in previous investigations. In addition, the mediation effects of green structures on respiratory mortality have not been assessed. This study explores the potential mediation pathways and effects of green structure characteristics on respiratory mortality through temperature, primary and secondary air pollutants separately using partial least squares model with data from Taiwan. The measurable characteristics of green structure include the largest patch percentage, landscape proportion, aggregation, patch distance, and fragmentation. The results showed that mortality of pneumonia and chronic lower respiratory diseases could be reduced by minimizing fragmentation and increasing the largest patch percentage of green structure, and the mediation effects are mostly through reducing air pollutants rather than temperature. Moreover, a high proportion of but fragmented green spaces would increase secondary air pollutants and enhance health risks; demonstrating the deficiency of traditional greening policy with primary focus on coverage ratio. This is the first research focusing on mediation effects of green structure characteristics on respiratory mortality, revealing that appropriate green structure planning can be a useful complementary strategy in environmental health management. PMID:28230108

  4. Mediation pathways and effects of green structures on respiratory mortality via reducing air pollution

    Science.gov (United States)

    Shen, Yu-Sheng; Lung, Shih-Chun Candice

    2017-02-01

    Previous studies have shown both health and environmental benefits of green spaces, especially in moderating temperature and reducing air pollution. However, the characteristics of green structures have been overlooked in previous investigations. In addition, the mediation effects of green structures on respiratory mortality have not been assessed. This study explores the potential mediation pathways and effects of green structure characteristics on respiratory mortality through temperature, primary and secondary air pollutants separately using partial least squares model with data from Taiwan. The measurable characteristics of green structure include the largest patch percentage, landscape proportion, aggregation, patch distance, and fragmentation. The results showed that mortality of pneumonia and chronic lower respiratory diseases could be reduced by minimizing fragmentation and increasing the largest patch percentage of green structure, and the mediation effects are mostly through reducing air pollutants rather than temperature. Moreover, a high proportion of but fragmented green spaces would increase secondary air pollutants and enhance health risks; demonstrating the deficiency of traditional greening policy with primary focus on coverage ratio. This is the first research focusing on mediation effects of green structure characteristics on respiratory mortality, revealing that appropriate green structure planning can be a useful complementary strategy in environmental health management.

  5. Reduced All-Cause Child Mortality After General Measles Vaccination Campaign in Rural Guinea-Bissau

    DEFF Research Database (Denmark)

    Fisker, Ane Bærent; Rodrigues, Amabelia; Martins, Cesario

    2015-01-01

    BACKGROUND: Randomised trials have shown that measles vaccine (MV) prevents non-measles deaths. MV-campaigns are conducted to eliminate measles infection.The overall mortality effect of MV-campaigns has not been studied. METHODS: Bandim Health Project (BHP) surveys children aged 0-4 years in rural...... in the 12 months after the campaign, compared with 203 and 206 deaths in the two previous years, the adjusted mortality rate ratio (aMRR) comparing all children in 2006 with all children in 2004-2005 being 0.80 (95%CI: 0.66-0.96).Censoring deaths due to measles infection the aMRR was 0.83 (0.69-1.00).The...... by prevention of measles deaths. If MV-campaigns reduce non-measles related mortality the policies for measles vaccination should take this into account....

  6. Serotonin neurones have anti-convulsant effects and reduce seizure-induced mortality

    Science.gov (United States)

    Buchanan, Gordon F; Murray, Nicholas M; Hajek, Michael A; Richerson, George B

    2014-01-01

    Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with refractory epilepsy. Defects in central control of breathing are important contributors to the pathophysiology of SUDEP, and serotonin (5-HT) system dysfunction may be involved. Here we examined the effect of 5-HT neurone elimination or 5-HT reduction on seizure risk and seizure-induced mortality. Adult Lmx1bf/f/p mice, which lack >99% of 5-HT neurones in the CNS, and littermate controls (Lmx1bf/f) were subjected to acute seizure induction by maximal electroshock (MES) or pilocarpine, variably including electroencephalography, electrocardiography, plethysmography, mechanical ventilation or pharmacological therapy. Lmx1bf/f/p mice had a lower seizure threshold and increased seizure-induced mortality. Breathing ceased during most seizures without recovery, whereas cardiac activity persisted for up to 9 min before terminal arrest. The mortality rate of mice of both genotypes was reduced by mechanical ventilation during the seizure or 5-HT2A receptor agonist pretreatment. The selective serotonin reuptake inhibitor citalopram reduced mortality of Lmx1bf/f but not of Lmx1bf/f/p mice. In C57BL/6N mice, reduction of 5-HT synthesis with para-chlorophenylalanine increased MES-induced seizure severity but not mortality. We conclude that 5-HT neurones raise seizure threshold and decrease seizure-related mortality. Death ensued from respiratory failure, followed by terminal asystole. Given that SUDEP often occurs in association with generalised seizures, some mechanisms causing death in our model might be shared with those leading to SUDEP. This model may help determine the relationship between seizures, 5-HT system dysfunction, breathing and death, which may lead to novel ways to prevent SUDEP. PMID:25107926

  7. Screening Program Reduced Melanoma Mortality at the Lawrence Livermore National Laboratory, 1984-1996

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, MD, J S; II, PhD, D; MD, PhD, M

    2006-10-12

    Worldwide incidence of cutaneous malignant melanoma has increased substantially, and no screening program has yet demonstrated reduction in mortality. We evaluated the education, self examination and targeted screening campaign at the Lawrence Livermore National Laboratory (LLNL) from its beginning in July 1984 through 1996. The thickness and crude incidence of melanoma from the years before the campaign were compared to those obtained during the 13 years of screening. Melanoma mortality during the 13-year period was based on a National Death Index search. Expected yearly deaths from melanoma among LLNL employees were calculated by using California mortality data matched by age, sex, and race/ethnicity and adjusted to exclude deaths from melanoma diagnosed before the program began or before employment at LLNL. After the program began, crude incidence of melanoma thicker than 0.75 mm decreased from 18 to 4 cases per 100,000 person-years (p = 0.02), while melanoma less than 0.75mm remained stable and in situ melanoma increased substantially. No eligible melanoma deaths occurred among LLNL employees during the screening period compared with a calculated 3.39 expected deaths (p = 0.034). Education, self examination and selective screening for melanoma at LLNL significantly decreased incidence of melanoma thicker than 0.75 mm and reduced the melanoma-related mortality rate to zero. This significant decrease in mortality rate persisted for at least 3 yr after employees retired or otherwise left the laboratory.

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

    Science.gov (United States)

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

    2014-11-01

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

  9. Self-affirmation and mortality salience: affirming values reduces worldview defense and death-thought accessibility.

    Science.gov (United States)

    Schmeichel, Brandon J; Martens, Andy

    2005-05-01

    To the extent that cultural worldviews provide meaning in the face of existential concerns, specifically the inevitability of death, affirming a valued aspect of one's worldview should render reminders of death less threatening. The authors report two studies in support of this view. In Study 1, mortality salience led to derogation of a worldview violator unless participants had first affirmed an important value. In Study 2, self-affirmation before a reminder of death was associated with reduced accessibility of death-related thoughts a short while thereafter. The authors propose that actively affirming one's worldview alters reactions to reminders of mortality by reducing the accessibility of death-related thoughts, not by boosting self-esteem. These studies attest to the flexible nature of psychological self-defense and to the central role of cultural worldviews in managing death-related concerns.

  10. Simple risk stratification at admission to identify patients with reduced mortality from primary angioplasty

    DEFF Research Database (Denmark)

    Thune, Jens Jakob; Hoefsten, Dan Eik; Lindholm, Matias Greve

    2005-01-01

    a patient group with reduced mortality from an invasive strategy would be important for early triage. The Thrombolysis in Myocardial Infarction (TIMI) risk score is a simple validated integer score that makes it possible to identify high-risk patients on admission to hospital. We hypothesized that a high-risk...... with primary angioplasty (25.3% versus 36.2%; P=0.02). CONCLUSIONS: Risk stratification at admission based on the TIMI risk score identifies a group of high-risk patients who have a significantly reduced mortality with an invasive strategy of primary angioplasty.......BACKGROUND: Randomized trials comparing fibrinolysis with primary angioplasty for acute ST-elevation myocardial infarction have demonstrated a beneficial effect of primary angioplasty on the combined end point of death, reinfarction, and disabling stroke but not on all-cause death. Identifying...

  11. Early cardiology assessment and intervention reduces mortality following myocardial injury after non-cardiac surgery (MINS)

    Science.gov (United States)

    Hua, Alina; Pattenden, Holly; Leung, Maria; Davies, Simon; George, David A.; Raubenheimer, Hilgardt; Niwaz, Zakiyah

    2016-01-01

    Background Myocardial injury after non-cardiac surgery (MINS) is defined as troponin elevation of ≥0.03 ng/mL associated with 3.87-fold increase in early mortality. We sought to determine the impact of cardiology intervention on mortality in patients who developed MINS after general thoracic surgery. Methods A retrospective review was performed in patients over 5 years. Troponin was routinely measured and levels ≥0.04 ng/mL classified as positive. Data acquisition and mortality status was obtained via medical records and NHS tracing systems. Thirty-day mortality was compared on MINS cohort using Fisher’s exact square testing and logistic regression analysis. Results Troponin levels were measured in 491 (96%) of 511 patients. Eighty (16%) patients fulfilled the MINS criteria. Sixty-one (76%) received early cardiology consult and “myocardial infarction” stated in four (5%) patients. Risk assessment (for AMI) was undertaken; 20 (25%) patients were commenced on aspirin, four (5%) on β-blockers and one (1%) underwent percutaneous coronary intervention. Forty-nine (61%) patients received primary risk factor modifications and 26 (33%) had outpatient follow-up. There were no significant differences in the proportion of patients who died within 30 days post-operatively in the MINS group of 2.6% compared to the non-MINS group of 1.6% (P=0.625). The odds ratio for 30-day mortality in the MINS group was 1.69 (95% CI: 0.34 to 8.57, P=0.522). Conclusions MINS is common after general thoracic surgery. Early cardiology intervention reduced the expected hazard ratio of early death from 3.87 to an odds ratio of 1.69 with no significant difference in 30-day mortality for patients who developed MINS. PMID:27162667

  12. Housework reduces all-cause and cancer mortality in Chinese men.

    Directory of Open Access Journals (Sweden)

    Ruby Yu

    Full Text Available BACKGROUND: Leisure time physical activity has been extensively studied. However, the health benefits of non-leisure time physical activity, particular those undertaken at home on all-cause and cancer mortality are limited, particularly among the elderly. METHODS: We studied physical activity in relation to all-cause and cancer mortality in a cohort of 4,000 community-dwelling elderly aged 65 and older. Leisure time physical activity (sport/recreational activity and lawn work/yard care/gardening and non-leisure time physical activity (housework, home repairs and caring for another person were self-reported on the Physical Activity Scale for the Elderly. Subjects with heart diseases, stroke, cancer or diabetes at baseline were excluded (n = 1,133. RESULTS: Among the 2,867 subjects with a mean age of 72 years at baseline, 452 died from all-cause and 185 died from cancer during the follow-up period (2001-2012. With the adjustment for age, education level and lifestyle factors, we found an inverse association between risk of all-cause mortality and heavy housework among men, with the adjusted hazard ratio (HR of 0.72 (95%CI = 0.57-0.92. Further adjustment for BMI, frailty index, living arrangement, and leisure time activity did not change the result (HR = 0.71, 95%CI = 0.56-0.91. Among women, however, heavy housework was not associated with all-cause mortality. The risk of cancer mortality was significantly lower among men who participated in heavy housework (HR = 0.52, 95%CI = 0.35-0.78, whereas among women the risk was not significant. Men participated in light housework also were at lower risk of cancer mortality than were their counterparts, however, the association was not significant. Leisure time physical activity was not related to all-cause or cancer mortality in either men or women. CONCLUSION: Heavy housework is associated with reduced mortality and cancer deaths over a 9-year period. The underlying mechanism needs

  13. Hot weather warning might help to reduce elderly mortality in Hong Kong

    Science.gov (United States)

    Chau, P. H.; Chan, K. C.; Woo, Jean

    2009-09-01

    While there was evidence on the relationship between extreme hot weather and the increase in mortality, particularly from ischaemic heart disease (IHD) and cerebrovascular disease (stroke), some researchers suggested that early warning systems might reduce mortality. In this study, the relationship between Very Hot Weather Warning (VHWW) and mortality was examined in the context of Hong Kong, which has a sub-tropical climate. An observational study was conducted on the daily number of deaths due to IHD and stroke in the Hong Kong elderly population (aged 65 or above) during summer (May-September) in 1997-2005. Totals of 4,281 deaths from IHD and 4,764 deaths from stroke occurred on days with maximum temperature reaching/exceeding 30.4°C. Multiple linear regression models were used to study the association between VHWW and the daily mortality rates from IHD and from stroke, respectively. Results showed that absence of VHWW was associated with an increase of about 1.23 (95% CI: 0.32, 2.14) deaths from IHD and 0.97 (95% CI: 0.02, 1.92) deaths from stroke among the elderly per day. Public education is required to inform the elderly to take appropriate preventive measures and to remind the public to pay more care and attention to the elderly on days which are not considered to be stressful to the general public. Warning systems tailored for the elderly could also be considered.

  14. Maternal health in fifty years of Tanzania independence: Challenges and opportunities of reducing maternal mortality.

    Science.gov (United States)

    Shija, Angela E; Msovela, Judith; Mboera, Leonard E G

    2011-12-01

    High rate of maternal death is one of the major public health concerns in Tanzania. Most of maternal deaths are caused by factors attributed to pregnancy, childbirth and poor quality of health services. More than 80% of maternal deaths can be prevented if pregnant women access essential maternity care and assured of skilled attendance at childbirth as well as emergency obstetric care. The objective of this review was to analyse maternal mortality situation in Tanzania during the past 50 years and to identify efforts, challenges and opportunities of reducing it. This paper was written through desk review of key policy documents, technical reports, publications and available internet-based literature. From 1961 to 1990 maternal mortality ratio in Tanzania had been on a downward trend from 453 to 200 per 100,000 live births. However, from 1990's there been an increasing trend to 578 per 100,000 live births. Current statistics indicate that maternal mortality ratio has dropped slightly in 2010 to 454 per 100,000 live births. Despite a high coverage (96%) in pregnant women who attend at least one antenatal clinic, only half of the women (51%) have access to skilled delivery. Coverage of emergence obstetric services is 64.5% and utilization of modern family planning method is 27%. Only about 13% of home deliveries access post natal check-up. Despite a number of efforts maternal mortality is still unacceptably high. Some of the efforts done to reduce maternal mortality in Tanzania included the following initiatives: reproductive and child survival; increased skilled delivery; maternal death audit; coordination and integration of different programs including maternal and child health services, family planning, malaria interventions, expanded program on immunization and adolescent health and nutrition programmes. These initiatives are however challenged by inadequate access to maternal health care services. In order to considerably reduce maternal deaths some of recommended

  15. Reduced neonatal mortality in Meishan piglets: a role for hepatic fatty acids?

    Directory of Open Access Journals (Sweden)

    Hernan P Fainberg

    Full Text Available The Meishan pig breed exhibits increased prolificacy and reduced neonatal mortality compared to commercial breeds, such as the Large White, prompting breeders to introduce the Meishan genotype into commercial herds. Commercial piglets are highly susceptible to hypoglycemia, hypothermia, and death, potentially due to limited lipid stores and/or delayed hepatic metabolic ability. We therefore hypothesized that variation in hepatic development and lipid metabolism could contribute to the differences in neonatal mortality between breeds. Liver samples were obtained from piglets of each breed on days 0, 7, and 21 of postnatal age and subjected to molecular and biochemical analysis. At birth, both breeds exhibited similar hepatic glycogen contents, despite Meishan piglets having significantly lower body weight. The livers from newborn Meishan piglets exhibited increased C18∶1n9C and C20∶1n9 but lower C18∶0, C20∶4n6, and C22∶6n3 fatty acid content. Furthermore, by using an unsupervised machine learning approach, we detected an interaction between C18∶1n9C and glycogen content in newborn Meishan piglets. Bioinformatic analysis could identify unique age-based clusters from the lipid profiles in Meishan piglets that were not apparent in the commercial offspring. Examination of the fatty acid signature during the neonatal period provides novel insights into the body composition of Meishan piglets that may facilitate liver responses that prevent hypoglycaemia and reduce offspring mortality.

  16. Losartan reduces ensuing chronic kidney disease and mortality after acute kidney injury

    Science.gov (United States)

    Cheng, Shun-Yang; Chou, Yu-Hsiang; Liao, Fang-Ling; Lin, Chi-Chun; Chang, Fan-Chi; Liu, Chia-Hao; Huang, Tao-Min; Lai, Chun-Fu; Lin, Yu-Feng; Wu, Vin-Cent; Chu, Tzong-Shinn; Wu, Ming-Shiou; Lin, Shuei-Liong

    2016-01-01

    Acute kidney injury (AKI) is an important risk factor for incident chronic kidney disease (CKD). Clinical studies disclose that ensuing CKD progresses after functional recovery from AKI, but the underlying mechanisms remain illusive. Using a murine model representing AKI-CKD continuum, we show angiotensin II type 1a (AT1a) receptor signaling as one of the underlying mechanisms. Male adult CD-1 mice presented severe AKI with 20% mortality within 2 weeks after right nephrectomy and left renal ischemia-reperfusion injury. Despite functional recovery, focal tubular atrophy, interstitial cell infiltration and fibrosis, upregulation of genes encoding angiotensinogen and AT1a receptor were shown in kidneys 4 weeks after AKI. Thereafter mice manifested increase of blood pressure, albuminuria and azotemia progressively. Drinking water with or without losartan or hydralazine was administered to mice from 4 weeks after AKI. Increase of mortality, blood pressure, albuminuria, azotemia and kidney fibrosis was noted in mice with vehicle administration during the 5-month experimental period. On the contrary, these parameters in mice with losartan administration were reduced to the levels shown in control group. Hydralazine did not provide similar beneficial effect though blood pressure was controlled. These findings demonstrate that losartan can reduce ensuing CKD and mortality after functional recovery from AKI. PMID:27677327

  17. The role of vitamin A in reducing child mortality and morbidity and improving growth

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    RAMAKRISHNAN USHA

    1998-01-01

    Full Text Available This is an update of knowledge on the role of the vitamin A status in determining child mortality, morbidity and growth. Recent information confirms the earlier conclusion of Beaton et al. that a 23% reduction in young child mortality results following improvements in the vitamin A status. Studies show that the mortality effect is primarily due to reductions in deaths due to acute gastroenteritis and measles but not acute respiratory infections (ARI and malaria. While improvement of the vitamin A status enhances the survival of older preschool children, it remains unclear whether it benefits infants (i.e. <6 months. Vitamin A supplementation does not reduce the overall incidence and prevalence of common childhood illness; however, it reduces the incidence of more severe episodes of diarrhea. Also, vitamin A supplementation either during and/or immediately after the illness does not improve its symptomatology. Finally, contrary to earlier expectations, recently completed, placebo-controlled randomized interventions have failed to detect improvements in child growth.

  18. Strategies to Reduce Mortality in Adult and Neonatal Candidemia in Developing Countries

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    Harsimran Kaur

    2017-07-01

    Full Text Available Candidemia, the commonest invasive fungal infection, is associated with high morbidity and mortality in developing countries, though the exact prevalence is not known due to lack of systematic epidemiological data from those countries. The limited studies report a very high incidence of candidemia and unique epidemiology with a different spectrum of Candida species. The recent global emergence of multi-drug resistant Candida auris is looming large as an important threat in hospitalized patients of developing countries. While managing candidemia cases in those countries several challenges are faced, which include poor infrastructure; compromised healthcare and infection control practices; misuse and overuse of antibiotics and steroids; lack of awareness in fungal infections; non-availability of advance diagnostic tests and antifungal drugs in many areas; poor compliance to antifungal therapy and stewardship program. Considering the above limitations, innovative strategies are required to reduce mortality due to candidemia in adults and neonates. In the present review, we have unraveled the challenges of candidemia faced by low resource countries and propose a ten part strategy to reduce mortality due candidemia.

  19. [Public health programs have greatly reduced infant mortality in Costa Rica].

    Science.gov (United States)

    1987-01-01

    The spectacular decline of infant mortality in Costa Rica from 68/1000 live births in 1970 to 20/1000 in 1980 was largely due to the implementation of public health programs in the 1970s. The abrupt decline was even more notable because deaths of infants constituted the major health problem of the country during the 1960s, accounting for 40% of all registered deaths. Socioeconomic development and reduced fertility contributed to the reduction, but 3/4 of the improvement can be attributed to extension of primary health care to previously unserved rural populations and to better secondary health care, according to a study by the Costa Rican demographer Luis Rosero Bixby. The programs targeted at less privileged groups substantially reduced class and geographic differentials in infant mortality. Infant mortality began to decline at an accelerating rate in 1972, coinciding with the first national health plan and the law of universal social security in 1971, the transfer of public hospitals to the social security system and promulgation of a general health law in 1973, and application of the rural health program in 1973 and community health program in 1976. By 1980, home services reached 60% of the population and immunization programs were in place for measles and diphtheria, pertussis, and tetanus. There was a doubling of outpatient services and a tripling of hours contracted by doctors between 1970-80. Also in 1980, 78% of the Costa Rican population was fully covered by health insurance. After 1972, infant mortality declined from all causes except complications of pregnancy and congenital anomalies. The decline was most rapid for deaths due to prematurity, illnesses avoidable by vaccination, and illnesses such as septicemia and meningitis in which prompt diagnosis and treatment can be lifesaving. Although impressive gains were made in neonatal mortality, the main share of the decline between 1970-80 was in postneonatal mortality. Reductions in deaths due to diarrheal

  20. Strategies to reduce mortality and morbidity due to AIDS-related cryptococcal meningitis in Latin America

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    Jose E. Vidal

    2013-06-01

    Full Text Available Latin America is the region with the third most AIDS-related cryptococcal meningitis infections globally. Highly active antiretroviral therapy (HAART has reduced the number of infections; however, the number of deaths and the case-fatality rate continues to be unacceptable. In this review, we focus on the burden of AIDS-related cryptococcosis in Latin America and discuss potential strategies to reduce early mortality from Cryptococcus. In this review, we highlight the importance of: (1 earlier HIV diagnosis and HAART initiation with retention-in-care to avoid AIDS; (2 pre-HAART cryptococcal antigen (CRAG screening with preemptive fluconazole treatment; (3 better diagnostics (e.g. CRAG testing; and (4 optimal treatment with aggressive management of intracranial pressure and induction therapy with antifungal combination. Implementation of these strategies can reduce cryptococcal-related deaths, improve care, and reduce healthcare costs.

  1. Systematic review of effect of community-level interventions to reduce maternal mortality

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    Deeks Jonathan J

    2009-01-01

    Full Text Available Abstract Background The objective was to provide a systematic review of the effectiveness of community-level interventions to reduce maternal mortality. Methods We searched published papers using Medline, Embase, Cochrane library, CINAHL, BNI, CAB ABSTRACTS, IBSS, Web of Science, LILACS and African Index Medicus from inception or at least 1982 to June 2006; searched unpublished works using National Research Register website, metaRegister and the WHO International Trial Registry portal. We hand searched major references. Selection criteria were maternity or childbearing age women, comparative study designs with concurrent controls, community-level interventions and maternal death as an outcome. We carried out study selection, data abstraction and quality assessment independently in duplicate. Results We found five cluster randomised controlled trials (RCT and eight cohort studies of community-level interventions. We summarised results as odds ratios (OR and confidence intervals (CI, combined using the Peto method for meta-analysis. Two high quality cluster RCTs, aimed at improving perinatal care practices, showed a reduction in maternal mortality reaching statistical significance (OR 0.62, 95% CI 0.39 to 0.98. Three equivalence RCTs of minimal goal-oriented versus usual antenatal care showed no difference in maternal mortality (1.09, 95% CI 0.53 to 2.25. The cohort studies were of low quality and did not contribute further evidence. Conclusion Community-level interventions of improved perinatal care practices can bring about a reduction in maternal mortality. This challenges the view that investment in such interventions is not worthwhile. Programmes to improve maternal mortality should be evaluated using randomised controlled techniques to generate further evidence.

  2. Putting the "M" back in the Maternal and Child Health Bureau: reducing maternal mortality and morbidity.

    Science.gov (United States)

    Lu, Michael C; Highsmith, Keisher; de la Cruz, David; Atrash, Hani K

    2015-07-01

    Maternal mortality and severe morbidity are on the rise in the United States. A significant proportion of these events are preventable. The Maternal Health Initiative (MHI), coordinated by the Maternal and Child Health Bureau at the Health Resources and Services Administration, is intensifying efforts to reduce maternal mortality and severe morbidity in the U.S. Through a public-private partnership, MHI is taking a comprehensive approach to improving maternal health focusing on five priority areas: improving women's health before, during and beyond pregnancy; improving the quality and safety of maternity care; improving systems of maternity care including both clinical and public health systems; improving public awareness and education; and improving surveillance and research.

  3. A strategy for reducing neonatal mortality at high altitude using oxygen conditioning.

    Science.gov (United States)

    West, J B

    2015-11-01

    Neonatal mortality increases with altitude. For example, in Peru the incidence of neonatal mortality in the highlands has been shown to be about double that at lower altitudes. An important factor is the low inspired PO2 of newborn babies. Typically, expectant mothers at high altitude will travel to low altitude to have their babies if possible, but often this is not feasible because of economic factors. The procedure described here raises the oxygen concentration in the air of rooms where neonates are being housed and, in effect, this means that both the mother and baby are at a much lower altitude. Oxygen conditioning is similar to air conditioning except that the oxygen concentration of the air is increased rather than the temperature being reduced. The procedure is now used at high altitude in many hotels, dormitories and telescope facilities, and has been shown to be feasible and effective.

  4. Reducing maternal mortality due to elective abortion: Potential impact of misoprostol in low-resource settings.

    Science.gov (United States)

    Harper, C C; Blanchard, K; Grossman, D; Henderson, J T; Darney, P D

    2007-07-01

    Over 99% of deaths due to abortion occur in developing countries. Maternal deaths due to abortion are preventable. Increasing the use of misoprostol for elective abortion could have a notable impact on maternal mortality due to abortion. As a test of this hypothesis, this study estimated the reduction in maternal deaths due to abortion in Africa, Asia and Latin America. The estimates were adjusted to changes in assumptions, yielding different possible scenarios of low and high estimates. This simple modeling exercise demonstrated that increased use of misoprostol, an option for pregnancy termination already available to many women in developing countries, could significantly reduce mortality due to abortion. Empirical testing of the hypothesis with data collected from developing countries could help to inform and improve the use of misoprostol in those settings.

  5. Icodextrin reduces mortality and the drop-out rate in Japanese peritoneal dialysis patients.

    Science.gov (United States)

    Kuriyama, Renjiro; Tranaeus, Anders; Ikegami, Tadashi

    2006-01-01

    Although numerous reports have shown that the use of icodextrin solution, as compared with conventional dextrose solutions, provides various clinical benefits, data on the impact of icodextrin solution on mortality and drop-out are sparse. In the present retrospective study, we compared clinical outcomes in a large cohort of patients prescribed either icodextrin or dextrose solution for the long dwell. A total of 7808 patients across Japan who were using Baxter peritoneal dialysis (PD) solutions in 2004 were included in this cross-sectional analysis. Outcomes data were retrieved from the Baxter Japan database. The annual drop-out rate in the icodextrin group (8.9%) was significantly (p icodextrin group, regardless of PD duration, was consistently lower than that in hemodialysis patients. These results indicate that, in PD, the use of icodextrin solution (as compared with dextrose solution) significantly reduces both mortality and drop-out rate.

  6. Home Monitoring Program Reduces Mortality in High-Risk Sociodemographic Single-Ventricle Patients.

    Science.gov (United States)

    Castellanos, Daniel Alexander; Herrington, Cynthia; Adler, Stacey; Haas, Karen; Ram Kumar, S; Kung, Grace C

    2016-12-01

    A clinician-driven home monitoring program can improve interstage outcomes in single-ventricle patients. Sociodemographic factors have been independently associated with mortality in interstage patients. We hypothesized that even in a population with high-risk sociodemographic characteristics, a home monitoring program is effective in reducing interstage mortality. We defined interstage period as the time period between discharge following Norwood palliation and second-stage surgery. We reviewed the charts of patients for the three-year period before (group 1) and after (group 2) implementation of the home monitoring program. Clinical variables around Norwood palliation, during the interstage period, and at the time of second-stage surgery were analyzed. There were 74 patients in group 1 and 52 in group 2. 59 % patients were Hispanic, and 84 % lived in neighborhoods where over 5 % families lived below poverty line. There was no significant difference in pre-Norwood variables, Norwood discharge variables, age at second surgery, or outcomes at second surgery. There were more Sano shunts performed at the Norwood procedure as the source of pulmonary blood flow in group 2 (p value <0.05). There were more unplanned hospital admissions and percutaneous re-interventions in group 2. Patients in group 2 whose admission criteria included desaturation had a 45 % likelihood of having an unplanned re-intervention. Group 2 noted an 80 % relative reduction in interstage mortality (p < 0.01). In a multiple regression analysis, after accounting for ethnicity, socio-economic status, and source of pulmonary blood flow, enrollment in a home monitoring program independently predicted improved interstage survival (p < 0.01). A clinician-driven home monitoring program reduces interstage mortality even when the majority of patients has high-risk sociodemographic characteristics.

  7. Reducing maternal mortality: can we derive policy guidance from developing country experiences?

    Science.gov (United States)

    Liljestrand, Jerker; Pathmanathan, Indra

    2004-01-01

    Developing countries are floundering in their efforts to meet the Millennium Development Goal of reducing maternal mortality by 75% by 2015. Two issues are being debated. Is it doable within this time frame? And is it affordable? Malaysia and Sri Lanka have in the past 50 years repeatedly halved their maternal mortality ratio (MMR) every 7-10 years to reduce MMR from over 500 to below 50. Experience from four other developing countries--Bolivia, Yunan in China, Egypt, and Jamaica-confirms that each was able to halve MMR in less than 10 years beginning from levels of 200-300. Malaysia and Sri Lanka, invested modestly (but wisely)--less than 0.4% of GDP--on maternal health throughout the period of decline, although the large majority of women depended on publicly funded maternal health care. Analysis of their experience suggests that provision of access to and removal of barriers for the use of skilled birth attendance has been the key. This included professionalization of midwifery and phasing out of traditional birth attendants; monitoring births and maternal deaths and use of such information for high profile advocacy on the importance of reducing maternal death; and addressing critical gaps in the health system; and reducing disparities between different groups through special attention to the poor and disadvantaged populations.

  8. Reducing maternal, newborn, and infant mortality globally: an integrated action agenda.

    Science.gov (United States)

    Bhutta, Zulfiqar A; Cabral, Sergio; Chan, Chok-Wan; Keenan, William J

    2012-10-01

    There has been increasing awareness over recent years of the persisting burden of worldwide maternal, newborn, and child mortality. The majority of maternal deaths occur during labor, delivery, and the immediate postpartum period, with obstetric hemorrhage as the primary medical cause of death. Other causes of maternal mortality include hypertensive diseases, sepsis/infections, obstructed labor, and abortion-related complications. Recent estimates indicate that in 2009 an estimated 3.3 million babies died in the first month of life and that overall, 7.3 million children under 5 die each year. Recent data also suggest that sufficient evidence- and consensus-based interventions exist to address reproductive, maternal, newborn, and child health globally, and if implemented at scale, these have the potential to reduce morbidity and mortality. There is an urgent need to put elements in place to promote integrated interventions among healthcare professionals and their associations. What is needed is the political will and partnerships to implement evidence-based interventions at scale.

  9. Transient turbid water mass reduces temperature-induced coral bleaching and mortality in Barbados

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    Hazel A. Oxenford

    2016-06-01

    Full Text Available Global warming is seen as one of the greatest threats to the world’s coral reefs and, with the continued rise in sea surface temperature predicted into the future, there is a great need for further understanding of how to prevent and address the damaging impacts. This is particularly so for countries whose economies depend heavily on healthy reefs, such as those of the eastern Caribbean. Here, we compare the severity of bleaching and mortality for five dominant coral species at six representative reef sites in Barbados during the two most significant warm-water events ever recorded in the eastern Caribbean, i.e., 2005 and 2010, and describe prevailing island-scale sea water conditions during both events. In so doing, we demonstrate that coral bleaching and subsequent mortality were considerably lower in 2010 than in 2005 for all species, irrespective of site, even though the anomalously warm water temperature profiles were very similar between years. We also show that during the 2010 event, Barbados was engulfed by a transient dark green turbid water mass of riverine origin coming from South America. We suggest that reduced exposure to high solar radiation associated with this transient water mass was the primary contributing factor to the lower bleaching and mortality observed in all corals. We conclude that monitoring these episodic mesoscale oceanographic features might improve risk assessments of southeastern Caribbean reefs to warm-water events in the future.

  10. Transient turbid water mass reduces temperature-induced coral bleaching and mortality in Barbados.

    Science.gov (United States)

    Oxenford, Hazel A; Vallès, Henri

    2016-01-01

    Global warming is seen as one of the greatest threats to the world's coral reefs and, with the continued rise in sea surface temperature predicted into the future, there is a great need for further understanding of how to prevent and address the damaging impacts. This is particularly so for countries whose economies depend heavily on healthy reefs, such as those of the eastern Caribbean. Here, we compare the severity of bleaching and mortality for five dominant coral species at six representative reef sites in Barbados during the two most significant warm-water events ever recorded in the eastern Caribbean, i.e., 2005 and 2010, and describe prevailing island-scale sea water conditions during both events. In so doing, we demonstrate that coral bleaching and subsequent mortality were considerably lower in 2010 than in 2005 for all species, irrespective of site, even though the anomalously warm water temperature profiles were very similar between years. We also show that during the 2010 event, Barbados was engulfed by a transient dark green turbid water mass of riverine origin coming from South America. We suggest that reduced exposure to high solar radiation associated with this transient water mass was the primary contributing factor to the lower bleaching and mortality observed in all corals. We conclude that monitoring these episodic mesoscale oceanographic features might improve risk assessments of southeastern Caribbean reefs to warm-water events in the future.

  11. Reduced mortality after the implementation of a protocol for the early detection of severe sepsis.

    Science.gov (United States)

    Westphal, Glauco A; Koenig, Álvaro; Caldeira Filho, Milton; Feijó, Janaína; de Oliveira, Louise Trindade; Nunes, Fernanda; Fujiwara, Kênia; Martins, Sheila Fonseca; Roman Gonçalves, Anderson R

    2011-02-01

    We evaluate the impact that implementing an in-hospital protocol for the early detection of sepsis risk has on mortality from severe sepsis/septic shock. This was a prospective cohort study conducted in 2 phases at 2 general hospitals in Brazil. In phase I, patients with severe sepsis/septic shock were identified and treated in accordance with the Surviving Sepsis Campaign guidelines. Over the subsequent 12 months (phase II), patients with severe sepsis/septic shock were identified by means of active surveillance for signs of sepsis risk (SSR). We compared the 2 cohorts in terms of demographic variables, the time required for the identification of at least 2 SSRs, compliance with sepsis bundles (6- and 24-hour), and mortality rates. We identified 217 patients with severe sepsis/septic shock (102 during phase I and 115 during phase II). There were significant differences between phases I and II in terms of the time required for the identification of at least 2 SSRs (34 ± 48 vs 11 ± 17 hours; P detection of sepsis promoted early treatment, reducing in-hospital mortality from severe sepsis/septic shock. Copyright © 2011 Elsevier Inc. All rights reserved.

  12. Assessing health and economic outcomes of interventions to reduce pregnancy-related mortality in Nigeria

    Science.gov (United States)

    2012-01-01

    Background Women in Nigeria face some of the highest maternal mortality risks in the world. We explore the benefits and cost-effectiveness of individual and integrated packages of interventions to prevent pregnancy-related deaths. Methods We adapt a previously validated maternal mortality model to Nigeria. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to Southwest and Northeast zones using survey-based data. Strategies consisted of improving coverage of effective interventions, and could include improved logistics. Results Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality, was cost saving in the Southwest zone and cost-effective elsewhere, and prevented nearly 1 in 5 abortion-related deaths. However, with a singular focus on family planning and safe abortion, mortality reduction would plateau below MDG 5. Strategies that could prevent 4 out of 5 maternal deaths included an integrated and stepwise approach that includes increased skilled deliveries, facility births, access to antenatal/postpartum care, improved recognition of referral need, transport, and availability quality of EmOC in addition to family planning and safe abortion. The economic benefits of these strategies ranged from being cost-saving to having incremental cost-effectiveness ratios less than $500 per YLS, well below Nigeria’s per capita GDP. Conclusions Early intensive efforts to improve family planning and control of fertility choices, accompanied by a stepwise effort to scale-up capacity for integrated maternal health services over several years, will save lives and provide equal or greater value than many public health interventions we consider among the most cost-effective (e.g., childhood immunization). PMID:22978519

  13. Assessing health and economic outcomes of interventions to reduce pregnancy-related mortality in Nigeria

    Directory of Open Access Journals (Sweden)

    Erim Daniel O

    2012-09-01

    Full Text Available Abstract Background Women in Nigeria face some of the highest maternal mortality risks in the world. We explore the benefits and cost-effectiveness of individual and integrated packages of interventions to prevent pregnancy-related deaths. Methods We adapt a previously validated maternal mortality model to Nigeria. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to Southwest and Northeast zones using survey-based data. Strategies consisted of improving coverage of effective interventions, and could include improved logistics. Results Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality, was cost saving in the Southwest zone and cost-effective elsewhere, and prevented nearly 1 in 5 abortion-related deaths. However, with a singular focus on family planning and safe abortion, mortality reduction would plateau below MDG 5. Strategies that could prevent 4 out of 5 maternal deaths included an integrated and stepwise approach that includes increased skilled deliveries, facility births, access to antenatal/postpartum care, improved recognition of referral need, transport, and availability quality of EmOC in addition to family planning and safe abortion. The economic benefits of these strategies ranged from being cost-saving to having incremental cost-effectiveness ratios less than $500 per YLS, well below Nigeria’s per capita GDP. Conclusions Early intensive efforts to improve family planning and control of fertility choices, accompanied by a stepwise effort to scale-up capacity for integrated maternal health services over several years, will save lives and provide equal or greater value than many public health interventions we consider among the most cost-effective (e.g., childhood immunization.

  14. Spending on vegetable and fruit consumption could reduce all-cause mortality among older adults

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    Lo Yuan-Ting

    2012-12-01

    Full Text Available Abstract Background Few studies have evaluated the linkage between food cost and mortality among older adults. This study considers the hypothesis that greater food expenditure in general, and particularly on more nutritious plant and animal-derived foods, decreases mortality in older adults. Methods This study uses the 1999–2000 Elderly Nutrition and Health Survey in Taiwan and follows the cohort until 2008, collecting 24-hr dietary recall data for 1781 participants (874 men and 907 women aged 65 y or older. Using monthly mean national food prices and 24-hr recall, this study presents an estimate of daily expenditures for vegetable, fruit, animal-derived, and grain food categories. Participants were linked to the national death registry. Results Of the 1781 original participants, 625 died during the 10-y follow-up period. Among the 4 food categories, the fourth and fifth expenditure quintiles for vegetables and for fruits had the highest survival rates. After adjusting for co-variates, higher (Q4 vegetable and higher fruit (Q4 food expenditures referent to Q1 were significantly predictive of reduced mortality (HR = 0.55, 95% CI: 0.39-0.78 and HR = 0.64, 95% CI: 0.42–0.99, respectively and the risk decreased by 12% and 10% for every NT$15 (US$0.50 increase in their daily expenditures. Animal-derived and grain food spending was not predictive of mortality. Conclusion Greater and more achievable vegetable and fruit affordability may improve food security and longevity for older adults.

  15. Reduced incidence and mortality from colorectal cancer with flexible-sigmoidoscopy screening: a meta-analysis.

    Science.gov (United States)

    Shroff, Jennifer; Thosani, Nirav; Batra, Sachin; Singh, Harminder; Guha, Sushovan

    2014-12-28

    To conduct a systematic review and meta-analysis of published population-based randomized controlled trials (RCTs). RCTs evaluating the difference in mortality and incidence of colorectal cancer (CRC) between a screening flexible sigmoidoscopy (FS) group and control group (not assigned to screening FS) with a minimum 5 years median follow-up were identified by a search of MEDLINE and EMBASE databases and the Cochrane Central Register for Controlled Trials through August 2013. Random effects model was used for meta-analysis. Four RCTs with a total of 165659 patients in the FS group and 249707 patients in the control group were included in meta-analysis. Intention-to-treat analysis showed that there was a 22% risk reduction in total incidence of CRC (RR = 0.78, 95%CI: 0.74-0.83), 31% in distal CRC incidence (RR = 0.69, 95%CI: 0.63-0.75), and 9% in proximal CRC incidence (RR = 0.91, 95%CI: 0.83-0.99). Those who underwent screening FS were 18% less likely to be diagnosed with advanced CRC (OR = 0.82, 95%CI: 0.71-0.94). There was a 28% risk reduction in overall CRC mortality (RR = 0.72, 95%CI: 0.65-0.80) and 43% in distal CRC mortality (RR = 0.57, 95%CI: 0.45-0.72). This meta-analysis suggests that screening FS can reduce the incidence of proximal and distal CRC and mortality from distal CRC along with reduction in diagnosis of advanced CRC.

  16. GENTAMICIN REDUCES BACTEREMIA AND MORTALITY-RATES ASSOCIATED WITH THE TREATMENT OF EXPERIMENTAL PERITONITIS WITH RECOMBINANT TISSUE-PLASMINOGEN ACTIVATOR

    NARCIS (Netherlands)

    van Goor, Harry; de Graaf, JS; KOOI, K; BLEICHRODT, RP

    BACKGROUND: Recombinant tissue plasminogen activator (rtPA), administered intraperitoneally, reduces intra-abdominal abscess formation in rats with fecal peritonitis at the costs of increased mortality and early Escherichia coli bacteremia. It was determined whether or not mortality and bacteremia

  17. Reducing maternal mortality on a countrywide scale: The role of emergency obstetric training.

    Science.gov (United States)

    Moran, Neil F; Naidoo, Mergan; Moodley, Jagidesa

    2015-11-01

    Training programmes to improve health worker skills in managing obstetric emergencies have been introduced in various countries with the aim of reducing maternal mortality through these interventions. In South Africa, based on an ongoing confidential enquiry system started in 1997, detailed information about maternal deaths is published in the form of regular 'Saving Mothers' reports. This article tracks the recommendations made in successive Saving Mothers reports with regard to emergency obstetric training, and it assesses the impact of these recommendations on reducing maternal mortality. Since 2009, South Africa has had its own training package, Essential Steps in the Management of Obstetric Emergencies (ESMOE), which the last three Saving Mothers reports have specifically recommended for all doctors and midwives working in maternity units. A special emphasis has been placed on the need for the simulation training component of ESMOE, also called obstetric 'fire drills', to be integrated into the clinical routines of all maternity units. The latest Saving Mothers report (2011-2013) suggests there has been little progress so far in improving emergency obstetric skills, indicating a need for further scale-up of ESMOE training in the country. The example of the KwaZulu-Natal province of South Africa is used to illustrate the process of scale-up and factors likely to facilitate that scale-up, including the introduction of ESMOE into the undergraduate medical training curriculum. Additional factors in the health system that are required to convert improved skills levels into improved quality of care and a reduction in maternal mortality are discussed. These include intelligent government health policies, formulated with input from clinical experts; strong clinical leadership to ensure that doctors and nurses apply the skills they have learnt appropriately, and work professionally and ethically; and a culture of clinical governance.

  18. Inhibition of the prostaglandin receptor EP2 following status epilepticus reduces delayed mortality and brain inflammation.

    Science.gov (United States)

    Jiang, Jianxiong; Quan, Yi; Ganesh, Thota; Pouliot, Wendy A; Dudek, F Edward; Dingledine, Raymond

    2013-02-26

    Prostaglandin E2 is now widely recognized to play critical roles in brain inflammation and injury, although the responsible prostaglandin receptors have not been fully identified. We developed a potent and selective antagonist for the prostaglandin E2 receptor subtype EP2, TG6-10-1, with a sufficient pharmacokinetic profile to be used in vivo. We found that in the mouse pilocarpine model of status epilepticus (SE), systemic administration of TG6-10-1 completely recapitulates the effects of conditional ablation of cyclooxygenase-2 from principal forebrain neurons, namely reduced delayed mortality, accelerated recovery from weight loss, reduced brain inflammation, prevention of blood-brain barrier opening, and neuroprotection in the hippocampus, without modifying seizures acutely. Prolonged SE in humans causes high mortality and morbidity that are associated with brain inflammation and injury, but currently the only effective treatment is to stop the seizures quickly enough with anticonvulsants to prevent brain damage. Our results suggest that the prostaglandin receptor EP2 is critically involved in neuroinflammation and neurodegeneration, and point to EP2 receptor antagonism as an adjunctive therapeutic strategy to treat SE.

  19. Deferoxamine Compensates for Decreases in B Cell Counts and Reduces Mortality in Enterovirus 71-Infected Mice

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    Yajun Yang

    2014-07-01

    Full Text Available Enterovirus 71 is one of the major causative agents of hand, foot and mouth disease in children under six years of age. No vaccine or antiviral therapy is currently available. In this work, we found that the number of B cells was reduced in enterovirus 71-infected mice. Deferoxamine, a marine microbial natural product, compensated for the decreased levels of B cells caused by enterovirus 71 infection. The neutralizing antibody titer was also improved after deferoxamine treatment. Furthermore, deferoxamine relieved symptoms and reduced mortality and muscle damage caused by enterovirus 71 infection. This work suggested that deferoxamine has the potential for further development as a B cell-immunomodulator against enterovirus 71.

  20. Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh

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    Rahman Anisur

    2011-12-01

    Full Text Available Abstract Background Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy, delivery and post-partum periods through integration of community- and facility-based services on perinatal mortality. Methods This study took advantage of an ongoing health and demographic surveillance system (HDSS and a new Maternal, Neonatal and Child Health (MNCH Project initiated in 2007 in Matlab, Bangladesh in half (intervention area of the HDSS area. In the other half, women received usual care through the government health system (comparison area. The MNCH Project strengthened ongoing maternal and child health services as well as added new services. The intervention followed a continuum of care model for pregnancy, intrapartum, and post-natal periods by improving established links between community- and facility-based services. With a separate pre-post samples design, we compared the perinatal mortality rates between two periods--before (2005-2006 and after (2008-2009 implementation of MNCH interventions. We also evaluated the difference-of-differences in perinatal mortality between intervention and comparison areas. Results Antenatal coverage, facility delivery and cesarean section rates were significantly higher in the post- intervention period in comparison with the period before intervention. In the intervention area, the odds of perinatal mortality decreased by 36% between the pre-intervention and post-intervention periods (odds ratio: 0.64; 95% confidence intervals: 0.52-0.78. The reduction in the intervention area was also significant relative to the reduction in the comparison area (OR 0.73, 95% CI: 0.56-0.95; P = 0.018. Conclusion The continuum

  1. Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh.

    Science.gov (United States)

    Rahman, Anisur; Moran, Allisyn; Pervin, Jesmin; Rahman, Aminur; Rahman, Monjur; Yeasmin, Sharifa; Begum, Hosneara; Rashid, Harunor; Yunus, Mohammad; Hruschka, Daniel; Arifeen, Shams E; Streatfield, Peter K; Sibley, Lynn; Bhuiya, Abbas; Koblinsky, Marge

    2011-12-10

    Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy, delivery and post-partum periods through integration of community- and facility-based services on perinatal mortality. This study took advantage of an ongoing health and demographic surveillance system (HDSS) and a new Maternal, Neonatal and Child Health (MNCH) Project initiated in 2007 in Matlab, Bangladesh in half (intervention area) of the HDSS area. In the other half, women received usual care through the government health system (comparison area). The MNCH Project strengthened ongoing maternal and child health services as well as added new services. The intervention followed a continuum of care model for pregnancy, intrapartum, and post-natal periods by improving established links between community- and facility-based services. With a separate pre-post samples design, we compared the perinatal mortality rates between two periods--before (2005-2006) and after (2008-2009) implementation of MNCH interventions. We also evaluated the difference-of-differences in perinatal mortality between intervention and comparison areas. Antenatal coverage, facility delivery and cesarean section rates were significantly higher in the post- intervention period in comparison with the period before intervention. In the intervention area, the odds of perinatal mortality decreased by 36% between the pre-intervention and post-intervention periods (odds ratio: 0.64; 95% confidence intervals: 0.52-0.78). The reduction in the intervention area was also significant relative to the reduction in the comparison area (OR 0.73, 95% CI: 0.56-0.95; P = 0.018). The continuum of care approach provided through the integration of service

  2. Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh

    Science.gov (United States)

    2011-01-01

    Background Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy, delivery and post-partum periods through integration of community- and facility-based services on perinatal mortality. Methods This study took advantage of an ongoing health and demographic surveillance system (HDSS) and a new Maternal, Neonatal and Child Health (MNCH) Project initiated in 2007 in Matlab, Bangladesh in half (intervention area) of the HDSS area. In the other half, women received usual care through the government health system (comparison area). The MNCH Project strengthened ongoing maternal and child health services as well as added new services. The intervention followed a continuum of care model for pregnancy, intrapartum, and post-natal periods by improving established links between community- and facility-based services. With a separate pre-post samples design, we compared the perinatal mortality rates between two periods--before (2005-2006) and after (2008-2009) implementation of MNCH interventions. We also evaluated the difference-of-differences in perinatal mortality between intervention and comparison areas. Results Antenatal coverage, facility delivery and cesarean section rates were significantly higher in the post- intervention period in comparison with the period before intervention. In the intervention area, the odds of perinatal mortality decreased by 36% between the pre-intervention and post-intervention periods (odds ratio: 0.64; 95% confidence intervals: 0.52-0.78). The reduction in the intervention area was also significant relative to the reduction in the comparison area (OR 0.73, 95% CI: 0.56-0.95; P = 0.018). Conclusion The continuum of care approach

  3. Assessment of the effectiveness of radon screening programs in reducing lung cancer mortality.

    Science.gov (United States)

    Gagnon, Fabien; Courchesne, Mathieu; Lévesque, Benoît; Ayotte, Pierre; Leclerc, Jean-Marc; Belles-Isles, Jean-Claude; Prévost, Claude; Dessau, Jean-Claude

    2008-10-01

    The present study was aimed at assessing the health consequences of the presence of radon in Quebec homes and the possible impact of various screening programs on lung cancer mortality. Lung cancer risk due to this radioactive gas was estimated according to the cancer risk model developed by the Sixth Committee on Biological Effects of Ionizing Radiations. Objective data on residential radon exposure, population mobility, and tobacco use in the study population were integrated into a Monte-Carlo-type model. Participation rates to radon screening programs were estimated from published data. According to the model used, approximately 10% of deaths due to lung cancer are attributable to residential radon exposure on a yearly basis in Quebec. In the long term, the promotion of a universal screening program would prevent less than one death/year on a province-wide scale (0.8 case; IC 99%: -3.6 to 5.2 cases/year), for an overall reduction of 0.19% in radon-related mortality. Reductions in mortality due to radon by (1) the implementation of a targeted screening program in the region with the highest concentrations, (2) the promotion of screening on a local basis with financial support, or (3) the realization of systematic investigations in primary and secondary schools would increase to 1%, 14%, and 16.4%, respectively, in the each of the populations targeted by these scenarios. Other than the battle against tobacco use, radon screening in public buildings thus currently appears as the most promising screening policy for reducing radon-related lung cancer.

  4. Plasma osmolality predicts mortality in patients with heart failure with reduced ejection fraction.

    Science.gov (United States)

    Kaya, HakkI; Yücel, Oğuzhan; Ege, Meltem Refiker; Zorlu, Ali; Yücel, Hasan; Güneş, Hakan; Ekmekçi, Ahmet; Yılmaz, Mehmet Birhan

    2017-01-01

    Heart failure (HF) is a fatal disease. Plasma osmolality with individual impacts of sodium, blood urea nitrogen (BUN), and glucose has not been studied prognostically in patients with HF. This study aims to investigate the impact of serum osmolality on clinical endpoints in HF patients. A total of 509 patients (383 males, 126 females) with HF with reduced ejection fraction in three HF centres were retrospectively analysed between January 2007 and December 2013. Follow-up data were completed for 496 patients. Plasma osmolality was calculated as (2 × Na) + (BUN/2.8) + (Glucose/18). Quartiles of plasma osmolality were produced, and the possible relationship between plasma osmolality and cardiovascular mortality was investigated. The mean follow-up was 25 ± 22 months. The mean age was 56.5 ± 17.3 years with a mean EF of 26 ± 8%. The mean levels of plasma osmolality were as follows in the quartiles: 1st % = 280 ± 6, 2nd % = 288 ± 1, 3rd % = 293 ± 2 (95% confidence interval [CI] 292.72-293.3), and 4th % = 301 ± 5 mOsm/kg. The EF and B-type natriuretic peptide levels were similar in the four quartiles. Univariate and multivariate analyses in the Cox proportional hazard model revealed a significantly higher rate of mortality in the patients with hypo-osmolality. The Kaplan-Meier plot showed graded mortality curves with the 1st quartile having the worst prognosis, followed by the 4th quartile and the 2nd quartile, while the 3rd quartile was shown to have the best prognosis. Our study results suggest that normal plasma osmolality is between 275 and 295 mOsm/kg. However, being close to the upper limit of normal range (292-293 mOsm/kg) seems to be the optimal plasma osmolality level in terms of cardiovascular prognosis in patients with HF.

  5. Emergency obstetric care as the priority intervention to reduce maternal mortality in Uganda.

    Science.gov (United States)

    Mbonye, A K; Asimwe, J B; Kabarangira, J; Nanda, G; Orinda, V

    2007-03-01

    We conducted a survey to determine availability of emergency obstetric care (EmOC) to provide baseline data for monitoring provision of obstetric care services in Uganda. The survey, covering 54 districts and 553 health facilities, assessed availability of EmOC signal functions. Following this, performance improvement process was implemented in 20 district hospitals to scale-up EmOC services. A maternal mortality ratio (MMR) of 671/100,000 live births was recorded. Hemorrhage, 42.2%, was the leading direct cause of maternal deaths, and malaria accounted for 65.5% of the indirect causes. Among the obstetric complications, abortion accounted for 38.9% of direct and malaria 87.4% of indirect causes. Removal of retained products (OR 3.3, PEmOC, 349 (97.2%) were not offering them. Using the performance improvement process, availability of EmOC in the 20 hospitals improved significantly. An integrated programming approach aiming at increasing access to EmOC, malaria treatment and prevention services could reduce maternal mortality in Uganda.

  6. Ketogenic Diet Reduces Midlife Mortality and Improves Memory in Aging Mice.

    Science.gov (United States)

    Newman, John C; Covarrubias, Anthony J; Zhao, Minghao; Yu, Xinxing; Gut, Philip; Ng, Che-Ping; Huang, Yu; Haldar, Saptarsi; Verdin, Eric

    2017-09-05

    Ketogenic diets recapitulate certain metabolic aspects of dietary restriction such as reliance on fatty acid metabolism and production of ketone bodies. We investigated whether an isoprotein ketogenic diet (KD) might, like dietary restriction, affect longevity and healthspan in C57BL/6 male mice. We find that Cyclic KD, KD alternated weekly with the Control diet to prevent obesity, reduces midlife mortality but does not affect maximum lifespan. A non-ketogenic high-fat diet (HF) fed similarly may have an intermediate effect on mortality. Cyclic KD improves memory performance in old age, while modestly improving composite healthspan measures. Gene expression analysis identifies downregulation of insulin, protein synthesis, and fatty acid synthesis pathways as mechanisms common to KD and HF. However, upregulation of PPARα target genes is unique to KD, consistent across tissues, and preserved in old age. In all, we show that a non-obesogenic ketogenic diet improves survival, memory, and healthspan in aging mice. Published by Elsevier Inc.

  7. Interaction between FOXO1A-209 Genotype and Tea Drinking is Significantly Associated with Reduced Mortality at Advanced Ages

    DEFF Research Database (Denmark)

    Zeng, Yi; Chen, Huashuai; Ni, Ting

    2016-01-01

    at advanced ages. Such significant association is replicated in two independent Han Chinese CLHLS cohorts (p =0.028-0.048 in the discovery and replication cohorts, and p =0.003-0.016 in the combined dataset). We found the associations between tea drinking and reduced mortality are much stronger among carriers...... of the FOXO1A-209 genotype compared to non-carriers, and drinking tea is associated with a reversal of the negative effects of carrying FOXO1A-209 minor alleles, that is, from a substantially increased mortality risk to substantially reduced mortality risk at advanced ages. The impacts are considerably...... gene expression and its biological functions, which reduces the negative impacts of FOXO1A-209 gene on longevity (as reported in the literature) and offers protection against mortality risk at oldest-old ages. Our empirical findings imply that the health outcomes of particular nutritional interventions...

  8. Statin Use Is Associated with Reduced Mortality in Patients with Interstitial Lung Disease

    DEFF Research Database (Denmark)

    Vedel-Krogh, Signe; Nielsen, Sune F; Nordestgaard, Børge G

    2015-01-01

    INTRODUCTION: We hypothesized that statin use begun before the diagnosis of interstitial lung disease is associated with reduced mortality. METHODS: We studied all patients diagnosed with interstitial lung disease in the entire Danish population from 1995 through 2009, comparing statin use versus...... no statin use in a nested 1:2 matched study. RESULTS: The cumulative survival as a function of follow-up time from the date of diagnosis of interstitial lung disease (n = 1,786 + 3,572) and idiopathic lung fibrosis (n = 261 + 522) was higher for statin users versus never users (log-rank: P = 7 · 10......(-9) and P = 0.05). The median survival time in patients with interstitial lung disease was 3.3 years in statin users and 2.1 years in never users. Corresponding values in patients with idiopathic lung fibrosis were 3.4 versus 2.4 years. After multivariable adjustment, the hazard ratio for all...

  9. Lycorine reduces mortality of human enterovirus 71-infected mice by inhibiting virus replication

    Directory of Open Access Journals (Sweden)

    Qin Chuan

    2011-10-01

    Full Text Available Abstract Human enterovirus 71 (EV71 infection causes hand, foot and mouth disease in children under 6 years old and this infection occasionally induces severe neurological complications. No vaccines or drugs are clinical available to control EV71 epidemics. In present study, we show that treatment with lycorine reduced the viral cytopathic effect (CPE on rhabdomyosarcoma (RD cells by inhibiting virus replication. Analysis of this inhibitory effect of lycorine on viral proteins synthesis suggests that lycorine blocks the elongation of the viral polyprotein during translation. Lycorine treatment of mice challenged with a lethal dose of EV71 resulted in reduction of mortality, clinical scores and pathological changes in the muscles of mice, which were achieved through inhibition of viral replication. When mice were infected with a moderate dose of EV71, lycorine treatment was able to protect them from paralysis. Lycorine may be a potential drug candidate for the clinical treatment of EV71-infected patients.

  10. Intensified Multifactorial Intervention in Type 2 Diabetes and Microalbuminuria Reduces End Stage Renal Disease and Mortality

    DEFF Research Database (Denmark)

    Oellgaard, Jens; Gæde, Peter; Rossing, Peter

    2016-01-01

    Center for Basic Metabolic research. Background: Despite declining rates of late diabetic complications in other organ systems, renal complication rates do not decline to the same extent according to epidemiological studies. The objective was to describe renal outcomes over 21.2 years in patients...... with type 2 diabetes and microalbuminuria and the influence of an intensified, multifactorial treatment regimen. Methods: 160 patients with type 2 diabetes and microalbuminuria assigned to conventional or intensified multifactorial intervention targeting multiple risk factors in a prospective, open...... treatment for 8 years in type 2 diabetes patients with microalbuminuria slows long-term progression in nephropathy and loss of renal function and reduces the risk of end stage renal disease and the mortality rate....

  11. Do Aspirin and Other Antiplatelet Drugs Reduce the Mortality in Critically Ill Patients?

    Directory of Open Access Journals (Sweden)

    Wolfgang Lösche

    2012-01-01

    Full Text Available Platelet activation has been implicated in microvascular thrombosis and organ failure in critically ill patients. In the first part the present paper summarises important data on the role of platelets in systemic inflammation and sepsis as well as on the beneficial effects of antiplatelet drugs in animal models of sepsis. In the second part the data of retrospective and prospective observational clinical studies on the effect of aspirin and other antiplatelet drugs in critically ill patients are reviewed. All of these studies have shown that aspirin and other antiplatelet drugs may reduce organ failure and mortality in these patients, even in case of high bleeding risk. From the data reviewed here interventional prospective trials are needed to test whether aspirin and other antiplatelet drugs might offer a novel therapeutic option to prevent organ failure in critically ill patients.

  12. Adherence of Primary Care Physicians to Evidence-Based Recommendations to Reduce Ovarian Cancer Mortality

    Science.gov (United States)

    Stewart, Sherri L.; Townsend, Julie S.; Puckett, Mary C.; Rim, Sun Hee

    2017-01-01

    Ovarian cancer is the deadliest gynecologic cancer. Receipt of treatment from a gynecologic oncologist is an evidence-based recommendation to reduce mortality from the disease. We examined knowledge and application of this evidence-based recommendation in primary care physicians as part of CDC gynecologic cancer awareness campaign efforts and discussed results in the context of CDC National Comprehensive Cancer Control Program (NCCCP). We analyzed primary care physician responses to questions about how often they refer patients diagnosed with ovarian cancer to gynecologic oncologists, and reasons for lack of referral. We also analyzed these physicians’ knowledge of tests to help determine whether a gynecologic oncologist is needed for a planned surgery. The survey response rate was 52.2%. A total of 84% of primary care physicians (87% of family/general practitioners, 81% of internists and obstetrician/gynecologists) said they always referred patients to gynecologic oncologists for treatment. Common reasons for not always referring were patient preference or lack of gynecologic oncologists in the practice area. A total of 23% of primary care physicians had heard of the OVA1 test, which helps to determine whether gynecologic oncologist referral is needed. Although referral rates reported here are high, it is not clear whether ovarian cancer patients are actually seeing gynecologic oncologists for care. The NCCCP is undertaking several efforts to assist with this, including education of the recommendation among women and providers and assistance with treatment summaries and patient navigation toward appropriate treatment. Expansion of these efforts to all populations may help improve adherence to recommendations and reduce ovarian cancer mortality. PMID:26978124

  13. Methods for reducing sepsis mortality in emergency departments and inpatient units.

    Science.gov (United States)

    Doerfler, Martin E; D'Angelo, John; Jacobsen, Diane; Jarrett, Mark P; Kabcenell, Andrea I; Masick, Kevin D; Parmentier, Darlene; Nelson, Karen L; Stier, Lori

    2015-05-01

    As part of a zero-tolerance approach to preventable deaths, North Shore-LIJ Health System (North Shore-LIJ) leadership prioritized a major patient safety initiative to reduce sepsis mortality in 2009 across 10 acute care hospitals (an 11th joined later). At baseline (2008), approximately 3,500 patients were discharged with a diagnosis of sepsis, which ranked as the top All Patient Refined Diagnosis-Related Group by number of deaths (N = 883). Initially, the focus was sepsis recognition and treatment in the emergency departments (EDs). North Shore-LIJ, the 14th largest health care system in the United States, cares for individuals at every stage of life at 19 acute care and specialty hospitals and more than 400 outpatient physician practice sites throughout New York City and the greater New York metropolitan area. The health system launched a strategic partnership with the Institute for Healthcare Improvement (IHI) in August 2011 to accelerate the pace of sepsis improvement. Throughout the course of the initiative, North Shore-LIJ collaborated with many local, state, national, and international organizations to test innovative ideas, share evidence-based best practices, and, more recently, to raise public awareness. North Shore-LIJ reduced overall sepsis mortality by approximately 50% in a six-year period (2008-2013; sustained through 2014) and increased compliance with sepsis resuscitation bundle elements in the EDs and inpatient units in the 11 acute care hospitals. Improvements were achieved by engaging leadership; fostering interprofessional collaboration, collaborating with other leading health care organizations; and developing meaningful, real-time metrics for all levels of staff.

  14. A window of opportunity for climate-change adaptation: Easing tree mortality by reducing forest basal area

    Science.gov (United States)

    Bradford, John B.; Bell, David M.

    2017-01-01

    Increasing aridity as a result of climate change is expected to exacerbate tree mortality. Reducing forest basal area – the cross-sectional area of tree stems within a given ground area – can decrease tree competition, which may reduce drought-induced tree mortality. However, neither the magnitude of expected mortality increases, nor the potential effectiveness of basal area reduction, has been quantified in dryland forests such as those of the drought-prone Southwest US. We used thousands of repeatedly measured forest plots to show that unusually warm and dry conditions are related to high tree mortality rates and that mortality is positively related to basal area. Those relationships suggest that while increasing high temperature extremes forecasted by climate models may lead to elevated tree mortality during the 21st century, future tree mortality might be partly ameliorated by reducing stand basal area. This adaptive forest management strategy may provide a window of opportunity for forest managers and policy makers to guide forest transitions to species and/or genotypes more suited to future climates.

  15. Reduced disease in black abalone following mass mortality: Phage therapy and natural selection

    Science.gov (United States)

    Vanblaricom, Glenn R.

    2014-01-01

    Black abalone, Haliotis cracherodii, populations along the NE Pacific ocean have declined due to the rickettsial disease withering syndrome (WS). Natural recovery on San Nicolas Island (SNI) of Southern California suggested the development of resistance in island populations. Experimental challenges in one treatment demonstrated that progeny of disease-selected black abalone from SNI survived better than did those from naïve black abalone from Carmel Point in mainland coastal central California. Unexpectedly, the presence of a newly observed bacteriophage infecting the WS rickettsia (WS-RLO) had strong effects on the survival of infected abalone. Specifically, presence of phage-infected RLO (RLOv) reduced the host response to infection, RLO infection loads, and associated mortality. These data suggest that the black abalone: WS-RLO relationship is evolving through dual host mechanisms of resistance to RLO infection in the digestive gland via tolerance to infection in the primary target tissue (the post-esophagus) coupled with reduced pathogenicity of the WS-RLO by phage infection, which effectively reduces the infection load in the primary target tissue by half. Sea surface temperature patterns off southern California, associated with a recent hiatus in global-scale ocean warming, do not appear to be a sufficient explanation for survival patterns in SNI black abalone. These data highlight the potential for natural recovery of abalone populations over time and that further understanding of mechanisms governing host–parasite relationships will better enable us to manage declining populations.

  16. Reduced disease in black abalone following mass mortality: Phage therapy and natural selection

    Directory of Open Access Journals (Sweden)

    Carolyn S Friedman

    2014-03-01

    Full Text Available Black abalone, Haliotis cracherodii, populations along the NE Pacific ocean have declined due to the rickettsial disease withering syndrome (WS. Natural recovery on San Nicolas Island (SNI off Southern California suggested the development of resistance in island populations. Experimental challenges in one treatment demonstrated that progeny of disease-selected black abalone from SNI survived better than did those from naïve black abalone from Carmel Point (CP in mainland coastal central California. Unexpectedly, the presence of a newly observed bacteriophage infecting the WS rickettsia (WS-RLO had strong effects on the survival of infected abalone. Specifically, presence of phage-infected RLO (RLOv reduced the host response to infection, RLO infection loads, and associated mortality. These data suggest that the black abalone: WS-RLO relationship is evolving through dual host mechanisms of resistance to RLO infection in the digestive gland via tolerance to infection in the primary target tissue (the post-esophagus coupled with reduced pathogenicity of the WS-RLO by phage infection, which effectively reduces the infection load in the primary target tissue by half. Sea surface temperature patterns off southern California, associated with a recent hiatus in global-scale ocean warming, do not appear to be a sufficient explanation for survival patterns in SNI black abalone. These data highlight the potential for natural recovery of abalone populations over time and that further understanding of mechanisms governing host-parasite relationships will better enable us to manage declining populations.

  17. Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation

    DEFF Research Database (Denmark)

    Møller, M H; Adamsen, S; Thomsen, R W;

    2011-01-01

    Morbidity and mortality rates in patients with perforated peptic ulcer (PPU) remain substantial. The aim of the present study was to evaluate the effect of a multimodal and multidisciplinary perioperative care protocol on mortality in patients with PPU.......Morbidity and mortality rates in patients with perforated peptic ulcer (PPU) remain substantial. The aim of the present study was to evaluate the effect of a multimodal and multidisciplinary perioperative care protocol on mortality in patients with PPU....

  18. Setting research priorities to reduce global mortality from preterm birth and low birth weight by 2015.

    Science.gov (United States)

    Bahl, Rajiv; Martines, Jose; Bhandari, Nita; Biloglav, Zrinka; Edmond, Karen; Iyengar, Sharad; Kramer, Michael; Lawn, Joy E; Manandhar, D S; Mori, Rintaro; Rasmussen, Kathleen M; Sachdev, H P S; Singhal, Nalini; Tomlinson, Mark; Victora, Cesar; Williams, Anthony F; Chan, Kit Yee; Rudan, Igor

    2012-06-01

    This paper aims to identify health research priorities that could improve the rate of progress in reducing global neonatal mortality from preterm birth and low birth weight (PB/LBW), as set out in the UN's Millennium Development Goal 4. We applied the Child Health and Nutrition Research Initiative (CHNRI) methodology for setting priorities in health research investments. In the process coordinated by the World Health Organization in 2007-2008, 21 researchers with interest in child, maternal and newborn health suggested 82 research ideas that spanned across the broad spectrum of epidemiological research, health policy and systems research, improvement of existing interventions and development of new interventions. The 82 research questions were then assessed for answerability, effectiveness, deliverability, maximum potential for mortality reduction and the effect on equity using the CHNRI method. The top 10 identified research priorities were dominated by health systems and policy research questions (eg, identification of LBW infants born at home within 24-48 hours of birth for additional care; approaches to improve quality of care of LBW infants in health facilities; identification of barriers to optimal home care practices including care seeking; and approaches to increase the use of antenatal corticosteriods in preterm labor and to improve access to hospital care for LBW infants). These were followed by priorities for improvement of the existing interventions (eg, early initiation of breastfeeding, including feeding mode and techniques for those unable to suckle directly from the breast; improved cord care, such as chlorhexidine application; and alternative methods to Kangaroo Mother Care (KMC) to keep LBW infants warm in community settings). The highest-ranked epidemiological question suggested improving criteria for identifying LBW infants who need to be cared for in a hospital. Among the new interventions, the greatest support was shown for the development of

  19. Birds be safe: Can a novel cat collar reduce avian mortality by domestic cats (Felis catus?

    Directory of Open Access Journals (Sweden)

    S.K. Willson

    2015-01-01

    Full Text Available The domestic cat (Felis catus has been described as the largest anthropogenic threat to songbird populations in North America. We examined the effectiveness of a novel cat collar in reducing avian and small mammal mortality by cats. The 2-inch wide Birdsbesafe® collar cover (CC is worn over a nylon quick-release collar, and the bright colors and patterns of the CC are hypothesized to warn birds of approaching cats. We conducted two seasonal trials, each lasting 12 weeks, in autumn 2013 (n=54 cats and spring 2014 (n=19 cats. Cats were randomly assigned to two groups, and CCs with interior collars were removed or put on every two weeks, to control for weather fluctuations and seasonal change. Cats wearing Birdsbesafe® CCs killed 19 times fewer birds than uncollared cats in the spring trial, and 3.4 times fewer birds in the fall. Birdsbesafe® CCs were extremely effective at reducing predation on birds. Small mammal data were less clear, but did decrease predation by half in the fall. The Birdsbesafe® CC is a highly effective device for decreasing bird predation, especially in the spring season. We suggest that the CCs be used as a conservation tool for owned as well as feral cats.

  20. Reducing Premature Mortality in the Mentally Ill Through Health Promotion Programs.

    Science.gov (United States)

    Price, James H; Khubchandani, Jagdish; Price, Joy A; Whaley, Cathy; Bowman, Sharon

    2016-09-01

    Nearly half of the U.S. adult population will have a major mental illness during their lifetimes. At any point in time, almost a fifth of all American adults have a serious mental illness (SMI). Too many in our society do not understand mental illnesses, placing the blame for the illness on those with the illness, resulting in isolation, marginalization, or incarceration of individuals with SMIs. They may experience stigma, inadequate and delayed health and mental health care, and major socioeconomic disadvantages. They may struggle with activities of daily living, lose many of their resources, and spiral down into poverty. The disadvantages and decreased ability to function experienced by individuals with SMIs lead to increased unhealthy behaviors, reduced participation in wellness-related activities, and premature morbidity and mortality. The general and physical health of individuals with SMIs poses greater challenges from both practice and research standpoints. However, health educators are poised uniquely to provide health promotion programs, conduct research, and advocate for the health and well-being of individuals with SMIs. In this review, we summarize the challenges and opportunities for health promotion in individuals with SMIs.

  1. RGS4 causes increased mortality and reduced cardiac hypertrophy in response to pressure overload.

    Science.gov (United States)

    Rogers, J H; Tamirisa, P; Kovacs, A; Weinheimer, C; Courtois, M; Blumer, K J; Kelly, D P; Muslin, A J

    1999-09-01

    RGS family members are GTPase-activating proteins (GAPs) for heterotrimeric G proteins. There is evidence that altered RGS gene expression may contribute to the pathogenesis of cardiac hypertrophy and failure. We investigated the ability of RGS4 to modulate cardiac physiology using a transgenic mouse model. Overexpression of RGS4 in postnatal ventricular tissue did not affect cardiac morphology or basal cardiac function, but markedly compromised the ability of the heart to adapt to transverse aortic constriction (TAC). In contrast to wild-type mice, the transgenic animals developed significantly reduced ventricular hypertrophy in response to pressure overload and also did not exhibit induction of the cardiac "fetal" gene program. TAC of the transgenic mice caused a rapid decompensation in most animals characterized by left ventricular dilatation, depressed systolic function, and increased postoperative mortality when compared with nontransgenic littermates. These results implicate RGS proteins as a crucial component of the signaling pathway involved in both the cardiac response to acute ventricular pressure overload and the cardiac hypertrophic program.

  2. Progenitor cells trapped in marrow filters can reduce GvHD and transplant mortality.

    Science.gov (United States)

    Vicente, D; Podestà, M; Pitto, A; Pozzi, S; Lucchetti, S; Lamparelli, T; Tedone, E; Ibatici, A; Figari, O; Frassoni, F; Van Lint, M T; Piaggio, G; Sacchi, N; Bacigalupo, A

    2006-07-01

    A bone marrow harvest is filtered either in the operating room, in the laboratory or during infusion to the patient. Filters are usually discarded. Little is known of haemopoietic progenitor cells (HPCs) trapped in the filters. The aim of the study was to evaluate HPC content in the filters and to assess the outcome of transplants with filter-discarded or filter-recovered cells. Haemopoietic progenitors were grown from filters of 19 marrow transplants. We then compared the outcome of 39 filter-recovered transplants from HLA-identical siblings (years 2001-2004) with a matched cohort of 43 filter-discarded marrow grafts (years 1997-2000). Filters contained on average 21% long-term culture-initiating cells (LTC-IC) and 15% fibroblasts colony-forming units (CFU-F) of the total progenitor cell content. Filter-discarded transplants had significantly more grade II-IV graft-versus-host disease (GvHD) (42 vs 15%, P=0.008) as compared to filter-recovered transplants, and more transplant-related mortality (TRM) (20 vs 3%, P=0.04). The actuarial survival at 5 years is 69 vs 87%, respectively (P=0.15). This study suggests that a significant proportion of LTC-IC is lost in the filters together with CFU-F. Recovery and add back of progenitors trapped in the filters may reduce GvHD and TRM.

  3. The safe motherhood referral system to reduce cesarean sections and perinatal mortality - a cross-sectional study [1995-2006

    Directory of Open Access Journals (Sweden)

    Rudge Marilza VC

    2011-11-01

    Full Text Available Abstract Background In 2000, the eight Millennium Development Goals (MDGs set targets for reducing child mortality and improving maternal health by 2015. Objective To evaluate the results of a new education and referral system for antenatal/intrapartum care as a strategy to reduce the rates of Cesarean sections (C-sections and maternal/perinatal mortality. Methods Design: Cross-sectional study. Setting: Department of Gynecology and Obstetrics, Botucatu Medical School, Sao Paulo State University/UNESP, Brazil. Population: 27,387 delivering women and 27,827 offspring. Data collection: maternal and perinatal data between 1995 and 2006 at the major level III and level II hospitals in Botucatu, Brazil following initiation of a safe motherhood education and referral system. Main outcome measures: Yearly rates of C-sections, maternal (/100,000 LB and perinatal (/1000 births mortality rates at both hospitals. Data analysis: Simple linear regression models were adjusted to estimate the referral system's annual effects on the total number of deliveries, C-section and perinatal mortality ratios in the two hospitals. The linear regression were assessed by residual analysis (Shapiro-Wilk test and the influence of possible conflicting observations was evaluated by a diagnostic test (Leverage, with p Results Over the time period evaluated, the overall C-section rate was 37.3%, there were 30 maternal deaths (maternal mortality ratio = 109.5/100,000 LB and 660 perinatal deaths (perinatal mortality rate = 23.7/1000 births. The C-section rate decreased from 46.5% to 23.4% at the level II hospital while remaining unchanged at the level III hospital. The perinatal mortality rate decreased from 9.71 to 1.66/1000 births and from 60.8 to 39.6/1000 births at the level II and level III hospital, respectively. Maternal mortality ratios were 16.3/100,000 LB and 185.1/100,000 LB at the level II and level III hospitals. There was a shift from direct to indirect causes of

  4. General health checks in adults for reducing morbidity and mortality from disease

    DEFF Research Database (Denmark)

    Krogsbøll, Lasse T; Jørgensen, Karsten Juhl; Grønhøj Larsen, Christian;

    2012-01-01

    To quantify the benefits and harms of general health checks in adults with an emphasis on patient-relevant outcomes such as morbidity and mortality rather than on surrogate outcomes.......To quantify the benefits and harms of general health checks in adults with an emphasis on patient-relevant outcomes such as morbidity and mortality rather than on surrogate outcomes....

  5. New effects of Roundup on amphibians: predators reduce herbicide mortality; herbicides induce antipredator morphology.

    Science.gov (United States)

    Relyea, Rick A

    2012-03-01

    The use of pesticides is important for growing crops and protecting human health by reducing the prevalence of targeted pest species. However, less attention is given to the potential unintended effects on nontarget species, including taxonomic groups that are of current conservation concern. One issue raised in recent years is the potential for pesticides to become more lethal in the presence of predatory cues, a phenomenon observed thus far only in the laboratory. A second issue is whether pesticides can induce unintended trait changes in nontarget species, particularly trait changes that might mimic adaptive responses to natural environmental stressors. Using outdoor mesocosms, I created simple wetland communities containing leaf litter, algae, zooplankton, and three species of tadpoles (wood frogs [Rana sylvatica or Lithobates sylvaticus], leopard frogs [R. pipiens or L. pipiens], and American toads [Bufo americanus or Anaxyrus americanus]). I exposed the communities to a factorial combination of environmentally relevant herbicide concentrations (0, 1, 2, or 3 mg acid equivalents [a.e.]/L of Roundup Original MAX) crossed with three predator-cue treatments (no predators, adult newts [Notophthalmus viridescens], or larval dragonflies [Anax junius]). Without predator cues, mortality rates from Roundup were consistent with past studies. Combined with cues from the most risky predator (i.e., dragonflies), Roundup became less lethal (in direct contrast to past laboratory studies). This reduction in mortality was likely caused by the herbicide stratifying in the water column and predator cues scaring the tadpoles down to the benthos where herbicide concentrations were lower. Even more striking was the discovery that Roundup induced morphological changes in the tadpoles. In wood frog and leopard frog tadpoles, Roundup induced relatively deeper tails in the same direction and of the same magnitude as the adaptive changes induced by dragonfly cues. To my knowledge, this

  6. Using Simulation Modeling to Inform Strategies to Reduce Breast Cancer Mortality in Black Women in the District of Columbia

    Directory of Open Access Journals (Sweden)

    Aimee M. Near

    2012-01-01

    Full Text Available Background. Black women in the District of Columbia (DC have the highest breast cancer mortality in the US. Local cancer control planners are interested in how to most efficiently reduce this mortality. Methods. An established simulation model was adapted to reflect the experiences of Black women in DC and estimate the past and future impact of changes in use of screening and adjuvant treatment. Results. The model estimates that the observed reduction in mortality that occurred from 1975 to 2007 attributable to screening, treatment, and both was 20.2%, 25.7%, and 41.0% respectively. The results suggest that, by 2020, breast cancer mortality among Black women in DC could be reduced by 6% more by initiating screening at age 40 versus age 50. Screening annually may also reduce mortality to a greater extent than biennially, albeit with a marked increase in false positive screening rates. Conclusion. This study demonstrates how modeling can provide data to assist local planners as they consider different cancer control policies based on their individual populations.

  7. Using Simulation Modeling to Inform Strategies to Reduce Breast Cancer Mortality in Black Women in the District of Columbia.

    Science.gov (United States)

    Near, Aimee M; Mandelblatt, Jeanne S; Schechter, Clyde B; Stoto, Michael A

    2012-04-26

    Black women in the District of Columbia (DC) have the highest breast cancer mortality in the US. Local cancer control planners are interested in how to most efficiently reduce this mortality. An established simulation model was adapted to reflect the experiences of Black women in DC and estimate the past and future impact of changes in use of screening and adjuvant treatment. The model estimates that the observed reduction in mortality that occurred from 1975 to 2007 attributable to screening, treatment, and both was 20.2%, 25.7%, and 41.0% respectively. The results suggest that, by 2020, breast cancer mortality among Black women in DC could be reduced by 6% more by initiating screening at age 40 vs. age 50. Screening annually may also reduce mortality to a greater extent than biennially, albeit with a marked increase in false positive screening rates. This study demonstrates how modeling can provide data to assist local planners as they consider different cancer control policies based on their individual populations.

  8. Interventions to reduce neonatal mortality from neonatal tetanus in low and middle income countries--a systematic review.

    Science.gov (United States)

    Khan, Adeel Ahmed; Zahidie, Aysha; Rabbani, Fauziah

    2013-04-09

    In 1988, WHO estimated around 787,000 newborns deaths due to neonatal tetanus. Despite few success stories majority of the Low and Middle Income Countries (LMICs) are still struggling to reduce neonatal mortality due to neonatal tetanus. We conducted a systematic review to understand the interventions that have had a substantial effect on reducing neonatal mortality rate due to neonatal tetanus in LMICs and come up with feasible recommendations for decreasing neonatal tetanus in the Pakistani setting. We systemically reviewed the published literature (Pubmed and Pubget databases) to identify appropriate interventions for reducing tetanus related neonatal mortality. A total of 26 out of 30 studies were shortlisted for preliminary screening after removing overlapping information. Key words used were "neonatal tetanus, neonatal mortality, tetanus toxoid women". Of these twenty-six studies, 20 were excluded. The pre-defined exclusion criteria was (i) strategies and interventions to reduce mortality among neonates not described (ii) no abstract/author (4 studies) (iii) not freely accessible online (1 study) (iv) conducted in high income countries (2 studies) and (v) not directly related to neonatal tetanus mortality and tetanus toxoid immunization (5). Finally six studies which met the eligibility criteria were entered in the pre-designed data extraction form and five were selected for commentary as they were directly linked with neonatal tetanus reduction. Interventions that were identified to reduce neonatal mortality in LMICs were: a) vaccination of women of child bearing age (married and unmarried both) with tetanus toxoid b) community based interventions i.e. tetanus toxoid immunization for all mothers; clean and skilled care at delivery; newborn resuscitation; exclusive breastfeeding; umbilical cord care and management of infections in newborns c) supplementary immunization (in addition to regular EPI program) d) safer delivery practices. The key intervention to

  9. Interventions to reduce neonatal mortality from neonatal tetanus in low and middle income countries - a systematic review

    Science.gov (United States)

    2013-01-01

    Background In 1988, WHO estimated around 787,000 newborns deaths due to neonatal tetanus. Despite few success stories majority of the Low and Middle Income Countries (LMICs) are still struggling to reduce neonatal mortality due to neonatal tetanus. We conducted a systematic review to understand the interventions that have had a substantial effect on reducing neonatal mortality rate due to neonatal tetanus in LMICs and come up with feasible recommendations for decreasing neonatal tetanus in the Pakistani setting. Methods We systemically reviewed the published literature (Pubmed and Pubget databases) to identify appropriate interventions for reducing tetanus related neonatal mortality. A total of 26 out of 30 studies were shortlisted for preliminary screening after removing overlapping information. Key words used were “neonatal tetanus, neonatal mortality, tetanus toxoid women”. Of these twenty-six studies, 20 were excluded. The pre-defined exclusion criteria was (i) strategies and interventions to reduce mortality among neonates not described (ii) no abstract/author (4 studies) (iii) not freely accessible online (1 study) (iv) conducted in high income countries (2 studies) and (v) not directly related to neonatal tetanus mortality and tetanus toxoid immunization (5). Finally six studies which met the eligibility criteria were entered in the pre-designed data extraction form and five were selected for commentary as they were directly linked with neonatal tetanus reduction. Results Interventions that were identified to reduce neonatal mortality in LMICs were: a) vaccination of women of child bearing age (married and unmarried both) with tetanus toxoid b) community based interventions i.e. tetanus toxoid immunization for all mothers; clean and skilled care at delivery; newborn resuscitation; exclusive breastfeeding; umbilical cord care and management of infections in newborns c) supplementary immunization (in addition to regular EPI program) d) safer delivery

  10. Health policy for sickle cell disease in Africa: experience from Tanzania on interventions to reduce under-five mortality.

    Science.gov (United States)

    Makani, Julie; Soka, Deogratias; Rwezaula, Stella; Krag, Marlene; Mghamba, Janneth; Ramaiya, Kaushik; Cox, Sharon E; Grosse, Scott D

    2015-02-01

    Tanzania has made considerable progress towards reducing childhood mortality, achieving a 57% decrease between 1980 and 2011. This epidemiological transition will cause a reduction in the contribution of infectious diseases to childhood mortality and increase in contribution from non-communicable diseases (NCDs). Haemoglobinopathies are amongst the most common childhood NCDs, with sickle cell disease (SCD) being the commonest haemoglobinopathy in Africa. In Tanzania, 10,313 children with SCD under 5 years of age (U5) are estimated to die every year, contributing an estimated 7% of overall deaths in U5 children. Key policies that governments in Africa are able to implement would reduce mortality in SCD, focusing on newborn screening and comprehensive SCD care programmes. Such programmes would ensure that interventions such as prevention of infections using penicillin plus prompt diagnosis and treatment of complications are provided to all individuals with SCD. © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  11. Alternative Strategies to Reduce Maternal Mortality in India: A Cost-Effectiveness Analysis

    Science.gov (United States)

    Goldie, Sue J.; Sweet, Steve; Carvalho, Natalie; Natchu, Uma Chandra Mouli; Hu, Delphine

    2010-01-01

    Background Approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occur in India. Taking into account the costs, feasibility, and operational complexity of alternative interventions, we estimate the clinical and population-level benefits associated with strategies to improve the safety of pregnancy and childbirth in India. Methods and Findings Country- and region-specific data were synthesized using a computer-based model that simulates the natural history of pregnancy (both planned and unintended) and pregnancy- and childbirth-associated complications in individual women; and considers delivery location, attendant, and facility level. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to urban and rural India using survey-based data (e.g., unmet need for birth spacing/limiting, facility births, skilled birth attendants). Model validation compared projected maternal indicators with empiric data. Strategies consisted of improving coverage of effective interventions that could be provided individually or packaged as integrated services, could reduce the incidence of a complication or its case fatality rate, and could include improved logistics such as reliable transport to an appropriate referral facility as well as recognition of referral need and quality of care. Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality. If over the next 5 y the unmet need for spacing and limiting births was met, more than 150,000 maternal deaths would be prevented; more than US$1 billion saved; and at least one of every two abortion-related deaths averted. Still, reductions in maternal mortality reached a threshold (∼23%–35%) without including strategies that ensured reliable access to intrapartum and emergency obstetrical care (EmOC). An integrated and stepwise approach was identified that would ultimately

  12. Alternative strategies to reduce maternal mortality in India: a cost-effectiveness analysis.

    Science.gov (United States)

    Goldie, Sue J; Sweet, Steve; Carvalho, Natalie; Natchu, Uma Chandra Mouli; Hu, Delphine

    2010-04-20

    Approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occur in India. Taking into account the costs, feasibility, and operational complexity of alternative interventions, we estimate the clinical and population-level benefits associated with strategies to improve the safety of pregnancy and childbirth in India. Country- and region-specific data were synthesized using a computer-based model that simulates the natural history of pregnancy (both planned and unintended) and pregnancy- and childbirth-associated complications in individual women; and considers delivery location, attendant, and facility level. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to urban and rural India using survey-based data (e.g., unmet need for birth spacing/limiting, facility births, skilled birth attendants). Model validation compared projected maternal indicators with empiric data. Strategies consisted of improving coverage of effective interventions that could be provided individually or packaged as integrated services, could reduce the incidence of a complication or its case fatality rate, and could include improved logistics such as reliable transport to an appropriate referral facility as well as recognition of referral need and quality of care. Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality. If over the next 5 y the unmet need for spacing and limiting births was met, more than 150,000 maternal deaths would be prevented; more than US$1 billion saved; and at least one of every two abortion-related deaths averted. Still, reductions in maternal mortality reached a threshold ( approximately 23%-35%) without including strategies that ensured reliable access to intrapartum and emergency obstetrical care (EmOC). An integrated and stepwise approach was identified that would ultimately prevent four of five

  13. Alternative strategies to reduce maternal mortality in India: a cost-effectiveness analysis.

    Directory of Open Access Journals (Sweden)

    Sue J Goldie

    2010-04-01

    Full Text Available BACKGROUND: Approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occur in India. Taking into account the costs, feasibility, and operational complexity of alternative interventions, we estimate the clinical and population-level benefits associated with strategies to improve the safety of pregnancy and childbirth in India. METHODS AND FINDINGS: Country- and region-specific data were synthesized using a computer-based model that simulates the natural history of pregnancy (both planned and unintended and pregnancy- and childbirth-associated complications in individual women; and considers delivery location, attendant, and facility level. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to urban and rural India using survey-based data (e.g., unmet need for birth spacing/limiting, facility births, skilled birth attendants. Model validation compared projected maternal indicators with empiric data. Strategies consisted of improving coverage of effective interventions that could be provided individually or packaged as integrated services, could reduce the incidence of a complication or its case fatality rate, and could include improved logistics such as reliable transport to an appropriate referral facility as well as recognition of referral need and quality of care. Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality. If over the next 5 y the unmet need for spacing and limiting births was met, more than 150,000 maternal deaths would be prevented; more than US$1 billion saved; and at least one of every two abortion-related deaths averted. Still, reductions in maternal mortality reached a threshold ( approximately 23%-35% without including strategies that ensured reliable access to intrapartum and emergency obstetrical care (EmOC. An integrated and stepwise approach was

  14. Supratherapeutic anticoagulation at presentation is associated with reduced mortality in nonvariceal upper gastrointestinal hemorrhage.

    Science.gov (United States)

    Irwin, James; Ferguson, Reid; Weilert, Frank; Smith, Anthony

    2014-09-01

    Warfarin is a widely used and easily reversible anticoagulant. Although bleeding is more likely in warfarin users, it may also be more readily treated. This retrospective observational case-control study compares the outcome of acute nonvariceal upper gastrointestinal hemorrhage in warfarin users with a supratherapeutic international normalized ratio (INR) and outcome in non - warfarin users. Clinical and endoscopic data for patients presenting with overt upper gastrointestinal hemorrhage were collected between 23rd February 2001 and 12 October 2010. Patients with variceal hemorrhage were excluded. Warfarin users with a supratherapeutic INR (≥ 3.0) at presentation (supratherapeutic anticoagulation [SA] group) were matched to a cohort with upper gastrointestinal hemorrhage not taking warfarin at presentation (control group). Patients were matched by age, sex, Rockall score, year of endoscopy, inpatient or outpatient status, and the presence of disseminated cancer at presentation. The incidence rates of major outcomes in the two groups were compared. A total of 128 patients (SA group) were matched to 135 control patients. The SA group patients were less likely to die within 30 days (6.25 % vs. 15.5 %, odds ratio = 0.36, P = 0.028 by Test for Equality of Proportions). There was a trend toward more surgery in the control group (5 % vs. 2 %), and rates of blood transfusion (77 % vs. 70 %) were similar in the two groups. In patients presenting with nonvariceal upper gastrointestinal hemorrhage, a supratherapeutic INR at presentation due to warfarin use is associated with reduced mortality.

  15. [Potential role of prenatal care in reducing maternal and perinatal mortality in sub-Saharan Africa].

    Science.gov (United States)

    Prual, A; De Bernis, L; El Joud, D Ould

    2002-02-01

    Prenatal care has been implemented in developing countries according to the same mode as applied in industrialized countries without considering its real effectiveness in reducing maternal and neonatal mortality. Several recent studies suggest that the goals should be revisited in order to implement a program of prenatal care based on real scientific evidence. Based on the current literature, we propose a potentially effective content for prenatal care adapted to the context of developing countries. Four antenatal consultations would be enough if appropriately timed at 12, 26, 32 and 36 weeks pregnancy. The purpose of these consultations would be: 1) to screen for three major risk factors, which, when recognized, lead to specific action: uterine, scare, malpresentation, premature rupture of the membranes; 2) to prevent and/or detect (and treat) specific complications of pregnancy: hypertension, infection (malaria, venereal disease, HIV, tetanus, urinary tract infection); anemia and trace element deficiencies, gestational diabetes mellitus; 3) to provide counseling, support and information for pregnant women and their families (including the partner) concerning: severe signs and symptoms of pregnancy and delivery, community organization of emergency transfer, delivery planning. These potentially effective actions can only have a real public health impact if implemented within an organized maternal health system with a functional network of delivery units, if truly quality care is given, and if the relationships between health care providers and the population are based on mutual respect. Sub-Saharan African women use prenatal care extensively when it is accessible; this opportunity must be used to implement evidence-based actions with appropriate and realistic goals.

  16. Reducing accidental shrew mortality associated with small-mammal livetrapping I: an inter- and intrastudy analysis

    National Research Council Canada - National Science Library

    Julia Shonfield; Randy Do; Ronald J. Brooks; Andrew G. McAdam

    2013-01-01

    .... We compiled data on mortality rates and protocols from 16 different small-mammal studies and analyzed 16 years of livetrapping data from a single study in Algonquin Provincial Park, Ontario to assess...

  17. Global Longitudinal Strain Is a Superior Predictor of All-Cause Mortality in Heart Failure With Reduced Ejection Fraction

    DEFF Research Database (Denmark)

    Sengeløv, Morten; Jørgensen, Peter Godsk; Jensen, Jan Skov

    2015-01-01

    OBJECTIVES: The purpose of this study was to investigate the prognostic value of global longitudinal strain (GLS) in heart failure with reduced ejection fraction (HFrEF) patients in relation to all-cause mortality. BACKGROUND: Measurement of myocardial deformation by 2-dimensional speckle tracking...

  18. Reduced positive affect (anhedonia) is independently associated with 7-year mortality in patients treated with percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Damen, Nikki L; Pelle, Aline J; Boersma, Eric

    2013-01-01

    Negative mood states (e.g., anxiety and depression) have been associated with increased cardiovascular morbidity and mortality in coronary artery disease (CAD), but little is known about the impact of positive emotions on these health outcomes. We examined whether anhedonia (i.e., reduced positive...

  19. Reducing neonatal mortality in India: critical role of access to emergency obstetric care.

    Directory of Open Access Journals (Sweden)

    Anu Rammohan

    Full Text Available BACKGROUND: Neonatal mortality currently accounts for 41% of all global deaths among children below five years. Despite recording a 33% decline in neonatal deaths between 2000 and 2009, about 900,000 neonates died in India in 2009. The decline in neonatal mortality is slower than in the post-neonatal period, and neonatal mortality rates have increased as a proportion of under-five mortality rates. Neonatal mortality rates are higher among rural dwellers of India, who make up at least two-thirds of India's population. Identifying the factors influencing neonatal mortality will significantly improve child survival outcomes in India. METHODS: Our analysis is based on household data from the nationally representative 2008 Indian District Level Household Survey (DLHS-3. We use probit regression techniques to analyse the links between neonatal mortality at the household level and households' access to health facilities. The probability of the child dying in the first month of birth is our dependent variable. RESULTS: We found that 80% of neonatal deaths occurred within the first week of birth, and that the probability of neonatal mortality is significantly lower when the child's village is closer to the district hospital (DH, suggesting the critical importance of specialist hospital care in the prevention of newborn deaths. Neonatal deaths were lower in regions where emergency obstetric care was available at the District Hospitals. We also found that parental schooling and household wealth status improved neonatal survival outcomes. CONCLUSIONS: Addressing the main causes of neonatal deaths in India--preterm deliveries, asphyxia, and sepsis--requires adequacy of specialised workforce and facilities for delivery and neonatal intensive care and easy access by mothers and neonates. The slow decline in neonatal death rates reflects a limited attention to factors which contribute to neonatal deaths. The suboptimal quality and coverage of Emergency

  20. Longer treatment time and slower ultrafiltration in hemodialysis: associations with reduced mortality in the DOPPS.

    Science.gov (United States)

    Saran, R; Bragg-Gresham, J L; Levin, N W; Twardowski, Z J; Wizemann, V; Saito, A; Kimata, N; Gillespie, B W; Combe, C; Bommer, J; Akiba, T; Mapes, D L; Young, E W; Port, F K

    2006-04-01

    Longer treatment time (TT) and slower ultrafiltration rate (UFR) are considered advantageous for hemodialysis (HD) patients. The study included 22,000 HD patients from seven countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Logistic regression was used to study predictors of TT > 240 min and UFR > 10 ml/h/kg bodyweight. Cox regression was used for survival analyses. Statistical adjustments were made for patient demographics, comorbidities, dose of dialysis (Kt/V), and body size. Europe and Japan had significantly longer (P V increased concomitantly with TT in all three regions with the largest absolute difference observed in Japan. TT > 240 min was independently associated with significantly lower relative risk (RR) of mortality (RR = 0.81; P = 0.0005). Every 30 min longer on HD was associated with a 7% lower RR of mortality (RR = 0.93; P V and TT (P = 0.007) toward mortality reduction. UFR > 10 ml/h/kg was associated with higher odds of intradialytic hypotension (odds ratio = 1.30; P = 0.045) and a higher risk of mortality (RR = 1.09; P = 0.02). Longer TT and higher Kt/V were independently as well as synergistically associated with lower mortality. Rapid UFR during HD was also associated with higher mortality risk. These results warrant a randomized clinical trial of longer dialysis sessions in thrice-weekly HD.

  1. Reduced perinatal mortality following enhanced training of birth attendants in the Democratic Republic of Congo: a time-dependent effect

    Directory of Open Access Journals (Sweden)

    Wallace Dennis

    2011-08-01

    . NRP training had no demonstrable effect on early neonatal mortality. Conclusion Training DRC birth attendants using the ENC program reduces perinatal mortality. However, a period of utilization and re-enforcement of training may be necessary before a decline in mortality occurs. ENC training has the potential to be a low cost, high impact intervention in developing countries. Trial registration This trial has been registered at http://www.clinicaltrials.gov (identifier NCT00136708.

  2. Reducing sow confinement during farrowing and in early lactation increases piglet mortality.

    Science.gov (United States)

    Condous, P C; Plush, K J; Tilbrook, A J; van Wettere, W H E J

    2016-07-01

    The aim of this study was to investigate the effect of sow confinement and nonconfinement during parturition and early lactation on the performance of sows and piglets prior to weaning. Sows and their litters were housed in either a conventional farrowing crate (control; 1.7 × 2.4 m) or a swing-sided pen (2.8 × 2.15 m). Sows housed in the swing-sided pen had the crate open (open) or closed (closed) during farrowing and opened on d 3 (LAC3) or 7 (LAC7) of lactation. Data are means ± SEM. The numbers of total and live-born piglets were not different between treatments and averaged 13.1 ± 0.4 and 12.3 ± 0.2 piglets/litter, respectively. Sows housed in a farrowing crate had a greater ( = 0.03) number of stillborn piglets compared with open sows from pens (1.1 ± 0.2 vs. 0.6 ± 0.1 piglets/litter, respectively). Live-born piglet mortality before litter equalization on d 1 was greater ( piglets/litter, respectively) and was largely explained by an increase in the incidence of piglets overlain ( piglets/litter, respectively). Overlay mortality between d 3 and 7 of lactation was greater ( = 0.03) in LAC3 sows compared to LAC7 and control sows (0.4 ± 0.1 vs. 0.2 ± 0.1 vs. 0.2 ± 0.1 piglets/litter, respectively). Treatment did not affect either the incidence or cause of piglet mortality after d 7 of lactation ( > 0.05). Total live-born piglet mortality from birth until weaning for the control, closedLAC7, closedLAC3, openLAC7, and openLAC3 was 1.86 ± 0.19, 1.95 ± 0.23, 2.10 ± 0.39, 2.45 ± 0.27, and 3.74 ± 0.48, piglets/litter, respectively. Total live-born piglet mortality from birth until weaning was greater in the openLAC3 and openLAC7 treatments compared to control ( piglet mortality compared to a farrowing crate, and removing confinement on d 3 of lactation further increased total piglet mortality compared to removing sow confinement on d 7 of lactation in sows that farrowed open. Sows that were confined during farrowing and until d 3 or 7 of lactation in a

  3. Reduced mortality rates in a cohort of long-term underground iron-ore miners.

    Science.gov (United States)

    Björ, Ove; Jonsson, Håkan; Damber, Lena; Wahlström, Jens; Nilsson, Tohr

    2013-05-01

    Historically, working in iron-ore mines has been associated with an increased risk of lung cancer and silicosis. However, studies on other causes of mortality are inconsistent and in the case of cancer incidence, sparse. The aim of this study was to examine the association between iron-ore mining, mortality and cancer incidence. A 54-year cohort study on iron-ore miners from mines in northern Sweden was carried out comprising 13,000 workers. Standardized rate ratios were calculated comparing the disease frequency, mortality, and cancer incidence with that of the general population of northern Sweden. Poisson regression was used to evaluate the association between the durations of employment and underground work, and outcome. Underground mining was associated with a significant decrease in adjusted mortality rate ratios for cerebrovascular and digestive system diseases, and stroke. For several outcomes, elevated standardized rate ratios were observed among blue-collar workers relative to the reference population. However, only the incidence of lung cancer increased with employment time underground (P iron-ore mining underground was associated with lower rates regarding several health outcomes. This is possibly explained by factors related to actual job activities, environmental exposure, or the selection of healthier workers for long-term underground employment. Copyright © 2013 Wiley Periodicals, Inc.

  4. Surveillance of Summer Mortality and Preparedness to Reduce the Health Impact of Heat Waves in Italy

    Science.gov (United States)

    Michelozzi, Paola; de’ Donato, Francesca K.; Bargagli, Anna Maria; D’Ippoliti, Daniela; De Sario, Manuela; Marino, Claudia; Schifano, Patrizia; Cappai, Giovanna; Leone, Michela; Kirchmayer, Ursula; Ventura, Martina; di Gennaro, Marta; Leonardi, Marco; Oleari, Fabrizio; De Martino, Annamaria; Perucci, Carlo A.

    2010-01-01

    Since 2004, the Italian Department for Civil Protection and the Ministry of Health have implemented a national program for the prevention of heat-health effects during summer, which to-date includes 34 major cities and 93% of the residents aged 65 years and over. The Italian program represents an important example of an integrated approach to prevent the impact of heat on health, comprising Heat Health Watch Warning Systems, a mortality surveillance system and prevention activities targeted to susceptible subgroups. City-specific warning systems are based on the relationship between temperature and mortality and serve as basis for the modulation of prevention measures. Local prevention activities, based on the guidelines defined by the Ministry of Health, are constructed around the infrastructures and services available. A key component of the prevention program is the identification of susceptible individuals and the active surveillance by General Practitioners, medical personnel and social workers. The mortality surveillance system enables the timely estimation of the impact of heat, and heat waves, on mortality during summer as well as to the evaluation of warning systems and prevention programs. Considering future predictions of climate change, the implementation of effective prevention programs, targeted to high risk subjects, become a priority in the public health agenda. PMID:20623023

  5. Does Family Planning Reduce Infant Mortality? Evidence from Surveillance Data in Matlab, Bangladesh

    NARCIS (Netherlands)

    van Soest, A.H.O.; Saha, U.R.

    2012-01-01

    Abstract: Analyzing the effect of family planning on child survival remains an important issue but is not straightforward because of several mechanisms linking family planning, birth intervals, total fertility, and child survival. This study uses a dynamic model jointly explaining infant mortality,

  6. Prenatal detection of transposition of the great arteries reduces mortality and morbidity

    NARCIS (Netherlands)

    van Velzen, C. L.; Haak, M. C.; Reijnders, G.; Rijlaarsdam, M. E. B.; Bax, C. J.; Pajkrt, E.; Hruda, J.; Galindo-Garre, F.; Bilardo, C. M.; de Groot, C. J. M.; Blom, N. A.; Clur, S. A.

    2015-01-01

    Objectives To evaluate the prenatal detection of transposition of the great arteries (TGA), after the introduction of a Dutch screening program in 2007, as well as the effect of prenatal detection on pre- and postsurgical mortality and morbidity. Methods In a geographical cohort study, all infants w

  7. Are we able to reduce the mortality and morbidity of oral cancer; Some considerations

    NARCIS (Netherlands)

    van der Waal, I.

    2013-01-01

    Oral cancer makes up 1%-2% of all cancers that may arise in the body. The majority of oral cancers consists of squamous cell carcinomas. Oral cancer carries a considerable mortality rate, being mainly dependent on the stage of the disease at admission. Worldwide some 50% of the patients with oral

  8. Are we able to reduce the mortality and morbidity of oral cancer; Some considerations

    NARCIS (Netherlands)

    van der Waal, I.

    2013-01-01

    Oral cancer makes up 1%-2% of all cancers that may arise in the body. The majority of oral cancers consists of squamous cell carcinomas. Oral cancer carries a considerable mortality rate, being mainly dependent on the stage of the disease at admission. Worldwide some 50% of the patients with oral ca

  9. The role of antiretroviral therapy in reducing TB incidence and mortality in high HIV-TB burden countries

    Directory of Open Access Journals (Sweden)

    Anthony D Harries

    2016-03-01

    Full Text Available With the adoption of the new Sustainable Development Goals in 2016, all countries have committed to end the tuberculosis (TB epidemic by 2030, defined as dramatic reductions in TB incidence and mortality combined with zero TB-induced catastrophic costs for families. This paper explores how antiretroviral therapy (ART in high HIV-TB burden countries may help in reducing TB incidence and mortality and thus contribute to the ambitious goal of ending TB. ART in people living with HIV has a potent TB preventive effect, with this being most apparent in those with the most advanced immunodeficiency. Early ART also significantly reduces the risk of TB, and with new World Health Organization guidance released in 2015 about initiating ART in all persons living with HIV irrespective of CD4 count, there is the potential for enormous benefit at the population level. Already, several countries with high HIVTB burdens have seen dramatic declines in TB case notification rates since ART scale up started in 2004. In patients already diagnosed with HIV-associated TB, mortality can be significantly decreased by ART, especially if started within 2–8 weeks of anti-TB treatment. The benefits of ART on TB incidence and TB mortality can be further augmented respectively by the addition of isoniazid preventive therapy and cotrimoxazole preventive therapy. These interventions must be effectively implemented and scaled up in order to end the TB epidemic by 2030.

  10. Recurrent sigmoid volvulus - early resection may obviate later emergency surgery and reduce morbidity and mortality.

    LENUS (Irish Health Repository)

    Larkin, J O

    2012-01-31

    INTRODUCTION: Acute sigmoid volvulus is a well recognised cause of acute large bowel obstruction. PATIENTS AND METHODS: We reviewed our unit\\'s experience with non-operative and operative management of this condition. A total of 27 patients were treated for acute sigmoid volvulus between 1996 and 2006. In total, there were 62 separate hospital admissions. RESULTS: Eleven patients were managed with colonoscopic decompression alone. The overall mortality rate for non-operative management was 36.4% (4 of 11 patients). Fifteen patients had operative management (five semi-elective following decompression, 10 emergency). There was no mortality in the semi-elective cohort and one in the emergency surgery group. The overall mortality for surgery was 6% (1 of 15). Five of the seven patients managed with colonoscopic decompression alone who survived were subsequently re-admitted with sigmoid volvulus (a 71.4% recurrence rate). The six deaths in our overall series each occurred in patients with established gangrene of the bowel. With early surgical intervention before the onset of gangrene, however, good outcomes may be achieved, even in patients apparently unsuitable for elective surgery. Eight of the 15 operatively managed patients were considered to be ASA (American Society of Anesthesiologists) grade 4. There was no postoperative mortality in this group. CONCLUSIONS: Given the high rate of recurrence of sigmoid volvulus after initial successful non-operative management and the attendant risks of mortality from gangrenous bowel developing with a subsequent volvulus, it is our contention that all patients should be considered for definitive surgery after initial colonoscopic decompression, irrespective of the ASA score.

  11. Urgent ERCP for acute cholangitis reduces mortality and hospital stay in elderly and very elderly patients

    Institute of Scientific and Technical Information of China (English)

    Chan Sun Park; Hee Seok Jeong; Ki Bae Kim; Joung-Ho Han; Hee Bok Chae; Sei Jin Youn; Seon Mee Park

    2016-01-01

    BACKGROUND: Acute cholangitis in old people is a cause of mortality and prolonged hospital stay. We evaluated the effects of methods and timing of biliary drainage on the outcomes of acute cholangitis in elderly and very elderly patients. METHODS: We analyzed 331 patients who were older than 75 years and were diagnosed with acute calculous cholangitis. They were admitted to our hospital from 2009 to 2014. Pa-tients’ demographics, severity grading, methods and timing of biliary drainage, mortality, and hospital stay were retrospec-tively obtained from medical records. Clinical parameters and outcomes were compared between elderly (75-80 years,n=156) and very elderly (≥81 years,n=175) patients. We analyzed the effects of methods [none, endoscopic retrograde cholangio-pancreatography (ERCP), percutaneous transhepatic biliary drainage, or failure] and timing (urgent or early) of biliary drainage on mortality and hospital stay in these patients. RESULTS: Acute cholangitis in older patients manifested as atypical symptoms characterized as infrequent Charcot’s triad (4.2%) and comorbidity in one-third of the patients. Patients were graded as mild, moderate, and severe cholangitis in 104 (31.4%), 175 (52.9%), and 52 (15.7%), respectively. Urgent bili-ary drainage (≤24 hours) was performed for 80.5% (247/307) of patients. Very elderly patients tended to have more severe grades and were treated with sequential procedures of tran-sient biliary drainage and stone removal at different sessions. Hospital stay was related to methods and timing of biliary drainage. Mortality was very low (1.5%) and not related to patient age but rather to the success or failure of biliary drainage and severity grading of the acute cholangitis. CONCLUSIONS: The methods and timing used for biliary drainage and severity of cholangitis are the major determi-nants of mortality and hospital stay in elderly and very elderly patients with acute cholangitis. Urgent successful ERCP is mandatory for

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

    Science.gov (United States)

    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 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.

  13. Strategies to Reduce Mortality in Adult and Neonatal Candidemia in Developing Countries

    OpenAIRE

    Harsimran Kaur; Arunaloke Chakrabarti

    2017-01-01

    Candidemia, the commonest invasive fungal infection, is associated with high morbidity and mortality in developing countries, though the exact prevalence is not known due to lack of systematic epidemiological data from those countries. The limited studies report a very high incidence of candidemia and unique epidemiology with a different spectrum of Candida species. The recent global emergence of multi-drug resistant Candida auris is looming large as an important threat in hospitalized patien...

  14. Importance of resin ducts in reducing ponderosa pine mortality from bark beetle attack.

    Science.gov (United States)

    Kane, Jeffrey M; Kolb, Thomas E

    2010-11-01

    The relative importance of growth and defense to tree mortality during drought and bark beetle attacks is poorly understood. We addressed this issue by comparing growth and defense characteristics between 25 pairs of ponderosa pine (Pinus ponderosa) trees that survived and trees that died from drought-associated bark beetle attacks in forests of northern Arizona, USA. The three major findings of our research were: (1) xylem resin ducts in live trees were >10% larger (diameter), >25% denser (no. of resin ducts mm(-2)), and composed >50% more area per unit ring growth than dead trees; (2) measures of defense, such as resin duct production (no. of resin ducts year(-1)) and the proportion of xylem ring area to resin ducts, not growth, were the best model parameters of ponderosa pine mortality; and (3) most correlations between annual variation in growth and resin duct characteristics were positive suggesting that conditions conducive to growth also increase resin duct production. Our results suggest that trees that survive drought and subsequent bark beetle attacks invest more carbon in resin defense than trees that die, and that carbon allocation to resin ducts is a more important determinant of tree mortality than allocation to radial growth.

  15. Fine particulate matter components and mortality in Greater Houston: Did the risk reduce from 2000 to 2011?

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Suyang; Zhang, Kai, E-mail: Kai.Zhang@uth.tmc.edu

    2015-12-15

    Fine particulate matter (less than 2.5 μm in aerodynamic diameter; PM{sub 2.5}) pollution poses a major environmental threat in Greater Houston due to rapid economic growth and the numerous PM{sub 2.5} sources including ports, vehicles, and the largest petrochemical industry in the United States (U.S.). Our objectives were to estimate the short-term associations between the PM{sub 2.5} components and mortality during 2000–2011, and evaluate whether these associations have changed over time. A total of 333,317 deaths were included in our assessment, with an average of 76 deaths per day. We selected 17 PM{sub 2.5} components from the U.S. Environmental Protection Agency's Chemical Speciation Network, and then applied Poisson regression models to assess the associations between the PM{sub 2.5} components and mortality. Additionally, we repeated our analysis for two consecutive periods: 2000–2005 and 2006–2011. Interquartile range increases in ammonium (0.881 μg/m{sup 3}), nitrate (0.487 μg/m{sup 3}), sulfate (2.245 μg/m{sup 3}), and vanadium (0.004 μg/m{sup 3}) were associated with an increased risk in mortality of 0.69% (95% confidence interval (CI): 0.26, 1.12%), 0.38% (95% CI: 0.11, 0.66%), 0.61% (95% CI: 0.15, 1.06%), and 0.58% (95% CI: 0.12, 1.04%), respectively. Seasonal analysis suggested that the associations were strongest during the winter months. The association between PM{sub 2.5} mass and mortality decreased during 2000–2011, however, the PM{sub 2.5} components showed no notable changes in mortality risk over time. Our study indicates that the short-term associations between PM{sub 2.5} and mortality differ across the PM{sub 2.5} components and suggests that future air pollution control measures should not only focus on mass but also pollutant sources. - Highlights: • PM{sub 2.5} concentrations were associated with increased mortality risk. • A few major PM{sub 2.5} components were associated with increased mortality risk.

  16. The American Cancer Society challenge goal to reduce US cancer mortality by 50% between 1990 and 2015: Results and reflections.

    Science.gov (United States)

    Byers, Tim; Wender, Richard C; Jemal, Ahmedin; Baskies, Arnold M; Ward, Elizabeth E; Brawley, Otis W

    2016-09-01

    In 1996, the Board of Directors of the American Cancer Society (ACS) challenged the United States to reduce what looked to be possible peak cancer mortality in 1990 by 50% by the year 2015. This analysis examines the trends in cancer mortality across this 25-year challenge period from 1990 to 2015. In 2015, cancer death rates were 26% lower than in 1990 (32% lower among men and 22% lower among women). The 50% reduction goal was more fully met for the cancer sites for which there was enactment of effective approaches for prevention, early detection, and/or treatment. Among men, mortality rates dropped for lung cancer by 45%, for colorectal cancer by 47%, and for prostate cancer by 53%. Among women, mortality rates dropped for lung cancer by 8%, for colorectal cancer by 44%, and for breast cancer by 39%. Declines in the death rates of all other cancer sites were substantially smaller (13% among men and 17% among women). The major factors that accounted for these favorable trends were progress in tobacco control and improvements in early detection and treatment. As we embark on new national cancer goals, this recent past experience should teach us that curing the cancer problem will require 2 sets of actions: making new discoveries in cancer therapeutics and more completely applying those discoveries in cancer prevention we have already made. CA Cancer J Clin 2016;66:359-369. © 2016 American Cancer Society.

  17. Which strategies reduce breast cancer mortality most? Collaborative modeling of optimal screening, treatment, and obesity prevention.

    Science.gov (United States)

    Mandelblatt, Jeanne; van Ravesteyn, Nicolien; Schechter, Clyde; Chang, Yaojen; Huang, An-Tsun; Near, Aimee M; de Koning, Harry; Jemal, Ahmedin

    2013-07-15

    US breast cancer mortality is declining, but thousands of women still die each year. Two established simulation models examine 6 strategies that include increased screening and/or treatment or elimination of obesity versus continuation of current patterns. The models use common national data on incidence and obesity prevalence, competing causes of death, mammography characteristics, treatment effects, and survival/cure. Parameters are modified based on obesity (defined as BMI  ≥  30 kg/m(2) ). Outcomes are presented for the year 2025 among women aged 25+ and include numbers of cases, deaths, mammograms and false-positives; age-adjusted incidence and mortality; breast cancer mortality reduction and deaths averted; and probability of dying of breast cancer. If current patterns continue, the models project that there would be about 50,100-57,400 (range across models) annual breast cancer deaths in 2025. If 90% of women were screened annually from ages 40 to 54 and biennially from ages 55 to 99 (or death), then 5100-6100 fewer deaths would occur versus current patterns, but incidence, mammograms, and false-positives would increase. If all women received the indicated systemic treatment (with no screening change), then 11,400-14,500 more deaths would be averted versus current patterns, but increased toxicity could occur. If 100% received screening plus indicated therapy, there would be 18,100-20,400 fewer deaths. Eliminating obesity yields 3300-5700 fewer breast cancer deaths versus continuation of current obesity levels. Maximal reductions in breast cancer deaths could be achieved through optimizing treatment use, followed by increasing screening use and obesity prevention. © 2013 American Cancer Society.

  18. Transient turbid water mass reduces temperature-induced coral bleaching and mortality in Barbados

    OpenAIRE

    Hazel A Oxenford; Vallès, Henri

    2016-01-01

    Global warming is seen as one of the greatest threats to the world’s coral reefs and, with the continued rise in sea surface temperature predicted into the future, there is a great need for further understanding of how to prevent and address the damaging impacts. This is particularly so for countries whose economies depend heavily on healthy reefs, such as those of the eastern Caribbean. Here, we compare the severity of bleaching and mortality for five dominant coral species at six representa...

  19. Does Prone Positioning Improve Oxygenation and Reduce Mortality in Patients with Acute Respiratory Distress Syndrome?

    Directory of Open Access Journals (Sweden)

    William R Henderson

    2014-01-01

    Full Text Available The emergence of computed tomography imaging more than 25 years ago led to characterization of acute respiratory distress syndrome (ARDS as areas of relatively normal lung parenchyma juxtaposed with areas of dense consolidation and atelectasis. Given that this heterogeneity is often dorsally distributed, investigators questioned whether care for ARDS patients in the prone position would lead to improved mortality outcomes. This clinical review discusses the physiological rationale and clinical evidence supporting prone positioning in treating ARDS, in addition to its complications and contraindications.

  20. Reducing maternal morbidity and mortality in the developing world: a simple, cost-effective example

    Directory of Open Access Journals (Sweden)

    Browning A

    2015-02-01

    Full Text Available Andrew Browning,1,2 Birhanu Menber21Maternity Africa, Arusha, Tanzania; 2Vision Maternity Care, Barhirdar, Ethiopia Objectives: To determine the impact of volunteer obstetricians and midwife teams on obstetric services in a rural hospital in Ethiopia.Methods: The intervention was undertaken in Mota district hospital, a rural hospital in the Amhara region of Ethiopia, which is the only hospital for 1.2 million people. Before the placement of volunteer teams it had a rudimentary basic obstetric service, no blood transfusion service, and no operative delivery. The study prospectively analyzed delivery data before, during, and after the placement of volunteer obstetrician and midwife teams. The volunteers established emergency obstetric care, and trained and supervised local staff over a 3-year period. Measurable outcomes consisted of the number of women delivering, the number of referrals of pregnant women, the number of maternal deaths, and the number of referrals of obstetric fistula patients.Results: With the establishment of the service the number of women attending hospital for delivery increased by 40%. In the hospital maternal mortality decreased from 7.1% to <0.5%, and morbidity, as measured by number of obstetric fistulae, decreased from 1.5% deliveries to 0.5% over the 3-year intervention period. The improvements were sustained after handing the project back to the government.Conclusion: The placement of volunteer teams was an effective method of decreasing maternal mortality and morbidity. Keywords: emergency obstetric care, volunteers, obstetric fistula, emergency obstetric care

  1. GIS as a community engagement tool: developing a plan to reduce infant mortality risk factors.

    Science.gov (United States)

    Detres, Maridelys; Lucio, Robert; Vitucci, Judi

    2014-07-01

    This article describes how a community coalition focusing on maternal and child health engages community participation through the use of geographic information systems (GIS) mapping, developing strategies that culminate in the implementation of a service delivery plan to improve birth outcomes. Vital statistics data from 2007 to 2009 was analyzed by zip code in Pinellas County Florida to produce choropleth thematic maps using ArcGIS for 3 year rolling average infant deaths and single year percentages for prematurity. The maps were presented at the organization's annual coalition meeting to discuss risk areas, changes over time in the selected indicators and solicit community feedback on how to best target issues addressing infant mortality and prematurity. The maps identified new zip codes of concern for prematurity in addition to known high risk zip codes for both infant mortality and prematurity. The community identified changes in demographic composition and changes in housing patterns, such as new mobile home areas, in the high risk areas. In response, the community assisted the Coalition in developing a holistic plan addressing risk factors affecting birth outcomes by expanding current services, hiring a nutritionist, and contracting a health navigator. When compared to tables and charts, a visual depiction of a neighborhood by recognizable zip codes is a useful tool to help community decision makers better visualize public health concerns and interpret trends based on local knowledge. Public health professionals should use this community knowledge to interpret research results and implement strategies to improve birth outcomes.

  2. Task shifting: A key strategy in the multipronged approach to reduce maternal mortality in India.

    Science.gov (United States)

    Bhushan, Himanshu; Bhardwaj, Ajey

    2015-10-01

    Task shifting from specialist to nonspecialist doctors (NSDs) is an important strategy that has been implemented in India to overcome the critical shortage of healthcare workers by using the human resources available to serve the vast population, particularly in rural areas. A competency-based training program in comprehensive emergency obstetric care was implemented to train and certify NSDs. Trained NSDs were able to provide key services in maternal health, which contribute toward reductions in maternal morbidity and mortality. The present article provides an overview of the maternal health challenges, shares important steps in program implementation, and shows how challenges can be overcome. The lessons learned from this experience contribute to understanding how task shifting can be used to address large-scale public health issues in low-resource countries and in particular solutions to address maternal health issues.

  3. Zoledronic Acid in Reducing Clinical Fracture and Mortality after Hip Fracture

    DEFF Research Database (Denmark)

    Lyles, Kenneth W; Colón-Emeric, Cathleen S; Magaziner, Jay S

    2007-01-01

    BACKGROUND: Mortality is increased after a hip fracture, and strategies that improve outcomes are needed. METHODS: In this randomized, double-blind, placebo-controlled trial, 1065 patients were assigned to receive yearly intravenous zoledronic acid (at a dose of 5 mg), and 1062 patients were...... assigned to receive placebo. The infusions were first administered within 90 days after surgical repair of a hip fracture. All patients received supplemental vitamin D and calcium. The median follow-up was 1.9 years. The primary end point was a new clinical fracture. RESULTS: The rates of any new clinical...... infusion of zoledronic acid within 90 days after repair of a low-trauma hip fracture was associated with a reduction in the rate of new clinical fractures and improved survival. (ClinicalTrials.gov number, NCT00046254.)....

  4. Reduce mortality risk above all else: a discrete-choice experiment in acute coronary syndrome patients.

    Science.gov (United States)

    Mühlbacher, Axel C; Bethge, Susanne

    2015-01-01

    Cardiovascular disease is the main cause of death in Germany and other industrialized countries. However, until now, little has been known about how people with acute coronary syndrome (ACS) value aspects of their medical treatment. The objective of this study was to evaluate patients' preferences regarding different antiplatelet medication options following an ACS. After identification of patient-relevant treatment attributes (a literature review and qualitative interviews), a discrete-choice experiment (DCE) including five patient-relevant attributes was conducted. The DCE used a forced-choice approach in which no "opt out" was present, as no treatment is not an option after ACS. The attribute and level combinations were created using a fractional-factorial NGene design with priors. Data analysis was performed using a random-effects logit model. An additional generalized linear latent and mixed models (GLLAMM) analysis was performed to evaluate subgroup differences. ACS patients (N = 683) participated in computer-assisted personal interviews. Preference analysis showed a clear dominance of the attribute "mortality risk" (coefficient: 0.803). Ranked second was "side effect: dyspnea" (coefficient: 0.550) followed by "risk of a new myocardial infarction" (coefficient: 0.464) and "side effect: bleeding" (coefficient: 0.400). "Frequency of intake" was less important (coefficient: 0.025). Within the 3-class GLLAMM, the variables "marital status" (p = 0.008), "highest level of education" (p = 0.003), and "body-mass index" (according to World Health Organization cluster; p = 0.014) showed a significant impact on the estimated class probabilities. Our study found "mortality risk" to be of the highest value for patients. Patient-centered care and decision making requires consideration of patient preferences; moreover, the information on preferences can be used to develop effective therapies after an ACS. The data generated will enable healthcare decision makers and

  5. The Mediterranean Diet Reduces the Risk and Mortality of the Prostate Cancer: A Narrative Review

    Directory of Open Access Journals (Sweden)

    Cristiano Capurso

    2017-08-01

    Full Text Available Prostate cancer is the second most common cancer in the world among men, and is the fifth most common cause of cancer death among men. The aim of our review was to analyze observational and case–control studies to point out the effects of overweight and diets components on the cancer risk, particularly on risk of prostate cancer, and the effect of the Mediterranean diet (MD on the reduction of risk and mortality of prostate cancer. It is known that incidence and progression of cancer is multifactorial. Cancer of the large bowel, breast, endometrium, and prostate are due also to a high body mass index and to high consumption of high carcinogenic dietary factors, as red and processed meat or saturated fats rich foods, and to a low consumption of vegetables and fruits. Previous meta-analysis suggested that high adherence to diet model based on the traditional MD pattern gives a significant protection from incidence and mortality of cancer of all types. The main component of the MD is olive oil, consumed in high amount by Mediterranean basin populations. In addition, phenolic compounds exert some strong chemo-preventive effects, which are due to several mechanisms, including both antioxidant effects and actions on cancer cell signaling and cell cycle progression and proliferation. The protective effect of the MD against the prostate cancer is also due to the high consumption of tomato sauce. Lycopene is the most relevant functional component in tomatoes; after activating by the cooking of tomato sauce, it exerts antioxidant properties by acting in the modulation of downregulation mechanisms of the inflammatory response. MD, therefore, represents a healthy dietary pattern in the context of a healthy lifestyle habits. In conclusion, our narrative review allows us to reaffirm how nutritional factors play an important role in cancer initiation and development, and how a healthy dietary pattern represented by MD and its components, especially olive oil

  6. Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review.

    NARCIS (Netherlands)

    Hahné, Susan J M; Charlett, André; Purcell, Bernadette; Samuelsson, Susanne; Camaroni, Ivonne; Ehrhard, Ingrid; Heuberger, Sigrid; Santamaria, Maria; Stuart, James M

    2006-01-01

    OBJECTIVE: To review the evidence for effectiveness of treatment with antibiotics before admission in reducing case fatality from meningococcal disease. DESIGN: Systematic review. DATA SOURCES: Cochrane register of trials and systematic reviews, database of abstracts of reviews of effectiveness, hea

  7. Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review.

    NARCIS (Netherlands)

    Hahné, Susan J M; Charlett, André; Purcell, Bernadette; Samuelsson, Susanne; Camaroni, Ivonne; Ehrhard, Ingrid; Heuberger, Sigrid; Santamaria, Maria; Stuart, James M

    2006-01-01

    OBJECTIVE: To review the evidence for effectiveness of treatment with antibiotics before admission in reducing case fatality from meningococcal disease. DESIGN: Systematic review. DATA SOURCES: Cochrane register of trials and systematic reviews, database of abstracts of reviews of effectiveness,

  8. Reduced clot strength upon admission, evaluated by thrombelastography (TEG, in trauma patients is independently associated with increased 30-day mortality

    Directory of Open Access Journals (Sweden)

    Thomsen Annemarie B

    2011-09-01

    Full Text Available Abstract Introduction Exsanguination due to uncontrolled bleeding is the leading cause of potentially preventable deaths among trauma patients. About one third of trauma patients present with coagulopathy on admission, which is associated with increased mortality and will aggravate bleeding in a traumatized patient. Thrombelastographic (TEG clot strength has previously been shown to predict outcome in critically ill patients. The aim of the present study was to investigate this relation in the trauma setting. Methods A retrospective study of trauma patients with an injury severity qualifying them for inclusion in the European Trauma Audit and Research Network (TARN and a TEG analysis performed upon arrival at the trauma centre. Results Eighty-nine patients were included. The mean Injury Severity Score (ISS was 21 with a 30-day mortality of 17%. Patients with a reduced clot strength (maximal amplitude Conclusion Low clot strength upon admission is independently associated with increased 30-day mortality in trauma patients and it could be speculated that targeted interventions based on the result of the TEG analysis may improve patient outcome. Prospective randomized trials investigating this potential are highly warranted.

  9. A Low Mortality, High Morbidity Reduced Intensity Status Epilepticus (RISE) Model of Epilepsy and Epileptogenesis in the Rat

    Science.gov (United States)

    Pérès, Isabelle A. A.; Hadid, Rebecca D.; Amada, Naoki; Hill, Charlotte; Williams, Claire; Stanford, Ian M.; Morris, Christopher M.; Jones, Roland S. G.; Whalley, Benjamin J.; Woodhall, Gavin L.

    2016-01-01

    Animal models of acquired epilepsies aim to provide researchers with tools for use in understanding the processes underlying the acquisition, development and establishment of the disorder. Typically, following a systemic or local insult, vulnerable brain regions undergo a process leading to the development, over time, of spontaneous recurrent seizures. Many such models make use of a period of intense seizure activity or status epilepticus, and this may be associated with high mortality and/or global damage to large areas of the brain. These undesirable elements have driven improvements in the design of chronic epilepsy models, for example the lithium-pilocarpine epileptogenesis model. Here, we present an optimised model of chronic epilepsy that reduces mortality to 1% whilst retaining features of high epileptogenicity and development of spontaneous seizures. Using local field potential recordings from hippocampus in vitro as a probe, we show that the model does not result in significant loss of neuronal network function in area CA3 and, instead, subtle alterations in network dynamics appear during a process of epileptogenesis, which eventually leads to a chronic seizure state. The model’s features of very low mortality and high morbidity in the absence of global neuronal damage offer the chance to explore the processes underlying epileptogenesis in detail, in a population of animals not defined by their resistance to seizures, whilst acknowledging and being driven by the 3Rs (Replacement, Refinement and Reduction of animal use in scientific procedures) principles. PMID:26909803

  10. Effectiveness of the clinical pharmacist in reducing mortality in hospitalized cardiac patients: a propensity score-matched analysis

    Directory of Open Access Journals (Sweden)

    Zhai XB

    2016-02-01

    . Results: Pharmacists were consulted by the physicians to correct any drug-related issues that they suspected may cause or contribute to a fatal outcome in the cardiology ward. A total of 1,541 interventions were suggested by the clinical pharmacist in the study group; 1,416 (92.0% of them were accepted by the cardiology team, and violation of incompatibilities had the highest percentage of acceptance by the cardiology team. All-cause mortality was 1.5% during Phase I (preintervention and was reduced to 0.9% during Phase II (postintervention, and the difference was statistically significant (P=0.0005. After PS matching, all-cause mortality changed from 1.7% during Phase I down to 1.0% during Phase II, and the difference was also statistically significant (P=0.0074. Conclusion: DRPs that were suspected to cause or contribute to a possibly fatal outcome were determined by clinical pharmacist service in patients hospitalized in a cardiology ward. Correction of these DRPs by physicians after pharmacist’s advice caused a significant decrease in mortality as analyzed by PS matching. The significant reduction in the mortality rate in this patient population observed in this study is “hypothesis generating” for future randomized studies. Keywords: drug-related problems, cardiology ward, clinical pharmacists, intervention, propensity score matching

  11. Cost-effectiveness of treatments reducing coronary heart disease mortality in Ireland, 2000 to 2010.

    LENUS (Irish Health Repository)

    Bennett, Kathleen

    2009-01-01

    OBJECTIVE: Coronary heart disease (CHD) is associated with a large burden of disease in Ireland and is responsible for more than 6000 deaths annually. This study examined the cost-effectiveness of specific CHD treatments in Ireland. METHODS: Irish epidemiological data on patient numbers and median survival in specific groups, plus the uptake, effectiveness, and costs of specific interventions, all stratified by age and sex, were incorporated into a previously validated CHD mortality model, the IMPACT model. This model calculates the number of life-years gained (LYGs) by specific cardiology interventions to generate incremental cost-effectiveness ratios (ICERs) per LYG for each intervention. RESULTS: In 2000, medical and surgical treatments together prevented or postponed approximately 1885 CHD deaths in patients aged 25 to 84 years, and thus generated approximately 14,505 extra life-years (minimum 7270, maximum 22,475). In general, all the cardiac interventions investigated were highly cost-effective in the Irish setting. Aspirin, beta-blockers, ACE inhibitors, spironolactone, and warfarin for specific conditions were the most cost-effective interventions (< euro 3000\\/LYG), followed by the statins for secondary prevention (< euro 6500\\/LYG). Revascularization for chronic angina and primary angioplasty for myocardial infarction, although still cost-effective, had the highest ICER (between euro 12,000 and euro 20,000\\/LYG). CONCLUSIONS: Using a comprehensive standardized methodology, cost-effectiveness ratios in this study clearly favored simple medical treatments for myocardial infarction, secondary prevention, angina, and heart failure.

  12. Does the Institution of a Statewide Trauma System Reduce Preventable Mortality and Yield a Positive Return on Investment for Taxpayers?

    Science.gov (United States)

    Maxson, Todd; Mabry, Charles D; Sutherland, Michael J; Robertson, Ronald D; Booker, James O; Collins, Terry; Spencer, Horace J; Rinker, Charles F; Sanddal, Teri L; Sanddal, Nels D

    2017-04-01

    In July 2009, Arkansas began to annually fund $20 million for a statewide trauma system (TS). We studied injury deaths both pre-TS (2009) and post-TS (2013 to 2014), with attention to causes of preventive mortality, societal cost of those preventable mortality deaths, and benefit to tax payers of the lives saved. A multi-specialty trauma-expert panel met and reviewed records of 672 decedents (290 pre-TS and 382 post-TS) who met standardized inclusion criteria, were judged potentially salvageable, and were selected by a proportional sampling of the roughly 2,500 annual trauma deaths. Deaths were adjudicated into sub-categories of nonpreventable and preventable causes. The value of lives lost was calculated for those lives potentially saved in the post-TS period. Total preventable mortality was reduced from 30% of cases pre-TS to 16% of cases studied post-TS, a reduction of 14%. Extrapolating a 14% reduction of preventable mortality to the post-TS study period, using the same inclusion criteria of the post-TS, we calculate that 79 lives were saved in 2013 to 2014 due to the institution of a TS. Using a minimal standard estimate of $100,000 value for a life-year, a lifetime value of $2,365,000 per person was saved. This equates to an economic impact of the lives saved of almost $186 million annually, representing a 9-fold return on investment from the $20 million of annual state funding invested in the TS. The implementation of a TS in Arkansas during a 5-year period resulted in a reduction of the preventable death rate to 16% post-TS, and a 9-fold return on investment by the tax payer. Additional life-saving gains can be expected with ongoing financial support and additional system performance-improvement efforts. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Adenosine A2A receptor activation reduces recurrence and mortality from Clostridium difficile infection in mice following vancomycin treatment

    Directory of Open Access Journals (Sweden)

    Li Yuesheng

    2012-12-01

    Full Text Available Abstract Background Activation of the A2A adenosine receptor (A2AAR decreases production of inflammatory cytokines, prevents C. difficile toxin A-induced enteritis and, in combination with antibiotics, increases survival from sepsis in mice. We investigated whether A2AAR activation improves and A2AAR deletion worsens outcomes in a murine model of C. difficile (strain VPI10463 infection (CDI. Methods C57BL/6 mice were pretreated with an antibiotic cocktail prior to infection and then treated with vancomycin with or without an A2AAR agonist. A2AAR-/- and littermate wild-type (WT mice were similarly infected, and IFNγ and TNFα were measured at peak of and recovery from infection. Results Infected, untreated mice rapidly lost weight, developed diarrhea, and had mortality rates of 50-60%. Infected mice treated with vancomycin had less weight loss and diarrhea during antibiotic treatment but mortality increased to near 100% after discontinuation of antibiotics. Infected mice treated with both vancomycin and an A2AAR agonist, either ATL370 or ATL1222, had minimal weight loss and better long-term survival than mice treated with vancomycin alone. A2AAR KO mice were more susceptible than WT mice to death from CDI. Increases in cecal IFNγ and blood TNFα were pronounced in the absence of A2AARs. Conclusion In a murine model of CDI, vancomycin treatment resulted in reduced weight loss and diarrhea during acute infection, but high recurrence and late-onset death, with overall mortality being worse than untreated infected controls. The administration of vancomycin plus an A2AAR agonist reduced inflammation and improved survival rates, suggesting a possible benefit of A2AAR agonists in the management of CDI to prevent recurrent disease.

  14. Leveraging human capital to reduce maternal mortality in India: enhanced public health system or public-private partnership?

    Directory of Open Access Journals (Sweden)

    Madhivanan Purnima

    2009-02-01

    Full Text Available Abstract Developing countries are currently struggling to achieve the Millennium Development Goal Five of reducing maternal mortality by three quarters between 1990 and 2015. Many health systems are facing acute shortages of health workers needed to provide improved prenatal care, skilled birth attendance and emergency obstetric services – interventions crucial to reducing maternal death. The World Health Organization estimates a current deficit of almost 2.4 million doctors, nurses and midwives. Complicating matters further, health workforces are typically concentrated in large cities, while maternal mortality is generally higher in rural areas. Additionally, health care systems are faced with shortages of specialists such as anaesthesiologists, surgeons and obstetricians; a maldistribution of health care infrastructure; and imbalances between the public and private health care sectors. Increasingly, policy-makers have been turning to human resource strategies to cope with staff shortages. These include enhancement of existing work roles; substitution of one type of worker for another; delegation of functions up or down the traditional role ladder; innovation in designing new jobs;transfer or relocation of particular roles or services from one health care sector to another. Innovations have been funded through state investment, public-private partnerships and collaborations with nongovernmental organizations and quasi-governmental organizations such as the World Bank. This paper focuses on how two large health systems in India – Gujarat and Tamil Nadu – have successfully applied human resources strategies in uniquely different contexts to the challenges of achieving Millennium Development Goal Five.

  15. Social Audits for Community Action: A tool to Initiate Community Action for Reducing Child Mortality

    Directory of Open Access Journals (Sweden)

    Nandan D

    2005-01-01

    Full Text Available Research question : (i What is the community′s perception (assessment & analysis of causes underlying neonatal, infant and under five deaths? (ii What action does the community take thereafter? Objectives : To stimulate the community to assess and analyze the causes and underlying social delays responsible for neonatal, infant and under five deaths in their villages and subsequently take collective action to prevent these deaths in future using Social Audits for Community Action (SACA. Design : Retrospective Participatory study. Setting : Rural community development blocks, district Agra, Uttar Pradesh. Material and Methods : SACA were conducted in a total of 152 villages of Fathehpur Sikri and Bichpuri blocks of district Agra, U.P. One SACA was conducted in each of the 211 anganwadi catchment areas, wherein 10-15 women from different socio-clusters of the community participated in a participatory discussion on issues pertaining to number of births and deaths of children less than five years of age in the last one-year. Results : 7656 live births and 749 under-five deaths were reported during the year 2002. The neonatal, infant and under-five mortality rate was 39.4, 73.5 and 85 per 1,000 live births respectively. Hypothermia, pneumonia, birth asphyxia, prematurity and low birth weight emerged as major causes of neonatal deaths. Majority of deaths of infants and children 1-5 years of age were found to have occurred due to severe malnutrition and diarrhoea. The community realized that majority of deaths occurred because of the delay in recognition of the seriousness of problem, delay in taking decision to seek appropriate care and delay in arranging transport/money. Subsequently, behaviour change communication strategies were re-defined to help community assess signs of illness and take preparedness measures to prevent child deaths in future. Conclusion : Strategies like dialoguing with the community using social audits for community action is

  16. Vegetation management for reducing mortality of ponderosa pine seedlings from Thomomys spp

    Science.gov (United States)

    Barnes, V.G.; Anthony, M.; ,

    1995-01-01

    The effects of vegetation management on Mazama pocket gopher activity and damage to ponderosa pine seedlings were studied using atrazine herbicide to alter the habitat. Atrazine treatments were applied to a large treatment unit and observed effects were compared to an untreated control unit. The greatly reduced forb and grass cover on the treated unit was associated with a corresponding decrease in pocket gopher activity. Times until seedlings first incurred gopher damage and overall survival of two cohorts of seedlings were greatly increased on the treated unit.

  17. (18)F-FDG PET/CT Optimizes Treatment in Staphylococcus Aureus Bacteremia and Is Associated with Reduced Mortality.

    Science.gov (United States)

    Berrevoets, Marvin A H; Kouijzer, Ilse J E; Aarntzen, Erik H J G; Janssen, Marcel J R; De Geus-Oei, Lioe-Fee; Wertheim, Heiman F L; Kullberg, Bart-Jan; Oever, Jaap Ten; Oyen, Wim J G; Bleeker-Rovers, Chantal P

    2017-09-01

    Metastatic infection is an important complication of Staphylococcus aureus bacteremia (SAB). Early diagnosis of metastatic infection is crucial, because specific treatment is required. However, metastatic infection can be asymptomatic and difficult to detect. In this study, we investigated the role of (18)F-FDG PET/CT in patients with SAB for detection of metastatic infection and its consequences for treatment and outcome. Methods: All patients with SAB at Radboud University Medical Center were included between January 2013 and April 2016. Clinical data and results of (18)F-FDG PET/CT and other imaging techniques, including echocardiography, were collected. Primary outcomes were newly diagnosed metastatic infection by (18)F-FDG PET/CT, subsequent treatment modifications, and patient outcome. Results: A total of 184 patients were included, and (18)F-FDG PET/CT was performed in 105 patients, of whom 99 had a high-risk bacteremia. (18)F-FDG PET/CT detected metastatic infectious foci in 73.7% of these high-risk patients. In 71.2% of patients with metastatic infection, no signs and symptoms suggesting metastatic complications were present before (18)F-FDG PET/CT was performed. (18)F-FDG PET/CT led to a total of 104 treatment modifications in 74 patients. Three-month mortality was higher in high-risk bacteremia patients without (18)F-FDG PET/CT performed than in those in whom (18)F-FDG PET/CT was performed (32.7% vs. 12.4%, P = 0.003). In multivariate analysis, (18)F-FDG PET/CT was the only factor independently associated with reduced mortality (P = 0.005; odds ratio, 0.204; 95% confidence interval, 0.066-0.624). A higher comorbidity score was independently associated with increased mortality (P = 0.003; odds ratio, 1.254; 95% confidence interval, 1.078-1.457). Conclusion:(18)F-FDG PET/CT is a valuable technique for early detection of metastatic infectious foci, often leading to treatment modification. Performing (18)F-FDG PET/CT is associated with significantly reduced

  18. Dietary S-Allyl-L-cysteine Reduces Mortality with Decreased Incidence of Stroke and Behavioral Changes in Stroke-Prone Spontaneously Hypertensive Rats

    National Research Council Canada - National Science Library

    KIM, Ji-Myung; CHANG, Namsoo; KIM, Won-Ki; CHUN, Hyang Sook

    2006-01-01

    S-Allyl-L-cysteine (SAC), an active organosulfur compound derived from garlic, was found to reduce mortality with lesser incidence of stroke and also to lower the overall stroke-related behavioral score in stroke-prone...

  19. Well-tolerated Spirulina extract inhibits influenza virus replication and reduces virus-induced mortality.

    Science.gov (United States)

    Chen, Yi-Hsiang; Chang, Gi-Kung; Kuo, Shu-Ming; Huang, Sheng-Yu; Hu, I-Chen; Lo, Yu-Lun; Shih, Shin-Ru

    2016-04-12

    Influenza is one of the most common human respiratory diseases, and represents a serious public health concern. However, the high mutability of influenza viruses has hampered vaccine development, and resistant strains to existing anti-viral drugs have also emerged. Novel anti-influenza therapies are urgently needed, and in this study, we describe the anti-viral properties of a Spirulina (Arthrospira platensis) cold water extract. Anti-viral effects have previously been reported for extracts and specific substances derived from Spirulina, and here we show that this Spirulina cold water extract has low cellular toxicity, and is well-tolerated in animal models at one dose as high as 5,000 mg/kg, or 3,000 mg/kg/day for 14 successive days. Anti-flu efficacy studies revealed that the Spirulina extract inhibited viral plaque formation in a broad range of influenza viruses, including oseltamivir-resistant strains. Spirulina extract was found to act at an early stage of infection to reduce virus yields in cells and improve survival in influenza-infected mice, with inhibition of influenza hemagglutination identified as one of the mechanisms involved. Together, these results suggest that the cold water extract of Spirulina might serve as a safe and effective therapeutic agent to manage influenza outbreaks, and further clinical investigation may be warranted.

  20. Drought reduces chytrid fungus (Batrachochytrium dendrobatidis) infection intensity and mortality but not prevalence in adult crawfish frogs (Lithobates areolatus).

    Science.gov (United States)

    Terrell, Vanessa C K; Engbrecht, Nathan J; Pessier, Allan P; Lannoo, Michael J

    2014-01-01

    To fully understand the impacts of the chytrid fungus Batrachochytrium dendrobatidis (Bd) on amphibians it is necessary to examine the interactions between populations and their environment. Ecologic variables can exacerbate or ameliorate Bd prevalence and infection intensity, factors that are positively related when Bd is acting on naive amphibian populations as an epidemic disease. In crawfish frogs (Lithobates areolatus), a North American species with a complex life history, we have shown that Bd acts as an endemic disease with impacts that vary seasonally; the highest infection prevalences and intensities and highest frog mortality occurred during late spring in postbreeding individuals. In this study, conducted between 28 February and 23 August 2011 in southwestern Indiana on the same population, we report an uncoupling of the previously observed relationship between Bd prevalence and intensity following an extreme drought. Specifically, there was a postdrought reduction in Bd infection intensity and mortality, but not in infection prevalence. This result suggests that the relationship between prevalence and intensity observed in Bd epidemics can be uncoupled in populations harboring endemic infections. Further, constant prevalence rates suggest either that crawfish frogs are being exposed to Bd sources independent of ambient moisture or that low-level infections below detection thresholds persist from year to year. Drought has several ecologically beneficial effects for amphibians with complex life histories, including eliminating fish and invertebrate populations that feed on larvae. To these ecologic benefits we suggest another, that drought can reduce the incidence of the severe skin disease (chytridiomycosis) due to Bd infection.

  1. Outdoor air pollution as a possible modifiable risk factor to reduce mortality in post-stroke population.

    Science.gov (United States)

    Desikan, Anita

    2017-03-01

    Outdoor air pollution is a known risk factor for mortality and morbidity. The type of air pollutant most reliably associated with disease is particulate matter (PM), especially finer particulate matter that can reach deeper into the lungs like PM2.5 (particulate matter diameter pollution. This review focuses on one subgroup, long-term stroke survivors, and the emerging evidence suggesting that survivors of a stroke may be at a higher risk from the deleterious effects of PM pollution. While the mechanisms for mortality are still under debate, long-term stroke survivors may be vulnerable to similar mechanisms that underlie the well-established association between PM pollution and cardiovascular disease. The fact that long-term stroke survivors of ischemic, but not hemorrhagic, strokes appear to be more vulnerable to the risk of death from higher PM pollution may also bolster the connection to ischemic heart disease. Survivors of an ischemic stroke may be more vulnerable to dying from higher concentrations of PM pollution than the general population. The clinical implications of this association suggest that reduced exposure to PM pollution may result in fewer deaths amongst stroke survivors.

  2. Reduced in-hospital mortality after improved management of children under 5 years admitted to hospital with malaria

    DEFF Research Database (Denmark)

    Biai, Sidu; Rodrigues, Amabelia; Gomes, Melba

    2007-01-01

    in the use of the standardised guidelines for the management of malaria, including strict follow-up procedures. Nurses and doctors were randomised to work on intervention or control wards. Personnel in the intervention ward received a small financial incentive ($50 (25 pounds sterling; 35 euros......OBJECTIVE: To test whether strict implementation of a standardised protocol for the management of malaria and provision of a financial incentive for health workers reduced mortality. DESIGN: Randomised controlled intervention trial. SETTING: Paediatric ward at the national hospital in Guinea......-Bissau. All children admitted to hospital with severe malaria received free drug kits. PARTICIPANTS: 951 children aged 3 months to 5 years admitted to hospital with a diagnosis of malaria randomised to normal or intervention wards. INTERVENTIONS: Before the start of the study, all personnel were trained...

  3. Quinolizidine alkaloids reduced mortality in EV71-infected mice by compensating for the levels of T cells.

    Science.gov (United States)

    Yang, Yajun; Guan, Feifei; Bai, Lin; Zhang, Li; Liu, Jiangning; Pan, Xiandao; Zhang, Lianfeng

    2015-09-01

    Recent outbreak of hand, foot and mouse disease caused by enterovirus 71 is a serious threat to infants and children in Asia-Pacific countries. No vaccines or antiviral therapies are available against this infection. In this study, we found that quinolizidine alkaloids could improve the levels of T cells in mice. The structure-activity relationships demonstrated that the oxidation and double bonds are important for the excellent potency. Oxysophocarpine, the most effective compound of six quinolizidine alkaloids, could also relieve symptoms and reduce mortality in lethal enterovirus 71-infected mice through compensating for the decreased levels of T cells. This work suggested that quinolizidine alkaloids have the potential against enterovirus 71 for further development of novel antiviral drugs.

  4. Reduced childhood mortality after standard measles vaccination at 4-8 months compared with 9-11 months of age

    DEFF Research Database (Denmark)

    Aaby, Peter; Andersen, M; Sodemann, Morten

    1993-01-01

    To evaluate the impact on mortality of standard Schwarz measles immunisation before 9 months of age.......To evaluate the impact on mortality of standard Schwarz measles immunisation before 9 months of age....

  5. Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock.

    Science.gov (United States)

    Andriolo, Brenda Ng; Andriolo, Regis B; Salomão, Reinaldo; Atallah, Álvaro N

    2017-01-18

    Serum procalcitonin (PCT) evaluation has been proposed for early diagnosis and accurate staging and to guide decisions regarding patients with sepsis, severe sepsis and septic shock, with possible reduction in mortality. To assess the effectiveness and safety of serum PCT evaluation for reducing mortality and duration of antimicrobial therapy in adults with sepsis, severe sepsis or septic shock. We searched the Central Register of Controlled Trials (CENTRAL; 2015, Issue 7); MEDLINE (1950 to July 2015); Embase (Ovid SP, 1980 to July 2015); Latin American Caribbean Health Sciences Literature (LILACS via BIREME, 1982 to July 2015); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO host, 1982 to July 2015), and trial registers (ISRCTN registry, ClinicalTrials.gov and CenterWatch, to July 2015). We reran the search in October 2016. We added three studies of interest to a list of 'Studies awaiting classification' and will incorporate these into formal review findings during the review update. We included only randomized controlled trials (RCTs) testing PCT-guided decisions in at least one of the comparison arms for adults (≥ 18 years old) with sepsis, severe sepsis or septic shock, according to international definitions and irrespective of the setting. Two review authors extracted study data and assessed the methodological quality of included studies. We conducted meta-analysis with random-effects models for the following primary outcomes: mortality and time spent receiving antimicrobial therapy in hospital and in the intensive care unit (ICU), as well as time spent on mechanical ventilation and change in antimicrobial regimen from a broad to a narrower spectrum. We included 10 trials with 1215 participants. Low-quality evidence showed no significant differences in mortality at longest follow-up (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.65 to 1.01; I(2) = 10%; 10 trials; N = 1156), at 28 days (RR 0.89, 95% CI 0.61 to 1.31; I(2

  6. Reduced Hospital Mortality With Surgical Ligation of Patent Ductus Arteriosus in Premature, Extremely Low Birth Weight Infants: A Propensity Score-matched Outcome Study.

    Science.gov (United States)

    Tashiro, Jun; Perez, Eduardo A; Sola, Juan E

    2016-03-01

    To evaluate outcomes after surgical ligation (SL) of patent ductus arteriosus (PDA) in premature, extremely low birth weight (ELBW) infants. Optimal management of PDA in this specialized population remains undefined. Currently, surgical therapy is largely reserved for infants failing medical management. To date, a large-scale, risk-matched population-based study has not been performed to evaluate differences in mortality and resource utilization. Data on identified premature (Propensity score-matched analysis of 1620 SL versus 1584 non-SL found reduced mortality (15% vs 26%) and more routine disposition (48% vs 41%) for SL (P Propensity score-matched analysis demonstrates reduced mortality in premature/ELBW infants with SL for PDA. NEC and sepsis are predictors of mortality and resource utilization.

  7. Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality

    Directory of Open Access Journals (Sweden)

    Berman Stuart

    2011-04-01

    Full Text Available Abstract Background Globally syphilis is an important yet preventable cause of stillbirth, neonatal mortality and morbidity. Objectives This review sought to estimate the effect of detection and treatment of active syphilis in pregnancy with at least 2.4MU benzathine penicillin (or equivalent on syphilis-related stillbirths and neonatal mortality. Methods We conducted a systematic literature review of multiple databases to identify relevant studies. Data were abstracted into standardised tables and the quality of evidence was assessed using adapted GRADE criteria. Where appropriate, meta-analyses were undertaken. Results Moderate quality evidence (3 studies supports a reduction in the incidence of clinical congenital syphilis of 97% (95% c.i 93 – 98% with detection and treatment of women with active syphilis in pregnancy with at least 2.4MU penicillin. The results of meta-analyses suggest that treatment with penicillin is associated with an 82% reduction in stillbirth (95% c.i. 67 – 90% (8 studies, a 64% reduction in preterm delivery (95% c.i. 53 – 73% (7 studies and an 80% reduction in neonatal deaths (95% c.i. 68 – 87% (5 studies. Although these effect estimates were large and remarkably consistent across studies, few of the studies adjusted for potential confounding factors and thus the overall quality of the evidence was considered low. However, given these large observed effects and a clear biological mechanism for effectiveness the GRADE recommendation is strong. Conclusion Detection and appropriate, timely penicillin treatment is a highly effective intervention to reduce adverse syphilis-related pregnancy outcomes. More research is required to identify the most cost-effective strategies for achieving maximum coverage of screening for all pregnant women, and access to treatment if required.

  8. OK-432 reduces mortality and bacterial translocation in irradiated and granulocyte-colony stimulating factor (G-CSF)-treated mice

    Energy Technology Data Exchange (ETDEWEB)

    Nose, Masako; Uzawa, Akiko; Ogyu, Toshiaki [National Inst. of Radiological Sciences, Chiba (Japan); Suzuki, Gen

    2001-06-01

    Acute radiation induces bacterial translocation from the gut, followed by systemic infection and sepsis. In order to reduce the mortality after acute whole body irradiation, it is essential to control bacterial translocation. In this study, we established a bacterial translocation assay as a sensitive method to detect minor mucosal injury by radiation. By utilizing this assay, we evaluated the adverse effects, if any, of hematopoietic reagents on the mucosal integrity in the respiratory and gastro-intestinal tracts. Bacterial translocation to the liver and spleen occurred after whole-body irradiation if the dose exceeded 6 Gy. The administration of G-CSF unexpectedly increased the bacterial translocation in 8 Gy-irradiated mice. The pharmaceutical preparation of low-virulent Streptococcus pyogenes, OK-432, significantly reduced the endotoxin levels in peripheral blood without any reduction of bacterial translocation. A combined treatment with G-CSF and OK-432 decreased bacterial translocation and prevented death. This result indicates that the early administration of G-CSF has an adverse effect on bacterial translocation, and that a combined treatment of G-CSF and OK-432 attenuates the adverse effect of G-CSF and improves the survival rate after acute irradiation. (author)

  9. In Ovo Delivery of CpG DNA Reduces Avian Infectious Laryngotracheitis Virus Induced Mortality and Morbidity

    Directory of Open Access Journals (Sweden)

    Simrika Thapa

    2015-04-01

    Full Text Available Endosomal toll-like receptor-21 and -9 sense CpG DNA activating production of pro-inflammatory mediators with antimicrobial effects. Here, we investigated the induction of antiviral response of in ovo delivered CpG DNA against infectious laryngotracheitis virus (ILTV infection. We found that in ovo delivered CpG DNA significantly reduces ILTV infection pre-hatch correlating with the expression of IL-1β and increase of macrophages in lungs. As assessed in vitro, CpG DNA stimulated avian macrophages could be a potential source of IL-1β and other pro-inflammatory mediators. Since we also found that in ovo CpG DNA delivery maintains increased macrophages in the lungs post-hatch, we infected the chickens on the day of hatch with ILTV. We found that in ovo delivered CpG DNA significantly reduces mortality and morbidity resulting from ILTV infection encountered post-hatch. Thus, CpG DNA can be a candidate innate immune stimulant worthy of further investigation for the control of ILTV infection in chickens.

  10. Malaria prevention reduces in-hospital mortality among severely ill tuberculosis patients: a three-step intervention in Bissau, Guinea-Bissau

    Directory of Open Access Journals (Sweden)

    Vieira Fina

    2011-03-01

    Full Text Available Abstract Background Malaria and Tuberculosis (TB are important causes of morbidity and mortality in Africa. Malaria prevention reduces mortality among HIV patients, pregnant women and children, but its role in TB patients is not clear. In the TB National Reference Center in Guinea-Bissau, admitted patients are in severe clinical conditions and mortality during the rainy season is high. We performed a three-step malaria prevention program to reduce mortality in TB patients during the rainy season. Methods Since 2005 Permethrin treated bed nets were given to every patient. Since 2006 environmental prevention with permethrin derivates was performed both indoor and outdoor during the rainy season. In 2007 cotrimoxazole prophylaxis was added during the rainy season. Care was without charge; health education on malaria prevention was performed weekly. Primary outcomes were death, discharge, drop-out. Results 427, 346, 549 patients were admitted in 2005, 2006, 2007, respectively. Mortality dropped from 26.46% in 2005 to 18.76% in 2007 (p-value 0.003, due to the significant reduction in rainy season mortality (death/discharge ratio: 0.79, 0.55 and 0.26 in 2005, 2006 and 2007 respectively; p-value 0.001 while dry season mortality remained constant (0.39, 0.37 and 0.32; p-value 0.647. Costs of malaria prevention were limited: 2€/person. No drop-outs were observed. Health education attendance was 96-99%. Conclusions Malaria prevention in African tertiary care hospitals seems feasible with limited costs. Vector control, personal protection and cotrimoxazole prophylaxis seem to reduce mortality in severely ill TB patients. Prospective randomized trials are needed to confirm our findings in similar settings. Trial registration number Current Controlled Trials: ISRCTN83944306

  11. Emergency obstetric care in Pakistan: potential for reduced maternal mortality through improved basic EmOC facilities, services, and access.

    Science.gov (United States)

    Ali, M; Hotta, M; Kuroiwa, C; Ushijima, H

    2005-10-01

    To ascertain and compare compliance with UN emergency obstetric care (EmOC) recommendations by public health care centers in Pakistan's Punjab and Northwest Frontier Province (NWFP) provinces. Cross-sectional data were collected from July through September 2003 using UN process indicators. From each province, 30% of districts (n=19); were randomly selected; all public health facilities providing EmOC services (n=170) were included. The study found that out of 170 facilities only 22 were providing basic and 37 comprehensive EmOC services in the areas studied. Only 5.7% of births occurred in EmOC health facilities. Met need was 9% and 0.5% of women gave birth by cesarean section. The case fatality rate was a low 0.7%, probably due to poor record keeping. Access and several indicators were better in NWFP than in Punjab. Almost all indicators were below UN recommendations. Health policy makers and planners must take immediate, appropriate measures at district and hospital levels to reduce maternal mortality.

  12. Age effects in monetary valuation of reduced mortality risks: the relevance of age-specific hazard rates.

    Science.gov (United States)

    Leiter, Andrea M

    2011-08-01

    This paper highlights the relevance of age-specific hazard rates in explaining the age variation in "value of statistical life" (VSL) figures. The analysis-which refers to a stated preference framework-contributes to the ongoing discussion of whether benefits resulting from reduced mortality risk should be valued differently depending on the age of the beneficiaries. By focussing on a life-threatening environmental phenomenon I show that the consideration of the individual's age-specific hazard rate is important. If a particular risk affects all individuals regardless of their age so that their hazard rate is age-independent, VSL is rather constant for people at different age; if hazard rate varies with age, VSL estimates are sensitive to age. The results provide an explanation for the mixed outcomes in empirical studies and illustrate in which cases an adjustment to age may or may not be justified. Efficient provision of live-saving measures requires that such differences to be taken into account.

  13. Role of birth spacing, family planning services, safe abortion services and post-abortion care in reducing maternal mortality.

    Science.gov (United States)

    Ganatra, Bela; Faundes, Anibal

    2016-10-01

    Access to contraception reduces maternal deaths by preventing or delaying pregnancy in women who do not intend to be pregnant or those at higher risk of complications. However, not all unintended pregnancies can be prevented through increase in contraceptive use, and access to safe abortion is needed to prevent unsafe abortions. Despite not preventing the problem, provision of emergency care for complications can help prevent deaths from such unsafe abortions. Safe abortion in early pregnancy can be provided at primary care level and by non-physician providers, and the risks of mortality associated with such safe, legal abortions are minimal. Although entirely preventable, unsafe abortions continue to occur because of numerous barriers such as legal and policy restrictions, service delivery issues and provider attitudes to abortion stigma. Overall, the provision of contraception and safe abortion is important not just to prevent maternal deaths but as a measure of our ability to respect women's decisions and ensure that they have access to timely, evidence-based care that protects their health and human rights. Copyright © 2016. Published by Elsevier Ltd.

  14. [Improved Blood Pressure Control to Reduce Cardiovascular Disease Morbidity and Mortality: The Standardized Hypertension Treatment and Prevention Project].

    Science.gov (United States)

    Patel, Pragna; Ordunez, Pedro; DiPette, Donald; Escobar, María Cristina; Hassell, Trevor; Wyss, Fernando; Hennis, Anselm; Asma, Samira; Angell, Sonia

    2017-06-08

    Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure. To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems-strengthening approach that advocates for standardized hypertension management using evidence-based interventions. These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care (task shifting), and community engagement. With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality.

  15. Mexico's path towards the Sustainable Development Goal for health: an assessment of the feasibility of reducing premature mortality by 40% by 2030.

    Science.gov (United States)

    González-Pier, Eduardo; Barraza-Lloréns, Mariana; Beyeler, Naomi; Jamison, Dean; Knaul, Felicia; Lozano, Rafael; Yamey, Gavin; Sepúlveda, Jaime

    2016-10-01

    The United Nations Sustainable Development Goal for health (SDG3) poses complex challenges for signatory countries that will require clear roadmaps to set priorities over the next 15 years. Building upon the work of the Commission on Investing in Health and published estimates of feasible global mortality SDG3 targets, we analysed Mexico's mortality to assess the feasibility of reducing premature (0-69 years) mortality and propose a path to meet SDG3. We developed a baseline scenario applying 2010 age-specific and cause-specific mortality rates from the Mexican National Institute of Statistics and Geography (INEGI) to the 2030 UN Population Division (UNPD) population projections. In a second scenario, INEGI age-specific and cause-specific trends in death rates from 2000 to 2014 were projected to 2030 and adjusted to match the UNPD 2030 mortality projections. A third scenario assumed a 40% reduction in premature deaths across all ages and causes. By comparing these scenarios we quantified shortfalls in mortality reductions by age group and cause, and forecasted life expectancy pathways for Mexico to converge to better performing countries. UNPD-projected death rates yield a 25·9% reduction of premature mortality for Mexico. Accelerated reductions in adult mortality are necessary to reach a 40% reduction by 2030. Mortality declines aggregated across all age groups mask uneven gains across health disorders. Injuries, particularly road traffic accidents and homicides, are the main health challenge for young adults (aged 20-49 years) whereas unabated diabetes mortality is the single most important health concern for older adults (aged 50-69 years). Urgent action is now required to control non-communicable diseases and reduce fatal injuries in Mexico, making a 40% reduction in premature mortality by 2030 feasible and putting Mexico back on a track of substantial life expectancy convergence with better performing countries. Our study provides a roadmap for setting

  16. Sabiporide improves cardiovascular function, decreases the inflammatory response and reduces mortality in acute metabolic acidosis in pigs.

    Directory of Open Access Journals (Sweden)

    Dongmei Wu

    Full Text Available INTRODUCTION: Acute metabolic acidosis impairs cardiovascular function and increases the mortality of critically ill patients. However, the precise mechanism(s underlying these effects remain unclear. We hypothesized that targeting pH-regulatory protein, Na(+/H(+ exchanger (NHE1 could be a novel approach for the treatment of acute metabolic acidosis. The aim of the present study was to examine the impact of a novel NHE1 inhibitor, sabiporide, on cardiovascular function, blood oxygen transportation, and inflammatory response in an experimental model of metabolic acidosis produced by hemorrhage-induced hypovolemia followed by an infusion of lactic acid. METHODS AND RESULTS: Anesthetized pigs were subjected to hypovolemia for 30 minutes. The animals then received a bolus infusion of sabiporide (3 mg/kg or vehicle, followed by an infusion of lactic acid for 2 hours. The animals were continuously monitored for additional 3 hours. Hypovolemia followed by a lactic acid infusion resulted in a severe metabolic acidosis with blood pH falling to 6.8. In association with production of the acidemia, there was an excessive increase in pulmonary artery pressure (PAP and pulmonary vascular resistance (PVR. Treatment with sabiporide significantly attenuated the increase in PAP by 38% and PVR by 67%, as well as significantly improved cardiac output by 51%. Sabiporide treatment also improved mixed venous blood oxygen saturation (55% in sabiporide group vs. 28% in control group, and improved systemic blood oxygen delivery by 36%. In addition, sabiporide treatment reduced plasma levels of TNF-α (by 33%, IL-6 (by 63%, troponin-I (by 54%, ALT (by 34%, AST (by 35%, and urea (by 40%. CONCLUSION: These findings support the possible beneficial effects of sabiporide in the treatment of acute metabolic acidosis and could have implications for the treatment of metabolic acidosis in man.

  17. Prediction of cardiovascular disease mortality by proteinuria and reduced kidney function: pooled analysis of 39,000 individuals from 7 cohort studies in Japan.

    Science.gov (United States)

    Nagata, Masaharu; Ninomiya, Toshiharu; Kiyohara, Yutaka; Murakami, Yoshitaka; Irie, Fujiko; Sairenchi, Toshimi; Miura, Katsuyuki; Okamura, Tomonori; Ueshima, Hirotsugu

    2013-07-01

    There are limited studies addressing whether proteinuria and estimated glomerular filtration rate (eGFR) are independently associated with cardiovascular disease in Asia. Using data from 7 prospective cohorts recruited between 1980 and 1994 in Japan, we assessed the influence of proteinuria (≥1+ on dipstick) and reduced eGFR on the risk of cardiovascular disease mortality in 39,405 participants (40-89 years) without kidney failure. During a 10.1-year follow-up, 1,927 subjects died from cardiovascular disease. Proteinuria was associated with a 1.75-fold (95% confidence interval (CI): 1.44, 2.11) increased risk of cardiovascular disease mortality after adjustment for potential confounding factors. Additionally, the multivariate-adjusted hazard ratio of cardiovascular disease mortality increased linearly with lower eGFR levels (P(trend) cardiovascular disease mortality than those with eGFR of ≥90 mL/minute/1.73 m². Subjects with both proteinuria and eGFR of cardiovascular disease mortality compared with those with neither of these risk factors. There was no evidence of interaction in the relationship between proteinuria and lower eGFR (P(interaction) = 0.77). The present results suggest that proteinuria and lower eGFR are independent risk factors for cardiovascular disease mortality in the Japanese population.

  18. Reduced-intensity conditioning lowers treatment-related mortality of allogeneic stem cell transplantation for chronic lymphocytic leukemia : a population-matched analysis

    NARCIS (Netherlands)

    Dreger, P; Brand, R; Milligan, D; Corradini, P; Finke, J; Deliliers, GL; Martino, R; Russell, N; van Biezen, A; Michallet, M; Niederwieser, D

    2005-01-01

    To elucidate whether reduced-intensity conditioning (RIC) decreases treatment-related mortality (TRM) after allogeneic stem cell transplantation (allo-SCT) for chronic lymphocytic leukemia (CLL), we retrospectively compared 73 RIC cases from a recent EBMT survey with 82 patients from the EBMT databa

  19. Attraction and mortality of Bactrocera dorsalis to STATIC Spinosad ME weathered under operational conditions in California and Florida: A reduced-risk male annihilation treatment

    Science.gov (United States)

    Studies were conducted in 2013 in Hawaii, USA, to quantify attraction, feeding, and mortality of male oriental fruit flies, Bactrocera dorsalis (Hendel)(Diptera: Tephritidae), to a reduced risk male annihilation treatment(MAT)formulation consisting of an amorphous polymer matrix in combination with...

  20. Lifesaving emergency obstetric services are inadequate in south-west Ethiopia: a formidable challenge to reducing maternal mortality in Ethiopia

    Science.gov (United States)

    2013-01-01

    Background Most maternal deaths take place during labour and within a few weeks after delivery. The availability and utilization of emergency obstetric care facilities is a key factor in reducing maternal mortality; however, there is limited evidence about how these institutions perform and how many people use emergency obstetric care facilities in rural Ethiopia. We aimed to assess the availability, quality, and utilization of emergency obstetric care services in the Gamo Gofa Zone of south-west Ethiopia. Methods We conducted a retrospective review of three hospitals and 63 health centres in Gamo Gofa. Using a retrospective review, we recorded obstetric services, documents, cards, and registration books of mothers treated and served in the Gamo Gofa Zone health facilities between July 2009 and June 2010. Results There were three basic and two comprehensive emergency obstetric care qualifying facilities for the 1,740,885 people living in Gamo Gofa. The proportion of births attended by skilled attendants in the health facilities was 6.6% of expected births, though the variation was large. Districts with a higher proportion of midwives per capita, hospitals and health centres capable of doing emergency caesarean sections had higher institutional delivery rates. There were 521 caesarean sections (0.8% of 64,413 expected deliveries and 12.3% of 4,231 facility deliveries). We recorded 79 (1.9%) maternal deaths out of 4,231 deliveries and pregnancy-related admissions at institutions, most often because of post-partum haemorrhage (42%), obstructed labour (15%) and puerperal sepsis (15%). Remote districts far from the capital of the Zone had a lower proportion of institutional deliveries (4% of deliveries, much higher than the average 1.9%). Conclusion Based on a population of 1.7 million people, there should be 14 basic and four comprehensive emergency obstetric care (EmOC) facilities in the Zone. Our study found that only three basic and two comprehensive EmOC service

  1. Lifesaving emergency obstetric services are inadequate in south-west Ethiopia: a formidable challenge to reducing maternal mortality in Ethiopia.

    Science.gov (United States)

    Girma, Meseret; Yaya, Yaliso; Gebrehanna, Ewenat; Berhane, Yemane; Lindtjørn, Bernt

    2013-11-04

    Most maternal deaths take place during labour and within a few weeks after delivery. The availability and utilization of emergency obstetric care facilities is a key factor in reducing maternal mortality; however, there is limited evidence about how these institutions perform and how many people use emergency obstetric care facilities in rural Ethiopia. We aimed to assess the availability, quality, and utilization of emergency obstetric care services in the Gamo Gofa Zone of south-west Ethiopia. We conducted a retrospective review of three hospitals and 63 health centres in Gamo Gofa. Using a retrospective review, we recorded obstetric services, documents, cards, and registration books of mothers treated and served in the Gamo Gofa Zone health facilities between July 2009 and June 2010. There were three basic and two comprehensive emergency obstetric care qualifying facilities for the 1,740,885 people living in Gamo Gofa. The proportion of births attended by skilled attendants in the health facilities was 6.6% of expected births, though the variation was large. Districts with a higher proportion of midwives per capita, hospitals and health centres capable of doing emergency caesarean sections had higher institutional delivery rates. There were 521 caesarean sections (0.8% of 64,413 expected deliveries and 12.3% of 4,231 facility deliveries). We recorded 79 (1.9%) maternal deaths out of 4,231 deliveries and pregnancy-related admissions at institutions, most often because of post-partum haemorrhage (42%), obstructed labour (15%) and puerperal sepsis (15%). Remote districts far from the capital of the Zone had a lower proportion of institutional deliveries (4% of deliveries, much higher than the average 1.9%). Based on a population of 1.7 million people, there should be 14 basic and four comprehensive emergency obstetric care (EmOC) facilities in the Zone. Our study found that only three basic and two comprehensive EmOC service qualifying facilities serve this large

  2. 双膦酸盐可能降低死亡率%Effects of bisphosphates on reduced mortality risk

    Institute of Scientific and Technical Information of China (English)

    贾觉睿智; 夏维波

    2014-01-01

    It has been more than 40 years since the first full publications on the biological effects of the bisphos-phonates , appeared in 1969 .Bisphosphonates are the leading drugs used to treat osteoporosis and skeletal complications associated with tumors , especially multiple myeloma and bone metastases .Interestingly , recent studies showed that bi-sphosphonate , may have the direct effect on reduced mortality risk .The underlying mechanisms may be the effects of bi-sphosphonates on preventing fracture , improving physiological resilience , preventing frailty , reducing risks of cardiovascu-lar events, or anti-tumor.Furthermore, studies in population with tumors ( e.g., multiple myeloma, colon cancer ) showed that patients treating with bisphosphonate had higher survival rate and longer overall survival duration than patients taking placebo .All of these results show us a new perspective of bisphosphonate in clinical application .How to further prove these results will be our next important step .%自1969年首次全面报道双膦酸盐的生理作用至今已逾40余年。作为最有效的抗骨吸收药物之一,双膦酸盐在防治骨质疏松以及肿瘤相关骨骼并发症方面的作用广为人知。近年研究表明,双膦酸盐可能具有直接降低人群死亡率的作用。除与双膦酸盐降低骨折发生率的作用相关外,可能还与双膦酸盐具有促进机体生理功能恢复、延缓机体衰老、降低心血管事件风险程度和抗肿瘤的作用有关。另外,对肿瘤人群的研究提示双膦酸盐具有提高生存率、延长肿瘤人群生存期限的作用。上述研究结果拓展了双膦酸盐的临床应用价值。如何进一步验证这些结果并将其更好地应用于临床,可能是未来的一个研究热点。

  3. The potential of medical abortion to reduce maternal mortality in Africa: what benefits for Tanzania and Ethiopia?

    Directory of Open Access Journals (Sweden)

    Rebecca F Baggaley

    Full Text Available BACKGROUND: Unsafe abortion is estimated to account for 13% of maternal mortality globally. Medical abortion is a safe alternative. METHODS: By estimating mortality risks for unsafe and medical abortion and childbirth for Tanzania and Ethiopia, we modelled changes in maternal mortality that are achievable if unsafe abortion were replaced by medical abortion. We selected Ethiopia and Tanzania because of their high maternal mortality ratios (MMRatios and contrasting situations regarding health care provision and abortion legislation. We focused on misoprostol-only regimens due to the drug's low cost and accessibility. We included the impact of medical abortion on women who would otherwise choose unsafe abortion and on women with unwanted/mistimed pregnancies who would otherwise carry to term. RESULTS: Thousands of lives could be saved each year in each country by implementing medical abortion using misoprostol (2122 in Tanzania and 2551 in Ethiopia assuming coverage equals family planning services levels: 56% for Tanzania, 31% for Ethiopia. Changes in MMRatios would be less pronounced because the intervention would also affect national birth rates. CONCLUSIONS: This is the first analysis of impact of medical abortion provision which takes into account additional potential users other than those currently using unsafe abortion. Thousands of women's lives could be saved, but this may not be reflected in as substantial changes in MMRatios because of medical abortion's demographic impact. Therefore policy makers must be aware of the inability of some traditional measures of maternal mortality to detect the real benefits offered by such an intervention.

  4. Occupational versus leisure-time physical activity in reducing cardiovascular risks and mortality among ethnic Chinese adults in Taiwan.

    Science.gov (United States)

    Hu, Gwo-Chi; Chien, Kuo-Liong; Hsieh, Shiau-Fu; Chen, Chun-Yen; Tsai, Wen-Hsiang; Su, Ta-Chen

    2014-11-01

    The aim of the study was to investigate the associations of occupational physical activity (OPA) and leisure-time physical activity (LTPA) with the risk of cardiovascular disease (CVD) and mortality. Physical activity data from the Baeck questionnaire was available for 1706 participants. During a follow-up period, there were 215 cases of CVD and 438 deaths. With the lowest tertile as the reference, the hazard ratios (HRs) for CVD and mortality in the highest tertiles of LTPA were 0.65 (95% confidence interval [CI] = 0.46-0.92) and 0.73 (95% CI = 0.58-0.92). In contrast, the HRs for CVD and mortality in the highest tertiles of OPA were 1.75 (95% CI = 1.10-2.80) and 1.53 (95% CI = 1.06-2.22). The association between OPA and the risk of CVD and mortality was significant in men but not in women. Our findings suggest that high OPA imposes harmful effects on the risk of CVD and mortality, particularly among men.

  5. [EMPA-REG OUTCOME: Empagliflozin reduces mortality in patients with type 2 diabetes at high cardiovascular risk].

    Science.gov (United States)

    Scheen, A J

    2015-11-01

    EMPA-REG OUTCOME is an international, prospective, placebo-controlled clinical trial investigating the cardiovascular outcomes of empagliflozin, an inhibitor of sodium-glucose cotransporters type 2 (SGLT2), in patients with type 2 diabetes mellitus and known cardiovascular disease. The trial succeeded in reaching the primary objective of non-inferiority and, in addition, showed, after a median follow up of 3.1 years, a superiority of empagliflozin (10 or 25 mg/day) versus placebo as regards the primary composite cardiovascular endpoint (hasard ratio or HR = 0.86; 95% CI 0.74-0.99; P = 0.04), hospitalisations for heart failure (-35%), cardiovascular mortality (-38%) and all-cause mortality (-32%, each p < 0.001). The reductionin mortality appeared early (< 6 months) and concerned all subgroups, without any obvious heterogeneity. This reduction in mortality does not seem to be fully explained by the concomitant slight reductions in HbA1c, body weight, waist circumference, blood pressure and serum uric acid levels in the empagliflozin groups versus the placebo group. Finally, the tolerance and safety profile of empagliflozin was good, with only a moderate increase in benign mycotic genital infections, a well-known adverse event with SGLT2 inhibitors. The remarkable effects of empagliflozin in the EMPA-REG OUTCOME trial, especially on mortality, should modify the management of patients with type 2 diabetes and a high cardiovascular risk in a near future.

  6. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study

    DEFF Research Database (Denmark)

    Garcia-Aymerich, J; Lange, Peter; Benet, M

    2006-01-01

    .97). Low, moderate and high levels of regular physical activity were associated with an adjusted lower risk of all-cause mortality (hazard ratio (HR) 0.76, 95% CI 0.65 to 0.90) and respiratory mortality (HR 0.70, 95% CI 0.48 to 1.02). No effect modification was found for sex, age group, COPD severity......BACKGROUND: Information about the influence of regular physical activity on the course of chronic obstructive pulmonary disease (COPD) is scarce. A study was undertaken to examine the association between regular physical activity and both hospital admissions for COPD and all-cause and specific...... mortality in COPD subjects. METHODS: From a population-based sample recruited in Copenhagen in 1981-3 and 1991-4, 2386 individuals with COPD (according to lung function tests) were identified and followed until 2000. Self-reported regular physical activity at baseline was classified into four categories...

  7. Availability and quality of emergency obstetric care, an alternative strategy to reduce maternal mortality: experience of Tongji Hospital, Wuhan, China.

    Science.gov (United States)

    Bangoura, Ismael Fatou; Hu, Jian; Gong, Xun; Wang, Xuanxuan; Wei, Jingjing; Zhang, Wenbin; Zhang, Xiang; Fang, Pengqian

    2012-04-01

    The burden of maternal mortality (MM) and morbidity is especially high in Asia. However, China has made significant progress in reducing MM over the past two decades, and hence maternal death rate has declined considerably in last decade. To analyze availability and quality of emergency obstetric care (EmOC) received by women at Tongji Hospital, Wuhan, China, this study retrospectively analyzed various pregnancy-related complications at the hospital from 2000 to 2009. Two baseline periods of equal length were used for the comparison of variables. A total of 11 223 obstetric complications leading to MM were identified on a total of 15 730 hospitalizations, either 71.35% of all activities. No maternal death was recorded. Mean age of women was 29.31 years with a wide range of 14-52 years. About 96.26% of women had higher levels of schooling, university degrees and above and received the education of secondary school or college. About 3.74% received primary education at period two (P2) from 2005 to 2009, which was significantly higher than that of period one (P1) from 2000 to 2004 (P<0.05) (OR: 0.586; 95% CI: 0.442 to 0.776). About 65.69% were employed as skilled or professional workers at P2, which was significantly higher than that of P1 (P<0.05). About 34.31% were unskilled workers at P2, which was significantly higher than that of P1 (P<0.05). Caesarean section was performed for 9,930 women (88.48%) and the percentage of the procedure increased significantly from 19.25% at P1 to 69.23% at P2 (P<0.05). We were led to conclude that, despite the progress, significant gaps in the performance of maternal health services between rural and urban areas remain. However, MM reduction can be achieved in China. Priorities must include, but not limited to the following: secondary healthcare development, health policy and management, strengthening primary healthcare services.

  8. An enhanced treatment program with markedly reduced mortality after a transtibial or higher non-traumatic lower extremity amputation

    DEFF Research Database (Denmark)

    Kristensen, Morten T; Holm, Gitte; Krasheninnikoff, Michael;

    2016-01-01

    Background and purpose - Historically, high 30-day and 1-year mortality post-amputation rates (> 30% and 50%, respectively) have been reported in patients with a transtibial or higher non-traumatic lower extremity amputation (LEA). We evaluated whether allocating experienced staff and implementing...... was compared with historical and concurrent national controls in Denmark. Results - The 30-day and 1-year mortality rates were 16% and 37%, respectively, in the intervention group, as compared to 35% and 59% in the historical control group treated in the same orthopedic ward. Cox proportional harzards models...

  9. Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi estimation of mortality effect

    Science.gov (United States)

    2011-01-01

    Background Annually over 520,000 newborns die from neonatal sepsis, and 60,000 more from tetanus. Estimates of the effect of clean birth and postnatal care practices are required for evidence-based program planning. Objective To review the evidence for clean birth and postnatal care practices and estimate the effect on neonatal mortality from sepsis and tetanus for the Lives Saved Tool (LiST). Methods We conducted a systematic review of multiple databases. Data were abstracted into standard tables and assessed by GRADE criteria. Where appropriate, meta-analyses were undertaken. For interventions with low quality evidence but a strong GRADE recommendation, a Delphi process was conducted. Results Low quality evidence supports a reduction in all-cause neonatal mortality (19% (95% c.i. 1–34%)), cord infection (30% (95% c.i. 20–39%)) and neonatal tetanus (49% (95% c.i. 35–62%)) with birth attendant handwashing. Very low quality evidence supports a reduction in neonatal tetanus mortality with a clean birth surface (93% (95% c.i. 77-100%)) and no relationship between a clean perineum and tetanus. Low quality evidence supports a reduction of neonatal tetanus with facility birth (68% (95% c.i. 47-88%). No relationship was found between birth place and cord infections or sepsis mortality. For postnatal clean practices, all-cause mortality is reduced with chlorhexidine cord applications in the first 24 hours of life (34% (95% c.i. 5–54%, moderate quality evidence) and antimicrobial cord applications (63% (95% c.i. 41–86%, low quality evidence). One study of postnatal maternal handwashing reported reductions in all-cause mortality (44% (95% c.i. 18–62%)) and cord infection ((24% (95% c.i. 5-40%)). Given the low quality of evidence, a Delphi expert opinion process was undertaken. Thirty experts reached consensus regarding reduction of neonatal sepsis deaths by clean birth practices at home (15% (IQR 10–20)) or in a facility (27% IQR 24–36)), and by clean

  10. Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis.

    Science.gov (United States)

    Barbosa, Fabiano Timbó; da Cunha, Rafael Martins; da Silva Ramos, Fernando Wagner; de Lima, Fernando José Camello; Rodrigues, Amanda Karine Barros; do Nascimento Galvão, Ailton Mota; de Sousa-Rodrigues, Célio Fernando; Lima, Paula Monique Barbosa

    2016-01-01

    Neuraxial anesthesia (NA) has been used in association with general anesthesia (GA) for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. Mortality, arrhythmias, cerebrovascular accident (CVA), myocardial infarction (MI), length of hospital stay (LHS), length of ICU stay (ICUS), reoperations, blood transfusion (BT), quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD) was estimated for continuous variables, and relative risk (RR) and risk difference (RD) for categorical variables. 17 original articles analyzed. Meta-analysis of mortality (RD=-0.01, 95% CI=-0.03 to 0.01), CVA (RR=0.79, 95% CI=0.32-1.95), MI (RR=0.96, 95% CI=0.52-1.79) and LHS (MD=-1.94, 95% CI=-3.99 to 0.12) were not statistically significant. Arrhythmia was less frequent with NA (RR=0.68, 95% CI=0.50-0.93). ICUS was lower in NA (MD=-2.09, 95% CI=-2.92 to -1.26). There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  11. Do antipsychotic medications reduce or increase mortality in schizophrenia? A critical appraisal of the FIN-11 study

    NARCIS (Netherlands)

    De Hert, Marc; Correll, Christoph U.; Cohen, Dan

    Compared to the general Population, people with schizophrenia are at risk of dying prematurely Clue to suicide and due to different somatic illnesses. The potential role of antipsychotic treatment in affecting suicide rates and in explaining the increased mortality due to somatic disorders is highly

  12. Do antipsychotic medications reduce or increase mortality in schizophrenia? A critical appraisal of the FIN-11 study

    NARCIS (Netherlands)

    De Hert, Marc; Correll, Christoph U.; Cohen, Dan

    2010-01-01

    Compared to the general Population, people with schizophrenia are at risk of dying prematurely Clue to suicide and due to different somatic illnesses. The potential role of antipsychotic treatment in affecting suicide rates and in explaining the increased mortality due to somatic disorders is highly

  13. The Role of the Nonpneumatic Antishock Garment in Reducing Blood Loss and Mortality Associated with Post-Abortion Hemorrhage.

    Science.gov (United States)

    Manandhar, Shila; El Ayadi, Alison M; Butrick, Elizabeth; Hosang, Robert; Miller, Suellen

    2015-09-01

    Maternal mortality attributable to post-abortion hemorrhage is often associated with delays in reaching or receiving definitive care. The nonpneumatic antishock garment (NASG), a low-technology first-aid device, has been shown to decrease blood loss and mortality among women experiencing hypovolemic shock secondary to obstetric hemorrhage etiologies. Women experiencing post-abortion hemorrhage face longer delays in receiving definitive treatment as a result of abortion-related stigma and lack of access to quality abortion care; thus the NASG has the potential to make an even greater impact within this population. We conducted a secondary analysis of data collected in Egypt, Nigeria, Zambia, and Zimbabwe in NASG trials, limiting our analytic sample to women who experienced post-abortion hemorrhage (n = 953). Blood loss significantly decreased when the NASG was added to standard hemorrhage management during the intervention phase, and there was a large, although not statistically significant, 52 percent decrease in mortality during the NASG phase. The results indicate that adding the NASG to post-abortion care among women experiencing severe hemorrhage and hypovolemic shock would decrease blood loss and mortality. © 2015 The Population Council, Inc.

  14. Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2016-04-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: Neuraxial anesthesia (NA has been used in association with general anesthesia (GA for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. METHODS: Mortality, arrhythmias, cerebrovascular accident (CVA, myocardial infarction (MI, length of hospital stay (LHS, length of ICU stay (ICUS, reoperations, blood transfusion (BT, quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD was estimated for continuous variables, and relative risk (RR and risk difference (RD for categorical variables. RESULTS: 17 original articles analyzed. Meta-analysis of mortality (RD = -0.01, 95% CI = -0.03 to 0.01, CVA (RR = 0.79, 95% CI = 0.32-1.95, MI (RR = 0.96, 95% CI = 0.52-1.79 and LHS (MD = -1.94, 95% CI = -3.99 to 0.12 were not statistically significant. Arrhythmia was less frequent with NA (RR = 0.68, 95% CI = 0.50-0.93. ICUS was lower in NA (MD = -2.09, 95% CI = -2.92 to -1.26. CONCLUSION: There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS.

  15. The effectiveness of antenatal care programmes to reduce infant mortality and preterm birth in socially disadvantaged and vulnerable women in high-income countries: a systematic review

    Directory of Open Access Journals (Sweden)

    Brocklehurst Peter

    2011-02-01

    Full Text Available Abstract Background Infant mortality has shown a steady decline in recent years but a marked socioeconomic gradient persists. Antenatal care is generally thought to be an effective method of improving pregnancy outcomes, but the effectiveness of specific antenatal care programmes as a means of reducing infant mortality in socioeconomically disadvantaged and vulnerable groups of women has not been rigorously evaluated. Methods We conducted a systematic review, focusing on evidence from high income countries, to evaluate the effectiveness of alternative models of organising or delivering antenatal care to disadvantaged and vulnerable groups of women vs. standard antenatal care. We searched Medline, Embase, Cinahl, PsychINFO, HMIC, CENTRAL, DARE, MIDIRS and a number of online resources to identify relevant randomised and observational studies. We assessed effects on infant mortality and its major medical causes (preterm birth, congenital anomalies and sudden infant death syndrome (SIDS Results We identified 36 distinct eligible studies covering a wide range of interventions, including group antenatal care, clinic-based augmented care, teenage clinics, prenatal substance abuse programmes, home visiting programmes, maternal care coordination and nutritional programmes. Fifteen studies had adequate internal validity: of these, only one was considered to demonstrate a beneficial effect on an outcome of interest. Six interventions were considered 'promising'. Conclusions There was insufficient evidence of adequate quality to recommend routine implementation of any of the programmes as a means of reducing infant mortality in disadvantaged/vulnerable women. Several interventions merit further more rigorous evaluation.

  16. Adjustment for smoking reduces radiation risk: fifth analysis of mortality of nuclear industry workers in Japan, 1999-2010

    Energy Technology Data Exchange (ETDEWEB)

    Kudo, S.; Ishida, J.; Yoshimoto, K.; Mizuno, S.; Ohshima, S.; Kasagi, F., E-mail: s_kudo@rea.or.jp [Instituto of Radiation Epidemiology, Radiation Effects Association, 1-9-16 Kajicho, Chiyoda-ku, 101-0044 Tokyo (Japan)

    2015-10-15

    Full text: Many cohort studies among nuclear industry workers have been carried out to determine the possible health effects of low-level radiation. In those studies, confounding factors, for example, age was adjusted to exclude the effect of difference of mortality by age to estimate radiation risk. But there are few studies adjusting for smoking that is known as a strong factor which affects mortality. Radiation Effects Association (Rea) initiated a cohort study of nuclear industry workers mortality in 1990. To examine non-radiation factors confounding on the mortality risk among the radiation workers, Rea have performed life-style questionnaire surveys among the part of workers at 1997 and 2003 and found the correlation between radiation dose and smoking rate. Mortality follow-up were made on 75,442 male respondents for an average of 8.3 years during the observation period 1999-2010. Estimates of Excess Relative Risk percent (Err %) per 10 mSv were obtained by using the Poisson regression. The Err for all causes was statistically significant (1.05 (90 % CI 0.31 : 1.80)), but no longer significant after adjusting for smoking (0.45 (-0.24 : 1.13)). The Err for all cancers excluding leukemia was not significant (0.92 (-0.30 : 2.16)), but after adjusting for smoking, it decreased (0.36 (-0.79 : 1.50)). Thus smoking has a large effect to obscure a radiation risk, so adjustment for smoking is important to estimate radiation risk. (Author)

  17. Early goal-directed therapy reduces mortality in adult patients with severe sepsis and septic shock: Systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Legese Chelkeba

    2015-01-01

    Full Text Available Introduction: Survival sepsis campaign guidelines have promoted early goal-directed therapy (EGDT as a means for reduction of mortality. On the other hand, there were conflicting results coming out of recently published meta-analyses on mortality benefits of EGDT in patients with severe sepsis and septic shock. On top of that, the findings of three recently done randomized clinical trials (RCTs showed no survival benefit by employing EGDT compared to usual care. Therefore, we aimed to do a meta-analysis to evaluate the effect of EGDT on mortality in severe sepsis and septic shock patients. Methodology: We included RCTs that compared EGDT with usual care in our meta-analysis. We searched in Hinari, PubMed, EMBASE, and Cochrane central register of controlled trials electronic databases and other articles manually from lists of references of extracted articles. Our primary end point was overall mortality. Results: A total of nine trails comprising 4783 patients included in our analysis. We found that EGDT significantly reduced mortality in a random-effect model (RR, 0.86; 95% confidence interval [CI], 0.72–0.94; P = 0.008;   I 2 =50%. We also did subgroup analysis stratifying the studies by the socioeconomic status of the country where studies were conducted, risk of bias, the number of sites where the trials were conducted, setting of trials, publication year, and sample size. Accordingly, trials carried out in low to middle economic income countries (RR, 0.078; 95% CI, 0.67–0.91; P = 0.002; I2 = 34% significantly reduced mortality compared to those in higher income countries (RR, 0.93; 95% CI, 0.33–1.06; P = 0.28; I2 = 29%. On the other hand, patients receiving EGDT had longer length of hospital stay compared to the usual care (mean difference, 0.49; 95% CI, –0.04–1.02; P = 0.07; I2 = 0%. Conclusion: The result of our study showed that EGDT significantly reduced mortality in patients with severe sepsis and septic shock. Paradoxically

  18. Colorectal stenting as a bridge to surgery reduces morbidity and mortality in left-sided malignant obstruction: a predictive risk score-based comparative study.

    Science.gov (United States)

    Cennamo, Vincenzo; Luigiano, Carmelo; Manes, Gianpiero; Zagari, Rocco Maurizio; Ansaloni, Luca; Fabbri, Carlo; Ceroni, Liza; Catena, Fausto; Pinna, Antonio Daniele; Fuccio, Lorenzo; Mussetto, Alessandro; Casetti, Tino; Coccolini, Federico; D'Imperio, Nicola; Bazzoli, Franco

    2012-06-01

    The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity model, and its Portsmouth and colorectal modifications are used to predict postoperative mortality and morbidity after colorectal surgery. To compare stent placement as a bridge to surgery vs. emergency surgical resection in patients with acute left-sided colorectal cancer obstruction using P-POSSUM and CR-POSSUM. From January 2008 to December 2009, the physiological and operative scores, morbidity and mortality predicted by the P-POSSUM and CR-POSSUM scores were collected in all consecutive patients with LCCO who underwent surgical resection directly (Group A) or after stent placement (Group B). Eighty-six patients were enrolled (Group A-41 and Group B-45). The observed 30-day mortality rate was 9.8% (4/41) in Group A and 2.4% (1/45) in Group B. The 30-day morbidity rate was 61% (25/41) in Group A and 29% (13/45) in Group B. The mean values of P-POSSUM morbidity (A=70.5% vs. B=34.3%; p=0.001), P-POSSUM mortality (A=13.6% vs. B=2.4%; p=0.001) and CR-POSSUM mortality (A=15.1% vs. B=4.9%; p=0.001) were significantly lower in the Group B patients than in the Group A patients. Bridge to surgery strategy reduces the surgical risks in LCCO, and P-POSSUM and CR-POSSUM scores represent a good tool for comparing the two strategies. Copyright © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  19. Selection for number of live piglets at five-days of age increased litter size and reduced mortality

    DEFF Research Database (Denmark)

    Nielsen, Bjarne; Madsen, Per; Henryon, Mark

    2012-01-01

    Breeding for increased litter size in Danish Landrace and Yorkshire started in 1992. Since then, litter size has in-creased significantly. Commercial pig producers and nucleus breeders argue that increases in litter size increase the number of dead piglets. Pig breeders in Denmark responded...... by including the total number of live piglets at day five (TN5) in the breeding goal. The objective of this study was to investigate whether breeding for TN5 has affected total number of born (TNB) and the mortality rate in five-day-old piglets. Data included records of first litter from 43,432 Landrace sows...... and 34,446 Yorkshire sows in Danish nucleus herds from January 2004 to December 2010. At far-rowing, litter size was recorded as TNB including number of still-births. Litter size and mortality rate up to day five after birth were analyzed using a two-trait animal model assuming normality...

  20. An inhibitor of bacterial quorum sensing reduces mortalities caused by vibriosis in rainbow trout (Oncorhynchus mykiss, Walbaum)

    DEFF Research Database (Denmark)

    Rasch, Maria; Buch, Christiane; Austin, B.

    2004-01-01

    The fish pathogen Vibrio anguillarum produces quorum sensing signal molecules, N-acyl homoserine lactones (AHLs), which in several Gram-negative human and plant pathogenic bacteria regulate virulence factors. Expression of these factors can be blocked using specific quorum-sensing inhibitors (QSIs......). The purpose of this study was to investigate the effect of a QSI, furanone C-30, on mortality of rainbow trout during challenge with V. anguillarum. Addition of 0.01 or 0.1 muM furanone C-30 to rainbow trout infected by cohabitation caused a significant reduction in accumulated mortality from 80...... experiments, thus avoiding selection for resistance. To elucidate the mechanism of disease control by furanone C-30, we determined its effect on the bacterial proteome, motility, and respiration. No effects were seen of furanone C-30 in any of these experiments. Although no cytotoxic effect on HeLa cells were...

  1. Reducing maternal mortality in Senegal: using GIS to identify priority regions for the expansion of human resources for health.

    Science.gov (United States)

    Massey, Philip

    2011-01-01

    In 2005, Senegal had an estimated maternal mortality ratio of 980 deaths per 100,000 live births, well above the global average of 400. The concentration of health workers has been shown to be associated with improved health outcomes, including maternal mortality. To explore this relationship, this paper uses geographic information systems (GIS) to examine the regional distribution of human resources for health and related maternal health indicators in Senegal. Results show that a regional imbalance in the distribution of health personnel and health indicators exists in Senegal. This disparity may contribute to the disproportionate burden of disease experienced in the eastern part of the country. Based on a spatial analysis, a priority index is used to identify regions to target for the recruitment and training of midwives. GIS is an appropriate and practical tool for governments and other agencies to use in identifying regional disparities and for priority setting.

  2. Community interventions to reduce child mortality in Dhanusha, Nepal: study protocol for a cluster randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Costello Anthony

    2011-06-01

    Full Text Available Abstract Background Neonatal mortality remains high in rural Nepal. Previous work suggests that local women's groups can effect significant improvement through community mobilisation. The possibility of identification and management of newborn infections by community-based workers has also arisen. Methods/Design The objective of this trial is to evaluate the effects on newborn health of two community-based interventions involving Female Community Health Volunteers. MIRA Dhanusha community groups: a participatory intervention with women's groups. MIRA Dhanusha sepsis management: training of community volunteers in the recognition and management of neonatal sepsis. The study design is a cluster randomized controlled trial involving 60 village development committee clusters allocated 1:1 to two interventions in a factorial design. MIRA Dhanusha community groups: Female Community Health Volunteers (FCHVs are supported in convening monthly women's groups. Nine groups per cluster (270 in total work through two action research cycles in which they (i identify local issues around maternity, newborn health and nutrition, (ii prioritise key problems, (iii develop strategies to address them, (iv implement the strategies, and (v evaluate their success. Cycle 1 focuses on maternal and newborn health and cycle 2 on nutrition in pregnancy and infancy and associated postpartum care practices. MIRA Dhanusha sepsis management: FCHVs are trained to care for vulnerable newborn infants. They (i identify local births, (ii identify low birth weight infants, (iii identify possible newborn infection, (iv manage the process of treatment with oral antibiotics and referral to a health facility to receive parenteral gentamicin, and (v follow up infants and support families. Primary outcome: neonatal mortality rates. Secondary outcomes: MIRA Dhanusha community group: stillbirth, infant and under-two mortality rates, care practices and health care seeking behaviour, maternal

  3. [Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis].

    Science.gov (United States)

    Barbosa, Fabiano Timbó; Cunha, Rafael Martins da; Ramos, Fernando Wagner da Silva; Lima, Fernando José Camello de; Rodrigues, Amanda Karine Barros; Galvão, Ailton Mota do Nascimento; de Sousa-Rodrigues, Célio Fernando; Lima, Paula Monique Barbosa

    2016-01-01

    Neuraxial anesthesia (NA) has been used in association with general anesthesia (GA) for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. Mortality, arrhythmias, cerebrovascular accident (CVA), myocardial infarction (MI), length of hospital stay (LHS), length of ICU stay (ICUS), reoperations, blood transfusion (BT), quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD) was estimated for continuous variables, and relative risk (RR) and risk difference (RD) for categorical variables. 17 original articles analyzed. Meta-analysis of mortality (RD=-0.01, 95% CI=-0.03 to 0.01), CVA (RR=0.79, 95% CI=0.32 to 1.95), MI (RR=0.96, 95% CI=0.52 to 1.79) and LHS (MD=-1.94, 95% CI=-3.99 to 0.12) were not statistically significant. Arrhythmia was less frequent with NA (RR=0.68, 95% CI=0.50 to 0.93). ICUS was lower in NA (MD=-2.09, 95% CI=-2.92 to -1.26). There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  4. Developing an acoustic method for reducing North Atlantic right whale (Eubalaena glacialis) ship strike mortality along the United States eastern seaboard

    Science.gov (United States)

    Mullen, Kaitlyn Allen

    North Atlantic right whales (Eubalaena glacialis ) are among the world's most endangered cetaceans. Although protected from commercial whaling since 1949, North Atlantic right whales exhibit little to no population growth. Ship strike mortality is the leading known cause of North Atlantic right whale mortality. North Atlantic right whales exhibit developed auditory systems, and vocalize in the frequency range that dominates ship acoustic signatures. With no behavioral audiogram published, current literature assumes these whales should be able to acoustically detect signals in the same frequencies they vocalize. Recorded ship acoustic signatures occur at intensities that are similar or higher to those recorded by vocalizing North Atlantic right whales. If North Atlantic right whales are capable of acoustically detecting oncoming ship, why are they susceptible to ship strike mortality? This thesis models potential acoustic impediments to North Atlantic right whale detection of oncoming ships, and concludes the presence of modeled and observed bow null effect acoustic shadow zones, located directly ahead of oncoming ships, are likely to impair the ability of North Atlantic right whales to detect and/or localize oncoming shipping traffic. This lack of detection and/or localization likely leads to a lack of ship strike avoidance, and thus contributes to the observed high rates of North Atlantic right whale ship strike mortality. I propose that North Atlantic right whale ship strike mortality reduction is possible via reducing and/or eliminating the presence of bow null effect acoustic shadow zones. This thesis develops and tests one method for bow null effect acoustic shadow zone reduction on five ships. Finally, I review current United States policy towards North Atlantic right whale ship strike mortality in an effort to determine if the bow null effect acoustic shadow zone reduction method developed is a viable method for reducing North Atlantic right whale ship

  5. An Upgrade on the Rabbit Model of Anthracycline-Induced Cardiomyopathy: Shorter Protocol, Reduced Mortality, and Higher Incidence of Overt Dilated Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Jesús Talavera

    2015-01-01

    Full Text Available Current protocols of anthracycline-induced cardiomyopathy in rabbits present with high premature mortality and nephrotoxicity, thus rendering them unsuitable for studies requiring long-term functional evaluation of myocardial function (e.g., stem cell therapy. We compared two previously described protocols to an in-house developed protocol in three groups: Group DOX2 received doxorubicin 2 mg/kg/week (8 weeks; Group DAU3 received daunorubicin 3 mg/kg/week (10 weeks; and Group DAU4 received daunorubicin 4 mg/kg/week (6 weeks. A cohort of rabbits received saline (control. Results of blood tests, cardiac troponin I, echocardiography, and histopathology were analysed. Whilst DOX2 and DAU3 rabbits showed high premature mortality (50% and 33%, resp., DAU4 rabbits showed 7.6% premature mortality. None of DOX2 rabbits developed overt dilated cardiomyopathy; 66% of DAU3 rabbits developed overt dilated cardiomyopathy and quickly progressed to severe congestive heart failure. Interestingly, 92% of DAU4 rabbits showed overt dilated cardiomyopathy and 67% developed congestive heart failure exhibiting stable disease. DOX2 and DAU3 rabbits showed alterations of renal function, with DAU3 also exhibiting hepatic function compromise. Thus, a shortened protocol of anthracycline-induced cardiomyopathy as in DAU4 group results in high incidence of overt dilated cardiomyopathy, which insidiously progressed to congestive heart failure, associated to reduced systemic compromise and very low premature mortality.

  6. An Upgrade on the Rabbit Model of Anthracycline-Induced Cardiomyopathy: Shorter Protocol, Reduced Mortality, and Higher Incidence of Overt Dilated Cardiomyopathy.

    Science.gov (United States)

    Talavera, Jesús; Giraldo, Alejandro; Fernández-Del-Palacio, María Josefa; García-Nicolás, Obdulio; Seva, Juan; Brooks, Gavin; Moraleda, Jose M

    2015-01-01

    Current protocols of anthracycline-induced cardiomyopathy in rabbits present with high premature mortality and nephrotoxicity, thus rendering them unsuitable for studies requiring long-term functional evaluation of myocardial function (e.g., stem cell therapy). We compared two previously described protocols to an in-house developed protocol in three groups: Group DOX2 received doxorubicin 2 mg/kg/week (8 weeks); Group DAU3 received daunorubicin 3 mg/kg/week (10 weeks); and Group DAU4 received daunorubicin 4 mg/kg/week (6 weeks). A cohort of rabbits received saline (control). Results of blood tests, cardiac troponin I, echocardiography, and histopathology were analysed. Whilst DOX2 and DAU3 rabbits showed high premature mortality (50% and 33%, resp.), DAU4 rabbits showed 7.6% premature mortality. None of DOX2 rabbits developed overt dilated cardiomyopathy; 66% of DAU3 rabbits developed overt dilated cardiomyopathy and quickly progressed to severe congestive heart failure. Interestingly, 92% of DAU4 rabbits showed overt dilated cardiomyopathy and 67% developed congestive heart failure exhibiting stable disease. DOX2 and DAU3 rabbits showed alterations of renal function, with DAU3 also exhibiting hepatic function compromise. Thus, a shortened protocol of anthracycline-induced cardiomyopathy as in DAU4 group results in high incidence of overt dilated cardiomyopathy, which insidiously progressed to congestive heart failure, associated to reduced systemic compromise and very low premature mortality.

  7. An Upgrade on the Rabbit Model of Anthracycline-Induced Cardiomyopathy: Shorter Protocol, Reduced Mortality, and Higher Incidence of Overt Dilated Cardiomyopathy

    Science.gov (United States)

    Talavera, Jesús; Fernández-Del-Palacio, María Josefa; García-Nicolás, Obdulio; Seva, Juan; Brooks, Gavin; Moraleda, Jose M.

    2015-01-01

    Current protocols of anthracycline-induced cardiomyopathy in rabbits present with high premature mortality and nephrotoxicity, thus rendering them unsuitable for studies requiring long-term functional evaluation of myocardial function (e.g., stem cell therapy). We compared two previously described protocols to an in-house developed protocol in three groups: Group DOX2 received doxorubicin 2 mg/kg/week (8 weeks); Group DAU3 received daunorubicin 3 mg/kg/week (10 weeks); and Group DAU4 received daunorubicin 4 mg/kg/week (6 weeks). A cohort of rabbits received saline (control). Results of blood tests, cardiac troponin I, echocardiography, and histopathology were analysed. Whilst DOX2 and DAU3 rabbits showed high premature mortality (50% and 33%, resp.), DAU4 rabbits showed 7.6% premature mortality. None of DOX2 rabbits developed overt dilated cardiomyopathy; 66% of DAU3 rabbits developed overt dilated cardiomyopathy and quickly progressed to severe congestive heart failure. Interestingly, 92% of DAU4 rabbits showed overt dilated cardiomyopathy and 67% developed congestive heart failure exhibiting stable disease. DOX2 and DAU3 rabbits showed alterations of renal function, with DAU3 also exhibiting hepatic function compromise. Thus, a shortened protocol of anthracycline-induced cardiomyopathy as in DAU4 group results in high incidence of overt dilated cardiomyopathy, which insidiously progressed to congestive heart failure, associated to reduced systemic compromise and very low premature mortality. PMID:26788502

  8. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study

    DEFF Research Database (Denmark)

    Garcia-Aymerich, J; Lange, Peter; Benet, M;

    2006-01-01

    mortality in COPD subjects. METHODS: From a population-based sample recruited in Copenhagen in 1981-3 and 1991-4, 2386 individuals with COPD (according to lung function tests) were identified and followed until 2000. Self-reported regular physical activity at baseline was classified into four categories......BACKGROUND: Information about the influence of regular physical activity on the course of chronic obstructive pulmonary disease (COPD) is scarce. A study was undertaken to examine the association between regular physical activity and both hospital admissions for COPD and all-cause and specific...

  9. What you count is what you target: the implications of maternal death classification for tracking progress towards reducing maternal mortality in developing countries.

    Science.gov (United States)

    Cross, Suzanne; Bell, Jacqueline S; Graham, Wendy J

    2010-02-01

    The first target of the fifth United Nations Millennium Development Goal is to reduce maternal mortality by 75% between 1990 and 2015. This target is critically off track. Despite difficulties inherent in measuring maternal mortality, interventions aimed at reducing it must be monitored and evaluated to determine the most effective strategies in different contexts. In some contexts, the direct causes of maternal death, such as haemorrhage and sepsis, predominate and can be tackled effectively through providing access to skilled birth attendance and emergency obstetric care. In others, indirect causes of maternal death, such as HIV/AIDS and malaria, make a significant contribution and require alternative interventions. Methods of planning and evaluating maternal health interventions that do not differentiate between direct and indirect maternal deaths may lead to unrealistic expectations of effectiveness or mask progress in tackling specific causes. Furthermore, the need for additional or alternative interventions to tackle the causes of indirect maternal death may not be recognized if all-cause maternal death is used as the sole outcome indicator. This article illustrates the importance of differentiating between direct and indirect maternal deaths by analysing historical data from England and Wales and contemporary data from Ghana, Rwanda and South Africa. The principal aim of the paper is to highlight the need to differentiate deaths in this way when evaluating maternal mortality, particularly when judging progress towards the fifth Millennium Development Goal. It is recommended that the potential effect of maternity services failing to take indirect maternal deaths into account should be modelled.

  10. Preventable fine sediment export from the Burdekin River catchment reduces coastal seagrass abundance and increases dugong mortality within the Townsville region of the Great Barrier Reef, Australia.

    Science.gov (United States)

    Wooldridge, Scott A

    2017-01-30

    The coastal seagrass meadows in the Townsville region of the Great Barrier Reef are crucial seagrass foraging habitat for endangered dugong populations. Deteriorating coastal water quality and in situ light levels reduce the extent of these meadows, particularly in years with significant terrestrial runoff from the nearby Burdekin River catchment. However, uncertainty surrounds the impact of variable seagrass abundance on dugong carrying capacity. Here, I demonstrate that a power-law relationship with exponent value of -1 (R(2)~0.87) links mortality data with predicted changes in annual above ground seagrass biomass. This relationship indicates that the dugong carrying capacity of the region is tightly coupled to the biomass of seagrass available for metabolism. Thus, mortality rates increase precipitously following large flood events with a response lag of flood events. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Zinc supplementation reduces morbidity and mortality in very-low-birth-weight preterm neonates: a hospital-based randomized, placebo-controlled trial in an industrialized country.

    Science.gov (United States)

    Terrin, Gianluca; Berni Canani, Roberto; Passariello, Annalisa; Messina, Francesco; Conti, Maria Giulia; Caoci, Stefano; Smaldore, Antonella; Bertino, Enrico; De Curtis, Mario

    2013-12-01

    Zinc plays a pivotal role in the pathogenesis of many diseases and in body growth. Preterm neonates have high zinc requirements. The objective of the study was to investigate the efficacy of zinc supplementation in reducing morbidity and mortality in preterm neonates and to promote growth. This was a prospective, double-blind, randomized controlled study of very-low-birth-weight preterm neonates randomly allocated on the seventh day of life to receive (zinc group) or not receive (control group) oral zinc supplementation. Total prescribed zinc intake ranged from 9.7 to 10.7 mg/d in the zinc group and from 1.3 to 1.4 mg/d in the placebo control group. The main endpoint was the rate of neonates with ≥ 1 of the following morbidities: late-onset sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, periventricular leucomalacia, and retinopathy of prematurity. Secondary outcomes were mortality and body growth. We enrolled 97 neonates in the zinc group and 96 in the control group. Morbidities were significantly lower in the zinc group (26.8% compared with 41.7%; P = 0.030). The occurrence of necrotizing enterocolitis was significantly higher in the control group (6.3% compared with 0%; P = 0.014). Mortality risk was higher in the placebo control group (RR: 2.37; 95% CI: 1.08, 5.18; P = 0.006). Daily weight gain was similar in the zinc (18.2 ± 5.6 g · kg⁻¹ · d⁻¹) and control (17.0 ± 8.7 g · kg⁻¹ · d⁻¹) groups (P = 0.478). Oral zinc supplementation given at high doses reduces morbidities and mortality in preterm neonates. This trial was registered in the Australian New Zealand Clinical Trial Register as ACTRN12612000823875.

  12. Population densities and tree diameter effects associated with verbenone treatments to reduce mountain pine beetle-caused mortality of lodgepole pine.

    Science.gov (United States)

    Progar, R A; Blackford, D C; Cluck, D R; Costello, S; Dunning, L B; Eager, T; Jorgensen, C L; Munson, A S; Steed, B; Rinella, M J

    2013-02-01

    Mountain pine beetle, Dendroctonus ponderosae Hopkins (Coleoptera: Curculionidae: Scolytinae), is among the primary causes of mature lodgepole pine, Pinus contorta variety latifolia mortality. Verbenone is the only antiaggregant semiochemical commercially available for reducing mountain pine beetle infestation of lodgepole pine. The success of verbenone treatments has varied greatly in previous studies because of differences in study duration, beetle population size, tree size, or other factors. To determine the ability of verbenone to protect lodgepole pine over long-term mountain pine beetle outbreaks, we applied verbenone treatments annually for 3 to 7 yr at five western United States sites. At one site, an outbreak did not develop; at two sites, verbenone reduced lodgepole pine mortality in medium and large diameter at breast height trees, and at the remaining two sites verbenone was ineffective at reducing beetle infestation. Verbenone reduced mountain pine beetle infestation of lodgepole pine trees in treated areas when populations built gradually or when outbreaks in surrounding untreated forests were of moderate severity. Verbenone did not protect trees when mountain pine beetle populations rapidly increase.

  13. Second-hand tobacco smoke in Oklahoma: a preventable cause of morbidity and mortality and means of reducing exposure.

    Science.gov (United States)

    Miner, Robert N; Crutcher, James M

    2002-03-01

    Evidence has mounted in recent years establishing second-hand tobacco smoke exposure as a cause of morbidity and mortality in nonsmokers. The ratio of deaths is approximately one nonsmoker dying from illness caused by second-hand smoke exposure for every eight smokers who die from diseases caused by tobacco use. This is equivalent to about 750 nonsmoker deaths each year in Oklahoma caused by exposure to second-hand smoke. This article reviews the components of second-hand smoke, its health effects, its prevalence in Oklahoma, and the means of protecting children and nonsmoking adults from exposure. Oklahoma physicians are encouraged to advise their patients about the harmful effects of second-hand smoke and to actively support public policies that decrease exposure to second-hand smoke in public places and workplaces.

  14. Injected phage-displayed-VP28 vaccine reduces shrimp Litopenaeus vannamei mortality by white spot syndrome virus infection.

    Science.gov (United States)

    Solís-Lucero, G; Manoutcharian, K; Hernández-López, J; Ascencio, F

    2016-08-01

    White spot syndrome virus (WSSV) is the most important viral pathogen for the global shrimp industry causing mass mortalities with huge economic losses. Recombinant phages are capable of expressing foreign peptides on viral coat surface and act as antigenic peptide carriers bearing a phage-displayed vaccine. In this study, the full-length VP28 protein of WSSV, widely known as potential vaccine against infection in shrimp, was successfully cloned and expressed on M13 filamentous phage. The functionality and efficacy of this vaccine immunogen was demonstrated through immunoassay and in vivo challenge studies. In ELISA assay phage-displayed VP28 was bind to Litopenaeus vannamei immobilized hemocyte in contrast to wild-type M13 phage. Shrimps were injected with 2 × 10(10) cfu animal(-1) single dose of VP28-M13 and M13 once and 48 h later intramuscularly challenged with WSSV to test the efficacy of the vaccine against the infection. All dead challenged shrimps were PCR WSSV-positive. The accumulative mortality of the vaccinated and challenged shrimp groups was significantly lower (36.67%) than the unvaccinated group (66.67%). Individual phenoloxidase and superoxide dismutase activity was assayed on 8 and 48 h post-vaccination. No significant difference was found in those immunological parameters among groups at any sampled time evaluated. For the first time, phage display technology was used to express a recombinant vaccine for shrimp. The highest percentage of relative survival in vaccinated shrimp (RPS = 44.99%) suggest that the recombinant phage can be used successfully to display and deliver VP28 for farmed marine crustaceans.

  15. Attraction and mortality of Bactrocera dorsalis (Diptera: Tephritidae) to STATIC Spinosad ME weathered under operational conditions in California and Florida: a reduced-risk male annihilation treatment.

    Science.gov (United States)

    Vargas, Roger I; Souder, Steven K; Hoffman, Kevin; Mercogliano, Juan; Smith, Trevor R; Hammond, Jack; Davis, Bobbie J; Brodie, Matt; Dripps, James E

    2014-08-01

    Studies were conducted in 2013-2014 to quantify attraction, feeding, and mortality of male oriental fruit flies, Bactrocera dorsalis (Hendel) (Diptera: Tephritidae), to STATIC Spinosad ME a reduced-risk male annihilation treatment (MAT) formulation consisting of an amorphous polymer matrix in combination with methyl eugenol (ME) and spinosad compared with the standard treatment of Min-U-Gel mixed with ME and naled (Dibrom). Our approach used a behavioral methodology for evaluation of slow-acting reduced-risk insecticides. ME treatments were weathered for 1, 7, 14, 21, and 28 d under operational conditions in California and Florida and shipped to Hawaii for bioassays. In field tests using bucket traps to attract and capture wild males, and in toxicity studies conducted in 1-m(3) cages using released males of controlled ages, STATIC Spinosad ME performed equally as well to the standard formulation of Min-U-Gel ME with naled for material aged up to 28 d in both California and Florida. In laboratory feeding tests in which individual males were exposed for 5 min to the different ME treatments, mortality induced by STATIC Spinosad ME recorded at 24 h did not differ from mortality caused by Min-U-Gel ME with naled at 1, 7, 14, and 21 d in California and was equal to or higher for all weathered time periods in Florida during two trials. Spinosad has low contact toxicity, and when mixed with an attractant and slow release matrix, offers a reduced-risk alternative for eradication of B. dorsalis and related ME attracted species, without many of the potential negative effects to humans and nontargets associated with broad-spectrum contact insecticides such as naled.

  16. Short Term Oral Zinc Supplementation among Babies with Neonatal Sepsis for Reducing Mortality and Improving Outcome - A Double-Blind Randomized Controlled Trial.

    Science.gov (United States)

    Banupriya, Newton; Bhat, Ballambattu Vishnu; Benet, Bosco Dhas; Catherine, Christina; Sridhar, Magadi Gopalakrishna; Parija, Subhash Chandra

    2017-09-11

    To evaluate the efficacy of short term zinc supplementation on the mortality rate and neurodevelopment outcome in neonates with sepsis at 12 mo corrected age. The clinical trial was undertaken in the neonatal intensive care unit of JIPMER during the time period from September 2013 through December 2016. Neonates with clinical manifestations of sepsis who exhibited two positive screening tests (microESR, C- reactive protein, band cell count) were included and randomized into no zinc and zinc group. The intervention was zinc sulfate monohydrate given at a dose of 3 mg/kg twice a day orally for 10 d along with standard antibiotics. The no zinc group was on antibiotic treatment. Blood samples from both groups were collected at baseline and after day 10. Babies were carefully discharged from the hospital. The babies were followed up till 12 mo corrected age using DASII (Development Assessment Scale for Indian Infants). At the time of enrolment, patient characteristics were similar in both the groups. The mortality rate was significantly higher in no zinc compared to zinc group (5 vs. 13; P = 0.04). Although motor development quotient was similar, mental development quotient was significantly better among babies who received zinc supplementation. Short term zinc supplementation of newborns with sepsis reduces mortality and improves mental development quotient at 12 mo of age.

  17. A robust rabbit line increases leucocyte counts at weaning and reduces mortality by digestive disorder during fattening.

    Science.gov (United States)

    García-Quirós, A; Arnau-Bonachera, A; Penadés, M; Cervera, C; Martínez-Paredes, E; Ródenas, L; Selva, L; Viana, D; Corpa, J M; Pascual, J J

    2014-10-15

    The present work evaluates how a rabbit line selected for robustness and two other lines selected for productive criteria, could have affected the physiological maturity and blood leukocytes counts of young rabbits at weaning, as well as their possible effect on the subsequent performance and health status during the growing period. The study was conducted on a total of 2904 young rabbits weaned at 30 days, belonging to three different genetic types (line H, founded for litter size at birth and selected for litter size at weaning during 17 generations; line LP, characterised by robustness founded for reproductive longevity criteria and selected for litter size at weaning for 7 generations; and line R, founded and selected during 25 generations for average daily gain from the 4th to the 9th week of life). Two different diets were used during lactation. The two diets were both isoenergetic and isoprotein but their main energy source differed, being either animal fat (AF) or cereal starch (CS). Leucocyte subsets were characterised at weaning, and growing performance was studied until 58 days of age (feed intake, live weight, mortality by digestive disorders and morbidity) for both medicated and non-medicated dietary versions. At weaning, young rabbits fed an AF lactating diet evidenced greater B lymphocyte count (on av. +8.6 ± 3.5 × 10(6)/L; P rabbits, blood from LP ones had higher counts for total (on av. 591 ± 167 × 10(6)/L; P rabbits also showed lower mortality by digestive disorders (on av. -8 points of percentage) and morbidity (on av. -4 points) than those from H and R lines during the growing period (P < 0.05). R animals presented higher feed intake and daily weight gain, and a lower feed conversion ratio than H and LP animals (on av. +16.7 ± 2.7 g dry matter/day, +10.3 ± 0.4 g/day and -0.22 ± 0.04 g dry matter/g, respectively). In conclusion, the foundation of a line for reproductive longevity, which has been previously reported to give greater

  18. High-Dose Conformal Radiotherapy Reduces Prostate Cancer-Specific Mortality: Results of a Meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Viani, Gustavo Arruda, E-mail: gusviani@gmail.com [Department of Radiation Oncology, Marilia Medical School, Marilia, Sao Paulo (Brazil); Godoi Bernardes da Silva, Lucas; Stefano, Eduardo Jose [Department of Radiation Oncology, Marilia Medical School, Marilia, Sao Paulo (Brazil)

    2012-08-01

    Purpose: To determine in a meta-analysis whether prostate cancer-specific mortality (PCSM), biochemical or clinical failure (BCF), and overall mortality (OM) in men with localized prostate cancer treated with conformal high-dose radiotherapy (HDRT) are better than those in men treated with conventional-dose radiotherapy (CDRT). Methods and Materials: The MEDLINE, Embase, CANCERLIT, and Cochrane Library databases, as well as the proceedings of annual meetings, were systematically searched to identify randomized, controlled studies comparing conformal HDRT with CDRT for localized prostate cancer. Results: Five randomized, controlled trials (2508 patients) that met the study criteria were identified. Pooled results from these randomized, controlled trials showed a significant reduction in the incidence of PCSM and BCF rates at 5 years in patients treated with HDRT (p = 0.04 and p < 0.0001, respectively), with an absolute risk reduction (ARR) of PCSM and BCF at 5 years of 1.7% and 12.6%, respectively. Two trials evaluated PCSM with 10 years of follow up. The pooled results from these trials showed a statistical benefit for HDRT in terms of PCSM (p = 0.03). In the subgroup analysis, trials that used androgen deprivation therapy (ADT) showed an ARR for BCF of 12.9% (number needed to treat = 7.7, p < 0.00001), whereas trials without ADT had an ARR of 13.6% (number needed to treat = 7, p < 0.00001). There was no difference in the OM rate at 5 and 10 years (p = 0.99 and p = 0.11, respectively) between the groups receiving HDRT and CDRT. Conclusions: This meta-analysis is the first study to show that HDRT is superior to CDRT in preventing disease progression and prostate cancer-specific death in trials that used conformational technique to increase the total dose. Despite the limitations of our study in evaluating the role of ADT and HDRT, our data show no benefit for HDRT arms in terms of BCF in trials with or without ADT.

  19. 1,25-dihydroxyvitamin D3 regulates LPS-induced cytokine production and reduces mortality in rats

    Institute of Scientific and Technical Information of China (English)

    Xiao-Ping Qi; Pei Li; Gang Li; Zhen Sun; Jie-Shou Li

    2008-01-01

    AIM: To study the immunoregulatory effect of 1,25-dihydroxyvitamin-D3 Von dominant Th1 response in rats.METHODS: Sixty adult Lewis rats were randomized into three groups.Rats in group 1 (n=25) were treated with 1,25-(OH)2D3 first and then challenged with LPS,rats in group 2 (n=2S) were treated with vehicle first and then challenged with LPS.Ten animals in groups 1 and 2 were preserved for mortality observation.The remaining animals were injected (i.p) with endotoxin,24 h after the last administration of 1,25-(OH)2D3 and vehicle.Rats in group 3 (n=10) were treated with 1,25-(OH)2D3 only.Serum IL-12,IFN-y,IL-2 and IL-4 levels were measured and target gene of 1,25-(OH)2D3 on Th cells was studied after 6 h.Gene abundance was verified by real-time quantitative PCR.RESULTS: No death occurred in rats pretreated with 1,25-(OH)2D3 after LPS injection.Death occurred 9 h after LPS injection in rats pretreated with the vehicle,and the number of deaths was 5 within 24 h,with a mortality rate of 50%.There was no change in the number of deaths within 96 h.Six hours after endotoxin stimulation,serum IL-12 and IFN-y levels decreased significantly in rats pretreated with 1,25-(OH)2D3 as compared with those in rats pretreatecl with the vehicle.The serum content of these two cytokines was very low in rats not challenged by endotoxin,and there was a significant difference as compared with the previous two groups.CONCLUSION: 1,25-(OH)2D3 attenuates injury induced by the lethal dose of LPS,regulates Th1 and Th2 cells at the transcription level,and dominantly responds to cytokine production in rats.

  20. Long-term use of amiodarone before heart transplantation significantly reduces early post-transplant atrial fibrillation and is not associated with increased mortality after heart transplantation

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    Rivinius R

    2016-02-01

    group (P=0.0123. There was no statistically significant difference between patients with and without long-term use of amiodarone prior to HTX in 1-year (P=0.8596, 2-year (P=0.8620, 5-year (P=0.2737, or overall follow-up mortality after HTX (P=0.1049. Moreover, Kaplan–Meier survival analysis showed no statistically significant difference in overall survival (P=0.1786.Conclusion: Long-term use of amiodarone in patients before HTX significantly reduces early post-transplant AF and is not associated with increased mortality after HTX. Keywords: amiodarone, atrial fibrillation, heart failure, heart transplantation, mortality

  1. SY 09-4 PUBLIC POLICIES TO REDUCE SALT IN PROCESSED FOODS: HOW THEY MAY CORRELATE WITH IMPROVEMENT IN BLOOD PRESSURE CONTROL AND REDUCED CARDIOVASCULAR MORTALITY.

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    Campbell, Norm

    2016-09-01

    Hypertension is the second leading global risk for death and disability after unhealthy diets. Amongst dietary risks, excess dietary salt (sodium) is the leading risk. As dietary sodium increases, blood pressure increases linearly. In meta-analyses of higher quality cohort studies and in a meta-analysis of randomized controlled trials, higher dietary sodium is linearly associated with increased cardiovascular disease. There are an estimated xxxx deaths and xxx DALYs in 2013 from excess dietary sodium. The World Health Organization has a recommended sodium (salt) intake of less than 2000 mg (5 g)/day with the World Health Assembly setting a voluntary target of a 30% reduction by 2025. In high income countries, the vast majority of dietary salt comes from additives during commercial food processing. In low income countries the vast majority of salt is 'discretionary' being added at home in cooking and at the table, often as condiments (e.g. soya/fish sauce or bouillon). Many highly populated countries are in nutritional transition and have the highest salt intakes with both commercial and discretionary sources. Notably diets of natural foods without added salt contain 500-800 mg sodium/day. Policies to reduce commercial sources of salt have had demonstrated efficacy at reducing salt intake, blood pressure and cardiovascular disease. Use of salt replacers (potassium partly replacing sodium) hold promise to reduce discretionary salt and in randomized controlled trials reduce blood pressure. There is renewed 'scientific' controversy about reducing dietary salt. The controversy is largely based on a small number of individuals many of whom have had associations with the food and salt industry and/or have conducted research using methods highly prone to erroneous findings. Sadly several of those dissenting have made false or misleading statements about the science supporting salt reduction, altered scientific formula to make their controversial data appear more

  2. Efficacy of early neonatal vitamin A supplementation in reducing mortality during infancy in Ghana, India and Tanzania: study protocol for a randomized controlled trial

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    Bahl Rajiv

    2012-02-01

    Full Text Available Abstract Background Vitamin A supplementation of 6-59 month old children is currently recommended by the World Health Organization based on evidence that it reduces mortality. There has been considerable interest in determining the benefits of neonatal vitamin A supplementation, but the results of existing trials are conflicting. A technical consultation convened by WHO pointed to the need for larger scale studies in Asia and Africa to inform global policy on the use of neonatal vitamin A supplementation. Three trials were therefore initiated in Ghana, India and Tanzania to determine if vitamin A supplementation (50,000 IU given to neonates once orally on the day of birth or within the next two days will reduce mortality in the period from supplementation to 6 months of age compared to placebo. Methods/Design The trials are individually randomized, double masked, and placebo controlled. The required sample size is 40,200 in India and 32,000 each in Ghana and Tanzania. The study participants are neonates who fulfil age eligibility, whose families are likely to stay in the study area for the next 6 months, who are able to feed orally, and whose parent(s provide informed written consent to participate in the study. Neonates randomized to the intervention group receive 50,000 IU vitamin A and the ones randomized to the control group receive placebo at the time of enrolment. Mortality and morbidity information are collected through periodic home visits by a study worker during infancy. The primary outcome of the study is mortality from supplementation to 6 months of age. The secondary outcome of the study is mortality from supplementation to 12 months of age. The three studies will be analysed independent of each other. Subgroup analysis will be carried out to determine the effect by birth weight, sex, and timing of DTP vaccine, socioeconomic groups and maternal large-dose vitamin A supplementation. Discussion The three ongoing studies are the

  3. TGF-β Blockade Reduces Mortality and Metabolic Changes in a Validated Murine Model of Pancreatic Cancer Cachexia.

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    Stephanie H Greco

    Full Text Available Cancer cachexia is a debilitating condition characterized by a combination of anorexia, muscle wasting, weight loss, and malnutrition. This condition affects an overwhelming majority of patients with pancreatic cancer and is a primary cause of cancer-related death. However, few, if any, effective therapies exist for both treatment and prevention of this syndrome. In order to develop novel therapeutic strategies for pancreatic cancer cachexia, appropriate animal models are necessary. In this study, we developed and validated a syngeneic, metastatic, murine model of pancreatic cancer cachexia. Using our model, we investigated the ability of transforming growth factor beta (TGF-β blockade to mitigate the metabolic changes associated with cachexia. We found that TGF-β inhibition using the anti-TGF-β antibody 1D11.16.8 significantly improved overall mortality, weight loss, fat mass, lean body mass, bone mineral density, and skeletal muscle proteolysis in mice harboring advanced pancreatic cancer. Other immunotherapeutic strategies we employed were not effective. Collectively, we validated a simplified but useful model of pancreatic cancer cachexia to investigate immunologic treatment strategies. In addition, we showed that TGF-β inhibition can decrease the metabolic changes associated with cancer cachexia and improve overall survival.

  4. TGF-β Blockade Reduces Mortality and Metabolic Changes in a Validated Murine Model of Pancreatic Cancer Cachexia.

    Science.gov (United States)

    Greco, Stephanie H; Tomkötter, Lena; Vahle, Anne-Kristin; Rokosh, Rae; Avanzi, Antonina; Mahmood, Syed Kashif; Deutsch, Michael; Alothman, Sara; Alqunaibit, Dalia; Ochi, Atsuo; Zambirinis, Constantinos; Mohaimin, Tasnima; Rendon, Mauricio; Levie, Elliot; Pansari, Mridul; Torres-Hernandez, Alejandro; Daley, Donnele; Barilla, Rocky; Pachter, H Leon; Tippens, Daniel; Malik, Hassan; Boutajangout, Allal; Wisniewski, Thomas; Miller, George

    2015-01-01

    Cancer cachexia is a debilitating condition characterized by a combination of anorexia, muscle wasting, weight loss, and malnutrition. This condition affects an overwhelming majority of patients with pancreatic cancer and is a primary cause of cancer-related death. However, few, if any, effective therapies exist for both treatment and prevention of this syndrome. In order to develop novel therapeutic strategies for pancreatic cancer cachexia, appropriate animal models are necessary. In this study, we developed and validated a syngeneic, metastatic, murine model of pancreatic cancer cachexia. Using our model, we investigated the ability of transforming growth factor beta (TGF-β) blockade to mitigate the metabolic changes associated with cachexia. We found that TGF-β inhibition using the anti-TGF-β antibody 1D11.16.8 significantly improved overall mortality, weight loss, fat mass, lean body mass, bone mineral density, and skeletal muscle proteolysis in mice harboring advanced pancreatic cancer. Other immunotherapeutic strategies we employed were not effective. Collectively, we validated a simplified but useful model of pancreatic cancer cachexia to investigate immunologic treatment strategies. In addition, we showed that TGF-β inhibition can decrease the metabolic changes associated with cancer cachexia and improve overall survival.

  5. Activism: working to reduce maternal mortality through civil society and health professional alliances in sub-Saharan Africa.

    Science.gov (United States)

    Ray, Sunanda; Madzimbamuto, Farai; Fonn, Sharon

    2012-06-01

    Partnerships between civil society groups campaigning for reproductive and human rights, health professionals and others could contribute more to the strengthening of health systems needed to bring about declines in maternal deaths in Africa. The success of the HIV treatment literacy model developed by the Treatment Action Campaign in South Africa provides useful lessons for activism on maternal mortality, especially the combination of a right-to-health approach with learning and capacity building, community networking, popular mobilisation and legal action. This paper provides examples of these from South Africa, Botswana, Kenya and Uganda. Confidential enquiries into maternal deaths can be powerful instruments for change if pressure to act on their recommendations is brought to bear. Shadow reports presented during UN human rights country assessments can be used in a similar way. Public protests and demonstrations over avoidable deaths have succeeded in drawing attention to under-resourced services, shortages of supplies, including blood for transfusion, poor morale among staff, and lack of training and supervision. Activists could play a bigger role in holding health services, governments, and policy-makers accountable for poor maternity services, developing user-friendly information materials for women and their families, and motivating appropriate human resources strategies. Training and support for patients' groups, in how to use health facility complaints procedures is also a valuable strategy.

  6. To Screen or not to Screen: Low Dose Computed Tomography in Comparison to Chest Radiography or Usual Care in Reducing Morbidity and Mortality from Lung Cancer

    Science.gov (United States)

    Kamdar, Jay; Moats, Austin; Nguyen, Brenda

    2016-01-01

    Lung cancer has the highest mortality rate of all cancers. This paper seeks to address the question: Can the mortality of lung cancer be decreased by screening with low-dose computerized tomography (LDCT) in higher risk patients compared to chest X-rays (CXR) or regular patient care? Currently, CXR screening is recommended for certain high-risk patients. Several recent trials have examined the effectiveness of LDCT versus chest radiography or usual care as a control. These trials include National Lung Screening Trial (NLST), Detection And screening of early lung cancer with Novel imaging TEchnology (DANTE), Lung Screening Study (LSS), Depiscan, Italian Lung (ITALUNG), and Dutch-Belgian Randomized Lung Cancer Screening Trial (Dutch acronym: NELSON study). NLST, the largest trial (n=53, 454), demonstrated a decrease in mortality from lung cancer in the LDCT group (RRR=20%, P=0.004). LSS demonstrated a greater sensitivity in detecting both early stage and any stage of lung cancer in comparison to traditional CXR. Although the DANTE trial yielded data consistent with findings in LSS, it also showed that via LDCT screening a greater proportion of patients were placed under unnecessary surgical procedures. The Depiscan trial yielded a high nodule detection rate at the cost of a high false-positive rate compared to CXR screening. The ITALUNG and NELSON trials demonstrated the early detection capabilities of LDCT for lung cancers compared to usual care without surveillance imaging. False-positive findings with unnecessary workup, intervention, and radiation exposure remain significant concerns for routine LDCT screening. However, current data suggests LDCT may provide a highly sensitive and specific means for detecting lung cancers and reducing mortality. PMID:27375974

  7. Keeping health staff healthy: evaluation of a workplace initiative to reduce morbidity and mortality from HIV/AIDS in Malawi

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    Bemelmans Marielle

    2011-01-01

    Full Text Available Abstract Background In Malawi, the dramatic shortage of human resources for health is negatively impacted by HIV-related morbidity and mortality among health workers and their relatives. Many staff find it difficult to access HIV care through regular channels due to fear of stigma and discrimination. In 2006, two workplace initiatives were implemented in Thyolo District: a clinic at the district hospital dedicated to all district health staff and their first-degree relatives, providing medical services, including HIV care; and a support group for HIV-positive staff. Methods Using routine programme data, we evaluated the following outcomes up to the end of 2009: uptake and outcome of HIV testing and counselling among health staff and their dependents; uptake and outcomes of antiretroviral therapy (ART among health staff; and membership and activities of the support group. In addition, we included information from staff interviews and a job satisfaction survey to describe health workers' opinions of the initiatives. Results Almost two-thirds (91 of 144, 63% of health workers and their dependents undergoing HIV testing and counselling at the staff clinic tested HIV positive. Sixty-four health workers had accessed ART through the staff clinic, approximately the number of health workers estimated to be in need of ART. Of these, 60 had joined the support group. Cumulative ART outcomes were satisfactory, with more than 90% alive on treatment as of June 2009 (the end of the study observation period. The availability, confidentiality and quality of care in the staff clinic were considered adequate by beneficiaries. Conclusions Staff clinic and support group services successfully provided care and support to HIV-positive health workers. Similar initiatives should be considered in other settings with a high HIV prevalence.

  8. Reduced renal function is associated with progression to AIDS but not with overall mortality in HIV-infected kenyan adults not initially requiring combination antiretroviral therapy

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    Gupta Samir K

    2011-06-01

    Full Text Available Abstract Background The World Health Organization (WHO has recently recommended that antiretrovirals be initiated in all individuals with CD4 counts of less than 350 cells/mm3. For countries with resources too limited to expand care to all such patients, it would be of value to able to identify and target populations at highest risk of HIV progression. Renal disease has been identified as a risk factor for disease progression or death in some populations. Methods Times to meeting combination antiretroviral therapy (cART initiation criteria (developing either a CD4 count 3 or WHO stage 3 or 4 disease and overall mortality were evaluated in cART-naïve, HIV-infected Kenyan adults with CD4 cell counts ≥200/mm3 and with WHO stage 1 or 2 disease. Cox proportional hazard regression models were used to evaluate the associations between renal function and these endpoints. Results We analyzed data of 7383 subjects with a median follow-up time of 59 (interquartile range, 27-97 weeks. In Cox regression analyses adjusted for age, sex, WHO disease stage, CD4 cell count and haemoglobin, estimated creatinine clearance (CrCl 2 was associated with shorter times to meeting cART initiation criteria (HR 1.39; 95% CI, 1.22-1.58, but not with overall mortality. CrCl and eGFR remained associated with shorter times to cART initiation criteria, but neither was associated with mortality, in weight-adjusted analyses. Conclusions In this large natural history study, reduced renal function was strongly associated with faster HIV disease progression in adult Kenyans not initially meeting cART initiation criteria. As such, renal function measurement in resource-limited settings may be an inexpensive method to identify those most in need of cART to prevent progression to AIDS. The initial association between reduced CrCl, but not reduced eGFR, and greater mortality was explained by the low weights in this population.

  9. Infant Stool Color Card Screening Helps Reduce the Hospitalization Rate and Mortality of Biliary Atresia: A 14-Year Nationwide Cohort Study in Taiwan.

    Science.gov (United States)

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

    2016-03-01

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

  10. A clinician-nurse model to reduce early mortality and increase clinic retention among high-risk HIV-infected patients initiating combination antiretroviral treatment

    Directory of Open Access Journals (Sweden)

    Braitstein Paula

    2012-02-01

    Full Text Available Abstract Background In resource-poor settings, mortality is at its highest during the first 3 months after combination antiretroviral treatment (cART initiation. A clear predictor of mortality during this period is having a low CD4 count at the time of treatment initiation. The objective of this study was to evaluate the effect on survival and clinic retention of a nurse-based rapid assessment clinic for high-risk individuals initiating cART in a resource-constrained setting. Methods The USAID-AMPATH Partnership has enrolled more than 140,000 patients at 25 clinics throughout western Kenya. High Risk Express Care (HREC provides weekly or bi-weekly rapid contacts with nurses for individuals initiating cART with CD4 counts of ≤100 cells/mm3. All HIV-infected individuals aged 14 years or older initiating cART with CD4 counts of ≤100 cells/mm3 were eligible for enrolment into HREC and for analysis. Adjusted hazard ratios (AHRs control for potential confounding using propensity score methods. Results Between March 2007 and March 2009, 4,958 patients initiated cART with CD4 counts of ≤100 cells/mm3. After adjusting for age, sex, CD4 count, use of cotrimoxazole, treatment for tuberculosis, travel time to clinic and type of clinic, individuals in HREC had reduced mortality (AHR: 0.59; 95% confidence interval: 0.45-0.77, and reduced loss to follow up (AHR: 0.62; 95% CI: 0.55-0.70 compared with individuals in routine care. Overall, patients in HREC were much more likely to be alive and in care after a median of nearly 11 months of follow up (AHR: 0.62; 95% CI: 0.57-0.67. Conclusions Frequent monitoring by dedicated nurses in the early months of cART can significantly reduce mortality and loss to follow up among high-risk patients initiating treatment in resource-constrained settings.

  11. Impact of programming strategies aimed at reducing nonessential implantable cardioverter defibrillator therapies on mortality: a systematic review and meta-analysis.

    Science.gov (United States)

    Tan, Vern Hsen; Wilton, Stephen B; Kuriachan, Vikas; Sumner, Glen L; Exner, Derek V

    2014-02-01

    Patients who receive implantable cardioverter defibrillator therapies are at higher risk of death versus those who do not. Programmed settings to reduce nonessential implantable cardioverter defibrillator therapies (therapy reduction programming) have been developed but may have adverse effects. This systematic review and meta-analysis assessed the relationship between therapy reduction programming with the risks of death from any cause, implantable cardioverter defibrillator shocks, and syncope. MEDLINE, EMBASE, and clinicaltrials.gov databases were searched to identify relevant studies. Those that followed patients for ≥6 months and reported mortality were included. Six met the inclusion criteria; 4 randomized (Comparison of Empiric to Physician-Tailored Programming of ICDs [EMPIRIC], Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy [MADIT-RIT], Avoid Delivering Therapies for Non-sustained Arrhythmias in ICD Patients III [ADVANCE III], and Programming Implantable Cardioverter-Defibrillators in Patients with Primary Prevention Indication to Prolong Time to First Shock [PROVIDE]) and 2 prospective studies (Role of Long Detection Window Programming in Patients With Left Ventricular Dysfunction, Non-ischemic Etiology in Primary Prevention Treated with a Biventricular ICD [RELEVANT] and Primary Prevention Parameters Evaluation [PREPARE]). These 6 studies included 7687 (3598 conventional and 4089 therapy reduction programming) patients. Most (77%) participants were men, had a history of ischemic heart disease (56%), and were prescribed β-blockers (84%). Therapy reduction programming was associated with a 30% relative reduction in mortality (95% confidence interval, 16%-41%; Pprogramming (P=0.5). Therapy reduction programming results in a large, significant, and consistent reduction in mortality, with no apparent increase in the risk of syncope.

  12. Applying Collaborative Learning and Quality Improvement to Public Health: Lessons from the Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality.

    Science.gov (United States)

    Ghandour, Reem M; Flaherty, Katherine; Hirai, Ashley; Lee, Vanessa; Walker, Deborah Klein; Lu, Michael C

    2017-06-01

    Infant mortality remains a significant public health problem in the U.S. The Collaborative Improvement & Innovation Network (CoIIN) model is an innovative approach, using the science of quality improvement and collaborative learning, which was applied across 13 Southern states in Public Health Regions IV and VI to reduce infant mortality and improve birth outcomes. We provide an in-depth discussion of the history, development, implementation, and adaptation of the model based on the experience of the original CoIIN organizers and participants. In addition to the political genesis and functional components of the initiative, 8 key lessons related to staffing, planning, and implementing future CoIINs are described in detail. This paper reports the findings from a process evaluation of the model. Data on the states' progress toward reducing infant mortality and improving birth outcomes were collected through a survey in the final months of a 24-month implementation period, as well as through ongoing team communications. The peer-to-peer exchange and platform for collaborative learning, as well as the sharing of data across the states, were major strengths and form the foundation for future CoIIN efforts. A lasting legacy of the initiative is the unique application and sharing of provisional "real time" data to inform "real time" decision-making. The CoIIN model of collaborative learning, QI, and innovation offers a promising approach to strengthening partnerships within and across states, bolstering data systems to inform and track progress more rapidly, and ultimately accelerating improvement toward healthier communities, States, and the Nation as a whole.

  13. Medroxyprogesterone - valproic acid - aspirin. MVA regime to reduce transfusion associated mortality in late-term hemoglobinopathies. Hypothesis and rationale.

    Science.gov (United States)

    Altinoz, Meric A; Ozdilli, Kursat; Carin, Mahmut N; Gedikoglu, Gunduz

    2007-01-01

    Medroxyprogesterone acetate (MPA) - a safe depot contraceptive - is shown previously to reduce painful crises of sickle cell anemia, which is parallel with the recent findings showing progesterone induction of fetal hemoglobin genes. This would be a way to reduce transfusions for late term thalassemia major and sickle cell-disease cases with no chances left for a stem cell transplantation. In these patients, transfusional hemosiderosis causes irreversible damage to many organs despite the available iron-chelating agents. Pharmacological strategies either target the conformal structure of the defective adult hemoglobin or aim to activate fetal hemoglobin concentrations. The only concern on MPA may be its thromboembolic risks, which may be uncoupled with agents acting both anti-coagulant and inductive on the blood oxygen-carrying affinity. Such agents could be valproic acid and aspirin. Valproic acid is being safely used to treat epilepsy and its histone acetylating function may lead its induction of fetal hemoglobin. Aspirin was shown to increase oxygen affinity of hemoglobin via acetylating lysine residues and its general acetylating activity on proteins such as histones makes it also an interesting candidate to activate fetal hemoglobin. We propose that combining MPA with clinically available doses of valproic acid and aspirin would be beneficial in terms of both reduced coagulation risks and increased oxygen affinity to decrease the transfusions and to improve the prognosis in late-phase hemoglobin disorders.

  14. Reducing Mortality from Terrorist Releases of Chemical and Biological Agents: I. Filtration for Ventilation Systems in Commercial Building

    Energy Technology Data Exchange (ETDEWEB)

    Thatcher, Tracy L.; Daisey, Joan M.

    1999-09-01

    There is growing concern about potential terrorist attacks involving releases of chemical and/or biological (CB) agents, such as sarin or anthrax, in and around buildings. For an external release, the CB agent can enter the building through the air intakes of a building's mechanical ventilation system and by infiltration through the building envelope. For an interior release in a single room, the mechanical ventilation system, which often recirculates some fraction of the air within a building, may distribute the released CB agent throughout the building. For both cases, installing building systems that remove chemical and biological agents may be the most effective way to protect building occupants. Filtration systems installed in the heating, ventilating and air-conditioning (HVAC) systems of buildings can significantly reduce exposures of building occupants in the event of a release, whether the release is outdoors or indoors. Reduced exposures can reduce the number of deaths from a terrorist attack. The purpose of this report is to provide information and examples of the design of filtration systems to help building engineers retrofit HVAC systems. The report also provides background information on the physical nature of CB agents and brief overviews of the basic principles of particle and vapor filtration.

  15. Reducing mortality in HIV-infected infants and achieving the 90–90–90 target through innovative diagnosis approaches

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    Shaffiq Essajee

    2015-12-01

    Full Text Available Introduction: Despite significant gains in access to early infant diagnosis (EID over the past decade, most HIV-exposed infants still do not get tested for HIV in the first two months of life. For those who are tested, the long turnaround time between when the sample is drawn and when the results are returned leads to a high rate of loss to follow-up, which in turn means that few infected infants start antiretroviral treatment. Consequently, there continues to be high mortality from perinatally acquired HIV, and the ambitious goals of 90% of infected children identified, 90% of identified children treated and 90% of treated children with sustained virologic suppression by 2020 seem far beyond our reach. The objective of this commentary is to review recent advances in the field of HIV diagnosis in infants and describe how these advances may overcome long-standing barriers to access to testing and treatment. Discussion: Several innovative approaches to EID have recently been described. These include point-of-care testing, use of SMS printers to connect the central laboratory and the health facility through a mobile phone network, expanding paediatric testing to other entry points where children access the health system and testing HIV-exposed infants at birth as a rapid way to identify in utero infection. Each of these interventions is discussed here, together with the opportunities and challenges associated with scale-up. Point-of-care testing has the potential to provide immediate results but is less cost-effective in settings where test volumes are low. Virological testing at birth has been piloted in some countries to identify those infants who need urgent treatment, but a negative test at birth does not obviate the need for additional testing at six weeks. Routine testing of infants in child health settings is a useful strategy to identify exposed and infected children whose mothers were not enrolled in programmes for the prevention of mother

  16. Superiority of Minimally Invasive Oesophagectomy in Reducing In-Hospital Mortality of Patients with Resectable Oesophageal Cancer: A Meta-Analysis.

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    Can Zhou

    Full Text Available Compared with open oesophagectomy (OE, minimally invasive oesophagectomy (MIO proves to have benefits in reducing the risk of pulmonary complications for patients with resectable oesophageal cancer. However, it is unknown whether MIO has superiority in reducing the occurrence of in-hospital mortality (IHM.The objective of this meta-analysis was to explore the effect of MIO vs. OE on the occurrence of in-hospital mortality (IHM.Sources such as Medline (through December 31, 2014, Embase (through December 31, 2014, Wiley Online Library (through December 31, 2014, and the Cochrane Library (through December 31, 2014 were searched.Data of randomized and non-randomized clinical trials related to MIO versus OE were included.Eligible studies were those that reported patients who underwent MIO procedure. The control group included patients undergoing conventional OE.Fixed or random -effects models were used to calculate summary odds ratios (ORs or relative risks (RRs for quantification of associations. Heterogeneity among studies was evaluated by using Cochran's Q and I2 statistics.A total of 48 studies involving 14,311 cases of resectable oesophageal cancer were included in the meta-analysis. Compared to patients undergoing OE, patients undergoing MIO had statistically reduced occurrence of IHM (OR=0.69, 95%CI =0.55 -0.86. Patients undergoing MIO also had significantly reduced incidence of pulmonary complications (PCs (RR=0.73, 95%CI = 0.63-0.86, pulmonary embolism (PE (OR=0.71, 95%CI= 0.51-0.99 and arrhythmia (OR=0.79, 95%CI = 0.68-0.92. Non-significant reductions were observed among the included studies in the occurrence of anastomotic leak (AL (OR=0.93, 95%CI =0.78-1.11, or Gastric Tip Necrosis (GTN (OR=0.89, 95%CI =0.54-1.49.Most of the included studies were non-randomized case-control studies, with a diversity of study designs, demographics of participants and surgical intervention.Minimally invasive oesophagectomy (MIO has superiority over open

  17. State of the science on prevention and screening to reduce melanoma incidence and mortality: The time is now.

    Science.gov (United States)

    Tripp, Mary K; Watson, Meg; Balk, Sophie J; Swetter, Susan M; Gershenwald, Jeffrey E

    2016-05-27

    Answer questions and earn CME/CNE Although overall cancer incidence rates are decreasing, melanoma incidence rates continue to increase about 3% annually. Melanoma is a significant public health problem that exacts a substantial financial burden. Years of potential life lost from melanoma deaths contribute to the social, economic, and human toll of this disease. However, most cases are potentially preventable. Research has clearly established that exposure to ultraviolet radiation increases melanoma risk. Unprecedented antitumor activity and evolving survival benefit from novel targeted therapies and immunotherapies are now available for patients with unresectable and/or metastatic melanoma. Still, prevention (minimizing sun exposure that may result in tanned or sunburned skin and avoiding indoor tanning) and early detection (identifying lesions before they become invasive or at an earlier stage) have significant potential to reduce melanoma incidence and melanoma-associated deaths. This article reviews the state of the science on prevention and early detection of melanoma and current areas of scientific uncertainty and ongoing debate. The US Surgeon General's Call to Action to Prevent Skin Cancer and US Preventive Services Task Force reviews on skin cancer have propelled a national discussion on melanoma prevention and screening that makes this an extraordinary and exciting time for diverse disciplines in multiple sectors-health care, government, education, business, advocacy, and community-to coordinate efforts and leverage existing knowledge to make major strides in reducing the public health burden of melanoma in the United States. CA Cancer J Clin 2016. © 2016 American Cancer Society. © 2016 American Cancer Society, Inc.

  18. Sustained virological response to interferon plus ribavirin reduces non-liver-related mortality in patients coinfected with HIV and Hepatitis C virus.

    Science.gov (United States)

    Berenguer, Juan; Rodríguez, Elena; Miralles, Pilar; Von Wichmann, Miguel A; López-Aldeguer, José; Mallolas, Josep; Galindo, María J; Van Den Eynde, Eva; Téllez, María J; Quereda, Carmen; Jou, Antoni; Sanz, José; Barros, Carlos; Santos, Ignacio; Pulido, Federico; Guardiola, Josep M; Ortega, Enrique; Rubio, Rafael; Jusdado, Juan J; Montes, María L; Gaspar, Gabriel; Esteban, Herminia; Bellón, José M; González-García, Juan

    2012-09-01

    Sustained virological response (SVR) after therapy with interferon plus ribavirin reduces liver-related complications and mortality in patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). We assessed the effect of SVR on HIV progression and mortality not related to liver disease. An observational cohort study including consecutive HIV/HCV-coinfected patients treated with interferon plus ribavirin between 2000 and 2008 in 19 centers in Spain. Of 1599 patients, 626 (39%) had an SVR. After a median follow-up of approximately 5 years, we confirmed that failure to achieve an SVR was associated with an increased risk of liver-related events and liver-related death. We also observed higher rates of the following events in nonresponders than in responders: AIDS-defining conditions (rate per 100 person years, 0.84 [95% confidence interval (CI), .59-1.10] vs 0.29 [.10-.48]; P= .003), non-liver-related deaths (0.65 [.42-.87] vs 0.16 [.02-.30]; P = .002), and non-liver-related, non-AIDS-related deaths (0.55 [.34-.75] vs 0.16 [.02-.30]; P = .002). Cox regression analysis showed that the adjusted hazard ratios of new AIDS-defining conditions, non-liver-related deaths, and non-liver-related, non-AIDS-related deaths for nonresponders compared with responders were 1.90 (95% CI, .89-4.10; P = .095), 3.19 (1.21-8.40; P = .019), and 2.85 (1.07-7.60; P = .036), respectively. Our findings suggest that eradication of HCV after therapy with interferon plus ribavirin in HIV/HCV-coinfected patients is associated not only with a reduction in liver-related events but also with a reduction in HIV progression and mortality not related to liver disease.

  19. Scaling Up Family Planning to Reduce Maternal and Child Mortality: The Potential Costs and Benefits of Modern Contraceptive Use in South Africa

    Science.gov (United States)

    Chola, Lumbwe; McGee, Shelley; Tugendhaft, Aviva; Buchmann, Eckhart; Hofman, Karen

    2015-01-01

    Introduction Family planning contributes significantly to the prevention of maternal and child mortality. However, many women still do not use modern contraception and the numbers of unintended pregnancies, abortions and subsequent deaths are high. In this paper, we estimate the service delivery costs of scaling up modern contraception, and the potential impact on maternal, newborn and child survival in South Africa. Methods The Family Planning model in Spectrum was used to project the impact of modern contraception on pregnancies, abortions and births in South Africa (2015-2030). The contraceptive prevalence rate (CPR) was increased annually by 0.68 percentage points. The Lives Saved Tool was used to estimate maternal and child deaths, with coverage of essential maternal and child health interventions increasing by 5% annually. A scenario analysis was done to test impacts when: the change in CPR was 0.1% annually; and intervention coverage increased linearly to 99% in 2030. Results If CPR increased by 0.68% annually, the number of pregnancies would reduce from 1.3 million in 2014 to one million in 2030. Unintended pregnancies, abortions and births decrease by approximately 20%. Family planning can avert approximately 7,000 newborn and child and 600 maternal deaths. The total annual costs of providing modern contraception in 2030 are estimated to be US$33 million and the cost per user of modern contraception is US$7 per year. The incremental cost per life year gained is US$40 for children and US$1,000 for mothers. Conclusion Maternal and child mortality remain high in South Africa, and scaling up family planning together with optimal maternal, newborn and child care is crucial. A huge impact can be made on maternal and child mortality, with a minimal investment per user of modern contraception. PMID:26076482

  20. Reduced Cardiovascular Mortality 10 Years after Supplementation with Selenium and Coenzyme Q10 for Four Years: Follow-Up Results of a Prospective Randomized Double-Blind Placebo-Controlled Trial in Elderly Citizens.

    Directory of Open Access Journals (Sweden)

    Urban Alehagen

    Full Text Available Selenium and coenzyme Q10 are important antioxidants in the body. As the intake of selenium is low in Europe, and the endogenous production of coenzyme Q10 decreases as age increases, an intervention trial using selenium and coenzyme Q10 for four years was performed. As previously reported, the intervention was accompanied by reduced cardiovascular mortality. The objective of the present study was to analyze cardiovascular mortality for up to 10 years after intervention, to evaluate if mortality differed in subgroups differentiated by gender, diabetes, ischemic heart disease (IHD, and functional class.Four-hundred forty-three healthy elderly individuals were included from a rural municipality in Sweden. All cardiovascular mortality was registered, and no participant was lost to the follow-up. Based on death certificates and autopsy results mortality was registered.Significantly reduced cardiovascular mortality could be seen in those on selenium and coenzyme Q10 intervention. A multivariate Cox regression analysis demonstrated a reduced cardiovascular mortality risk in the active treatment group (HR: 0.51; 95%CI 0.36-0.74; P = 0.0003. The reduced mortality could be seen to persist during the 10-year period. Subgroup analysis showed positive effects in both genders. An equally positive risk reduction could be seen in those with ischemic heart disease (HR: 0.51; 95%CI 0.27-0.97; P = 0.04, but also in the different functional classes.In a 10-year follow-up of a group of healthy elderly participants given four years of intervention with selenium and coenzyme Q10, significantly reduced cardiovascular mortality was observed. The protective action was not confined to the intervention period, but persisted during the follow-up period. The mechanism explaining the persistency remains to be elucidated. Since this was a small study, the observations should be regarded as hypothesis-generating.

  1. Previous infection with virulent strains of Newcastle disease virus reduces highly pathogenic avian influenza virus replication, disease, and mortality in chickens.

    Science.gov (United States)

    Costa-Hurtado, Mar; Afonso, Claudio L; Miller, Patti J; Shepherd, Eric; Cha, Ra Mi; Smith, Diane; Spackman, Erica; Kapczynski, Darrell R; Suarez, David L; Swayne, David E; Pantin-Jackwood, Mary J

    2015-09-23

    Highly pathogenic avian influenza virus (HPAIV) and Newcastle disease virus (NDV) are two of the most important viruses affecting poultry worldwide and produce co-infections especially in areas of the world where both viruses are endemic; but little is known about the interactions between these two viruses. The objective of this study was to determine if co-infection with NDV affects HPAIV replication in chickens. Only infections with virulent NDV strains (mesogenic Pigeon/1984 or velogenic CA/2002), and not a lentogenic NDV strain (LaSota), interfered with the replication of HPAIV A/chicken/Queretaro/14588-19/95 (H5N2) when the H5N2 was given at a high dose (10(6.9) EID50) two days after the NDV inoculation, but despite this interference, mortality was still observed. However, chickens infected with the less virulent mesogenic NDV Pigeon/1984 strain three days prior to being infected with a lower dose (10(5.3-5.5) EID50) of the same or a different HPAIV, A/chicken/Jalisco/CPA-12283-12/2012 (H7N3), had reduced HPAIV replication and increased survival rates. In conclusion, previous infection of chickens with virulent NDV strains can reduce HPAIV replication, and consequently disease and mortality. This interference depends on the titer of the viruses used, the virulence of the NDV, and the timing of the infections. The information obtained from these studies helps to understand the possible interactions and outcomes of infection (disease and virus shedding) when HPAIV and NDV co-infect chickens in the field.

  2. Costs and cost-effectiveness of training traditional birth attendants to reduce neonatal mortality in the Lufwanyama Neonatal Survival study (LUNESP.

    Directory of Open Access Journals (Sweden)

    Lora L Sabin

    Full Text Available BACKGROUND: The Lufwanyama Neonatal Survival Project ("LUNESP" was a cluster randomized, controlled trial that showed that training traditional birth attendants (TBAs to perform interventions targeting birth asphyxia, hypothermia, and neonatal sepsis reduced all-cause neonatal mortality by 45%. This companion analysis was undertaken to analyze intervention costs and cost-effectiveness, and factors that might improve cost-effectiveness. METHODS AND FINDINGS: We calculated LUNESP's financial and economic costs and the economic cost of implementation for a forecasted ten-year program (2011-2020. In each case, we calculated the incremental cost per death avoided and disability-adjusted life years (DALYs averted in real 2011 US dollars. The forecasted 10-year program analysis included a base case as well as 'conservative' and 'optimistic' scenarios. Uncertainty was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. The estimated financial and economic costs of LUNESP were $118,574 and $127,756, respectively, or $49,469 and $53,550 per year. Fixed costs accounted for nearly 90% of total costs. For the 10-year program, discounted total and annual program costs were $256,455 and $26,834 respectively; for the base case, optimistic, and conservative scenarios, the estimated cost per death avoided was $1,866, $591, and $3,024, and cost per DALY averted was $74, $24, and $120, respectively. Outcomes were robust to variations in local costs, but sensitive to variations in intervention effect size, number of births attended by TBAs, and the extent of foreign consultants' participation. CONCLUSIONS: Based on established guidelines, the strategy of using trained TBAs to reduce neonatal mortality was 'highly cost effective'. We strongly recommend consideration of this approach for other remote rural populations with limited access to health care.

  3. Preemptive heme oxygenase-1 gene delivery reveals reduced mortality and preservation of left ventricular function 1 yr after acute myocardial infarction.

    Science.gov (United States)

    Liu, Xiaoli; Simpson, Jeremy A; Brunt, Keith R; Ward, Christopher A; Hall, Sean R R; Kinobe, Robert T; Barrette, Valerie; Tse, M Yat; Pang, Stephen C; Pachori, Alok S; Dzau, Victor J; Ogunyankin, Kofo O; Melo, Luis G

    2007-07-01

    We reported previously that predelivery of heme oxygenase-1 (HO-1) gene to the heart by adeno-associated virus-2 (AAV-2) markedly reduces ischemia and reperfusion (I/R)-induced myocardial injury. However, the effect of preemptive HO-1 gene delivery on long-term survival and prevention of postinfarction heart failure has not been determined. We assessed the effect of HO-1 gene delivery on long-term survival, myocardial function, and left ventricular (LV) remodeling 1 yr after myocardial infarction (MI) using echocardiographic imaging, pressure-volume (PV) analysis, and histomorphometric approaches. Two groups of Lewis rats were injected with 2 x 10(11) particles of AAV-LacZ (control) or AAV-human HO-1 (hHO-1) in the anterior-posterior apical region of the LV wall. Six weeks after gene transfer, animals were subjected to 30 min of ischemia by ligation of the left anterior descending artery followed by reperfusion. Echocardiographic measurements and PV analysis of LV function were obtained at 2 wk and 12 mo after I/R. One year after acute MI, mortality was markedly reduced in the HO-1-treated animals compared with the LacZ-treated animals. PV analysis demonstrated significantly enhanced LV developed pressure, elevated maximal dP/dt, and lower end-diastolic volume in the HO-1 animals compared with the LacZ animals. Echocardiography showed a larger apical anterior-to-posterior wall ratio in HO-1 animals compared with LacZ animals. Morphometric analysis revealed extensive myocardial scarring and fibrosis in the infarcted LV area of LacZ animals, which was reduced by 62% in HO-1 animals. These results suggest that preemptive HO-1 gene delivery may be useful as a therapeutic strategy to reduce post-MI LV remodeling and heart failure.

  4. Utility of population models to reduce uncertainty and increase value relevance in ecological risk assessments of pesticides: an example based on acute mortality data for daphnids.

    Science.gov (United States)

    Hanson, Niklas; Stark, John D

    2012-04-01

    Traditionally, ecological risk assessments (ERA) of pesticides have been based on risk ratios, where the predicted concentration of the chemical is compared to the concentration that causes biological effects. The concentration that causes biological effect is mostly determined from laboratory experiments using endpoints on the level of the individual (e.g., mortality and reproduction). However, the protection goals are mostly defined at the population level. To deal with the uncertainty in the necessary extrapolations, safety factors are used. Major disadvantages with this simplified approach is that it is difficult to relate a risk ratio to the environmental protection goals, and that the use of fixed safety factors can result in over- as well as underprotective assessments. To reduce uncertainty and increase value relevance in ERA, it has been argued that population models should be used more frequently. In the present study, we have used matrix population models for 3 daphnid species (Ceriodaphnia dubia, Daphnia magna, and D. pulex) to reduce uncertainty and increase value relevance in the ERA of a pesticide (spinosad). The survival rates in the models were reduced in accordance with data from traditional acute mortality tests. As no data on reproductive effects were available, the conservative assumption that no reproduction occurred during the exposure period was made. The models were used to calculate the minimum population size and the time to recovery. These endpoints can be related to the European Union (EU) protection goals for aquatic ecosystems in the vicinity of agricultural fields, which state that reversible population level effects are acceptable if there is recovery within an acceptable (undefined) time frame. The results of the population models were compared to the acceptable (according to EU documents) toxicity exposure ratio (TER) that was based on the same data. At the acceptable TER, which was based on the most sensitive species (C. dubia

  5. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy

    Directory of Open Access Journals (Sweden)

    Aradeon SB

    2016-03-01

    Full Text Available Susan B Aradeon,1 Henry V Doctor2 1Freelance International Consultant (Social and Behavioral Change Communication, Aventura, FL, USA; 2Department of Information, Evidence and Research, Regional Office for the Eastern Mediterranean, World Health Organization, Nasr City, Cairo, Egypt Abstract: The Sustainable Development Goal (SDG maternal mortality target risks being underachieved like its Millennium Development Goal (MDG predecessor. The MDG skilled birth attendant (SBA strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and

  6. Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data

    OpenAIRE

    Muthuri, Stella G.; Venkatesan, Sudhir; Myles, Puja R.; Leonardi-Bee, Jo; Al Khuwaitir, Tarig S.; Al Mamun, Abdullah; Anovadiya, Ashish P.; Azziz-Baumgartner, Eduardo; Báez, Clarisa; Bassetti, Matteo; Beovic, Bojana; Bertisch, Barbara; Bonmarin, Isabelle; Booy, Robert; Victor H. Borja-Aburto

    2014-01-01

    Neuraminidase inhibitors were widely used during the 2009/10 influenza A H1N1 pandemic, but evidence for their effectiveness in reducing mortality is uncertain. We did a meta-analysis of individual participant data to investigate the association between use of neuraminidase inhibitors and mortality in patients admitted to hospital with pandemic influenza A H1N1pdm09 virus infection. We assembled data for patients (all ages) admitted to hospital worldwide with laboratory confirmed or clinicall...

  7. The Meaning of Administrative Intervention for Reducing Maternal Mortality%行政干预对降低孕产妇死亡率的意义

    Institute of Scientific and Technical Information of China (English)

    宣兆宇

    2015-01-01

    目的:进一步探究行政干预政策对降低孕产妇死亡概率的临床影响。方法根据某院2010年1月—2015年3月所收治的46000名孕产妇的临床资料及院后随访结果,对该地区孕产妇死亡因素进行解析,并分析行政干预对降低孕产妇死亡的临床意义。结果46000名孕产妇中,因文化程度、经济收入、居住环境这3个主要因素的不同,其妊娠过程中的死亡概率差异有统计学意义(P<0.05)。吉林省于2010年起拟定并执行新的母婴安全行政法规,与以往资料相比孕产妇死亡率差异有统计学意义(P<0.05)。结论行政干预不仅是保证母婴安全的一项重--求和内容,更是妇产科医院未来发展和完善指向标,建立健全的母婴安全行政制度可以使妇科科医院的社会职能得到最大化的发挥,使母亲安全生产、并确保新生儿健康。%Objective To explore the clinical effect of administrative intervention policy to reduce the probability of mater-nal mortality. Methods According to the clinical data of 46000 pregnant women in our hospital from January 2010 to March 2015, the clinical data and follow-up results were analyzed, and the factors of maternal death in this area were analyzed, and the clinical significance of administrative intervention to reduce maternal mortality was analyzed. Results 46000 mater-nal, because of the degree of culture, economic income, living environment, the three main factors, the probability of death in the course of their pregnancy has a significant statistical difference (P<0.05). In 2010, we have developed and imple-mented new maternal and child safety administrative regulations, compared with the previous data; the maternal mortality rate has a statistically significant difference (P<0.05). Conclusion Administrative intervention is not only an important re-quirement of maternal and child safety, but also the future development and improvement of Obstetrics and

  8. The P50 Research Center in Perioperative Sciences: How the investment by the National Institute of General Medical Sciences in team science has reduced postburn mortality.

    Science.gov (United States)

    Finnerty, Celeste C; Capek, Karel D; Voigt, Charles; Hundeshagen, Gabriel; Cambiaso-Daniel, Janos; Porter, Craig; Sousse, Linda E; El Ayadi, Amina; Zapata-Sirvent, Ramon; Guillory, Ashley N; Suman, Oscar E; Herndon, David N

    2017-09-01

    Since the inception of the P50 Research Center in Injury and Peri-operative Sciences (RCIPS) funding mechanism, the National Institute of General Medical Sciences has supported a team approach to science. Many advances in critical care, particularly burns, have been driven by RCIPS teams. In fact, burns that were fatal in the early 1970s, prior to the inception of the P50 RCIPS program, are now routinely survived as a result of the P50-funded research. The advances in clinical care that led to the reduction in postburn death were made by optimizing resuscitation, incorporating early excision and grafting, bolstering acute care including support for inhalation injury, modulating the hypermetabolic response, augmenting the immune response, incorporating aerobic exercise, and developing antiscarring strategies. The work of the Burn RCIPS programs advanced our understanding of the pathophysiologic response to burn injury. As a result, the effects of a large burn on all organ systems have been studied, leading to the discovery of persistent dysfunction, elucidation of the underlying molecular mechanisms, and identification of potential therapeutic targets. Survival and subsequent patient satisfaction with quality of life have increased. In this review article, we describe the contributions of the Galveston P50 RCIPS that have changed postburn care and have considerably reduced postburn mortality.

  9. Research report--Volunteer infant feeding and care counselors: a health education intervention to improve mother and child health and reduce mortality in rural Malawi.

    Science.gov (United States)

    Rosato, Mikey; Lewycka, Sonia; Mwansambo, Charles; Kazembe, Peter; Phiri, Tambosi; Chapota, Hilda; Vergnano, Stefania; Newell, Marie-Louise; Osrin, David; Costello, Anthony

    2012-06-01

    The aim of this report is to describe a health education intervention involving volunteer infant feeding and care counselors being implemented in Mchinji district, Malawi. The intervention was established in January 2004 and involves 72 volunteer infant feeding and care counselors, supervised by 24 government Health Surveillance Assistants, covering 355 villages in Mchinji district. It aims to change the knowledge, attitudes and behaviour of women to promote exclusive breastfeeding and other infant care practices. The main target population are women of child bearing age who are visited at five key points during pregnancy and after birth. Where possible, their partners are also involved. The visits cover exclusive breastfeeding and other important neonatal and infant care practices. Volunteers are provided with an intervention manual and picture book. Resource inputs are low and include training allowances and equipment for counselors and supervisors, and a salary, equipment and materials for a coordinator. It is hypothesized that the counselors will encourage informational and attitudinal change to enhance motivation and risk reduction skills and self-efficacy to promote exclusive breastfeeding and other infant care practices and reduce infant mortality. The impact is being evaluated through a cluster randomised controlled trial and results will be reported in 2012.

  10. Pre-eclampsia and the HELLP syndrome still cause maternal mortality in the Netherlands and other developed countries; can we reduce it?

    NARCIS (Netherlands)

    Onrust, S; Santema, JG; Aarnoudse, JG

    1999-01-01

    Maternal mortality in developed countries does not seem to have decreased during the past decade, despite good prenatal care. Hypertensive disorders of pregnancy are the main cause of maternal mortality in most countries. In more than half of these cases, the HELLP syndrome is involved. In this arti

  11. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy

    Science.gov (United States)

    Aradeon, Susan B; Doctor, Henry V

    2016-01-01

    The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support

  12. Cause of Death in Women of Reproductive Age in Rural Nepal Obtained Through Community-Based Surveillance: Is Reducing Maternal Mortality the Right Priority for Women's Health Programs?

    Science.gov (United States)

    Pyakurel, Ram; Sharma, Nirmala; Paudel, Deepak; Coghill, Anna; Sinden, Laura; Bost, Liberty; Larkin, Melissa; Burrus, Carla Jean; Roy, Khrist

    2015-01-01

    We used a community surveillance system to gather information regarding pregnancy outcomes and the cause of death for women of reproductive age (WRA) in Kanchanpur, Nepal. A total of 784 mother groups participated in the collection of pregnancy outcomes and mortality data. Of the 273 deaths among WRA, the leading causes of death reported were chronic diseases (94, 34.4%) poisoning, snake bites, and suicide (grouped together; 55, 20.1%), and accidents (29, 10.6%), while maternal mortality accounted for 7%. Nevertheless, the calculated maternal mortality ratio was quite high (259.3 per 100,000 live births).

  13. Maternal education is associated with reduced female disadvantages in under-five mortality in sub-Saharan Africa and southern Asia.

    Science.gov (United States)

    Monden, Christiaan W S; Smits, Jeroen

    2013-02-01

    The male:female (M:F) mortality ratio for under-five mortality varies considerably across and within societies. Maternal education has been linked to better outcomes for girls, but the evidence is mixed. We examined how the M:F ratio for under-five mortality varies by maternal education in sub-Saharan Africa and southern Asia. We used recent Demographic and Health Surveys from 31 sub-Saharan African and 4 southern Asian countries. M:F mortality ratios were determined using information on 49 769 deaths among 521 551 children. We estimate M:F ratios for under-five (month 0-59), neonatal (month 0), post-neonatal (month 1-11) and child mortality (month 12-59) by maternal education while controlling for demographic and household characteristics. M:F ratios for under-five mortality and child mortality are compared with more 'gender neutral' thresholds (of 1.25 and 1.17, respectively) estimated on the basis of the Human Mortality Database. In sub-Saharan Africa, the M:F ratio for under-five mortality is 1.09 [95% confidence interval (CI) 1.06-1.13] among non-educated mothers, 1.14 (95% CI 1.09-1.19) among mothers with some primary education and 1.25 (95% CI 1.16-1.34) among mothers with some secondary or more education. For southern Asia, the ratios are 0.88 (95% CI 0.82-0.95), 1.10 (95% CI 0.97-1.25) and 1.13 (95% CI 1.02-1.26), respectively. The M:F ratio for child mortality also shows an educational gradient in both regions, with the M:F ratio being lower among non-educated mothers. In southern Asia, the M:F ratio for child mortality is particularly low among mothers with no education, M:F ratio = 0.54 (95% CI 0.41-0.72). Among mothers with more education, the difference in the mortality chances of boys and girls more closely resembles a 'gender neutral' situation than among women with no or little education. Girls benefit both in absolute and relative terms from having a more educated mother.

  14. Supply of neuraminidase inhibitors related to reduced influenza A (H1N1) mortality during the 2009-2010 H1N1 pandemic: summary of an ecological study.

    Science.gov (United States)

    Miller, Paula E; Rambachan, Aksharananda; Hubbard, Roderick J; Li, Jiabai; Meyer, Alison E; Stephens, Peter; Mounts, Anthony W; Rolfes, Melissa A; Penn, Charles R

    2013-09-01

    When the influenza A (H1N1) pandemic spread across the globe from April 2009 to August 2010, many WHO Member States used antiviral drugs, specifically neuraminidase inhibitors (NAIs) oseltamivir and zanamivir, to treat influenza patients in critical condition. Antivirals have been found to be effective in reducing severity and duration of influenza illness, and likely reduce morbidity; however, it is unclear whether NAIs used during the pandemic reduced H1N1 mortality. To assess the association between antivirals and influenza mortality, at an ecologic level, country-level data on supply of oseltamivir and zanamivir were compared to laboratory-confirmed H1N1 deaths (per 100 000 people) from July 2009 to August 2010 in 42 WHO Member States. From this analysis, it was found that each 10% increase in kilograms of oseltamivir, per 100 000 people, was associated with a 1·6% reduction in H1N1 mortality over the pandemic period [relative rate (RR) = 0·84 per log increase in oseltamivir supply]. Each 10% increase in kilogram of active zanamivir, per 100 000, was associated with a 0·3% reduction in H1N1 mortality (RR = 0·97 per log increase). While limitations exist in the inference that can be drawn from an ecologic evaluation, this analysis offers evidence of a protective relationship between antiviral drug supply and influenza mortality and supports a role for influenza antiviral use in future pandemics. This article summarises the original study described previously, which can be accessed through the following citation: Miller PE, Rambachan A, Hubbard RJ, Li J, Meyer AE, et al. (2012) Supply of Neuraminidase Inhibitors Related to Reduced Influenza A (H1N1) Mortality during the 2009-2010 H1N1 Pandemic: An Ecological Study. PLoS ONE 7(9): e43491.

  15. LATERAL FLOW ASSAY FOR CRYPTOCOCCAL ANTIGEN: AN IMPORTANT ADVANCE TO IMPROVE THE CONTINUUM OF HIV CARE AND REDUCE CRYPTOCOCCAL MENINGITIS-RELATED MORTALITY

    Directory of Open Access Journals (Sweden)

    Jose E. VIDAL

    2015-09-01

    Full Text Available SUMMARYAIDS-related cryptococcal meningitis continues to cause a substantial burden of death in low and middle income countries. The diagnostic use for detection of cryptococcal capsular polysaccharide antigen (CrAg in serum and cerebrospinal fluid by latex agglutination test (CrAg-latex or enzyme-linked immunoassay (EIA has been available for over decades. Better diagnostics in asymptomatic and symptomatic phases of cryptococcosis are key components to reduce mortality. Recently, the cryptococcal antigen lateral flow assay (CrAg LFA was included in the armamentarium for diagnosis. Unlike the other tests, the CrAg LFA is a dipstick immunochromatographic assay, in a format similar to the home pregnancy test, and requires little or no lab infrastructure. This test meets all of the World Health Organization ASSURED criteria (Affordable, Sensitive, Specific, User friendly, Rapid/robust, Equipment-free, and Delivered. CrAg LFA in serum, plasma, whole blood, or cerebrospinal fluid is useful for the diagnosis of disease caused by Cryptococcusspecies. The CrAg LFA has better analytical sensitivity for C. gattii than CrAg-latex or EIA. Prevention of cryptococcal disease is new application of CrAg LFA via screening of blood for subclinical infection in asymptomatic HIV-infected persons with CD4 counts < 100 cells/mL who are not receiving effective antiretroviral therapy. CrAg screening of leftover plasma specimens after CD4 testing can identify persons with asymptomatic infection who urgently require pre-emptive fluconazole, who will otherwise progress to symptomatic infection and/or die.

  16. LATERAL FLOW ASSAY FOR CRYPTOCOCCAL ANTIGEN: AN IMPORTANT ADVANCE TO IMPROVE THE CONTINUUM OF HIV CARE AND REDUCE CRYPTOCOCCAL MENINGITIS-RELATED MORTALITY.

    Science.gov (United States)

    Vidal, Jose E; Boulware, David R

    2015-09-01

    AIDS-related cryptococcal meningitis continues to cause a substantial burden of death in low and middle income countries. The diagnostic use for detection of cryptococcal capsular polysaccharide antigen (CrAg) in serum and cerebrospinal fluid by latex agglutination test (CrAg-latex) or enzyme-linked immunoassay (EIA) has been available for over decades. Better diagnostics in asymptomatic and symptomatic phases of cryptococcosis are key components to reduce mortality. Recently, the cryptococcal antigen lateral flow assay (CrAg LFA) was included in the armamentarium for diagnosis. Unlike the other tests, the CrAg LFA is a dipstick immunochromatographic assay, in a format similar to the home pregnancy test, and requires little or no lab infrastructure. This test meets all of the World Health Organization ASSURED criteria (Affordable, Sensitive, Specific, User friendly, Rapid/robust, Equipment-free, and Delivered). CrAg LFA in serum, plasma, whole blood, or cerebrospinal fluid is useful for the diagnosis of disease caused by Cryptococcus species. The CrAg LFA has better analytical sensitivity for C. gattii than CrAg-latex or EIA. Prevention of cryptococcal disease is new application of CrAg LFA via screening of blood for subclinical infection in asymptomatic HIV-infected persons with CD4 counts < 100 cells/mL who are not receiving effective antiretroviral therapy. CrAg screening of leftover plasma specimens after CD4 testing can identify persons with asymptomatic infection who urgently require pre-emptive fluconazole, who will otherwise progress to symptomatic infection and/or die.

  17. LATERAL FLOW ASSAY FOR CRYPTOCOCCAL ANTIGEN: AN IMPORTANT ADVANCE TO IMPROVE THE CONTINUUM OF HIV CARE AND REDUCE CRYPTOCOCCAL MENINGITIS-RELATED MORTALITY

    Science.gov (United States)

    VIDAL, Jose E.; BOULWARE, David R.

    2015-01-01

    SUMMARY AIDS-related cryptococcal meningitis continues to cause a substantial burden of death in low and middle income countries. The diagnostic use for detection of cryptococcal capsular polysaccharide antigen (CrAg) in serum and cerebrospinal fluid by latex agglutination test (CrAg-latex) or enzyme-linked immunoassay (EIA) has been available for over decades. Better diagnostics in asymptomatic and symptomatic phases of cryptococcosis are key components to reduce mortality. Recently, the cryptococcal antigen lateral flow assay (CrAg LFA) was included in the armamentarium for diagnosis. Unlike the other tests, the CrAg LFA is a dipstick immunochromatographic assay, in a format similar to the home pregnancy test, and requires little or no lab infrastructure. This test meets all of the World Health Organization ASSURED criteria (Affordable, Sensitive, Specific, User friendly, Rapid/robust, Equipment-free, and Delivered). CrAg LFA in serum, plasma, whole blood, or cerebrospinal fluid is useful for the diagnosis of disease caused by Cryptococcus species. The CrAg LFA has better analytical sensitivity for C. gattii than CrAg-latex or EIA. Prevention of cryptococcal disease is new application of CrAg LFA via screening of blood for subclinical infection in asymptomatic HIV-infected persons with CD4 counts < 100 cells/mL who are not receiving effective antiretroviral therapy. CrAg screening of leftover plasma specimens after CD4 testing can identify persons with asymptomatic infection who urgently require pre-emptive fluconazole, who will otherwise progress to symptomatic infection and/or die. PMID:26465368

  18. Occupational mortality

    DEFF Research Database (Denmark)

    Lynge, Elsebeth

    2011-01-01

    INTRODUCTION: This paper aims to present the methods and main results from the Danish occupational mortality studies, and to set the Danish studies into the international context of occupational mortality studies. RESEARCH TOPICS: The first Danish occupational mortality study from 1970...

  19. Report from the Rockefellar Foundation Sponsored International Workshop on reducing mortality and improving quality of life in long-term survivors of Hodgkin's disease: July 9-16, 2003, Bellagio, Italy

    DEFF Research Database (Denmark)

    Mauch, Peter; Ng, Andrea; Aleman, Berthe;

    2005-01-01

    A workshop, sponsored by the Rockefellar Foundation, was held between 9 to 16 July, 2003 to devise strategies to reduce mortality and improve quality of life of long-term survivors of Hodgkin's disease. Participants were selected for their clinical and research background on late effects after...

  20. Reduced colon cancer incidence and mortality in postmenopausal women treated with an oral bisphosphonate-Danish National Register Based Cohort Study

    DEFF Research Database (Denmark)

    Pazianas, M; Abrahamsen, B; Eiken, Pia Agnete;

    2012-01-01

    In this Danish national register-based cohort study, we examined the effects of alendronate on the development of colon cancers and survival. The incidence of colon cancer and mortality rate, once colon cancer had been diagnosed, were lower in patients treated with alendronate, posing the questio...

  1. Ten-year mortality is increased after hospitalization for atopic dermatitis compared with the general population, but reduced compared with psoriasis.

    Science.gov (United States)

    Egeberg, Alexander; Skov, Lone; Andersen, Yuki M F; Mallbris, Lotus; Gislason, Gunnar H; Silverberg, Jonathan I; Wu, Jashin J; Thyssen, Jacob P

    2017-01-01

    Psoriasis and atopic dermatitis (AD) are chronic inflammatory skin disorders. Mortality is increased in psoriasis, yet no studies on mortality in AD are currently available. We investigated 10-year mortality after hospitalization for AD compared with psoriasis and the general population. Between 1996 and 2002 all Danes aged 18 years or older with a first-time hospitalization as a result of AD or psoriasis and AD-matched healthy control subjects were examined in nationwide registers. Multivariable (adjusted for age, sex, socioeconomic status, Charlson Comorbidity Index score, smoking, and medication) hazard ratios were estimated by Cox regression. The study comprised 576 and 951 hospitalized patients with AD and psoriasis, respectively, with a maximum follow-up time of 10 years. During the study period, there were 65 and 286 deaths among patients with AD and psoriasis. Risk of death was decreased in patients with AD versus psoriasis (hazard ratio 0.75; 95% confidence interval 0.57-1.00), but higher than in general population control subjects (n = 5760) (hazard ratio 1.71; 95% confidence interval 1.20-2.44). Patients hospitalized with AD died on average 8.3 years younger than control subjects. Lifestyle may have affected the risk. The 10-year mortality was significantly lower after hospitalization for AD compared with psoriasis, but increased when compared with the general population. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  2. Efficacy of a novel prebiotic and a commercial probiotic in reducing mortality and production losses due to cold stress and Escherichia coli challenge of broiler chicks 1.

    Science.gov (United States)

    Huff, G R; Huff, W E; Rath, N C; El-Gohary, F A; Zhou, Z Y; Shini, S

    2015-05-01

    Prebiotics consisting of resistant starch may alter intestinal ecology, thus modulating inflammation and increasing intestinal health through increased cecal production of short-chain fatty acids (SCFA). Probiotics may directly alter the intestinal microbiome, resulting in the same effects. We hypothesize that adding prebiotics and probiotics to feed may protect the gut of young chicks under stress. Studies 1, 2, and 3 evaluated treatments in a cold stress (CS) and Escherichia coli (EC) oral challenge to 430 day-old broiler chicks for 3 wk. In study 1, prebiotics were administered as 15% of the diet during the first week only and consisted of the following: Hi-Maize resistant starch (HM), potato starch (PS), or raw potato (RP). In studies 2 and 3, the PS treatment was identical to study 1, and an additional probiotic treatment (PRO) was administered in feed and water. In study 1, PS protected BW during the first week and decreased the mortality of CS/EC-challenged birds during the first week and wk 3, while RP decreased the mortality of warm-brooded birds challenged with EC during the first week. In study 2, PS decreased and PRO increased the main effect mean (MEM) of the first week BW. PS and PRO numerically decreased the feed conversion ratio (FCR) by 23 and 29 points, respectively, in CS/EC-challenged birds with no effects on mortality. In study 3, PS decreased and PRO increased the first week and wk 3 MEM BW. PS numerically increased FCR by 16 points, while PRO decreased FCR by 2 points. Both PS and PRO tended to increase overall mortality, and PRO significantly increased mortality in the CS/EC challenge. These results suggest that the effects of PS may be too variable in this challenge model for further study; however, the PRO treatment improved production values and may have potential as an alternative to antibiotics during the first weeks after hatch.

  3. Trends in child mortality in India.

    Science.gov (United States)

    Behl, A S

    2013-01-08

    To assess Indias recent trends in child mortality rates and disparities and identify ways to reduce child mortality and wealth-related health disparities, we analyzed three years of data from Indias National Family Health Survey related to child mortality. Nationally, declines in average child mortality were statistically significant, but declines in inequality were not. Urban areas had lower child mortality rates than rural areas but higher inequalities. Interstate differences in child mortality rates were significant, with rates in the highest-mortality states four to six times higher than in the lowest-mortality states. However, child mortality in most states declined.

  4. Erythrocytic mobilization enhanced by the granulocyte colony-stimulating factor is associated with reduced anthrax-lethal-toxin-induced mortality in mice.

    Directory of Open Access Journals (Sweden)

    Hsin-Hou Chang

    Full Text Available Anthrax lethal toxin (LT, one of the primary virulence factors of Bacillus anthracis, causes anthrax-like symptoms and death in animals. Experiments have indicated that levels of erythrocytopenia and hypoxic stress are associated with disease severity after administering LT. In this study, the granulocyte colony-stimulating factor (G-CSF was used as a therapeutic agent to ameliorate anthrax-LT- and spore-induced mortality in C57BL/6J mice. We demonstrated that G-CSF promoted the mobilization of mature erythrocytes to peripheral blood, resulting in a significantly faster recovery from erythrocytopenia. In addition, combined treatment using G-CSF and erythropoietin tended to ameliorate B. anthracis-spore-elicited mortality in mice. Although specific treatments against LT-mediated pathogenesis remain elusive, these results may be useful in developing feasible strategies to treat anthrax.

  5. Simulation of reduced breast cancer mortality in breast cancer screening programs; Simulacion de la reduccion de mortalidad por cancer de mama en programas de cribado mamografico

    Energy Technology Data Exchange (ETDEWEB)

    Zamora, L. I.; Forastero, C.; Guirado, D.; Lallena, A. M.

    2011-07-01

    The breast cancer screening programs are an essential tool in the fight against breast cancer. Currently, many questions concerning the setup of these programs are open, namely: age range of women who undergo the same, frequency of mammography, ... The effectiveness of a program should be evaluated in terms of mortality reduction is its systematic implementation in the population. In this sense, we performed Monte Carlo simulations to assess that these reductions.

  6. Reducing neonatal mortality associated with preterm birth: gaps in knowledge of the impact of antenatal corticosteroids on preterm birth outcomes in low-middle income countries.

    Science.gov (United States)

    McClure, Elizabeth M; Goldenberg, Robert L; Jobe, Alan H; Miodovnik, Menachem; Koso-Thomas, Marion; Buekens, Pierre; Belizan, Jose; Althabe, Fernando

    2016-05-24

    The Global Network's Antenatal Corticosteroids Trial (ACT), was a multi-country, cluster-randomized trial to improve appropriate use of antenatal corticosteroids (ACS) in low-resource settings in low-middle income countries (LMIC). ACT substantially increased ACS use in the intervention clusters, but the intervention failed to show benefit in the targeted < 5th percentile birth weight infants and was associated with increased neonatal mortality and stillbirth in the overall population. In this issue are six papers which are secondary analyses related to ACT that explore potential reasons for the increase in adverse outcomes overall, as well as site differences in outcomes. The African sites appeared to have increased neonatal mortality in the intervention clusters while the Guatemalan site had a significant reduction in neonatal mortality, perhaps related to a combination of ACS and improving obstetric care in the intervention clusters. Maternal and neonatal infections were increased in the intervention clusters across all sites and increased infections are a possible partial explanation for the increase in neonatal mortality and stillbirth in the intervention clusters, especially in the African sites. The analyses presented here provide guidance for future ACS trials in LMIC. These include having accurate gestational age dating of study subjects and having care givers who can diagnose conditions leading to preterm birth and predict which women likely will deliver in the next 7 days. All study subjects should be followed through delivery and the neonatal period, regardless of when they deliver. Clearly defined measures of maternal and neonatal infection should be utilized. Trials in low income country facilities including clinics and those without newborn intensive care seem to be of the highest priority.

  7. Antibiotic stewardship ward rounds and a dedicated prescription chart reduce antibiotic consumption and pharmacy costs without affecting inpatient mortality or re-admission rates.

    Directory of Open Access Journals (Sweden)

    Tom H Boyles

    Full Text Available BACKGROUND: Antibiotic consumption is a major driver of bacterial resistance. To address the increasing burden of multi-drug resistant bacterial infections, antibiotic stewardship programmes are promoted worldwide to rationalize antibiotic prescribing and conserve remaining antibiotics. Few studies have been reported from developing countries and none from Africa that report on an intervention based approach with outcomes that include morbidity and mortality. METHODS: An antibiotic prescription chart and weekly antibiotic stewardship ward round was introduced into two medical wards of an academic teaching hospital in South Africa between January-December 2012. Electronic pharmacy records were used to collect the volume and cost of antibiotics used, the patient database was analysed to determine inpatient mortality and 30-day re-admission rates, and laboratory records to determine use of infection-related tests. Outcomes were compared to a control period, January-December 2011. RESULTS: During the intervention period, 475.8 defined daily doses were prescribed per 1000 inpatient days compared to 592.0 defined daily doses/1000 inpatient days during the control period. This represents a 19.6% decrease in volume with a cost reduction of 35% of the pharmacy's antibiotic budget. There was a concomitant increase in laboratory tests driven by requests for procalcitonin. There was no difference in inpatient mortality or 30-day readmission rate during the control and intervention periods. CONCLUSIONS: Introduction of antibiotic stewardship ward rounds and a dedicated prescription chart in a developing country setting can achieve reduction in antibiotic consumption without harm to patients. Increased laboratory costs should be anticipated when introducing an antibiotic stewardship program.

  8. Increases in soil water content after the mortality of non-native trees in oceanic island forest ecosystems are due to reduced water loss during dry periods.

    Science.gov (United States)

    Hata, Kenji; Kawakami, Kazuto; Kachi, Naoki

    2016-03-01

    The control of dominant, non-native trees can alter the water balance of soils in forest ecosystems via hydrological processes, which results in changes in soil water environments. To test this idea, we evaluated the effects of the mortality of an invasive tree, Casuarina equisetifolia Forst., on the water content of surface soils on the Ogasawara Islands, subtropical islands in the northwestern Pacific Ocean, using a manipulative herbicide experiment. Temporal changes in volumetric water content of surface soils at 6 cm depth at sites where all trees of C. equisetifolia were killed by herbicide were compared with those of adjacent control sites before and after their mortality with consideration of the amount of precipitation. In addition, the rate of decrease in the soil water content during dry periods and the rate of increase in the soil water content during rainfall periods were compared between herbicide and control sites. Soil water content at sites treated with herbicide was significantly higher after treatment than soil water content at control sites during the same period. Differences between initial and minimum values of soil water content at the herbicide sites during the drying events were significantly lower than the corresponding differences in the control quadrats. During rainfall periods, both initial and maximum values of soil water contents in the herbicided quadrats were higher, and differences between the maximum and initial values did not differ between the herbicided and control quadrats. Our results indicated that the mortality of non-native trees from forest ecosystems increased water content of surface soils, due primarily to a slower rate of decrease in soil water content during dry periods.

  9. Mortality investigation

    Science.gov (United States)

    Work, Thierry M.; Franson, J. Christian; Friend, Milton; Gibbs, Samantha E.J.; Wild, Margaret A.

    2015-01-01

    Wildlife mortality events usually occur unannounced and may find management agencies unaware. These events can become highly visible and politically charged affairs, depending upon the scale or species involved. The public, media, and (or) politicians may pressure managers, field investigators, and diagnosticians to quickly identify the cause or to comment on potential causes, the significance of the event, what is being done about it, and a resolution. It may be common during such events for speculation to rage, and for conflicting theories to be advanced to explain either the environmental conditions that led to the mortality or the actual cause of death.

  10. Relationship of serum sodium concentration to mortality in a wide spectrum of heart failure patients with preserved and with reduced ejection fraction

    DEFF Research Database (Denmark)

    Rusinaru, Dan; Tribouilloy, Christophe; Berry, Colin

    2012-01-01

    Hyponatraemia has been associated with reduced survival in patients with heart failure and reduced ejection fraction (HF-REF). The relationship between serum sodium and outcome is unclear in heart failure with preserved (≥ 50%) ejection fraction (HF-PEF). Therefore, we used a large individual...... patient data meta-analysis to study the risk of death associated with hyponatraemia in HF-REF and in HF-PEF....

  11. Strengthening health systems capacity to monitor and evaluate programmes targeted at reducing abortion-related maternal mortality in Jessore district, Bangladesh.

    Science.gov (United States)

    Huda, Fauzia Akhter; Ahmed, Anisuddin; Ford, Evelyn Rebecca; Johnston, Heidi Bart

    2015-09-28

    Abortion related deaths as a proportion of maternal mortality appears to have fallen dramatically in Bangladesh from 5 % in 2001 to 1 % in 2010. Yet complications from menstrual regulation (MR) and unsafe abortion continue to cause deleterious health, economic and social consequences for women in the country. This quasi experimental design study with a baseline (January to December 2008) and an endline survey (August to October 2009) was conducted in 69 public, private, and NGO sector health facilities in Jessore district of Bangladesh with the objective of adapting and implementing a set of process indicators, specifically to supplement the indicators for monitoring emergency obstetric care interventions. At the baseline, we collected retrospective data from all 69 health facilities that provided MR, legal abortion or post-abortion care (PAC), by reviewing their last one year's records. Three months after introducing the safe menstrual regulation and abortion care (SMRAC) model, endline data was collected. Signal function (critical services that facilities must perform in order to prevent and treat abortion complications) analysis was used to characterize facilities as providing basic care, comprehensive care, or neither. Facility mapping, and records on services provided and complications treated were used to further characterize service availability and to describe service use and quality. No facilities fulfilled criteria for 'comprehensive' care at either the baseline or end line while only one met the 'basic' criteria during the endline of the project. Recommended uterine evacuation technology, manual vacuum aspiration (MVA) was used for 100.0 % of MR clients but only for 8.0 % or fewer PAC patients. MR clients were 37.5 times more likely than PAC patients to leave facilities with a contraceptive method (75.0 % vs. 2.0 %). Persistent use of older uterine evacuation technologies was observed when recommended techniques were widely available in the facilities

  12. Signal functions for emergency obstetric care as an intervention for reducing maternal mortality: a survey of public and private health facilities in Lusaka District, Zambia.

    Science.gov (United States)

    Tembo, Tannia; Chongwe, Gershom; Vwalika, Bellington; Sitali, Lungowe

    2017-09-06

    Zambia's maternal mortality ratio was estimated at 398/100,000 live births in 2014. Successful aversion of deaths is dependent on availability and usability of signal functions for emergency obstetric and neonatal care. Evidence of availability, usability and quality of signal functions in urban settings in Zambia is minimal as previous research has evaluated their distribution in rural settings. This survey evaluated the availability and usability of signal functions in private and public health facilities in Lusaka District of Zambia. A descriptive cross sectional study was conducted between November 2014 and February 2015 at 35 public and private health facilities. The Service Availability and Readiness Assessment tool was adapted and administered to overall in-charges, hospital administrators or maternity ward supervisors at health facilities providing maternal and newborn health services. The survey quantified infrastructure, human resources, equipment, essential drugs and supplies and used the UN process indicators to determine availability, accessibility and quality of signal functions. Data on deliveries and complications were collected from registers for periods between June 2013 and May 2014. Of the 35 (25.7% private and 74.2% public) health facilities assessed, only 22 (62.8%) were staffed 24 h a day, 7 days a week and had provided obstetric care 3 months prior to the survey. Pre-eclampsia/ eclampsia and obstructed labor accounted for most direct complications while postpartum hemorrhage was the leading cause of maternal deaths. Overall, 3 (8.6%) and 5 (14.3%) of the health facilities had provided Basic and Comprehensive EmONC services, respectively. All facilities obtained blood products from the only blood bank at a government referral hospital. The UN process indicators can be adequately used to monitor progress towards maternal mortality reduction. Lusaka district had an unmet need for BEmONC as health facilities fell below the minimum UN standard

  13. Intracoronary Compared to Intravenous Abciximab in Patients with ST Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention Reduces Mortality, Target Vessel Revascularization and Reinfarction after 1 Year

    DEFF Research Database (Denmark)

    Iversen, Allan Zeeberg; Galatius, Soeren; Abildgaard, Ulrik;

    2011-01-01

    Objectives: Administration of the glycoprotein IIb/IIIa inhibitor abciximab to patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) improves outcome. Data have suggested that an intracoronary (IC) bolus might be superior...... to the standard intravenous (IV) administration. We have previously reported reduced short-term mortality and need for target vessel revascularization (TVR) with the IC route. We now present long-term data from our randomized trial on IC versus IV abciximab in pPCI-treated STEMI patients. Methods: A total of 355...

  14. Winter grazing decreases the probability of fire-induced mortality of bunchgrasses and may reduce wildfire size: a response to Smith et al (this issue)

    Science.gov (United States)

    A recent commentary by Smith et al. (this issue) attempted to discount the findings of our study (Davies et al. this issue) by claiming that our study contained methodological errors and lacked the data necessary to support our conclusions, in particular that winter grazing may reduce the probabilit...

  15. Modeling HIV vaccines in Brazil: assessing the impact of a future HIV vaccine on reducing new infections, mortality and number of people receiving ARV.

    Directory of Open Access Journals (Sweden)

    Maria Goretti P Fonseca

    Full Text Available BACKGROUND: The AIDS epidemic in Brazil remains concentrated in populations with high vulnerability to HIV infection, and the development of an HIV vaccine could make an important contribution to prevention. This study modeled the HIV epidemic and estimated the potential impact of an HIV vaccine on the number of new infections, deaths due to AIDS and the number of people receiving ARV treatment, under various scenarios. METHODS AND FINDINGS: The historical HIV prevalence was modeled using Spectrum and projections were made from 2010 to 2050 to study the impact of an HIV vaccine with 40% to 70% efficacy, and 80% coverage of adult population, specific groups such as MSM, IDU, commercial sex workers and their partners, and 15 year olds. The possibility of disinhibition after vaccination, neglecting medium- and high-risk groups, and a disease-modifying vaccine were also considered. The number of new infections and deaths were reduced by 73% and 30%, respectively, by 2050, when 80% of adult population aged 15-49 was vaccinated with a 40% efficacy vaccine. Vaccinating medium- and high-risk groups reduced new infections by 52% and deaths by 21%. A vaccine with 70% efficacy produced a great decline in new infections and deaths. Neglecting medium- and high-risk population groups as well as disinhibition of vaccinated population reduced the impact or even increased the number of new infections. Disease-modifying vaccine also contributed to reducing AIDS deaths, the need for ART and new HIV infections. CONCLUSIONS: Even in a country with a concentrated epidemic and high levels of ARV coverage, such as Brazil, moderate efficacy vaccines as part of a comprehensive package of treatment and prevention could have a major impact on preventing new HIV infections and AIDS deaths, as well as reducing the number of people on ARV. Targeted vaccination strategies may be highly effective and cost-beneficial.

  16. Mortality Implications of Mortality Plateaus

    DEFF Research Database (Denmark)

    Missov, T. I.; Vaupel, J. W.

    2015-01-01

    This article aims to describe in a unified framework all plateau-generating random effects models in terms of (i) plausible distributions for the hazard (baseline mortality) and the random effect (unobserved heterogeneity, frailty) as well as (ii) the impact of frailty on the baseline hazard. Mor...

  17. Providing instrumental social support is more beneficial to reduce mortality risk among the elderly with low educational level in Taiwan: a 12-year follow-up national longitudinal study.

    Science.gov (United States)

    Liao, C C; Yeh, C J; Lee, S H; Liao, W C; Liao, M Y; Lee, M C

    2015-04-01

    To evaluate whether the effects of providing or receiving social support are more beneficial to reduce mortality risk among the elderly with different educational levels. In this long-term prospective cohort study, data were retrieved from the Taiwan Longitudinal Study on Aging. This study was initiated from 1996 until 2007. The complete data from 1492 males and 1177 females aged ≥67 years were retrieved. Participants received financial, instrumental, and emotional support, and they actively provided instrumental and emotional support to others and involved in social engagement. Education attainment was divided into two levels: high and low. The low education level included illiterate and elementary school. The high education level included junior high school to senior high school and above college. Cox regression analysis was used to examine the association between providing or receiving social support on mortality with different educational levels. The average age of the participants in 1996 was 73.0 (IQR=8.0) years, and the median survival following years (1996-2007) of participants was 10.3 (IQR=6.7) years. Most participants were low educational level including illiterate (39.3%) and elementary school (41.2%). Participants with high educational level tend to be younger and more male significantly. On the contrary, participants with low educational level tend to have significant more poor income, more depression, more cognition impairment, more with IADL and ADL disability than high educational level. Most participants received instrumental support from others (95.5%) and also provided emotional support to others (97.7%). Providing instrumental support can reduce 17% of mortality risk among the elderly with a low level of education after adjusting several covariates [Hazard ratio (HR) = 0.83; 95% confidence interval (CI) = 0.70-0.99; p = 0.036]. Providing instrumental social support to others confer benefits to the giver and prolong life expectancy among the

  18. Gender difference in child mortality.

    Science.gov (United States)

    Ahmed, F A

    1990-12-01

    1976 census data and data on births to 8788 ever married women from the 1980 Egyptian Fertility Survey were analyzed to determine if son preference was responsible for higher mortality among girls than among boys and what factors were associated with this higher mortality. During 0-3 years, boys were more likely to die than females. For example, the overall male-female sex ratio for the 1st year was 118:100. At ages 5, 10, 15, and 2 0, however, girls were more likely to die. The sex rations for these years were 98, 95, 93, and 91. In fact, the excess mortality among illiterate mothers accounted for most of the overall excess mortality. As mother's educational level rose, the excess mortality of girls fell, so that by university level boys experienced excess mortality (130, 111, 112, 105). Less educated mothers breast fed sons longer and waited more months after birth of a son to have another child indicating son preference, but these factors did not necessarily contribute to excess mortality. The major cause of female excess mortality in Egypt was that boys received favored treatment of digestive and respiratory illnesses as indicated by accessibility to a pharmacy (p.01). Norms/traditions and religion played a significant role in excess mortality. The effect of norms/traditions was greater than religion, however. Mother's current and past employment strongly contributed to reducing girls' mortality levels (p.01). These results indicated that Egypt should strive to increase the educational level of females and work opportunities for women to reduce female child mortality. Further, it should work to improve women's status which in turn will reduce norms/traditions that encourage son preference and higher mortality level for girls.

  19. Child health and mortality.

    Science.gov (United States)

    El Arifeen, Shams

    2008-09-01

    substantial health-system challenges relating to the design and implementation, at scale, of interventions to reduce neonatal mortality.

  20. “降消”项目对孕产妇死亡率的影响%Effect of the project of "Reducing the mortality of the pregnant and lying-in women and eliminating the newborn's tetanus" on mortality of pregnant women

    Institute of Scientific and Technical Information of China (English)

    徐冬梅; 施凤涟; 赵悦淑

    2012-01-01

    目的:了解“降消”项目对孕产妇死亡率的影响,进一步改革或加强“降消”措施.方法:分析2007年和2008年“降消”项目在河南省43个县监测点的孕产妇死亡情况.结果:2008年孕产妇平均死亡率为18.73/10万,比2007年的26.11/10万降低了28.27%;2008年住院分娩率是97.94%,比2007年的95.51%增加了2.54%;2008年新生儿破伤风患病率是9.12/10万,比2007年的破伤风患病率4.78/10万升高了90.79%.结论:“降消”项目实施后明显降低了孕产妇死亡率,提高了孕产妇住院分娩率.%Objective: To understand the effect of the project of " Reducing the mortality of the pregnant and lying - in women and eliminating the newborn's tetanus" on mortality of pregnant women, further reform or enhance measures of the project Methods; The monitoring situations of maternal death in monitoring points of 43 counties in He'nan province after implementation of the project in 2007 and 2008 were analyzed. Results: The mean maternal mortality in 2008 was 18. 73/100 000, which decreased by 28. 27% compared with the mean maternal mortality in 2007 (26. 11/100 000) ; the hospital delivery rate in 2008 was 97.94% , which increased by 2. 54% compared with the hospital delivery rate in 2007 (95.51% ) ; the prevalence of neonatal tetanus in 2008 was 9. 12/100 000, which increased by 90. 79% compared with the prevalence of neonatal tetanus in 2007 (4. 78/100 000) . Conclusion: After implementation of the project, the maternal mortality was decreased obviously, and the hospital delivery rate was increased significantly.

  1. Creatine supplementation during pregnancy: summary of experimental studies suggesting a treatment to improve fetal and neonatal morbidity and reduce mortality in high-risk human pregnancy.

    Science.gov (United States)

    Dickinson, Hayley; Ellery, Stacey; Ireland, Zoe; LaRosa, Domenic; Snow, Rodney; Walker, David W

    2014-04-27

    While the use of creatine in human pregnancy is yet to be fully evaluated, its long-term use in healthy adults appears to be safe, and its well documented neuroprotective properties have recently been extended by demonstrations that creatine improves cognitive function in normal and elderly people, and motor skills in sleep-deprived subjects. Creatine has many actions likely to benefit the fetus and newborn, because pregnancy is a state of heightened metabolic activity, and the placenta is a key source of free radicals of oxygen and nitrogen. The multiple benefits of supplementary creatine arise from the fact that the creatine-phosphocreatine [PCr] system has physiologically important roles that include maintenance of intracellular ATP and acid-base balance, post-ischaemic recovery of protein synthesis, cerebral vasodilation, antioxidant actions, and stabilisation of lipid membranes. In the brain, creatine not only reduces lipid peroxidation and improves cerebral perfusion, its interaction with the benzodiazepine site of the GABAA receptor is likely to counteract the effects of glutamate excitotoxicity - actions that may protect the preterm and term fetal brain from the effects of birth hypoxia. In this review we discuss the development of creatine synthesis during fetal life, the transfer of creatine from mother to fetus, and propose that creatine supplementation during pregnancy may have benefits for the fetus and neonate whenever oxidative stress or feto-placental hypoxia arise, as in cases of fetal growth restriction, premature birth, or when parturition is delayed or complicated by oxygen deprivation of the newborn.

  2. The proline-rich peptide Bac7(1-35 reduces mortality from Salmonella typhimurium in a mouse model of infection

    Directory of Open Access Journals (Sweden)

    Benincasa Monica

    2010-06-01

    Full Text Available Abstract Background Bac7 is a proline-rich peptide with a potent in vitro antimicrobial activity against Gram-negative bacteria. Here we investigated its activity in biological fluids and in vivo using a mouse model of S. typhimurium infection. Results The efficacy of the active 1-35 fragment of Bac7 was assayed in serum and plasma, and its stability in biological fluids analyzed by Western blot and mass spectrometry. The ability of the peptide to protect mice against Salmonella was assayed in a typhoid fever model of infection by determination of survival rates and bacterial load in liver and spleen of infected animals. In addition, the peptide's biodistribution was evaluated by using time-domain optical imaging. Bac7(1-35 retained a substantial in vivo activity showing a very low toxicity. The peptide increased significantly the number of survivors and the mean survival times of treated mice reducing the bacterial load in their organs despite its rapid clearance. Conclusions Our results provide a first indication for a potential development of Bac7-based drugs in the treatment of salmonellosis and, eventually, other Gram-negative infections. The in vivo activity for this peptide might be substantially enhanced by decreasing its excretion rate or modifying the treatment schedule.

  3. Mortal assets

    Energy Technology Data Exchange (ETDEWEB)

    Howe, Geoffrey R.; Zablotska, Lydia B.; Fix, John J.; Egel, John N.; Buchanan, Jeffrey A.

    2005-11-01

    Workers employed in 15 utilities that generate nuclear power in the United States have been followed for up to 18 years between 1979 and 1997. Their cumulative dose from whole-body ionizing radiation has been determined from the dose records maintained by the facilities themselves and the REIRS and REMS systems maintained by the Nuclear Regulatory Commission and the Department of Energy, respectively. Mortality in the cohort from a number of causes has been analyzed with respect to individual radiation doses. The cohort displays a very substantial healthy worker effect, i.e. considerably lower cancer and noncancer mortality than the general population. Based on 26 and 368 deaths, respectively, positive though statistically nonsignificant associations were seen for mortality from leukemia (excluding chronic lymphocytic leukemia) and all solid cancers combined, with excess relative risks per sievert of 5.67 (95% confidence interval (CI) -2.56, 30.4) and 0.596 (95% CI -2.01, 4.64), respectively. These estimates are very similar to those from the atomic bomb survivors study, though the wide confidence intervals are also consistent with lower or higher risk estimates. A strong positive and statistically significant association between radiation dose and deaths from arteriosclerotic heart disease including coronary heart disease was also observed in the cohort, with an ERR of 8.78 (95% CI 2.10, 20.0). Whle associations with heart disease have been reported in some other occupational studies, the magnitude of the present association is not consistent with them and therefore needs cautious interpretation and merits further attention. At present, the relatively small number of deaths and the young age of the cohort (mean age at end of follow-up is 45 years) limit the power of the study, but further follow-up is 45 years) limit the power of the study, but further follow-up and the inclusion of the present data in an ongoing IARC combined analysis of nuclear workers from 15

  4. Retraction: 'rhBNP therapy can improve clinical outcomes and reduce in-hospital mortality compared with dobutamine in heart failure patients: a meta-analysis' by Ming-Yi Lv, Shu-Ling Deng and Xiao-Feng Long.

    Science.gov (United States)

    2016-05-01

    The above article, published online on 28(th) November 2015 in Wiley Online Library (http://onlinelibrary.wiley.com/doi/10.1111/bcp.12788/full), and in volume 81, pp. 174-185, has been retracted by agreement between the authors, the journal Editor in Chief, Professor A Cohen, and John Wiley & Sons Limited. The retraction has been agreed owing to evidence indicating that the peer review of this paper was compromised. The authors were unaware of the actions of the third party responsible for compromising the peer review. Reference Lv M-Y, Deng S-L, Long X-F. rhBNP therapy can improve clinical outcomes and reduce in-hospital mortality compared with dobutamine in heart failure patients: a meta-analysis. Br J Clin Pharmacol 2016; 81: 174-85. doi:10.1111/bcp.12788.

  5. Report from the Rockefellar Foundation Sponsored International Workshop on reducing mortality and improving quality of life in long-term survivors of Hodgkin's disease: July 9-16, 2003, Bellagio, Italy

    DEFF Research Database (Denmark)

    Mauch, Peter; Ng, Andrea; Aleman, Berthe;

    2005-01-01

    A workshop, sponsored by the Rockefellar Foundation, was held between 9 to 16 July, 2003 to devise strategies to reduce mortality and improve quality of life of long-term survivors of Hodgkin's disease. Participants were selected for their clinical and research background on late effects after...... Hodgkin's disease therapy. Experts from both developed and developing nations were represented in the workshop, and efforts were made to ensure that the proposed strategies would be globally applicable whenever possible. The types of late complications, magnitude of the problem, contributing risk factors......, methodology to assess the risk, and challenges faced by developing countries were presented. The main areas of late effects of Hodgkin's disease discussed were as follows: second malignancy, cardiac disease, infection, pulmonary dysfunction, endocrine abnormalities, and quality of life. This report summarizes...

  6. Reducing Maternal Mortality by Strengthening Community Maternal ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    One rural community each reported the existence of community savings for obstetric .... also indicates the value of integrating these with ..... permission each time before leaving the house) ... communities have to travel long distances to reach.

  7. Root growth restraint can be an acclimatory response to low pH and is associated with reduced cell mortality: a possible role of class III peroxidases and NADPH oxidases.

    Science.gov (United States)

    Graças, J P; Ruiz-Romero, R; Figueiredo, L D; Mattiello, L; Peres, L E P; Vitorello, V A

    2016-07-01

    Low pH (pH through step-wise changes in pH over periods ranging from 4 to 24 h. Roots exposed gradually to pH 4.5 grew even less than those exposed directly, indicating a plant-coordinated response. Direct exposure to pH 4.0 suppressed root growth and caused high cell mortality, in contrast to roots exposed gradually, in which growth remained inhibited but cell viability was maintained. Total class III peroxidase activity increased significantly in all low pH treatments, but was not correlated with the observed differential responses. Use of the enzyme inhibitors salicylhydroxamic acid (SHAM) or diphenyleneiodonium chloride (DPI) suggest that peroxidase and, to a lesser extent, NADPH oxidase were required to prevent or reduce injury in all low pH treatments. However, a role for other enzymes, such as the alternative oxidase is also possible. The results with SHAM, but not DPI, were confirmed in tobacco BY-2 cells. Our results indicate that root growth inhibition from low pH can be part of an active plant response, and suggest that peroxidases may have a critical early role in reducing loss of cell viability and in the observed root growth constraint.

  8. Strategies for reducing morbidity and mortality from diabetes through health-care system interventions and diabetes self-management education in community settings. A report on recommendations of the Task Force on Community Preventive Services.

    Science.gov (United States)

    2001-09-28

    Reducing morbidity and mortality and improving quality of life for persons with diabetes is an ongoing challenge for health-care providers and organizations and public health practitioners. Interventions are available that focus on persons with diabetes, health-care systems, families, and public policies. The Task Force on Community Preventive Services (the Task Force) has conducted systematic reviews of seven population-oriented interventions that can be implemented by health-care organizations and communities. Two of these interventions focus on health-care systems (disease and case management), and five focus on persons with diabetes (diabetes self-management education delivered in community settings). On the basis of these reviews, the Task Force has made recommendations regarding use of these seven interventions. The Task Force strongly recommends disease and case management in health-care systems for persons with diabetes. Diabetes self-management education is recommended in community gathering places (e.g., community centers or faith institutions) for adults and in the home for children and adolescents with type 1 diabetes. Evidence was insufficient to recommend diabetes self-management education interventions in other settings (i.e., schools, work sites, and recreational camps) or in the home for adults with type 2 diabetes. This report provides additional information regarding these recommendations, briefly describes how the reviews were conducted, provides sources of full reviews of interventions and information to assist in applying the interventions locally, and describes additional diabetes-related work in progress.

  9. Targeted interventions and infant mortality.

    Science.gov (United States)

    Lovel, H

    1989-01-01

    The main causes of infant mortality in 71% of the cases are diarrhea, measles, acute respiratory infection, and neonatal tetanus. A UN child survival strategy includes growth monitoring, oral rehydration, breast feeding, immunization, fertility, food and female literacy (GOBI-FFF). Previous research has shown a correlation between low levels of infant mortality and high levels of female literacy. Educated women are more likely to delay marriage, and childbearing. Child mortality is much higher for those born to women under 20 years old and also much higher for those born within 1 or 2 after the previous birth. Maternal mortality is also higher for mothers under 20 and with closely spaced births of 3 or more children. The majority of adults in developing countries have knowledge of family planning but teen pregnancy is a concern. Better nutrition during pregnancy would decrease infant deaths. Growth monitoring is another way to reduce infant mortality and morbidity. The difficulties are in the reluctance to adapt programs to local traditional methods of growth monitoring and going to direct recording scales. Immunization is estimated to have prevented over 3 million deaths from measles, tetanus, whooping cough and polio in 1984 alone. In spite of progress, only 50% of children in developing countries are immunized against diphtheria, pertussis, polio, and tetanus by the age of 1 year. these activities must be integrated into primary health care and community development projects to make better contact with people needing this service. oral rehydration therapy not only reduces mortality from diarrhea but can reduce morbidity by reducing the duration of the illness and by increasing the weight gain. Breast feeding has been shown in many studies to reduce the risk of deaths of infants. The promotion of breast feeding includes the issues of maternity leave, job security, and child care at the work place.

  10. Efficacy of dofetilide in the treatment of atrial fibrillation-flutter in patients with reduced left ventricular function: a Danish investigations of arrhythmia and mortality on dofetilide (diamond) substudy

    DEFF Research Database (Denmark)

    Pedersen, O D; Bagger, H; Keller, N;

    2001-01-01

    BACKGROUND: In patients with left ventricular dysfunction, atrial fibrillation and flutter (AF and AFl, respectively) are common arrhythmias associated with increased morbidity and mortality. The present study investigated the potential of dofetilide in AF-AFl patients with left ventricular...

  11. Mortality table construction

    Science.gov (United States)

    Sutawanir

    2015-12-01

    Mortality tables play important role in actuarial studies such as life annuities, premium determination, premium reserve, valuation pension plan, pension funding. Some known mortality tables are CSO mortality table, Indonesian Mortality Table, Bowers mortality table, Japan Mortality table. For actuary applications some tables are constructed with different environment such as single decrement, double decrement, and multiple decrement. There exist two approaches in mortality table construction : mathematics approach and statistical approach. Distribution model and estimation theory are the statistical concepts that are used in mortality table construction. This article aims to discuss the statistical approach in mortality table construction. The distributional assumptions are uniform death distribution (UDD) and constant force (exponential). Moment estimation and maximum likelihood are used to estimate the mortality parameter. Moment estimation methods are easier to manipulate compared to maximum likelihood estimation (mle). However, the complete mortality data are not used in moment estimation method. Maximum likelihood exploited all available information in mortality estimation. Some mle equations are complicated and solved using numerical methods. The article focus on single decrement estimation using moment and maximum likelihood estimation. Some extension to double decrement will introduced. Simple dataset will be used to illustrated the mortality estimation, and mortality table.

  12. Maternal Mortality in the United States

    Science.gov (United States)

    Lee, Anne S.

    1977-01-01

    Figures from 1800 through 1973 are used to demonstrate that black women have had substantially higher rates of death in childbirth than white women. As mortality has declined, the relative difference between whites and blacks has actually increased. Factors affecting mortality and future prospects for reducing maternal deaths are discussed. (GC)

  13. Testosterone deficiency and cardiovascular mortality

    Institute of Scientific and Technical Information of China (English)

    Abraham Morgentaler

    2015-01-01

    New concerns have been raised regarding cardiovascular (CV) risks with testosterone (T) therapy (TTh). These concerns are based primarily on two widely reported retrospective studies. However, methodological flaws and data errors invalidate both studies as credible evidence of risk. One showed reduced adverse events by half in T‑treated men but reversed this result using an unproven statistical approach. The authors subsequently acknowledged serious data errors including nearly 10% contamination of the dataset by women. The second study mistakenly used the rate of T prescriptions written by healthcare providers to men with recent myocardial infarction (MI) as a proxy for the naturally occurring rate of MI. Numerous studies suggest T is beneficial, including decreased mortality in association with TTh, reduced MI rate with TTh in men with the greatest MI risk prognosis, and reduced CV and overall mortality with higher serum levels of endogenous T. Randomized controlled trials have demonstrated benefits of TTh in men with coronary artery disease and congestive heart failure. Improvement in CV risk factors such as fat mass and glycemic control have been repeatedly demonstrated in T‑deficient men treated with T. The current evidence does not support the belief that TTh is associated with increased CV risk or CV mortality. On the contrary, a wealth of evidence accumulated over several decades suggests that low serum T levels are associated with increased risk and that higher endogenous T, as well as TTh itself, appear to be beneficial for CV mortality and risk.

  14. Challenge of Fetal Mortality

    Science.gov (United States)

    ... Reports from the National Medical Care Utilization and Expenditure Survey Clearinghouse on Health Indexes Statistical Notes for ... Fetal mortality is a major, but often overlooked, public health problem. Fetal mortality refers to spontaneous intrauterine ...

  15. Excess mortality in hyperthyroidism

    DEFF Research Database (Denmark)

    Hjelm Brandt Kristensen, Frans; Pedersen, Dorthe Almind; Christensen, Kaare

    2012-01-01

    Hyperthyroidism is associated with severe comorbidity, such as stroke, and seems to confer increased mortality. However, it is unknown whether this increased mortality is explained by hyperthyroidism per se, comorbidity, and/or genetic confounding.......Hyperthyroidism is associated with severe comorbidity, such as stroke, and seems to confer increased mortality. However, it is unknown whether this increased mortality is explained by hyperthyroidism per se, comorbidity, and/or genetic confounding....

  16. Maternal mortality in Bijapur district

    Directory of Open Access Journals (Sweden)

    Vidya A. Thobbi

    2015-04-01

    Full Text Available Objectives: The objectives of this study is to evaluate the incidence of maternal deaths, causes responsible for maternal mortality, direct and indirect factors, and various preventable methods to reduce maternal mortality rate. Background: 95% of maternal deaths occur in Asia and Africa. The need for undertaking this study is to know the maternal mortality rate, analyze the causes and preventable factors of death occurring in the district of Bijapur, Karnataka, India. Methodology: It is a study of 2years from the Records of District Health Office and Institutions on maternal mortality from June 2011 to May 2013 in Bijapur. Results: In two years there were fifty eight maternal deaths and seventy nine thousand five hundred and sixty six live births, hence maternal mortality ratio was seventy three per lakh live births. Eighty two percent of maternal deaths occurred in families who belonged to Below Poverty Line. Prevalence of anemia in pregnancy was 79.3%. Severe anemia (Hemoglobin <7g% seen in 5.1% was the most common indirect cause of death. Forty three percent of the deaths occurred at private setups. Hemorrhage, Septicemia and Preeclampsia & Eclampsia were responsible for 44.82%, 15.51% and 6.89% respectively. Conclusion: Majority of the maternal deaths are preventable if these four delays are avoided: a Delay in identifying the problem. b Delay in seeking care. c Delay in reaching the referral institute. d Delay in getting treatment on reaching the referral institute.

  17. Occupational Mortality, Background on

    DEFF Research Database (Denmark)

    Lynge, Elsebeth

    2016-01-01

    The study of occupational mortality involves the systematic tabulation of mortality by occupational or socioeconomic groups. Three main methods are used to conduct these studies: cross-sectional studies, death certificate studies, and follow-up studies. Cross-sectional studies were undertaken in ...... the mortality rates of blue- and white-collar workers....

  18. Phenomenological theory of mortality

    Science.gov (United States)

    Azbel, Mark Ya.

    1997-09-01

    Extensive demographic studies relate aging to the increase in mortality, terminated by the species-specific lifespan limit. Meanwhile, recent experiments demonstrate that medfly mortality decreases at older ages, and challenge a limited lifespan paradigm. This paper proves that there exists a genetically programmed probability to die at any given age, and presents its phenomenological theory. The implications of the universal mortality law crucially depend on the cohort heterogeneity. For relatively high heterogeneity the law predicts unitarily vanishing old age mortality; this is verified with medfly data. For relatively low heterogeneity it predicts a precipitous drop in mortality fluctuations in old age. This is verified with demographic data. If comprehensive studies verify a species-specific characteristic age, then that age may be genetically manipulated. If the studies verify a unitary law of mortality, the results may be generalized to all species. A phenomenological model of mortality is presented.

  19. Intracoronary Compared to Intravenous Abciximab in Patients with ST Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention Reduces Mortality, Target Vessel Revascularization and Reinfarction after 1 Year

    DEFF Research Database (Denmark)

    Iversen, Allan Zeeberg; Galatius, Soeren; Abildgaard, Ulrik

    2011-01-01

    pPCI-treated STEMI patients were randomized to either IC or IV bolus abciximab followed by a 12-hour IV infusion. Patients were followed for 1 year to observe mortality, TVR or myocardial infarction (MI) and the combination of these. Results: The two treatment arms (IV, n = 170; IC, n = 185) were...... a relative risk reduction of 55% for the combined endpoint after 1 year (p = 0.002) compared to the IV treatment arm. Conclusions: In pPCI-treated STEMI patients treated with abciximab, IC bolus administration resulted in a significant reduction in mortality, TVR and MI compared to IV bolus administration.......Objectives: Administration of the glycoprotein IIb/IIIa inhibitor abciximab to patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) improves outcome. Data have suggested that an intracoronary (IC) bolus might be superior...

  20. Environmental temperature and mortality

    OpenAIRE

    Näyhä, Simo

    2005-01-01

    In Finland, mortality increases steeply in autumn, reaches a peak during the Christhmas holidays and declines slowly towards a trough in August. The relative excess in daily mortality (peak vs. trough) is 30% for coronary heart disease, 40% for cerebral vascular accidents and 90% for diseases of the respiratory organs. There is a secondary peak in Midsummer, especially in coronary deaths of working aged men. Mortality is lowest at mean daily temperature of +14 degrees C, and it increases slow...

  1. Maternal mortality from hemorrhage.

    Science.gov (United States)

    Haeri, Sina; Dildy, Gary A

    2012-02-01

    Hemorrhage remains as one of the top 3 obstetrics related causes of maternal mortality, with most deaths occurring within 24-48 hours of delivery. Although hemorrhage related maternal mortality has declined globally, it continues to be a vexing problem. More specifically, the developing world continue to shoulder a disproportionate share of hemorrhage related deaths (99%) compared with industrialized nations (1%). Given the often preventable nature of death from hemorrhage, the cornerstone of effective mortality reduction involves risk factor identification, quick diagnosis, and timely management. In this monograph we will review the epidemiology, etiology, and preventative measures related to maternal mortality from hemorrhage.

  2. Mortality and GH deficiency

    DEFF Research Database (Denmark)

    Stochholm, Kirstine; Gravholt, Claus Højbjerg; Laursen, Torben;

    2007-01-01

    OBJECTIVE: To estimate the mortality in Denmark in patients suffering from GH deficiency (GHD). DESIGN: Mortality was analyzed in 1794 GHD patients and 8014 controls matched on age and gender. All records in GHD patients were studied and additional morbidity noted. Patients were divided into chil......OBJECTIVE: To estimate the mortality in Denmark in patients suffering from GH deficiency (GHD). DESIGN: Mortality was analyzed in 1794 GHD patients and 8014 controls matched on age and gender. All records in GHD patients were studied and additional morbidity noted. Patients were divided...

  3. Percutaneous endoscopic gastrostomy and early mortality.

    Science.gov (United States)

    Clarkston, W K; Smith, O J; Walden, J M

    1990-12-01

    To assess morbidity, mortality, and benefit associated with percutaneous endoscopic gastronomy (PEG), we retrospectively studied 42 patients who had had PEG. Mortality was exceptionally high during the first 60 days after PEG (43%), and then stabilized. In nearly half of the cases (20/42) the PEG tube was removed during the first 60 days because of either death or improvement. Patients with malignancy had a significantly higher morbidity and 60-day mortality than the neurologically impaired. We concluded that patients should be carefully selected for PEG because early mortality is high; a 60-day trial of soft nasogastric feedings should be considered before PEG, and could reduce by nearly half the number of patients failing to receive long-term benefit; and patients with malignancy have significantly greater morbidity and mortality after PEG and may not receive the same advantage from the procedure.

  4. Mortality in ankylosing spondylitis

    DEFF Research Database (Denmark)

    Exarchou, Sofia; Lie, Elisabeth; Lindström, Ulf

    2016-01-01

    OBJECTIVES: Information on mortality in ankylosing spondylitis (AS) is scarce. Our study therefore aimed to assess: (1) mortality in AS versus the general population, and (2) predictors of death in the AS population. METHODS: Nationwide cohorts of patients with AS diagnosed at rheumatology...

  5. Mortality associated with phaeochromocytoma

    NARCIS (Netherlands)

    Prejbisz, A.; Lenders, J.W.M.; Eisenhofer, G.; Januszewicz, A.

    2013-01-01

    Two major categories of mortality are distinguished in patients with phaeochromocytoma. First, the effects of excessive circulating catecholamines may result in lethal complications if the disease is not diagnosed and/or treated timely. The second category of mortality is related to development of m

  6. Social Welfare Expenditures and Infant Mortality.

    Science.gov (United States)

    Shim, Joyce

    2015-01-01

    This study examines the effects of social welfare expenditures on infant mortality (deaths younger than age 1 per 1,000 live births) across 19 Organisation for Economic Co-operation and Development (OECD) countries from 1980 to 2010. Data are obtained from various sources including the OECD, World Health Organization, and World Bank. The findings indicate that among three social welfare expenditure measures for families, the expenditures on family cash allowances are predicted to reduce infant mortality. However, the other two measures-the expenditures on parental and maternity leave and expenditures on family services-have no significant effects on infant mortality.

  7. RISK FACTORS OF MORTALITY IN NEONATAL ILLNESS

    Directory of Open Access Journals (Sweden)

    Jeyanthi

    2016-03-01

    Full Text Available BACKGROUND Infant Mortality Rate (IMR is high in India. Identification of risk factors of mortality in neonatal illness is essential to reduce Neonatal Mortality Rate (NMR and ultimately the IMR. AIM To identify the risk factors of mortality in neonatal illness. SETTING AND DESIGN It was a nested case control study done at the sick neonatal unit of urban tertiary referral centre. METHODS AND MATERIALS After obtaining ethical committee approval, retrospective analysis of 150 out born neonatal case records of babies admitted during the period from October 2015 to December 2015 was done. Data such as demographic features, maternal details, referral details, perinatal events, clinical features, laboratory reports and outcome were recorded. STATISTICAL ANALYSIS These risk factors were subjected to univariate and multivariate logistic regression analysis and P value calculated for the same to find out significant risk factors of mortality in neonatal illness. RESULTS Neonatal mortality rate was 22%. Male-to-female ratio was 2:1, death occurred more commonly in female neonates (23.1%. Home deliveries carried more risk of mortality. Birth order 4 and above had 25% mortality. Neonates of mother who had primary education and below had higher mortality. Perinatal asphyxia and sepsis were the most common causes of neonatal mortality. By univariate analysis, preterms had 4.9 times increased risk of mortality than term babies. Apnoeic spells, chest retractions and shock had 8 times, 3 times and 3.6 times increased risk of mortality respectively. By multivariate analysis, birth weight below 2 kilograms (kg carried 11.8 times more risk of mortality with a p value 0.00 (95% C.I 3.2, 30.4 and poor maternal intake of iron and folic acid tablets was 3.9 times more risk p value 0.003 (95% C.I 1.6, 9.6, apnoeic spells were 5.8 times more risk of mortality with p value 0.02 (95% C.I 1.3, 26.2. CONCLUSION Birth weight below 2 kg, poor maternal intake of iron and folic

  8. The excess mortality of patients with diabetes and concurrent psychiatric illness is markedly reduced by structured personal diabetes care. A 19-year follow up of the randomized controlled study Diabetes Care in General Practice (DCGP)

    DEFF Research Database (Denmark)

    Larsen, Julie Rask; Siersma, Volkert Dirk; Davidsen, Annette Sofie;

    2016-01-01

    were randomized to 6 years of structured personal diabetes care or routine diabetes care (ClinicalTrials.gov NCT01074762). In this observational post-hoc analysis, the effectiveness of the intervention for diabetes in 179 patients with concurrent PI was analyzed. RESULTS: During the 19-year follow......-up period, patients with PI in the structured personal care group experienced a lower risk for all-cause mortality [105.3 vs. 140.4 events per 1000 patient-years; hazard ratio (HR): 0.63, P=0.023, multivariably adjusted], diabetes-related death (66.0 vs. 95.1; HR: 0.57, P=0.015), any diabetes...... that in primary care, structured diabetes care allowing for individualization was highly effective among diabetic patients with co-occurring PI....

  9. Mortality after shoulder arthroplasty

    DEFF Research Database (Denmark)

    Amundsen, Alexander; Rasmussen, Jeppe Vejlgaard; Olsen, Bo Sanderhoff

    2016-01-01

    BACKGROUND: The primary aim was to quantify the 30-day, 90-day, and 1-year mortality rates after primary shoulder replacement. The secondary aims were to assess the association between mortality and diagnoses and to compare the mortality rate with that of the general population. METHODS: The study...... included 5853 primary operations reported to the Danish Shoulder Arthroplasty Registry between 2006 and 2012. Information about deaths was obtained from the Danish Cause of Death Register and the Danish Civil Registration System. Age- and sex-adjusted control groups were retrieved from Statistics Denmark...

  10. Mortality in Asia.

    Science.gov (United States)

    1981-01-01

    Although the general trend in mortality between 1950 and 1975 in South and East Asia has been downward, there is considerable country-to-country variation in the rate of decline. In countries where combined economic, social, and political circumstances resulted in controlling the disease spectrum (e.g., China, Malaysia, Sri Lanka), mortality levels declined to those seen in low-mortality countries. In most of the large countries of the region however, mortality declined at a slower rate, even slowing down considerably in the 1970's while the death rates remained high (e.g., India, Bangladesh, Thailand, Philippines); this slowing down of mortality level is attributed essentially to the poverty-stricken masses of society which were not able to take advantage of social, technological, and health-promoting behavioral changes conducive to mortality decline. Infant mortality levels, although declining since 1950, followed the same dismal pattern of the general mortality level. The rate varies from less than 10/1000 live births (Japan) to more than 140/1000 (Bangladesh, Laos, Nepal). Generally, rural areas exhibited higher infant mortality than urban areas. The level of child mortality declines with increases in the mother's educational level in Bangladesh, India, Indonesia, Sri Lanka, and Thailand. The largest decline in child mortality occurs when at least 1 parent has secondary education. The premature retardation of mortality decline is caused by several factors: economic development, nutrition and food supply, provision and adequacy of health services, and demographic trends. The outlook for the year 2000 for most of Asia's countries will depend heavily on significant population increases. In most countries, particularly in South Asia, population is expected to increase by 75%, much of it in rural areas and among poorer socioeconomic groups. In view of this, Asia's health planners and policymakers will have to develop health policies which will strike a balance

  11. Mortality and causes of death in schizophrenic patients in Denmark

    DEFF Research Database (Denmark)

    Mortensen, P B; Juel, K

    1990-01-01

    A cohort consisting of 6178 people that were psychiatric inpatients with a clinical schizophrenia diagnosis in 1957 were followed up from 1957 through 1986, and their cause-specific mortality was determined. Mortality from cardiovascular diseases, lung diseases, gastrointestinal and urogenital...... disorders, accidents and suicide was increased, whereas mortality from cerebrovascular disorders was reduced. In the male patients cancer mortality was reduced whereas cancer mortality in the female patients was increased. Mortality from a number of causes that theoretically could be associated with side...... effects from neuroleptics was increased. Mortality from some causes of death used as a measurement of the quality of medical care was found to be slightly increased. Further studies of the quality of the medical care provided to schizophrenic patients and of the association between neuroleptic medication...

  12. [Mortality by avoidable causes in preschool children].

    Science.gov (United States)

    Lurán, Albenia; López, Elizabeth; Pinilla, Consuelo; Sierra, Pedro

    2009-03-01

    The infant-mortality rate in children aged less than five is an indicator of the general state of health of a population and directly reflects the quality of life and the level of socio-economic development of a country. Avoidable mortality was assessed in preschool children as a reflection of Colombia quality of life and socio-economic development. Mortality trends were analyzed in preschool children aged less than five throughout Colombia during a 20-year period from 1985-2004, and focused on mortality causes that were considered avoidable. This was a descriptive, retrospective study; the sources of information were Departamento Administrativo Nacional de Estadística records of deaths and population projections 1985-2004. Mortality rate due to avoidable causes was the statistical indicator. In children aged less than one, the reducible mortality due to "early diagnosis and medical treatment" occupied the first place amongst causes for every year of the study period and accounted for more than 50% of recorded deaths. In children aged 1 to 4, the category "other important reducible causes" was associated with 40% of recorded deaths-deaths due mainly to respiratory diseases. Over the 20-year period, the avoidable mortality rate decreased by 34% in children aged less than one, in children 1-4, it decreased by 23%. Although the infant-mortality rate in preschool children was reduced, the decrease was small, from 80% to 77%. The situation requires more analysis with respect to strategies in public health, particularly concerning preventable diseases of the infancy.

  13. Under-Five Mortality

    African Journals Online (AJOL)

    children under five are still not reached and disparities are observed in ... while malnutrition and HIV/AIDS are both the cause and contributor. ... prosperity, a number of internal and external factors including a ... mortality and its determinants.

  14. Increased mortality in narcolepsy.

    Science.gov (United States)

    Ohayon, Maurice M; Black, Jed; Lai, Chinglin; Eller, Mark; Guinta, Diane; Bhattacharyya, Arun

    2014-03-01

    To evaluate the mortality rate in patients with narcolepsy. Data were derived from a large database representative of the US population, which contains anonymized patient-linked longitudinal claims for 173 million individuals. Symphony Health Solutions (SHS) Source Lx, an anonymized longitudinal patient dataset. All records of patients registered in the SHS database between 2008 and 2010. None. Identification of patients with narcolepsy was based on ≥ 1 medical claim with the diagnosis of narcolepsy (ICD-9 347.xx) from 2002 to 2012. Dates of death were acquired from the Social Security Administration via a third party; the third party information was encrypted in the same manner as the claims data such that anonymity is ensured prior to receipt by SHS. Annual all-cause mortality rates for 2008, 2009, and 2010 were calculated retrospectively for patients with narcolepsy and patients without narcolepsy in the database, and standardized mortality ratios (SMR) were calculated. Mortality rates were also compared with the general US population (Centers for Disease Control data). SMRs of the narcolepsy population were consistent over the 3-year period and showed an approximate 1.5-fold excess mortality relative to those without narcolepsy. The narcolepsy population had consistently higher mortality rates relative to those without narcolepsy across all age groups, stratified by age decile, from 25-34 years to 75+ years of age. The SMR for females with narcolepsy was lower than for males with narcolepsy. Narcolepsy was associated with approximately 1.5-fold excess mortality relative to those without narcolepsy. While the cause of this increased mortality is unknown, these findings warrant further investigation.

  15. Mortality in spondylarthritis.

    Science.gov (United States)

    Prati, Clément; Claudepierre, Pascal; Pham, Thao; Wendling, Daniel

    2011-10-01

    Ankylosing spondylitis (AS) is a chronic inflammatory joint disease that can lead to chronic pain in axial and peripheral joints and to functional impairments after several years. Excess mortality has been reported in patients with AS. We reviewed recent studies of patients with AS who were treated and monitored according to the improved methods developed in the past few years, without radiation therapy. Our results do not support excess mortality in these patients. Long-term follow-up data from patients enrolled in biologics registries will provide additional information. Cardiovascular disease is the leading cause of death in patients with AS, as in the general population. However, the cardiovascular mortality rate may be slightly increased in patients with AS, probably as a result of dyslipidemia and early endothelial dysfunction. Similarly, and as expected, there is excess mortality related to the spinal disease itself and to renal and gastrointestinal disease. More surprisingly, alcohol abuse and injury or suicide cause excess mortality compared to the general population. In the absence of radiation or radium-224 therapy, and regardless of the other treatments used, the evidence does not support an increased rate of lymphoma or other malignancies compared to the general population. In this review, we discuss the causes and rates of mortality in patients with AS.

  16. Endogenous fertility, mortality and growth.

    Science.gov (United States)

    Blackburn, K; Cipriani, G P

    1998-01-01

    This paper presents a model that illustrates the joint determination of population and development. "Economic and demographic outcomes are determined jointly in a choice-theoretic model of fertility, mortality and capital accumulation.... In addition to choosing savings and births, parents may reduce (infant) deaths by incurring expenditures on health-care which is also provided by the government. A generalised production technology accounts for long-run endogenous growth with short-run transitional dynamics. The analysis yields testable time series and cross-section implications which accord with the empirical evidence on the relationship between demography and development."

  17. Doctors' strikes and mortality: a review.

    Science.gov (United States)

    Cunningham, Solveig Argeseanu; Mitchell, Kristina; Narayan, K M; Yusuf, Salim

    2008-12-01

    A paradoxical pattern has been suggested in the literature on doctors' strikes: when health workers go on strike, mortality stays level or decreases. We performed a review of the literature during the past forty years to assess this paradox. We used PubMed, EconLit and Jstor to locate all peer-reviewed English-language articles presenting data analysis on mortality associated with doctors' strikes. We identified 156 articles, seven of which met our search criteria. The articles analyzed five strikes around the world, all between 1976 and 2003. The strikes lasted between nine days and seventeen weeks. All reported that mortality either stayed the same or decreased during, and in some cases, after the strike. None found that mortality increased during the weeks of the strikes compared to other time periods. The paradoxical finding that physician strikes are associated with reduced mortality may be explained by several factors. Most importantly, elective surgeries are curtailed during strikes. Further, hospitals often re-assign scarce staff and emergency care was available during all of the strikes. Finally, none of the strikes may have lasted long enough to assess the effects of long-term reduced access to a physician. Nonetheless, the literature suggests that reductions in mortality may result from these strikes.

  18. The role of vitamin A in reducing child mortality and morbidity and improving growth El papel de la vitamina A en la reducción de la mortalidad y morbilidad infantiles y en la mejoría del crecimiento

    Directory of Open Access Journals (Sweden)

    USHA RAMAKRISHNAN

    1998-03-01

    Full Text Available This is an update of knowledge on the role of the vitamin A status in determining child mortality, morbidity and growth. Recent information confirms the earlier conclusion of Beaton et al. that a 23% reduction in young child mortality results following improvements in the vitamin A status. Studies show that the mortality effect is primarily due to reductions in deaths due to acute gastroenteritis and measles but not acute respiratory infections (ARI and malaria. While improvement of the vitamin A status enhances the survival of older preschool children, it remains unclear whether it benefits infants (i.e. La presente es una revisión del conocimiento actual sobre el papel de la vitamina A en la mortalidad, morbilidad y crecimiento infantiles. Recientemente, algunas investigaciones han confirmado la conclusión de Beaton y colaboradores (1993 que indica que se puede reducir la mortalidad infantil en un 23% mejorando el estado de la vitamina A. Se ha demostrado que este efecto se debe a la reducción de la mortalidad por gastroenteritis aguda y sarampión y no por infecciones respiratorias agudas y paludismo. Queda claro que el mejoramiento del estado de la vitamina A favorece la sobrevivencia de los niños prescolares mayores; sin embargo, no se ha definido si también beneficia a los infantes (<6 meses. El suplemento de vitamina A no reduce la incidencia total ni la prevalencia de enfermedades comunes de la niñez; sin embargo, sí reduce la incidencia de episodios graves de diarrea. Asimismo, tal suplementación, ya sea durante o inmediatamente después de la enfermedad, no mejora la sintomatología. Finalmente, en contra de lo esperado, estudios recientes con asignación aleatoria a grupos que reciben vitamina A o un placebo indican que la vitamina A no mejora el crecimiento de los niños.

  19. When to Monitor CD4 Cell Count and HIV RNA to Reduce Mortality and AIDS-Defining Illness in Virologically Suppressed HIV-Positive Persons on Antiretroviral Therapy in High-Income Countries: A Prospective Observational Study

    Science.gov (United States)

    Caniglia, Ellen C.; Sabin, Caroline; Robins, James M.; Logan, Roger; Cain, Lauren E.; Abgrall, Sophie; Mugavero, Michael J.; Hernandez-Diaz, Sonia; Meyer, Laurence; Seng, Remonie; Drozd, Daniel R.; Seage, George R.; Bonnet, Fabrice; Dabis, Francois; Moore, Richard R.; Reiss, Peter; van Sighem, Ard; Mathews, William C.; del Amo, Julia; Moreno, Santiago; Deeks, Steven G.; Muga, Roberto; Boswell, Stephen L.; Ferrer, Elena; Eron, Joseph J.; Napravnik, Sonia; Jose, Sophie; Phillips, Andrew; Olson, Ashley; Justice, Amy C.; Tate, Janet P.; Bucher, Heiner C.; Egger, Matthias; Touloumi, Giota; Sterne, Jonathan A.; Costagliola, Dominique; Saag, Michael; Hernán, Miguel A.

    2016-01-01

    Objective: To illustrate an approach to compare CD4 cell count and HIV-RNA monitoring strategies in HIV-positive individuals on antiretroviral therapy (ART). Design: Prospective studies of HIV-positive individuals in Europe and the USA in the HIV-CAUSAL Collaboration and The Center for AIDS Research Network of Integrated Clinical Systems. Methods: Antiretroviral-naive individuals who initiated ART and became virologically suppressed within 12 months were followed from the date of suppression. We compared 3 CD4 cell count and HIV-RNA monitoring strategies: once every (1) 3 ± 1 months, (2) 6 ± 1 months, and (3) 9–12 ± 1 months. We used inverse-probability weighted models to compare these strategies with respect to clinical, immunologic, and virologic outcomes. Results: In 39,029 eligible individuals, there were 265 deaths and 690 AIDS-defining illnesses or deaths. Compared with the 3-month strategy, the mortality hazard ratios (95% CIs) were 0.86 (0.42 to 1.78) for the 6 months and 0.82 (0.46 to 1.47) for the 9–12 month strategy. The respective 18-month risk ratios (95% CIs) of virologic failure (RNA >200) were 0.74 (0.46 to 1.19) and 2.35 (1.56 to 3.54) and 18-month mean CD4 differences (95% CIs) were −5.3 (−18.6 to 7.9) and −31.7 (−52.0 to −11.3). The estimates for the 2-year risk of AIDS-defining illness or death were similar across strategies. Conclusions: Our findings suggest that monitoring frequency of virologically suppressed individuals can be decreased from every 3 months to every 6, 9, or 12 months with respect to clinical outcomes. Because effects of different monitoring strategies could take years to materialize, longer follow-up is needed to fully evaluate this question. PMID:26895294

  20. Gallstone disease and mortality

    DEFF Research Database (Denmark)

    Shabanzadeh, Daniel Mønsted; Sørensen, Lars Tue; Jørgensen, Torben

    2017-01-01

    OBJECTIVES: The objective of this cohort study was to determine whether subjects with gallstone disease identified by screening of a general population had increased overall mortality when compared to gallstone-free participants and to explore causes of death. METHODS: The study population (N...... = 5928) was examined 1982-1992 and included an abdominal ultrasound examination to assess gallstone status, a physical examination, blood samples, and a questionnaire about medical history. Participants were followed up through national registers until 2015. Multiple adjusted Cox regression models were...... built. RESULTS: Gallstone disease was present in 10%. Mortality was 46% during median 24.7 years of follow-up with 1% lost. Overall mortality and death from cardiovascular diseases were significantly associated to gallstone disease. Death from unknown causes was significantly associated to gallstone...

  1. The mortality of companies

    Science.gov (United States)

    Daepp, Madeleine I. G.; Hamilton, Marcus J.; West, Geoffrey B.; Bettencourt, Luís M. A.

    2015-01-01

    The firm is a fundamental economic unit of contemporary human societies. Studies on the general quantitative and statistical character of firms have produced mixed results regarding their lifespans and mortality. We examine a comprehensive database of more than 25 000 publicly traded North American companies, from 1950 to 2009, to derive the statistics of firm lifespans. Based on detailed survival analysis, we show that the mortality of publicly traded companies manifests an approximately constant hazard rate over long periods of observation. This regularity indicates that mortality rates are independent of a company's age. We show that the typical half-life of a publicly traded company is about a decade, regardless of business sector. Our results shed new light on the dynamics of births and deaths of publicly traded companies and identify some of the necessary ingredients of a general theory of firms. PMID:25833247

  2. Mortality Dynamics of Spodoptera frugiperda (Lepidoptera: Noctuidae) Immatures in Maize.

    Science.gov (United States)

    Varella, Andrea Corrêa; Menezes-Netto, Alexandre Carlos; Alonso, Juliana Duarte de Souza; Caixeta, Daniel Ferreira; Peterson, Robert K D; Fernandes, Odair Aparecido

    2015-01-01

    We characterized the dynamics of mortality factors affecting immature developmental stages of the fall armyworm, Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae). Multiple decrement life tables for egg and early larval stages of S. frugiperda in maize (Zea mays L.) fields were developed with and without augmentative releases of Telenomus remus Nixon (Hymenoptera: Platygastridae) from 2009 to 2011. Total egg mortality ranged from 73 to 81% and the greatest egg mortality was due to inviability, dislodgement, and predation. Parasitoids did not cause significant mortality in egg or early larval stages and the releases of T. remus did not increase egg mortality. Greater than 95% of early larvae died from predation, drowning, and dislodgment by rainfall. Total mortality due to these factors was largely irreplaceable. Results indicate that a greater effect in reducing generational survival may be achieved by adding mortality to the early larval stage of S. frugiperda.

  3. Mortality Dynamics of Spodoptera frugiperda (Lepidoptera: Noctuidae) Immatures in Maize

    Science.gov (United States)

    Varella, Andrea Corrêa; Menezes-Netto, Alexandre Carlos; Alonso, Juliana Duarte de Souza; Caixeta, Daniel Ferreira; Peterson, Robert K. D.; Fernandes, Odair Aparecido

    2015-01-01

    We characterized the dynamics of mortality factors affecting immature developmental stages of the fall armyworm, Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae). Multiple decrement life tables for egg and early larval stages of S. frugiperda in maize (Zea mays L.) fields were developed with and without augmentative releases of Telenomus remus Nixon (Hymenoptera: Platygastridae) from 2009 to 2011. Total egg mortality ranged from 73 to 81% and the greatest egg mortality was due to inviability, dislodgement, and predation. Parasitoids did not cause significant mortality in egg or early larval stages and the releases of T. remus did not increase egg mortality. Greater than 95% of early larvae died from predation, drowning, and dislodgment by rainfall. Total mortality due to these factors was largely irreplaceable. Results indicate that a greater effect in reducing generational survival may be achieved by adding mortality to the early larval stage of S. frugiperda. PMID:26098422

  4. Snakebite Mortality in India: A Nationally Representative Mortality Survey

    Science.gov (United States)

    Mohapatra, Bijayeeni; Warrell, David A.; Suraweera, Wilson; Bhatia, Prakash; Dhingra, Neeraj; Jotkar, Raju M.; Rodriguez, Peter S.; Mishra, Kaushik; Whitaker, Romulus; Jha, Prabhat

    2011-01-01

    Background India has long been thought to have more snakebites than any other country. However, inadequate hospital-based reporting has resulted in estimates of total annual snakebite mortality ranging widely from about 1,300 to 50,000. We calculated direct estimates of snakebite mortality from a national mortality survey. Methods and Findings We conducted a nationally representative study of 123,000 deaths from 6,671 randomly selected areas in 2001–03. Full-time, non-medical field workers interviewed living respondents about all deaths. The underlying causes were independently coded by two of 130 trained physicians. Discrepancies were resolved by anonymous reconciliation or, failing that, by adjudication. A total of 562 deaths (0.47% of total deaths) were assigned to snakebites. Snakebite deaths occurred mostly in rural areas (97%), were more common in males (59%) than females (41%), and peaked at ages 15–29 years (25%) and during the monsoon months of June to September. This proportion represents about 45,900 annual snakebite deaths nationally (99% CI 40,900 to 50,900) or an annual age-standardised rate of 4.1/100,000 (99% CI 3.6–4.5), with higher rates in rural areas (5.4/100,000; 99% CI 4.8–6.0), and with the highest state rate in Andhra Pradesh (6.2). Annual snakebite deaths were greatest in the states of Uttar Pradesh (8,700), Andhra Pradesh (5,200), and Bihar (4,500). Conclusions Snakebite remains an underestimated cause of accidental death in modern India. Because a large proportion of global totals of snakebites arise from India, global snakebite totals might also be underestimated. Community education, appropriate training of medical staff and better distribution of antivenom, especially to the 13 states with the highest prevalence, could reduce snakebite deaths in India. PMID:21532748

  5. maternal mortality in Malawi

    African Journals Online (AJOL)

    Malawi; however there has been a lack of effective imple- mentation. ... the SWAp Programme of Work. 3”. Methods ... the current maternal mortality strategy may be implement- ... point of delivery. ... include the cost of a new chitenje (sarong) necessary for child- ..... nomic status and access to care for TB in urban Lilongwe.

  6. Affine stochastic mortality

    NARCIS (Netherlands)

    D.F. Schrager

    2006-01-01

    We propose a new model for stochastic mortality. The model is based on the literature on affine term structure models. It satisfies three important requirements for application in practice: analytical tractibility, clear interpretation of the factors and compatibility with financial option pricing m

  7. [Mortality in metropolitan regions].

    Science.gov (United States)

    Simoes Ccds

    1980-01-01

    Data from the 1970 census and a 1974-1975 survey carried out in Brazil by the Fundacao Instituto Brasileiro de Geografia e Estatistica are used to examine recent mortality trends in urban areas. Specifically, life expectancy in nine metropolitan areas is analyzed in relation to income, diet, and sanitary facilities in the home.

  8. Factors contributing to amphibian road mortality in a wetland

    Institute of Scientific and Technical Information of China (English)

    Haijun GU; Qiang DAI; Qian WANG; Yuezhao WANG

    2011-01-01

    To understand road characteristics and landscape features associated with high road mortality of amphibians in Zoige Wetland National Nature Reserve,we surveyed road mortality along four major roads after rainfall in May and September 2007.Road mortality of three species,Rana kukunoris,Nanorana pleskei and Bufo minshanicus,was surveyed across 225 transects (115 in May and 110 in September).Transects were 100 m long and repeated every two kilometers along the four major roads.We used model averaging to assess factors that might determine amphibian road mortality.We recorded an average of 24.6 amphibian road mortalities per kilometer in May and 19.2 in September.Among road characteristics,road width was positively associated with road morality for R.kukunori and B.minshanicus.Traffic volume also increased the road mortality of B.minshanicus in September.Of the landscape features measured,area proportions of three types of grassland (wet,mesic and dry) within 1 km of the roads,particularly that of wet grassland,significantly increased road mortality for R.kukunori and total mortality across all three species.To most effectively reduce road mortality of amphibians in the Zoige wetlands,we suggest better road design such as avoiding wet grasslands,minimizing road width,underground passes and traffic control measures.The implementation of public transit in the area would reduce traffic volume,and hence mortality [Current Zoology 57 (6):768-774,2011].

  9. Interferon-Based Treatment of Hepatitis C Virus Infection Reduces All-Cause Mortality in Patients With End-Stage Renal Disease: An 8-Year Nationwide Cohort Study in Taiwan.

    Science.gov (United States)

    Hsu, Yueh-Han; Hung, Peir-Haur; Muo, Chih-Hsin; Tsai, Wen-Chen; Hsu, Chih-Cheng; Kao, Chia-Hung

    2015-11-01

    The long-term survival of end-stage renal disease (ESRD) patients with hepatitis C virus (HCV) infection who received interferon treatment has not been extensively evaluated.The HCV cohort was the ESRD patients with de novo HCV infection from 2004 to 2011; they were classified into treated and untreated groups according to interferon therapy records. Patients aged interferon treatment. Compared with the uninfected control cohort, the treated group had a lower risk of death (hazard ratio 0.47, 95% confidence interval [CI] 0.22-0.99). The untreated group had a 2.62-fold higher risk (95% CI 1.24-5.55) of death compared with the treated group. For the HCV cohort without cirrhosis or hepatoma, the risk of death in the treated group was further markedly reduced (hazard ratio 0.17, 95% CI 0.04-0.68) compared with that in the control cohort.For ESRD patients with HCV infection, receiving interferon treatment is associated with a survival advantage. Such an advantage is more prominent in HCV patients without cirrhosis or hepatoma.

  10. Dietary patterns and mortality in Danish men and women

    DEFF Research Database (Denmark)

    Osler, M; Heitmann, B L; Gerdes, Lars Ulrik

    2001-01-01

    was associated with reduced all-cause mortality in both men and women, but the relations were attenuated after adjustment for smoking, physical activity, educational level, BMI, and alcohol intake. The prudent pattern was inversely associated with all-cause and cardiovascular mortality after controlling...

  11. The Mediterranean diet in relation to mortality and CVD

    DEFF Research Database (Denmark)

    Tognon, G.; Lissner, L.; Saebye, D.

    2014-01-01

    The aim of the present study was to determine whether the Mediterranean Diet Score (MDS) is associated with reduced total mortality, cardiovascular incidence and mortality in a Danish population. Analyses were performed on 1849 men and women sampled during the 1982-83 Danish MONICA (MONItoring tr...

  12. [AIDS mortality in France].

    Science.gov (United States)

    Hatton, F; Maguin, P; Nicaud, V; Renaud, G

    1986-01-01

    A study about mortality by AIDS had been undertaken since July 1st 1983, in the Service of Information on Medical causes of Death (INSERM SC8), which is in charge of developing mortality statistics in France. From July 1st 1983 to September 30th 1985, 243 deaths due to AIDS were recorded. Only the cases where this diagnosis was clearly mentioned were selected; more than 90% were notified by hospitals and mainly by highly specialized services. The number of deaths, which was low and varied rather irregularly at the beginning, then increased by successive stages. The first year, during which a tenth of deaths was recorded every three months, was followed by a great increase, doubling, then tripling the initial numbers. Lastly, a second and sudden rise occurred during the third trimester of 1985, the trimestrial number of deaths due to AIDS reaching 80.

  13. HIV and maternal mortality.

    Science.gov (United States)

    Lathrop, Eva; Jamieson, Denise J; Danel, Isabella

    2014-11-01

    The majority of the 17 million women globally that are estimated to be infected with HIV live in Sub-Saharan Africa. Worldwide, HIV-related causes contributed to 19 000-56 000 maternal deaths in 2011 (6%-20% of maternal deaths). HIV-infected pregnant women have two to 10 times the risk of dying during pregnancy and the postpartum period compared with uninfected pregnant women. Many of these deaths can be prevented with the implementation of high-quality obstetric care, prevention and treatment of common co-infections, and treatment of HIV with ART. The paper summarizes what is known about HIV disease progression in pregnancy, specific causes of HIV-related maternal deaths, and the potential impact of treatment with antiretroviral therapy on maternal mortality. Recommendations are proposed for improving maternal health and decreasing maternal mortality among HIV-infected women based on existing evidence.

  14. Deciphering infant mortality

    Science.gov (United States)

    Berrut, Sylvie; Pouillard, Violette; Richmond, Peter; Roehner, Bertrand M.

    2016-12-01

    This paper is about infant mortality. In line with reliability theory, "infant" refers to the time interval following birth during which the mortality (or failure) rate decreases. This definition provides a systems science perspective in which birth constitutes a sudden transition falling within the field of application of the Transient Shock (TS) conjecture put forward in Richmond and Roehner (2016c). This conjecture provides predictions about the timing and shape of the death rate peak. It says that there will be a death rate spike whenever external conditions change abruptly and drastically and also predicts that after a steep rise there will be a much longer hyperbolic relaxation process. These predictions can be tested by considering living organisms for which the transient shock occurs several days after birth. Thus, for fish there are three stages: egg, yolk-sac and young adult phases. The TS conjecture predicts a mortality spike at the end of the yolk-sac phase and this timing is indeed confirmed by observation. Secondly, the hyperbolic nature of the relaxation process can be tested using very accurate Swiss statistics for postnatal death rates spanning the period from one hour immediately after birth through to age 10 years. It turns out that since the 19th century despite a significant and large reduction in infant mortality, the shape of the age-specific death rate has remained basically unchanged. Moreover the hyperbolic pattern observed for humans is also found for small primates as recorded in the archives of zoological gardens. Our overall objective is to identify a series of cases which start from simple systems and move step by step to more complex organisms. The cases discussed here we believe represent initial landmarks in this quest.

  15. Pelvic fractures and mortality.

    OpenAIRE

    K.H. Chong; DeCoster, T.; Osler, T.; Robinson, B.

    1997-01-01

    A retrospective study of all patients (N = 343) with pelvic fractures admitted to our trauma service was conducted to evaluate the impact of pelvic fractures on mortality. All patients sustained additional injuries with an average Injury Severity Score (ISS) of twenty. Thirty-six patients died. This group had more severe pelvic fractures as graded by the Tile classification as well as a greater number and severity of associated injuries. Six patients died as a direct result of pelvic hemorrha...

  16. Retraction: ‘rhBNP therapy can improve clinical outcomes and reduce in‐hospital mortality compared with dobutamine in heart failure patients: a meta‐analysis’ by Ming‐Yi Lv, Shu‐Ling Deng and Xiao‐Feng Long

    Science.gov (United States)

    2016-01-01

    The above article, published online on 28th November 2015 in Wiley Online Library (http://onlinelibrary.wiley.com/doi/10.1111/bcp.12788/full), and in volume 81, pp. 174–185, has been retracted by agreement between the authors, the journal Editor in Chief, Professor A Cohen, and John Wiley & Sons Limited. The retraction has been agreed owing to evidence indicating that the peer review of this paper was compromised. The authors were unaware of the actions of the third party responsible for compromising the peer review. Reference LvM‐Y , DengS‐L , LongX‐F . rhBNP therapy can improve clinical outcomes and reduce in‐hospital mortality compared with dobutamine in heart failure patients: a meta‐analysis. Br J Clin Pharmacol 2016; 81: 174–85. doi:10.1111/bcp.12788.26382927 PMID:27086732

  17. Russian mortality beyond vital statistics

    Directory of Open Access Journals (Sweden)

    2004-04-01

    .69-4.17. Adjustment for other variables reduced the size of these odds ratios, but they remained strikingly large for circulatory disease (adjusted OR=3.54, 95% CI 1.76-7.13 and considerable for external causes (adjusted OR 1.75, 95% CI 1.02-3.00. These may be underestimates of the true effects as nearly all of them increased when employment status (which can in part at least be seen as being on the causal pathway was excluded from the final model. In summary, however, our key finding is that a history of heavy drinking in the recent past is strongly associated with risk of death from circulatory disease. This provides the first individual-level evidence in support of the hypothesis that episodic heavy drinking is key to explaining the heavy burden of circulatory disease mortality among Russian men of working age.

  18. Telomere Length and Mortality

    DEFF Research Database (Denmark)

    Kimura, Masayuki; Hjelmborg, Jacob V B; Gardner, Jeffrey P

    2008-01-01

    telomeres predicted the death of the first co-twin better than the mTRFL did (mTRFL: 0.56, 95% confidence interval (CI): 0.49, 0.63; mTRFL(50): 0.59, 95% CI: 0.52, 0.66; mTRFL(25): 0.59, 95% CI: 0.52, 0.66; MTRFL: 0.60, 95% CI: 0.53, 0.67). The telomere-mortality association was stronger in years 3-4 than......Leukocyte telomere length, representing the mean length of all telomeres in leukocytes, is ostensibly a bioindicator of human aging. The authors hypothesized that shorter telomeres might forecast imminent mortality in elderly people better than leukocyte telomere length. They performed mortality...... analysis in 548 same-sex Danish twins (274 pairs) aged 73-94 years, of whom 204 pairs experienced the death of one or both co-twins during 9-10 years of follow-up (1997-2007). From the terminal restriction fragment length (TRFL) distribution, the authors obtained the mean TRFL (mTRFL) and the mean values...

  19. Effects of wolf mortality on livestock depredations.

    Directory of Open Access Journals (Sweden)

    Robert B Wielgus

    Full Text Available Predator control and sport hunting are often used to reduce predator populations and livestock depredations, but the efficacy of lethal control has rarely been tested. We assessed the effects of wolf mortality on reducing livestock depredations in Idaho, Montana and Wyoming from 1987-2012 using a 25 year time series. The number of livestock depredated, livestock populations, wolf population estimates, number of breeding pairs, and wolves killed were calculated for the wolf-occupied area of each state for each year. The data were then analyzed using a negative binomial generalized linear model to test for the expected negative relationship between the number of livestock depredated in the current year and the number of wolves controlled the previous year. We found that the number of livestock depredated was positively associated with the number of livestock and the number of breeding pairs. However, we also found that the number of livestock depredated the following year was positively, not negatively, associated with the number of wolves killed the previous year. The odds of livestock depredations increased 4% for sheep and 5-6% for cattle with increased wolf control--up until wolf mortality exceeded the mean intrinsic growth rate of wolves at 25%. Possible reasons for the increased livestock depredations at ≤25% mortality may be compensatory increased breeding pairs and numbers of wolves following increased mortality. After mortality exceeded 25%, the total number of breeding pairs, wolves, and livestock depredations declined. However, mortality rates exceeding 25% are unsustainable over the long term. Lethal control of individual depredating wolves may sometimes necessary to stop depredations in the near-term, but we recommend that non-lethal alternatives also be considered.

  20. Mortality in Levodopa-Treated Parkinson's Disease

    Directory of Open Access Journals (Sweden)

    John C. Morgan

    2014-01-01

    Full Text Available Parkinson’s disease (PD is associated with increased mortality despite many advances in treatment. Following the introduction of levodopa in the late 1960’s, many studies reported improved or normalized mortality rates in PD. Despite the remarkable symptomatic benefits provided by levodopa, multiple recent studies have demonstrated that PD patients continue to die at a rate in excess of their peers. We undertook this retrospective study of 211 deceased PD patients to determine the factors associated with mortality in levodopa-treated PD. Our findings confirm that PD is associated with increased mortality in both men and women. Unlike the majority of other mortality studies, we found that women have a greater reduction in lifespan compared to men. We also found that patients with early onset PD (onset at the age of 50 or before have reduced survival relative to PD patients with later ages of onset. A final important finding is that survival is equal in PD patients treated with levodopa early (within 2 years or less of PD onset versus later.

  1. Current therapies and mortality in acromegaly.

    Science.gov (United States)

    Găloiu, S; Poiană, C

    2015-01-01

    Acromegaly is a rare disease most frequently due to a GH secreting pituitary adenoma. Without an appropriate therapy, life of patients with acromegaly can be shortened with ten years. Pituitary surgery is usually the first line therapy for GH secreting pituitary adenomas. A meta-analysis proved that mortality is much lower in operated patients, even uncured, than the entire group of patients and is similar with the general population in patients with GH30% utilization of SRAs reported a lower mortality ratio than studies with lower percentages of SRA administration. Although therapy with DA has long been used in patients with acromegaly, there are no studies reporting its effect on mortality, but its efficacy is limited by the low remission rate obtained. The use of conventional external radiotherapy, although with good remission rate in time, was linked with increased mortality, mostly due to cerebrovascular diseases. Mortality in acromegaly can be reduced to expected levels from general population by using modern therapies either in monotherapy or by using multimodal approaches in experienced centers.

  2. Neonatal resuscitation technique to reduce neonatal asphyxia rate and mortality rate in China:a Meta-analysis%复苏技术降低我国新生儿窒息发生率和死亡率的 Meta分析

    Institute of Scientific and Technical Information of China (English)

    李鸿斌; 顾建明; 冯海娟; 沈莉

    2015-01-01

    目的:评价新生儿复苏技术对我国新生儿窒息发生率和死亡率下降的效果。方法检索万方数据库、知网数据库资料,收集有关新生儿复苏项目现状与效果的相关文献,并根据纳入标准及排除标准筛选文献,采用非随机前后对照试验的二分类数据Meta分析法判断复苏实施效果。结果最终纳入文献3篇。 Meta分析结果显示,项目地区推广应用新生儿复苏技术促进了新生儿窒息发生率和死亡率的下降,新生儿窒息发生率降低46%,RR=0.54,95%CI:0.33~0.91,P=0.02;新生儿窒息死亡率降低45%,RR=0.55,95%CI:0.35~0.86,P=0.009。结论新生儿复苏技术有助于降低新生儿窒息发生率和死亡率,建议向农村、基层医院普及推广。%Objective To evaluate the effect of neonatal resuscitation technique on reducing the neonatal asphyxia rate and mortality in China.Methods Wanfang data and CNKI-CAJD were retrieved to collect the literatures of neonatal resuscitation, and they were screened according to inclusion criteria and exclusion criteria.Meta-analysis of two-category data of non-randomized control study was conducted to evaluate the effect of neonatal resuscitation technique.Results Finally three articles were recruited.Meta-analysis showed that neonatal resuscitation technique applied in program areas reduced the neonatal asphyxia rate and mortality.The neonatal asphyxia rate decreased by 46%(RR=0.54,95%CI:0.33-0.91,P=0.02), and the mortality rate decreased by 45% (RR=0.55,95%CI:0.35-0.86, P=0.009) .Conclusion Neonatal resuscitation technique helps to reduce neonatal asphyxia rate and mortality, so it is suggested to be promoted in countryside and basic-level hospitals.

  3. Excess Early Mortality in Schizophrenia

    DEFF Research Database (Denmark)

    Laursen, Thomas Munk; Nordentoft, Merete; Mortensen, Preben Bo

    2014-01-01

    Schizophrenia is often referred to as one of the most severe mental disorders, primarily because of the very high mortality rates of those with the disorder. This article reviews the literature on excess early mortality in persons with schizophrenia and suggests reasons for the high mortality as ...

  4. Conquering maternal mortality: skill development in medical curriculum

    National Research Council Canada - National Science Library

    Parimala A; Nidhi Sharma; K. Jayashree

    2016-01-01

    .... A skill development method was initiated in the final year curriculum of medical students to integrate the basic knowledge of labor with the final outcome of reducing maternal mortality rate. Methods...

  5. Stillbirth and Infant Mortality

    DEFF Research Database (Denmark)

    Nøhr, Ellen Aagaard

    2012-01-01

    mechanisms behind these associations remain largely unknown. Although maternal obesity is associated with a wide range of complications in the mother and neonate that may impair fetal and infant survival, the increased risk of stillbirth and infant mortality is virtually unchanged when accounting...... indicating that some of the excess risk may have a placental origin. To further understand the associations between maternal obesity and late fetal and infant death, we need better and more detailed clinical data, which is difficult to obtain on a population level given the rarity of the outcomes. The best...

  6. A Specific Screening Strategy to Reduce Prostate Cancer Mortality

    Science.gov (United States)

    2013-09-01

    determination, proliferation, cell -cycle regulation, angiogenesis, invasion, and migration [8, 9]. Id1 gene expression is cancer -specific and has been...diagnostic vector can be used for in situ detection and localization of prostate cancer . By simulating low (2.5%) and high (17.5%) tumor cell ...Troncoso, P, Tu, SM, et al. (1997). Establishment of two human prostate cancer cell lines derived from a single bone metastasis . Clinical cancer

  7. Screening with urinary dipsticks for reducing morbidity and mortality

    DEFF Research Database (Denmark)

    Krogsbøll, Lasse T; Juhl Jørgensen, Karsten; Gøtzsche, Peter C

    2015-01-01

    BACKGROUND: Urinary dipsticks are sometimes used for screening asymptomatic people, and for case-finding among inpatients or outpatients who do not have genitourinary symptoms. Abnormalities identified on screening sometimes lead to additional investigations, which may identify serious disease, s...

  8. Evaluation of a project to reduce morbidity and mortality from ...

    African Journals Online (AJOL)

    2011-05-30

    May 30, 2011 ... and eligibility for other social events in the community. An .... Provide a venue for training and transport for team members to attend meetings ... What we would like to see: real engagement with the ..... BMC Public Health. 2008 ...

  9. Control temperature of young chicks to reduce mortality

    NARCIS (Netherlands)

    Lourens, A.; Kuijpers, M.

    2002-01-01

    Individual chicks may have different environmental temperature demands. The trick is to provide every chick with the right body temperature. By measuring individual chick temperatures, hatchery staff and broiler growers or layer producers are better able to provide the right environmental temperatur

  10. Pulse oximetry : technology to reduce child mortality in developing countries

    NARCIS (Netherlands)

    Duke, T.; Subhi, R.; Peel, D.; Frey, B.

    2009-01-01

    The causes of hypoxaemia in children include the commonest causes of childhood illness: pneumonia and other acute respiratory infections, and neonatal illness, particularly sepsis, low birthweight, birth asphyxia and aspiration syndromes. The systematic use of pulse oximetry to monitor and treat chi

  11. Medication review in hospitalised patients to reduce morbidity and mortality

    DEFF Research Database (Denmark)

    Christensen, Mikkel; Lundh, Andreas

    2013-01-01

    accepted definition of medication review exists, it can be defined as a systematic assessment of the pharmacotherapy of an individual patient that aims to evaluate and optimise patient medication by a change (or not) in prescription, either by a recommendation or by a direct change. Medication review...

  12. High motility reduces grazing mortality of planktonic bacteria

    DEFF Research Database (Denmark)

    Matz, Carsten; Jurgens, K.

    2005-01-01

    We tested the impact of bacterial swimming speed on the survival of planktonic bacteria in the presence of protozoan grazers. Grazing experiments with three common bacterivorous nanoflagellates revealed low clearance rates for highly motile bacteria. High-resolution video microscopy demonstrated ......(3), >50 mum s(-1)) illustrated the combined protective action of small cell size and high motility. Our findings suggest that motility has an important adaptive function in the survival of planktonic bacteria during protozoan grazing....

  13. Targeting the Mevalonate Pathway to Reduce Mortality from Ovarian Cancer

    Science.gov (United States)

    2016-10-01

    Visvanathan, MD MHS CONTRACTING ORGANIZATION: Johns Hopkins University Baltimore, MD 21205 REPORT DATE: October 2016 TYPE OF REPORT: Annual...8. PERFORMING ORGANIZATION REPORT NUMBER The Johns Hopkins University Johns Hopkins Bloomberg School of Public Health Epidemiology Dept., E6141...prescribed statin) alone or in combination with carboplatin/paclitaxel in a mouse orthotopic tumor xenograft model bearing luciferase-expressing OVCAR3

  14. A Specific Screening Strategy to Reduce Prostate Cancer Mortality

    Science.gov (United States)

    2014-09-01

    Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202- 4302...delivery to target tumors. Previous research has indicated that US-stimulated therapy can enhance delivery of both drugs and plasmids for cancer treatment...groups compared with antibody alone; this was most likely caused by previously reported involvement of splenic macro- phages and mononuclear phagocyte

  15. Weather-related Tree Swallow Mortality and Reduced Nesting Effort

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This report documents the spring 2007 die-off of 216 Tree Swallows in western New York due to a period of unseasonably warm temperatures followed immediately by a...

  16. PREVALENT DISEASES AND OVERALL MORTALITY IN BROILERS

    Directory of Open Access Journals (Sweden)

    M. Farooq, Zahir-ud-Din, F .R. Durrani, M.A. Mian, N. Chand and J. Ahmed1

    2002-03-01

    Full Text Available Records from 62-broiler farms located in Swat, North West Frontier Province (NWFP, Pakistan were, collected during the year 1998 to investigate prevalent diseases and overall mortality in broilers. Losses due Hydro-pericardium syndrome (HPS were the highest (17.05 ± 2.08% and the lowest due to coccidiosis 9.39 ± 3.82%. Non-significant differences existed in mortality caused by Newcastle, IBD and yolk sac infection. Differences in losses caused by infectious coryza, enteritis and coccidiosis were also non- significant. Average overall mortality was 13.05 ± 1.16%, representing 7.59 ± 0.46% losses from day-1 to day 14 and 18.52 ± 0.95% from day-15 till marketing of broilers (42-50 days. Lower (p<0.05 overall mortality was observed in broilers reared on well-finished concrete floors (12.43 ± 1.45 % than in those on brick+mud made floors (14.36 ± 1.55. Higher (p<0.05 overall mortality was found in overcrowded houses 5.60 ± 5.62% than in optimally utilized houses (10.69 ± 1.51%. Overall mortality was higher (p<0.05 in flocks under substandard vaccination schedule (15.92 ± 1.55% than in those maintained under standard lancination schedule (10.20 ± 1.21%. Overall mortality was higher (21.11 ± 3.39% when the interval between two batches was ≤ 7 days than 16-20 days (5.72 ± 3.01%. Lower (p<0.05 overall mortality was und in broilers maintained under good hygienic ( 11.59 ±1.93% and sanitary conditions ( 10.82 ± 1.16% compared to those under poor hygienic and sanitary conditions (14.12 ± 2.81% and 15.15 ± 1.68 %respectively. Maintenance of broilers under good hygienic conditions on well finished concrete floor, providing the required space/broiler, following recommended vaccination schedule without HPS vaccine and keeping 8.20 days interval between two batches were suggested as key factors in reducing mortality among broilers in Swat

  17. Mortality in Schizophrenia: Clinical and Serological Predictors

    Science.gov (United States)

    Dickerson, Faith; Stallings, Cassie; Origoni, Andrea; Schroeder, Jennifer; Khushalani, Sunil; Yolken, Robert

    2014-01-01

    Persons with schizophrenia have a reduced life expectancy largely due to death from natural causes. Factors that have been previously associated with excess mortality include cigarette smoking and antipsychotic medication. The role of other environmental factors such as exposure to infectious agents has been the subject of only limited investigation. We prospectively assessed a cohort of persons with schizophrenia with a clinical evaluation and a blood sample from which antibodies to human herpes viruses and Toxoplasma gondii were measured. Mortality was determined with data from the National Death Index following a period of up to 11 years. We examined the role of demographic, serological, and clinical factors on mortality. A total of 25 (5%) of 517 persons died of natural causes. The standardized mortality ratio was 2.80 (95% CI 0.89, 6.38). After adjusting for age and gender, mortality from natural causes was predicted in separate models by cigarette smoking (relative risk [RR] = 4.66, P = .0029); lower cognitive score (RR = 0.96, P = .013); level of antibodies to Epstein–Barr virus (RR = 1.22, P = .0041) and to Herpes Simplex virus type 1 (RR = 1.19, P = .030); immunologic disease (RR = 3.14, P = .044); and genitourinary disease (RR = 2.70; P = .035). Because cigarette smoking confers an almost 5-fold risk of mortality, smoking cessation is an urgent priority. Having an elevated level of antibodies to Epstein–Barr virus and to Herpes Simplex virus type 1 are also significant predictors of death from natural causes. PMID:23943410

  18. Child mortality after Hurricane Katrina.

    Science.gov (United States)

    Kanter, Robert K

    2010-03-01

    Age-specific pediatric health consequences of community disruption after Hurricane Katrina have not been analyzed. Post-Katrina vital statistics are unavailable. The objectives of this study were to validate an alternative method to estimate child mortality rates in the greater New Orleans area and compare pre-Katrina and post-Katrina mortality rates. Pre-Katrina 2004 child mortality was estimated from death reports in the local daily newspaper and validated by comparison with pre-Katrina data from the Louisiana Department of Health. Post-Katrina child mortality rates were analyzed as a measure of health consequences. Newspaper-derived estimates of mortality rates appear to be valid except for possible underreporting of neonatal rates. Pre-Katrina and post-Katrina mortality rates were similar for all age groups except infants. Post-Katrina, a 92% decline in mortality rate occurred for neonates (Katrina decline in infant mortality rate exceeds the pre-Katrina discrepancy between newspaper-derived and Department of Health-reported rates. A declining infant mortality rate raises questions about persistent displacement of high-risk infants out of the region. Otherwise, there is no evidence of long-lasting post-Katrina excess child mortality. Further investigation of demographic changes would be of interest to local decision makers and planners for recovery after public health emergencies in other regions.

  19. Beverage-Specific Alcohol Sale and Cardiovascular Mortality in Russia

    Directory of Open Access Journals (Sweden)

    Y. E. Razvodovsky

    2010-01-01

    Full Text Available Objective. Recent research evidence suggests that the consumption of different types of alcoholic beverage may have a differential effect on cardiovascular diseases (CVD mortality rates. The aim of this study was to examine the relation between the consumption of different beverage types and CVD mortality rates in Russia across the later-Soviet and post-Soviet periods. Method. Age-standardized male and female CVD mortality data for the period 1970–2005 and data on beverage-specific alcohol sales were obtained Russian State Statistical Committee (Rosstat. Time-series analytical modeling techniques (ARIMA were used to examine the relation between the sales of different alcoholic beverages and CVD mortality rates. Results. Vodka consumption as measured by sales was significantly associated with both male and female CVD mortality rates: a 1 liter increase in vodka sales would result in a 5.3% increase in the male CVD mortality rate and a 3.7% increase in the female rate. The consumption of beer and wine were not associated with CVD mortality rates. Conclusions. The findings from this study suggest that public health efforts should focus on both reducing overall consumption and changing beverage preference away from distilled spirits in order to reduce cardiovascular mortality rates in Russia.

  20. Mortality Causes in Children 1-59 Months in Iran

    Directory of Open Access Journals (Sweden)

    T Sanaei-Shoar

    2013-01-01

    Full Text Available Background: Mortality rate indicator for children under 5 years old is one of the important indicators in countries' development. Identifying the most common causes of mortality is one of the most important attempts to reduce mortality in children less than 5 years. The purpose of this study was to identify distribution of the mortality causes in Iranian children less than 5 years.Methods: This cross-sectional study has been carried out based on the results of data from the Child Mortality Surveillance System since 2007 to 2008. To determine the causes of death questionnaires have been designed which include personal data of the deceased child, medical history, and information on procedures at the time of hospitalization or death.Results: Of 5926 deaths on children under 5 years which the questionnaires were filled out, 63.2% were postneonatal deaths (1-11 month. Totally 60% of mortalities occurred in the rural areas and 52% of them had been among boys. The most common causes of mortality were the congenital and chromosomal abnormalities with 23.4%. The most incidences among diseases were respiratory system diseases.Conclusions: Carrying out more epidemiologic studies, providing health programs to control and prevent diseases with high incidences and delivering more specialized health facilities and services could be the proper strategies to reduce under 5 mortality rates in Iran.

  1. Projecting the impact of AIDS on mortality.

    Science.gov (United States)

    Stover, J; Way, P

    1998-01-01

    The authors describe the projected impact of AIDS on mortality, explain the reasons for the differences in mortality projections by major international organizations, and offer an approach to estimating the impact of AIDS upon life expectancy. Although AIDS has already significantly increased mortality in many countries, the impact of AIDS upon mortality is expected to grow substantially over the next 10 years and into future decades. By 2005, the population of the most severely affected countries in Africa will be 13-59 million less than it would have been without AIDS, and life expectancy may decline by as much as 27% in those countries. Uncertainty about current and future trends in HIV prevalence among adults has led to differences in the projections of future AIDS-related mortality. For example, while the UN projects that AIDS will reduce the population growth of the most severely affected countries in Africa by 13 million by 2005 and 30 million by 2025, the US Census Bureau projects the reduction to be 59 million by 2005 and 120 million by 2025. These differences are largely due to the use of different methodologies for projecting future levels of adult HIV prevalence. There are also differing estimates of current levels of HIV prevalence and differing assumptions about the length of the incubation period and the perinatal transmission rate. As data and projection methodologies improve, the differences in projections may be reduced for sub-Saharan Africa, while the growing epidemic in some of the largest countries of Asia may increase uncertainty about future global impacts.

  2. Mortality after hemorrhagic stroke

    DEFF Research Database (Denmark)

    González-Pérez, Antonio; Gaist, David; Wallander, Mari-Ann

    2013-01-01

    OBJECTIVE: To investigate short-term case fatality and long-term mortality after intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) using data from The Health Improvement Network database. METHODS: Thirty-day case fatality was stratified by age, sex, and calendar year after ICH...... during the first year of follow-up compared with controls (ICH: hazard ratio [HR] 2.60, 95% confidence interval [CI] 2.09-3.24, p year (ICH: HR 2.02, 95% CI 1.75-2.32, p ... and SAH using logistic regression. Cox proportional hazards regression analyses were used to estimate the risk of death during the first year of follow-up and survivors at 1 year. RESULTS: Case fatality after ICH was 42.0%, compared with 28.7% after SAH. It increased with age (ICH: 29.7% for 20-49 years...

  3. Changes in mortality in Pakistan 1960-88.

    Science.gov (United States)

    Sathar, Z A

    1991-01-01

    declines through birth spacing, educational attainment increases, contraceptive use increases, and the declining trend in length of breast feeding. The Population Program needs to achieve its targets of reducing family size norms and greater spacing between children. Improvements in combating communicable disease, including infective and parasitic diseases, are integral to decline in death rates. Better sanitation, particularly in slums, and availability of potable water are government objectives and will contribute to mortality decline. Access and availability of health care are crucial to improvements, particularly in rural areas.

  4. Socio-economic determinants of mortality in Latin America.

    Science.gov (United States)

    Behm, H

    1980-01-01

    The characteristics and sources of socioeconomic differentials of mortality in Latin America, in so far as they are currently known, are examined in an attempt to clarify the present situation and its perspectives. Mortality in a population is a function of the frequency of illness (incidence) and the probability of dying of the sick individual (lethality). Information on the socioeconomic differentials of mortality in Latin America is systematically reviewed with attention directed to the following: differentials among Latin American countries, regional differences within countries, urban-rural contrasts in mortality, mortality and income level and level of education, and mortality and ethnic groups. Latin America shows considerable heterogeneity with respect to the risk of dying, which varies from 202/1000 births in Bolivia to 38/1000 in Uruguay. It is estimated that more than 1/2 of the children born in Latin America are exposed to a mortality rate of over 120/1000. A study of the urban and rural populations of 12 Latin American countries revealed that the risk for rural populations exceeds that for urban populations by 30-60%. There is extensive evidence showing that mortality is higher in the working class and is associated with lower levels of education and income. Mortality was also higher in certain indigenous groups. Socioeconomic differentials of mortality are more marked in Latin America than in the developed nations. The mother's level of educational attainment is the variable most significantly associated with infant and child mortality. The prospect of reducing the current mortality levels is dependent primarily upon the implementation of policies aimed at a more egalitarian distribution of the benefits of socioeconomic development among the population.

  5. Siberian Pine Decline and Mortality in Southern Siberian Mountains

    Science.gov (United States)

    Kharuk, V. I.; Im, S. T.; Oskorbin, P. A.; Petrov, I. A.; Ranson, K. J.

    2013-01-01

    The causes and resulting spatial patterns of Siberian pine mortality in eastern Kuznetzky Alatau Mountains, Siberia were analyzed based on satellite (Landsat, MODIS) and dendrochronology data. Climate variables studied included temperature, precipitation and Standardized Precipitation-Evapotranspiration Index (SPEI) drought index. Landsat data analysis showed that stand mortality was first detected in the year 2006 at an elevation of 650 m, and extended up to 900 m by the year 2012. Mortality was accompanied by a decrease in MODIS derived vegetation index (EVI).. The area of dead stands and the upper mortality line were correlated with increased drought. The uphill margin of mortality was limited by elevational precipitation gradients. Dead stands (i.e., >75% tree mortality) were located mainly on southern slopes. With respect to slope, mortality was observed within a 7 deg - 20 deg range with greatest mortality occurring on convex terrain. Tree radial incrementmeasurements correlate and were synchronous with SPEI (r sq = 0.37, r(sub s) = 80). Increasing synchrony between tree ring growth and SPEI indicates that drought has reduced the ecological niche of Siberian pine. The results also showed the primary role of drought stress on Siberian pine mortality. A secondary role may be played by bark beetles and root fungi attacks. The observed Siberian pine mortality is part of a broader phenomenon of "dark needle conifers" (DNC, i.e., Siberian pine, fir and spruce) decline and mortality in European Russia, Siberia, and the Russian Far East. All locations of DNC decline coincided with areas of observed drought increase. The results obtained are one of the first observations of drought-induced decline and mortality of DNC at the southern border of boreal forests. Meanwhile if model projections of increased aridity are correct DNC, within the southern part of its range may be replaced by drought-resistant Pinus silvestris and Larix sibirica.

  6. Applicability of lives saved tool in projecting effects of scaling up interventions on reducing maternal mortality rates in the rural area of Guangxi province in China%运用生命挽救工具预测降低广西农村孕产妇死亡率的干预措施健康效果的适用性

    Institute of Scientific and Technical Information of China (English)

    骆大胜; 陈荔丽; 韦萍; 江震; 郭岩

    2013-01-01

    Objective:To evaluate applicability of lives saved tool (LiST) in projecting effects of maternal health interventions on reducing maternal mortality in the rural area of Guangxi Zhuang Autonomous Region in China,and provide evidence for promoting LiST in China.Methods:By using maternal intervention coverage and other information collected through the cross-sectional household survey,literature review and expert consultation,LiST projection was performed and modeled.The maternal mortality reduction and causes of death were measured and compared,and the differences were analyzed.SPSS 19.0 was used in the household survey data analysis.Results:Coverage of calcium supplementation,MgSO4-management of pre-eclampsia and institutional delivery reached 51.9%,99.0% and 98.4% respectively in rural Guangxi in 2011.The LiST captured the general trend of maternal mortality in rural Guangxi.The modeled maternal mortality rate was 4.71%,lower than the measured in 2009 and 10.43% higher in 2010.Maternal mortality rate would decreased to 18/100 000 in 2015 assuming all relevant interventions reached full coverage,and 90% of the maternal morality reduction was attributed to the labor and delivery management.Conclusion:LiST can be applied to project effects of maternal health interventions on reducing the maternal mortality in rural Guangxi,but its accuracy was limited by the fact that the effect of relevant interventions on some major causes of maternal death,such as amniotic embolism,was not calculated in LiST and maternal deaths caused by those causes varied by the year in the area.Based on the LiST projection,labor and delivery management was found to be the priority intervention in improving maternal health in rural Guangxi.Improving the quality of obstetric care in township hospitals and facilitating referral of high-risk pregnant women were highly recommended.%目的:运用生命挽救工具(lives saved tool,LiST)预测在广西农村地区扩大相关干预措施

  7. 77 FR 7594 - Advisory Committee on Infant Mortality; Notice of Meeting

    Science.gov (United States)

    2012-02-13

    ... HUMAN SERVICES Health Resources and Services Administration Advisory Committee on Infant Mortality...-463), notice is hereby given of the following meeting: Name: Advisory Committee on Infant Mortality...: Department of Health and Human Services' programs that focus on reducing infant mortality and improving...

  8. 77 FR 36549 - Advisory Committee on Infant Mortality; Notice of Meeting

    Science.gov (United States)

    2012-06-19

    ... HUMAN SERVICES Health Resources and Services Administration Advisory Committee on Infant Mortality...-463), notice is hereby given of the following meeting: Name: Advisory Committee on Infant Mortality...: Department of Health and Human Services' programs that focus on reducing infant mortality and improving...

  9. 77 FR 64524 - Advisory Committee on Infant Mortality; Notice of Meeting

    Science.gov (United States)

    2012-10-22

    ... HUMAN SERVICES Health Resources and Services Administration Advisory Committee on Infant Mortality...-463), notice is hereby given of the following meeting: Name: Advisory Committee on Infant Mortality...: Department of Health and Human Services' programs that focus on reducing infant mortality and improving...

  10. 76 FR 39112 - Advisory Committee on Infant Mortality; Notice of Meeting

    Science.gov (United States)

    2011-07-05

    ... HUMAN SERVICES Health Resources and Services Administration Advisory Committee on Infant Mortality...-463), notice is hereby given of the following meeting: Name: Advisory Committee on Infant Mortality...: Department of Health and Human Services' programs that focus on reducing infant mortality and improving...

  11. The impact of profitability of hospital admissions on mortality.

    Science.gov (United States)

    Lindrooth, Richard C; Konetzka, R Tamara; Navathe, Amol S; Zhu, Jingsan; Chen, Wei; Volpp, Kevin

    2013-04-01

    Fiscal constraints faced by Medicare are leading to policies designed to reduce expenditures. Evidence of the effect of reduced reimbursement on the mortality of Medicare patients discharged from all major hospital service lines is limited. We modeled risk-adjusted 30-day mortality of patients discharged from 21 hospital service lines as a function of service line profitability, service line time trends, and hospital service line and year-fixed effects. We simulated the effect of alternative revenue-neutral reimbursement policies on mortality. Our sample included all Medicare discharges from PPS-eligible hospitals (1997, 2001, and 2005). The results reveal a statistically significant inverse relationship between changes in profitability and mortality. A $0.19 average reduction in profit per $1.00 of costs led to a 0.010-0.020 percentage-point increase in mortality rates (p profitable. Policy simulations that target service line inequities in payment generosity result in lower mortality rates, roughly 700-13,000 fewer deaths nationally. The policy simulations raise questions about the trade-offs implicit in universal reductions in reimbursement. The effect of reduced payment generosity on mortality could be mitigated by targeting highly profitable services only for lower reimbursement. © Health Research and Educational Trust.

  12. Maternal mortality due to trauma.

    Science.gov (United States)

    Romero, Vivian Carolina; Pearlman, Mark

    2012-02-01

    Maternal mortality is an important indicator of adequacy of health care in our society. Improvements in the obstetric care system as well as advances in technology have contributed to reduction in maternal mortality rates. Trauma complicates up to 7% of all pregnancies and has emerged as the leading cause of maternal mortality, becoming a significant concern for the public health system. Maternal mortality secondary to trauma can often be prevented by coordinated medical care, but it is essential that caregivers recognize the unique situation of providing simultaneous care to 2 patients who have a complex physiologic relationship. Optimal management of the pregnant trauma victim requires a multidisciplinary team, where the obstetrician plays a central role. This review focuses on the incidence of maternal mortality due to trauma, the mechanisms involved in traumatic injury, the important anatomic and physiologic changes that may predispose to mortality due to trauma, and finally, preventive strategies that may decrease the incidence of traumatic maternal death.

  13. Out of control mortality matters: the effect of perceived uncontrollable mortality risk on a health-related decision

    Directory of Open Access Journals (Sweden)

    Gillian V. Pepper

    2014-06-01

    Full Text Available Prior evidence from the public health literature suggests that both control beliefs and perceived threats to life are important for health behaviour. Our previously presented theoretical model generated the more specific hypothesis that uncontrollable, but not controllable, personal mortality risk should alter the payoff from investment in health protection behaviours. We carried out three experiments to test whether altering the perceived controllability of mortality risk would affect a health-related decision. Experiment 1 demonstrated that a mortality prime could be used to alter a health-related decision: the choice between a healthier food reward (fruit and an unhealthy alternative (chocolate. Experiment 2 demonstrated that it is the controllability of the mortality risk being primed that generates the effect, rather than mortality risk per se. Experiment 3 showed that the effect could be seen in a surreptitious experiment that was not explicitly health related. Our results suggest that perceptions about the controllability of mortality risk may be an important factor in people’s health-related decisions. Thus, techniques for adjusting perceptions about mortality risk could be important tools for use in health interventions. More importantly, tackling those sources of mortality that people perceive to be uncontrollable could have a dual purpose: making neighbourhoods and workplaces safer would have the primary benefit of reducing uncontrollable mortality risk, which could lead to a secondary benefit from improved health behaviours.

  14. Assessing the relationship between global warming and mortality: Lag effects of temperature fluctuations by age and mortality categories

    Energy Technology Data Exchange (ETDEWEB)

    Yu Weiwei, E-mail: weiwei.yu@qut.edu.au [School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD 4050, Brisbane (Australia); Mengersen, Kerrie [Discipline of Mathematical Sciences, Faculty of Science and Technology, Queensland University of Technology, Brisbane (Australia); Hu Wenbiao [School of Population Health and Institute of Health and Biomedical Innovation, University of Queensland, Brisbane (Australia); Guo Yuming [School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD 4050, Brisbane (Australia); Pan Xiaochuan [School of Public Health, Peking University, Beijing 100191 (China); Tong Shilu, E-mail: s.tong@qut.edu.au [School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD 4050, Brisbane (Australia)

    2011-07-15

    Although interests in assessing the relationship between temperature and mortality have arisen due to climate change, relatively few data are available on lag structure of temperature-mortality relationship, particularly in the Southern Hemisphere. This study identified the lag effects of mean temperature on mortality among age groups and death categories using polynomial distributed lag models in Brisbane, Australia, a subtropical city, 1996-2004. For a 1 deg. C increase above the threshold, the highest percent increase in mortality on the current day occurred among people over 85 years (7.2% (95% CI: 4.3%, 10.2%)). The effect estimates among cardiovascular deaths were higher than those among all-cause mortality. For a 1 deg. C decrease below the threshold, the percent increases in mortality at 21 lag days were 3.9% (95% CI: 1.9%, 6.0%) and 3.4% (95% CI: 0.9%, 6.0%) for people aged over 85 years and with cardiovascular diseases, respectively. These findings may have implications for developing intervention strategies to reduce and prevent temperature-related mortality. - Highlights: > A longer lag effects in cold days and shorter lag effects in hot days. > The very old people were most vulnerable to temperature stress. > The cardiovascular mortality was also sensitive to the temperature variation. - In Brisbane, the lag effects lasted longer for cold temperatures, and shorter for hot temperatures. Elderly people and cardiovascular mortality were vulnerable to temperature stress.

  15. Determinants of neonatal mortality in Indonesia

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    Agho Kingsley

    2008-07-01

    Full Text Available Abstract Background Neonatal mortality accounts for almost 40 per cent of under-five child mortality, globally. An understanding of the factors related to neonatal mortality is important to guide the development of focused and evidence-based health interventions to prevent neonatal deaths. This study aimed to identify the determinants of neonatal mortality in Indonesia, for a nationally representative sample of births from 1997 to 2002. Methods The data source for the analysis was the 2002–2003 Indonesia Demographic and Health Survey from which survival information of 15,952 singleton live-born infants born between 1997 and 2002 was examined. Multilevel logistic regression using a hierarchical approach was performed to analyze the factors associated with neonatal deaths, using community, socio-economic status and proximate determinants. Results At the community level, the odds of neonatal death was significantly higher for infants from East Java (OR = 5.01, p = 0.00, and for North, Central and Southeast Sulawesi and Gorontalo combined (OR = 3.17, p = 0.03 compared to the lowest neonatal mortality regions of Bali, South Sulawesi and Jambi provinces. A progressive reduction in the odds was found as the percentage of deliveries assisted by trained delivery attendants in the cluster increased. The odds of neonatal death were higher for infants born to both mother and father who were employed (OR = 1.84, p = 0.00 and for infants born to father who were unemployed (OR = 2.99, p = 0.02. The odds were also higher for higher rank infants with a short birth interval (OR = 2.82, p = 0.00, male infants (OR = 1.49, p = 0.01, smaller than average-sized infants (OR = 2.80, p = 0.00, and infant's whose mother had a history of delivery complications (OR = 1.81, p = 0.00. Infants receiving any postnatal care were significantly protected from neonatal death (OR = 0.63, p = 0.03. Conclusion Public health interventions directed at reducing neonatal death should

  16. Hopelessly mortal: The role of mortality salience, immortality and trait self-esteem in personal hope.

    Science.gov (United States)

    Wisman, Arnaud; Heflick, Nathan A

    2016-08-01

    Do people lose hope when thinking about death? Based on Terror Management Theory, we predicted that thoughts of death (i.e., mortality salience) would reduce personal hope for people low, but not high, in self-esteem, and that this reduction in hope would be ameliorated by promises of immortality. In Studies 1 and 2, mortality salience reduced personal hope for people low in self-esteem, but not for people high in self-esteem. In Study 3, mortality salience reduced hope for people low in self-esteem when they read an argument that there is no afterlife, but not when they read "evidence" supporting life after death. In Study 4, this effect was replicated with an essay affirming scientific medical advances that promise immortality. Together, these findings uniquely demonstrate that thoughts of mortality interact with trait self-esteem to cause changes in personal hope, and that literal immortality beliefs can aid psychological adjustment when thinking about death. Implications for understanding personal hope, trait self-esteem, afterlife beliefs and terror management are discussed.

  17. Adult mortality in preindustrial Quebec

    Directory of Open Access Journals (Sweden)

    Claudine Lacroix - - - Bertrand Desjardins

    2012-01-01

    Full Text Available This paper presents the main results of a detailed study on adult mortality in French Canadians born before 1750 and having married inthe colony of New France. Using data from parish registers, mortality is studied using abridged life tables, with staggered entries according to age at first marriage. Survival tables and log-Rank tests are used to support the results. Three features were selected for the study of differential mortality: gender, type of residence area (urban or rural, and cohort. The mortality of French Canadians is compared to that of their French contemporaries.

  18. Community level risk factors for maternal mortality in Madagascar.

    Science.gov (United States)

    Hernandez, Julio C; Moser, Christine M

    2013-12-01

    This paper explores the effect of risk and socioeconomic factors on maternal mortality at the community level in Madagascar using a unique, nationwide panel of communes (i.e., counties). Previous work in this area uses individual or cross-country data to study maternal mortality, however, studying maternal mortality at the community level is imperative because this is the level at which most policy is implemented. The results show that longer travel time from the community to the hospital leads to a high level of maternal mortality. The findings suggest that improvement to transportation systems and access to hospitals with surgery rooms are needed to deal with obstetric complications and reduce maternal mortality.

  19. Indonesia lowers infant mortality.

    Science.gov (United States)

    Bain, S

    1991-11-01

    Indonesia's success in reaching World Health Organization (WHO) universal immunization coverage standards is described as the result of a strong national program with timely, targeted donor support. USAID/Indonesia's Expanded Program for Immunization (EPI) and other USAID bilateral cooperation helped the government of Indonesia in its goal to immunize children against diphtheria, pertussis, tetanus, polio, tuberculosis, and measles by age 1. The initial project was to identify target areas and deliver vaccines against the diseases, strengthen the national immunization organization and infrastructure, and develop the Ministry of Health's capacity to conduct studies and development activities. This EPI project spanned the period 1979-90, and set the stage for continued expansion of Indonesia's immunization program to comply with the full international schedule and range of immunizations of 3 DPT, 3 polio, 1 BCG, and 1 measles inoculation. The number of immunization sites has increased from 55 to include over 5,000 health centers in all provinces, with additional services provided by visiting vaccinators and nurses in most of the 215,000 community-supported integrated health posts. While other contributory factors were at play, program success is at least partially responsible for the 1990 infant mortality rate of 58/1,000 live births compared to 72/1,000 in 1985. Strong national leadership, dedicated health workers and volunteers, and cooperation and funding from UNICEF, the World Bank, Rotary International, and WHO also played crucially positive roles in improving immunization practice in Indonesia.

  20. Risk of All-Cause Mortality in Alcohol-Dependent Individuals: A Systematic Literature Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Philippe Laramée

    2015-10-01

    Interpretation: AD was found to significantly increase an individual's risk of all-cause mortality. While abstinence in alcohol-dependent subjects led to greater mortality reduction than non-abstinence, this study suggests that alcohol-dependent subjects can significantly reduce their mortality risk by reducing alcohol consumption.

  1. Social Capital and Human Mortality: Explaining the Rural Paradox with County-Level Mortality Data

    Science.gov (United States)

    Jensen, Leif; Haran, Murali

    2014-01-01

    The “rural paradox” refers to standardized mortality rates in rural areas that are unexpectedly low in view of well-known economic and infrastructural disadvantages there. We explore this paradox by incorporating social capital, a promising explanatory factor that has seldom been incorporated into residential mortality research. We do so while being attentive to spatial dependence, a statistical problem often ignored in mortality research. Analyzing data for counties in the contiguous United States, we find that: (1) the rural paradox is confirmed with both metro/non-metro and rural-urban continuum codes, (2) social capital significantly reduces the impacts of residence on mortality after controlling for race/ethnicity and socioeconomic covariates, (3) this attenuation is greater when a spatial perspective is imposed on the analysis, (4) social capital is negatively associated with mortality at the county level, and (5) spatial dependence is strongly in evidence. A spatial approach is necessary in county-level analyses such as ours to yield unbiased estimates and optimal model fit. PMID:25392565

  2. Effects of gill-net trauma, barotrauma, and deep release on postrelease mortality of Lake Trout

    Science.gov (United States)

    Ng, Elizabeth L.; Fredericks, Jim P.; Quist, Michael C.

    2015-01-01

    Unaccounted postrelease mortality violates assumptions of many fisheries studies, thereby biasing parameter estimates and reducing efficiency. We evaluated effects of gill-net trauma, barotrauma, and deep-release treatment on postrelease mortality of lake trout Salvelinus namaycush. Lake trout were captured at depths up to 65 m with gill nets in Priest Lake, Idaho, and held in a large enclosure for 10–12 d. Postrelease mortality was the same for surface-release–and deep-release–treated fish (41%). Mixed-effects logistic regression models were used to evaluate effects of intrinsic and environmental factors on the probability of mortality. Presence of gill-net trauma and degree of barotrauma were associated with increased probability of postrelease mortality. Smaller fish were also more likely to suffer postrelease mortality. On average, deep-release treatment did not reduce postrelease mortality, but effectiveness of treatment increased with fish length. Of the environmental factors evaluated, only elapsed time between lifting the first and last anchors of a gill-net gang (i.e., lift time) was significantly related to postrelease mortality. Longer lift times, which may allow ascending lake trout to acclimate to depressurization, were associated with lower postrelease mortality rates. Our study suggests that postrelease mortality may be higher than previously assumed for lake trout because mortality continues after 48 h. In future studies, postrelease mortality could be reduced by increasing gill-net lift times and increasing mesh size used to increase length of fish captured.

  3. One-year mortality after severe COPD exacerbation in Bulgaria

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    Evgeni Mekov

    2016-12-01

    Full Text Available Introduction One-year mortality in COPD patients is reported to be between 4% and 43%, depending on the group examined. Aim To examine the one-year mortality in COPD patients after severe exacerbation and the correlation between mortality and patients’ characteristics and comorbidities. Methods A total of 152 COPD patients hospitalized for severe exacerbation were assessed for vitamin D status, diabetes mellitus (DM, arterial hypertension (AH, and metabolic syndrome (MS. Data were gathered about smoking status and number of exacerbations in previous year. CAT and mMRC questionnaires were completed by all patients. Pre- and post-bronchodilatory spirometry was performed. One-year mortality was established from national death register. Results One-year mortality is 7.2%. DM, MS, and VD are not predictors for one-year mortality. However there is a trend for increased mortality in patients with AH (9.5% vs. 2.1%, p = 0.107. There is increased mortality in patients with mMRC > 2 (11.1 vs. 0%, p = 0.013. The presence of severe exacerbation in the previous year is a risk factor for mortality (12.5% vs. 1.4%, p = 0.009. There is a trend for increased mortality in the group with FEV1  80% may be factors for good prognosis. Risk factors for increased mortality are age, FEV1 value, severe exacerbation in previous year and reduced quality of life.

  4. Stressful social relations and mortality

    DEFF Research Database (Denmark)

    Lund, Rikke; Christensen, Ulla; Nilsson, Charlotte Juul

    2014-01-01

    BACKGROUND: Few studies have examined the relationship between stressful social relations in private life and all-cause mortality. OBJECTIVE: To evaluate the association between stressful social relations (with partner, children, other family, friends and neighbours, respectively) and all...... men and women aged 36-52 years, linked to the Danish Cause of Death Registry for information on all-cause mortality until 31 December 2011. Associations between stressful social relations with partner, children, other family, friends and neighbours, respectively, and all-cause mortality were examined...... hazards model. RESULTS: Frequent worries/demands from partner or children were associated with 50-100% increased mortality risk. Frequent conflicts with any type of social relation were associated with 2-3 times increased mortality risk. Interaction between labour force participation and worries...

  5. Risk-Adjusted Mortality: Problems and Possibilities

    Directory of Open Access Journals (Sweden)

    Daniel Shine

    2012-01-01

    Full Text Available The ratio of observed-to-expected deaths is considered a measure of hospital quality and for this reason will soon become a basis for payment. However, there are drivers of that metric more potent than quality: most important are medical documentation and patient acuity. If hositals underdocument and therefore do not capture the full “expected mortality” they may be tempted to lower their observed/expected ratio by reducing “observed mortality” through limiting access to the very ill. Underdocumentation occurs because hospitals do not recognize, and therefore cannot seek to confirm, specific comorbidities conferring high mortality risk. To help hospitals identify these comorbidities, this paper describes an easily implemented spread-sheet for evaluating comorbid conditions associated, in any particular hospital, with each discharge. This method identifies comorbidities that increase in frequency as mortality risk increases within each diagnostic grouping. The method is inductive and therefore independent of any particular risk-adjustment technique.

  6. Perinatal mortality: a hospital based study.

    Science.gov (United States)

    Kameswaran, C; Bhatia, B D; Bhat, B V; Oumachigui, A

    1993-08-01

    Three thousand seven hundred and two deliveries between January and December, 1990 were the study subjects. The perinatal mortality rate (PNMR), stillbirth rate (SBR) and early neonatal death rates (ENDR) were found to be 57/1000, 35.1/1000 and 22.7/1000, respectively. The preterms had much higher PNMR, SBR and ENDR as compared to term babies. Term babies weighing > or = 2500 g had a PNMR of 18/1000. In preterm and term babies the mortality was reduced considerably with increase in birth weight (BW). The unbooked deliveries had significantly higher PNMR, SBR and ENDR compared to booked deliveries. The fall in PNMR compared to observations of a decade ago was due to a fall primarily in ENDR, with SBR remaining unchanged signifying failure of existing MCH set up. Nearly, 92% of ENDR were in first 72 hours which signifies the need for developing and strengthening the intensive care facilities along with timely referral of high risk mothers.

  7. Cholesterol lowering, low cholesterol, and mortality.

    Science.gov (United States)

    LaRosa, J C

    1993-10-01

    Cholesterol lowering in both primary and secondary prevention has been clearly demonstrated to lower coronary morbidity and, in secondary prevention, to lower coronary mortality as well. Putative dangers of cholesterol lowering remain unproven. Population studies linking low cholesterol to noncoronary mortalities do not demonstrate cause-and-effect relations. In fact, based on current studies, the opposite is more likely to be the case. Neither gender nor age should automatically exclude persons from cholesterol screening. Drug intervention, however, should be used conservatively, particularly in young adults and the elderly. Drugs should be used only after diet and lifestyle interventions have failed. The evidence linking high blood cholesterol to coronary atherosclerosis and cholesterol lowering to its prevention is broad-based and definitive. Concerns about cholesterol lowering and spontaneously low cholesterols should be pursued but should not interfere with the implementation of current public policies to reduce the still heavy burden of atherosclerosis in Western society.

  8. Factors Influencing Mortality after Bioprosthetic Valve Replacement; A Midterm Outcome

    Directory of Open Access Journals (Sweden)

    Hassan Javadzadegan

    2013-12-01

    Conclusion: Our study shows that using biprosthetic valve could reduce the risk of morbidity occurrence in patient who needs valve replacement. However, if medical treatments fail, patients should be referred for surgery. This would reduce the risk of mortality because of lower incident of complications such as atrial fibrillation and morbidities due to younger patients’ population.

  9. Monitoring child mortality through community health worker reporting of births and deaths in Malawi: validation against a household mortality survey.

    Science.gov (United States)

    Amouzou, Agbessi; Banda, Benjamin; Kachaka, Willie; Joos, Olga; Kanyuka, Mercy; Hill, Kenneth; Bryce, Jennifer

    2014-01-01

    The rate of decline in child mortality is too slow in most African countries to achieve the Millennium Development Goal of reducing under-five mortality by two-thirds between 1990 and 2015. Effective strategies to monitor child mortality are needed where accurate vital registration data are lacking to help governments assess and report on progress in child survival. We present results from a test of a mortality monitoring approach based on recording of births and deaths by specially trained community health workers (CHWs) in Malawi. Government-employed community health workers in Malawi are responsible for maintaining a Village Health Register, in which they record births and deaths that occur in their catchment area. We expanded on this system to provide additional training, supervision and incentives. We tested the equivalence between child mortality rates obtained from data on births and deaths collected by 160 randomly-selected and trained CHWs over twenty months in two districts to those computed through a standard household mortality survey. CHW reports produced an under-five mortality rate that was 84% (95%CI: [0.71,1.00]) of the household survey mortality rate and statistically equivalent to it. However, CHW data consistently underestimated under-five mortality, with levels of under-estimation increasing over time. Under-five deaths were more likely to be missed than births. Neonatal and infant deaths were more likely to be missed than older deaths. This first test of the accuracy and completeness of vital events data reported by CHWs in Malawi as a strategy for monitoring child mortality shows promising results but underestimated child mortality and was not stable over the four periods assessed. Given the Malawi government's commitment to strengthen its vital registration system, we are working with the Ministry of Health to implement a revised version of the approach that provides increased support to CHWs.

  10. Social and demographic effects of anthropogenic mortality: a test of the compensatory mortality hypothesis in the red wolf.

    Directory of Open Access Journals (Sweden)

    Amanda M Sparkman

    Full Text Available Whether anthropogenic mortality is additive or compensatory to natural mortality in animal populations has long been a question of theoretical and practical importance. Theoretically, under density-dependent conditions populations compensate for anthropogenic mortality through decreases in natural mortality and/or increases in productivity, but recent studies of large carnivores suggest that anthropogenic mortality can be fully additive to natural mortality and thereby constrain annual survival and population growth rate. Nevertheless, mechanisms underlying either compensatory or additive effects continue to be poorly understood. Using long-term data on a reintroduced population of the red wolf, we tested for evidence of additive vs. compensatory effects of anthropogenic mortality on annual survival and population growth rates, and the preservation and reproductive success of breeding pairs. We found that anthropogenic mortality had a strong additive effect on annual survival and population growth rate at low population density, though there was evidence for compensation in population growth at high density. When involving the death of a breeder, anthropogenic mortality was also additive to natural rates of breeding pair dissolution, resulting in a net decrease in the annual preservation of existing breeding pairs. However, though the disbanding of a pack following death of a breeder resulted in fewer recruits per litter relative to stable packs, there was no relationship between natural rates of pair dissolution and population growth rate at either high or low density. Thus we propose that short-term additive effects of anthropogenic mortality on population growth in the red wolf population at low density were primarily a result of direct mortality of adults rather than indirect socially-mediated effects resulting in reduced recruitment. Finally, we also demonstrate that per capita recruitment and the proportion of adults that became

  11. [Asthma mortality trends in Mexico].

    Science.gov (United States)

    Salas Ramírez, M; Segura Méndez, N H; Martínez-Cairo Cueto, S

    1994-04-01

    The objective of this cross-sectional study was to estimate mortality and morbidity from asthma in Mexico by federative entity (state) of residence, age, and sex during the period between 1960 and 1988. Statistics published by the National Institute of Statistics, Geography, and Information Science were reviewed, as were vital statistics and information from other sources. Data were selected on mortality, hospital admissions, and outpatient visits, as well as population by federative entity, age, and sex. Mortality and morbidity rates were adjusted for age using the direct method. From 1960 to 1987, mortality decreased for both sexes. The groups with the highest asthma mortality were those under 4 years of age and those over 50. From 1960 to the present, the state with the highest mortality was Tlaxcala. Hospitalizations increased from 10 to 140 per 100,000 population for the country as a whole. When both outpatient visits and hospitalizations were considered, the morbidity rates rose from 180 to 203.4 per 100,000 between 1960 and 1970. In 1970, hospital morbidity was higher among males than females. From 1960 up to the 1990s, the highest rates of hospitalization and outpatient visits were registered among those under 4 and those over 60. The states with the highest asthma hospitalization rates were Morelos, Baja California Sur, Nuevo León, Durango, and Tamaulipas. It is concluded that asthma mortality in Mexico is showing a downward trend, while morbidity is increasing considerably, especially among adolescents.

  12. The law of mortality revisited: interspecies comparisons of mortality.

    Science.gov (United States)

    Olshansky, S J

    2010-01-01

    In 1825 the British actuary Benjamin Gompertz believed he had discovered a consistency in the timing of death in people that was so important that he labelled his observation a 'law of mortality'. To Gompertz, this 'law' was equivalent in importance to Newton's law of gravity because he believed it would be observed in all living things. Gompertz's quest for the 'law' eventually failed, as did similar efforts by other scientists in the 19th and most of the 20th century. However, the search for the law of mortality was successfully resolved in 1996 when my colleagues and I discovered that the only way to 'see' Gompertz's law expressed as common age patterns of death across species was to partition total mortality into its intrinsic and extrinsic components, and examine mortality schedules on a uniform time scale. Scientists had been unable to reveal the law of mortality in the past not only because they could not partition total mortality, but also because of the previous anthropocentric perspective that forced some scientists to view duration of life along a single time scale - one based on human measurements of chronological time. The law of mortality is relevant today not only because it links the epidemiology of disease, ageing and death across species, but because it creates a window into the future for those who study disease epidemiology in animals that now live long enough in protected environments to experience the biological consequences of ageing. In this paper I summarize the historical search for the law of mortality, explain why the solution could only be found by linking two seemingly unconnected scientific disciplines (evolution biology and actuarial/demographics), explain why age patterns of disease and death in humans may be used to understand and predict disease epidemiology in other species, and describe how a new scientific discipline has arisen in the modern era as a result of this research.

  13. Influence of women's autonomy on infant mortality in Nepal

    Directory of Open Access Journals (Sweden)

    Adhikari Ramesh

    2011-04-01

    (OR = 0.75 chance of dying than did infants whose mothers who were not involved in healthcare decisions. Conclusion Infant mortality is high in Nepal. In this context, mother's literacy and involvement in healthcare decision making appear to be the most powerful predictors for reducing infant mortality. Hence, in order to reduce infant mortality further, ongoing female education should be sustained and expanded to include all women so that the millennium development goals for the year 2015 can be attained. In addition, programs should focus on increasing women's autonomy so that infant mortality will decrease and the overall well being of the family can be maintained and enhanced.

  14. Influence of women's autonomy on infant mortality in Nepal.

    Science.gov (United States)

    Adhikari, Ramesh; Sawangdee, Yothin

    2011-04-19

    mothers who were not involved in healthcare decisions. Infant mortality is high in Nepal. In this context, mother's literacy and involvement in healthcare decision making appear to be the most powerful predictors for reducing infant mortality. Hence, in order to reduce infant mortality further, ongoing female education should be sustained and expanded to include all women so that the millennium development goals for the year 2015 can be attained. In addition, programs should focus on increasing women's autonomy so that infant mortality will decrease and the overall well being of the family can be maintained and enhanced.

  15. Risk factors for mortality during the 2002 landslides in Chuuk, Federated States of Micronesia.

    Science.gov (United States)

    Sanchez, Carlos; Lee, Tze-San; Young, Stacy; Batts, Dahna; Benjamin, Jefferson; Malilay, Josephine

    2009-10-01

    This study examines health effects resulting from landslides in Chuuk during Tropical Storm Chata'an in July 2002, and suggests strategies to prevent future mortality. In August 2002, we conducted a cross-sectional survey to identify risk factors for mortality during landslides, which included 52 survivors and 40 surrogates for 43 decedents to identify risk factors for death. Findings suggest that 1) females had a higher mortality rate from this event than males, and 2) children aged 5-14 years had a 10-fold increase in mortality when compared with annual mortality rates from all causes. Awareness of landslides occurring elsewhere and knowledge of natural warning signs were significantly associated with lower risks of death; being outside during landslides was not associated with reduced mortality. In Chuuk, improving communication systems during tropical storms and increasing knowledge of natural warnings can reduce the risk for mortality during landslides.

  16. Reducing Iatrogenic Risks

    Science.gov (United States)

    Ely, E. Wesley; Speroff, Theodore; Pun, Brenda T.; Boehm, Leanne; Dittus, Robert S.

    2010-01-01

    ICUs are experiencing an epidemic of patients with acute brain dysfunction (delirium) and weakness, both associated with increased mortality and long-term disability. These conditions are commonly acquired in the ICU and are often initiated or exacerbated by sedation and ventilation decisions and management. Despite > 10 years of evidence revealing the hazards of delirium, the quality chasm between current and ideal processes of care continues to exist. Monitoring of delirium and sedation levels remains inconsistent. In addition, sedation, ventilation, and physical therapy practices proven successful at reducing the frequency and severity of adverse outcomes are not routinely practiced. In this article, we advocate for the adoption and implementation of a standard bundle of ICU measures with great potential to reduce the burden of ICU-acquired delirium and weakness. Individual components of this bundle are evidence based and can help standardize communication, improve interdisciplinary care, reduce mortality, and improve cognitive and functional outcomes. We refer to this as the “ABCDE bundle,” for awakening and breathing coordination, delirium monitoring, and exercise/early mobility. This evidence-based bundle of practices will build a bridge across the current quality chasm from the “front end” to the “back end” of critical care and toward improved cognitive and functional outcomes for ICU survivors. PMID:21051398

  17. CDC WONDER: Mortality - Infant Deaths

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Mortality - Infant Deaths (from Linked Birth / Infant Death Records) online databases on CDC WONDER provide counts and rates for deaths of children under 1 year...

  18. Infant Mortality in Novo Hamburgo: Associated Factors and Cardiovascular Causes

    Science.gov (United States)

    Brum, Camila de Andrade; Stein, Airton Tetelbom; Pellanda, Lucia Campos

    2015-01-01

    Background Infant mortality has decreased in Brazil, but remains high as compared to that of other developing countries. In 2010, the Rio Grande do Sul state had the lowest infant mortality rate in Brazil. However, the municipality of Novo Hamburgo had the highest infant mortality rate in the Porto Alegre metropolitan region. Objective To describe the causes of infant mortality in the municipality of Novo Hamburgo from 2007 to 2010, identifying which causes were related to heart diseases and if they were diagnosed in the prenatal period, and to assess the access to healthcare services. Methods This study assessed infants of the municipality of Novo Hamburgo, who died, and whose data were collected from the infant death investigation records. Results Of the 157 deaths in that period, 35.3% were reducible through diagnosis and early treatment, 25% were reducible through partnership with other sectors, 19.2% were non-preventable, 11.5% were reducible by means of appropriate pregnancy monitoring, 5.1% were reducible through appropriate delivery care, and 3.8% were ill defined. The major cause of death related to heart disease (13.4%), which was significantly associated with the variables ‘age at death’, ‘gestational age’ and ‘birth weight’. Regarding access to healthcare services, 60.9% of the pregnant women had a maximum of six prenatal visits. Conclusion It is mandatory to enhance prenatal care and newborn care at hospitals and basic healthcare units to prevent infant mortality. PMID:25993588

  19. Infant Mortality in Novo Hamburgo: Associated Factors and Cardiovascular Causes

    Directory of Open Access Journals (Sweden)

    Camila de Andrade Brum

    2015-04-01

    Full Text Available Background: Infant mortality has decreased in Brazil, but remains high as compared to that of other developing countries. In 2010, the Rio Grande do Sul state had the lowest infant mortality rate in Brazil. However, the municipality of Novo Hamburgo had the highest infant mortality rate in the Porto Alegre metropolitan region. Objective: To describe the causes of infant mortality in the municipality of Novo Hamburgo from 2007 to 2010, identifying which causes were related to heart diseases and if they were diagnosed in the prenatal period, and to assess the access to healthcare services. Methods: This study assessed infants of the municipality of Novo Hamburgo, who died, and whose data were collected from the infant death investigation records. Results: Of the 157 deaths in that period, 35.3% were reducible through diagnosis and early treatment, 25% were reducible through partnership with other sectors, 19.2% were non-preventable, 11.5% were reducible by means of appropriate pregnancy monitoring, 5.1% were reducible through appropriate delivery care, and 3.8% were ill defined. The major cause of death related to heart disease (13.4%, which was significantly associated with the variables ‘age at death’, ‘gestational age’ and ‘birth weight’. Regarding access to healthcare services, 60.9% of the pregnant women had a maximum of six prenatal visits. Conclusion: It is mandatory to enhance prenatal care and newborn care at hospitals and basic healthcare units to prevent infant mortality.

  20. Infant Mortality in Novo Hamburgo: Associated Factors and Cardiovascular Causes

    Energy Technology Data Exchange (ETDEWEB)

    Brum, Camila de Andrade [Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS (Brazil); Stein, Airton Tetelbom [Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS (Brazil); Grupo Hospitalar Conceição (GHC), Porto Alegre, RS (Brazil); Universidade Luterana do Brasil (ULBRA), Porto Alegre, RS (Brazil); Pellanda, Lucia Campos, E-mail: luciapell.pesquisa@cardiologia.org.br [Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS (Brazil); Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS (Brazil)

    2015-04-15

    Infant mortality has decreased in Brazil, but remains high as compared to that of other developing countries. In 2010, the Rio Grande do Sul state had the lowest infant mortality rate in Brazil. However, the municipality of Novo Hamburgo had the highest infant mortality rate in the Porto Alegre metropolitan region. To describe the causes of infant mortality in the municipality of Novo Hamburgo from 2007 to 2010, identifying which causes were related to heart diseases and if they were diagnosed in the prenatal period, and to assess the access to healthcare services. This study assessed infants of the municipality of Novo Hamburgo, who died, and whose data were collected from the infant death investigation records. Of the 157 deaths in that period, 35.3% were reducible through diagnosis and early treatment, 25% were reducible through partnership with other sectors, 19.2% were non-preventable, 11.5% were reducible by means of appropriate pregnancy monitoring, 5.1% were reducible through appropriate delivery care, and 3.8% were ill defined. The major cause of death related to heart disease (13.4%), which was significantly associated with the variables ‘age at death’, ‘gestational age’ and ‘birth weight’. Regarding access to healthcare services, 60.9% of the pregnant women had a maximum of six prenatal visits. It is mandatory to enhance prenatal care and newborn care at hospitals and basic healthcare units to prevent infant mortality.

  1. Adverse Trends in Ischemic Heart Disease Mortality among Young New Yorkers, Particularly Young Black Women.

    Directory of Open Access Journals (Sweden)

    Nathaniel R Smilowitz

    Full Text Available Ischemic heart disease (IHD mortality has been on the decline in the United States for decades. However, declines in IHD mortality have been slower in certain groups, including young women and black individuals.Trends in IHD vary by age, sex, and race in New York City (NYC. Young female minorities are a vulnerable group that may warrant renewed efforts to reduce IHD.IHD mortality trends were assessed in NYC 1980-2008. NYC Vital Statistics data were obtained for analysis. Age-specific IHD mortality rates and confidence bounds were estimated. Trends in IHD mortality were compared by age and race/ethnicity using linear regression of log-transformed mortality rates. Rates and trends in IHD mortality rates were compared between subgroups defined by age, sex and race/ethnicity.The decline in IHD mortality rates slowed in 1999 among individuals aged 35-54 years but not ≥55. IHD mortality rates were higher among young men than women age 35-54, but annual declines in IHD mortality were slower for women. Black women age 35-54 had higher IHD mortality rates and slower declines in IHD mortality than women of other race/ethnicity groups. IHD mortality trends were similar in black and white men age 35-54.The decline in IHD mortality rates has slowed in recent years among younger, but not older, individuals in NYC. There was an association between sex and race/ethnicity on IHD mortality rates and trends. Young black women may benefit from targeted medical and public health interventions to reduce IHD mortality.

  2. Quantification of social contributions to earthquake mortality

    Science.gov (United States)

    Main, I. G.; NicBhloscaidh, M.; McCloskey, J.; Pelling, M.; Naylor, M.

    2013-12-01

    Death tolls in earthquakes, which continue to grow rapidly, are the result of complex interactions between physical effects, such as strong shaking, and the resilience of exposed populations and supporting critical infrastructures and institutions. While it is clear that the social context in which the earthquake occurs has a strong effect on the outcome, the influence of this context can only be exposed if we first decouple, as much as we can, the physical causes of mortality from our consideration. (Our modelling assumes that building resilience to shaking is a social factor governed by national wealth, legislation and enforcement and governance leading to reduced levels of corruption.) Here we attempt to remove these causes by statistically modelling published mortality, shaking intensity and population exposure data; unexplained variance from this physical model illuminates the contribution of socio-economic factors to increasing earthquake mortality. We find that this variance partitions countries in terms of basic socio-economic measures and allows the definition of a national vulnerability index identifying both anomalously resilient and anomalously vulnerable countries. In many cases resilience is well correlated with GDP; people in the richest countries are unsurprisingly safe from even the worst shaking. However some low-GDP countries rival even the richest in resilience, showing that relatively low cost interventions can have a positive impact on earthquake resilience and that social learning between these countries might facilitate resilience building in the absence of expensive engineering interventions.

  3. Risk factors for mortality in patients with Stenotrophomonas maltophilia bacteremia

    Science.gov (United States)

    Jeon, Yong Duk; Jeong, Woo Yong; Kim, Moo Hyun; Jung, In Young; Ahn, Mi Young; Ann, Hea Won; Ahn, Jin Young; Han, Sang Hoon; Choi, Jun Yong; Song, Young Goo; Kim, June Myung; Ku, Nam Su

    2016-01-01

    Abstract Stenotrophomonas maltophilia is a nosocomial pathogen associated with high morbidity and mortality, particularly in immunocompromised or critically ill patients. In this study, we investigated the risk factors for mortality in patients with S. maltophilia bacteremia. Retrospectively, medical records from all patients with S. maltophilia bacteremia between December 2005 and 2014 at Severance Hospital, a 2000-bed tertiary care hospital in Seoul, Korea, were reviewed. Analysis was performed to identify factors associated with 28-day mortality. In total, 142 bacteremia patients were enrolled in this study. The overall 28-day mortality rate was 36.6%. Based on the univariate analysis, hematologic malignancy (P = 0.015), Sepsis-related Organ Failure Assessment (SOFA) score (P < 0.001) and the removal of a central venous catheter (CVC) (P = 0.040) were significantly related to mortality. In the intensive care unit patients, the Acute Physiology and Chronic Health Evaluation II score (P = 0.001) also had significance. Based on the multivariate analysis, the SOFA score (odds ratio [OR] = 1.323; 95% confidence interval [CI]: 1.159, 1.509; P < 0.001) and removal of the CVC (OR = 0.330; 95% CI: 0.109, 0.996; P = 0.049) were independent factors associated with mortality. Our results suggest that removing a CVC may considerably reduce mortality in patients with S. maltophilia bacteremia. PMID:27495046

  4. Low birthweight and mortality

    DEFF Research Database (Denmark)

    Bakketeig, Leiv S.; Jacobsen, Geir; Skjærven, Rolv

    2006-01-01

    Previous studies have demonstrated the tendency to repeat gestational age and birthweight in successive pregnancies. Also, it has been shown that this tendency is associated with infant survival. Women tend to give birth to babies of a certain foetal age and size and if the outcome departs...... considerably from this age and weight, then the baby’s survival is reduced. This study focuses on which diseases or conditions that might lie behind this affected survival. Data were provided through linkages between three Danish health registries, namely the Danish Medical Birth Registry, the National...... Hospital Registry, and a Registry for Preventive Medicine. Such linkage is possible due to the use of unique ID-person numbers. The study was based on Danish births, 1981-1994. All 8 219 second order low birth weight (LBW) singleton births from that period were included, of whom 7 811 were live born...

  5. Impact of Cerebrovascular Disease Mortality on Life Expectancy in China

    Institute of Scientific and Technical Information of China (English)

    LI Guo Qi; LI Yan; ZHAO Dong; FAN Jie; LIU Jing; WANG Wei; WANG Miao; QI Yue; XIE Wu Xiang; LIU Jun; ZHAO Fan

    2014-01-01

    Objective To evaluate the impact of cerebrovascular disease mortality on life expectancy (LE) in China in 2010 compared with 2005, and to identify the high-risk population (age, sex, and region) where cerebrovascular disease mortality has had a major impact on LE. Methods LE and cause-eliminated LE were calculated by using standard life tables which used adjusted mortality data from the Death Surveillance Data Sets in 2005 and 2010 from the National Disease Surveillance System. Decomposition was used to quantitate the impact of cerebrovascular disease in different age groups. Results LE in China was 73.24 years in 2010, which was higher in women and urban residents compared with men and rural residents. The loss of LE caused by cerebrovascular disease mortality was 2.26 years, which was higher in men and rural residents compared with women and urban residents. More than 30%of the loss of LE were attributed to premature death from cerebrovascular disease in people aged Conclusion Cerebrovascular disease mortality had a major impact on LE in China, with a significant difference between urban and rural residents. LE is likely to be further increased by reducing cerebrovascular disease mortality, and special attention should be paid to reducing premature deaths in people aged<65 years.

  6. Case-control study on infant mortality in Southern Brazil

    Directory of Open Access Journals (Sweden)

    Mendes Karina Giane

    2006-01-01

    Full Text Available OBJECTIVE: To identify risk factors associated with infant mortality and, more specifically, with neonatal mortality. METHODS: A case-control study was carried out in the municipality of Caxias do Sul, Southern Brazil. Characteristics of prenatal care and causes of mortality were assessed for all live births in the 2001-2002 period with a completed live-birth certificate and whose mothers lived in the municipality. Cases were defined as all deaths within the first year of life. As controls, there were selected the two children born immediately after each case in the same hospital, who were of the same sex, and did not die within their first year of life. Multivariate analysis was performed using conditional logistic regression. RESULTS: There was a reduction in infant mortality, the greatest reduction was observed in the post-neonatal period. The variables gestational age (<36 weeks, birth weight (<2,500 g, and 5-minute Apgar (<6 remained in the final model of the multivariate analysis, after adjustment. CONCLUSIONS: Perinatal conditions comprise almost the totality of neonatal deaths, and the majority of deaths occur at delivery. The challenge for reducing infant mortality rate in the city is to reduce the mortality by perinatal conditions in the neonatal period.

  7. Invited review: piglet mortality: management solutions.

    Science.gov (United States)

    Kirkden, R D; Broom, D M; Andersen, I L

    2013-07-01

    Preweaning mortality varies greatly among herds and this is partly attributed to differences in farrowing house management. In this review, we describe the various management strategies than can be adopted to decrease mortality and critically examine the evidence that exists to support their use. First, we consider which management procedures are effective against specific causes of death: intrapartum stillbirth, hypothermia, starvation, disease, crushing, and savaging. The most effective techniques include intervention to assist dystocic sows, measures to prevent and treat sow hypogalactia, good farrowing house hygiene, providing newborn piglets with a warm microenvironment, early fostering of supernumerary piglets, methods that assist small and weak piglets to breathe and obtain colostrum, and intervention to prevent deaths from crushing and savaging. The provision of nest-building material and modifications to the pen to assist the sow when lying down may also be beneficial, but the evidence is less clear. Because most deaths occur around the time of farrowing and during the first few days of life, the periparturient period is a particularly important time for management interventions intended to reduce piglet mortality. A number of procedures require a stockperson to be present during and immediately after farrowing. Second, we consider the benefits of farrowing supervision for preweaning mortality in general, focusing particularly on methods for the treatment of dystocia and programs of piglet care that combine multiple procedures. Third, we discuss the need for good stockmanship if farrowing supervision is to be effective. Stockmanship refers not only to technical skills but also to the manner in which sows are handled because this influences their fearfulness of humans. We conclude that piglet survival can be improved by a range of management procedures, many of which occur in the perinatal period and require the supervision of farrowing by trained staff

  8. Medieval monastic mortality: hazard analysis of mortality differences between monastic and nonmonastic cemeteries in England.

    Science.gov (United States)

    DeWitte, Sharon N; Boulware, Jessica C; Redfern, Rebecca C

    2013-11-01

    Scholarship on life in medieval European monasteries has revealed a variety of factors that potentially affected mortality in these communities. Though there is some evidence based on age-at-death distributions from England that monastic males lived longer than members of the general public, what is missing from the literature is an explicit examination of how the risks of mortality within medieval monastic settings differed from those within contemporaneous lay populations. This study examines differences in the hazard of mortality for adult males between monastic cemeteries (n = 528) and non-monastic cemeteries (n = 368) from London, all of which date to between AD 1050 and 1540. Age-at-death data from all cemeteries are pooled to estimate the Gompertz hazard of mortality, and "monastic" (i.e., buried in a monastic cemetery) is modeled as a covariate affecting this baseline hazard. The estimated effect of the monastic covariate is negative, suggesting that individuals in the monastic communities faced reduced risks of dying compared to their peers in the lay communities. These results suggest better diets, the positive health benefits of religious behavior, better living conditions in general in monasteries, or selective recruitment of healthy or higher socioeconomic status individuals.

  9. [Liver cirrhosis mortality in Mexico. II. Excess mortality and pulque consumption].

    Science.gov (United States)

    Narro-Robles, J; Gutiérrez-Avila, J H; López-Cervantes, M; Borges, G; Rosovsky, H

    1992-01-01

    Over the years high cirrhosis mortality rates have been reported in Mexico City and in the surrounding states (Hidalgo, Tlaxcala, Puebla and the State of Mexico); on the contrary, well defined areas, such as the northern states, have shown a considerably lower mortality rate. This situation may indicate that some factors such as the pattern of alcoholic intake and other environmental characteristics could explain this striking difference. To determine the role of alcohol, the availability and consumption of alcohol at regional and state level were compared with cirrhosis mortality rates. A high and statistically significant correlation was found with pulque availability and consumption (r = 72-92%, p less than 0.01) in all periods of time under examination. On the contrary, a statistically significant negative association was observed with beer consumption and a positive, but not significant correlation, with distilled alcoholic beverages. Infectious hepatitis incidence, prevalence of exclusive use of native languages (as an indirect index of ethnic background) and nutritional deficiencies were also studied as possible risk factors. Nutritional deficiencies and the prevalence of exclusive use of náhuatl and otomí languages were positively correlated. These results can be useful to conduct further epidemiological studies still needed to determine the etiologic role of pulque consumption as well as of the other risk factors. Nonetheless, the current data stress the need to implement public health programs to reduce alcohol consumption, especially pulque, and to minimize the impact of these risk factors in high mortality areas.

  10. Vegetarian dietary patterns and mortality in Adventist Health Study 2.

    Science.gov (United States)

    Orlich, Michael J; Singh, Pramil N; Sabaté, Joan; Jaceldo-Siegl, Karen; Fan, Jing; Knutsen, Synnove; Beeson, W Lawrence; Fraser, Gary E

    2013-07-08

    Some evidence suggests vegetarian dietary patterns may be associated with reduced mortality, but the relationship is not well established. To evaluate the association between vegetarian dietary patterns and mortality. Prospective cohort study; mortality analysis by Cox proportional hazards regression, controlling for important demographic and lifestyle confounders. Adventist Health Study 2 (AHS-2), a large North American cohort. A total of 96,469 Seventh-day Adventist men and women recruited between 2002 and 2007, from which an analytic sample of 73,308 participants remained after exclusions. Diet was assessed at baseline by a quantitative food frequency questionnaire and categorized into 5 dietary patterns: nonvegetarian, semi-vegetarian, pesco-vegetarian, lacto-ovo-vegetarian, and vegan. The relationship between vegetarian dietary patterns and all-cause and cause-specific mortality; deaths through 2009 were identified from the National Death Index. There were 2570 deaths among 73,308 participants during a mean follow-up time of 5.79 years. The mortality rate was 6.05 (95% CI, 5.82-6.29) deaths per 1000 person-years. The adjusted hazard ratio (HR) for all-cause mortality in all vegetarians combined vs nonvegetarians was 0.88 (95% CI, 0.80-0.97). The adjusted HR for all-cause mortality in vegans was 0.85 (95% CI, 0.73-1.01); in lacto-ovo-vegetarians, 0.91 (95% CI, 0.82-1.00); in pesco-vegetarians, 0.81 (95% CI, 0.69-0.94); and in semi-vegetarians, 0.92 (95% CI, 0.75-1.13) compared with nonvegetarians. Significant associations with vegetarian diets were detected for cardiovascular mortality, noncardiovascular noncancer mortality, renal mortality, and endocrine mortality. Associations in men were larger and more often significant than were those in women. Vegetarian diets are associated with lower all-cause mortality and with some reductions in cause-specific mortality. Results appeared to be more robust in males. These favorable associations should be considered

  11. Vegetarian Dietary Patterns and Mortality in Adventist Health Study 2

    Science.gov (United States)

    Orlich, Michael J.; Singh, Pramil N; Sabaté, Joan; Jaceldo-Siegl, Karen; Fan, Jing; Knutsen, Synnove; Beeson, W. Lawrence; Fraser, Gary E.

    2014-01-01

    Importance Some evidence suggests vegetarian dietary patterns may be associated with reduced mortality, but the relationship is not well established. Objective To evaluate the association between vegetarian dietary patterns and mortality. Design Prospective cohort study; mortality analysis by Cox proportional hazards regression, controlling for important demographic and lifestyle confounders. Setting Adventist Health Study 2 (AHS-2), a large North American cohort. Participants A total of 96 469 Seventh-day Adventist men and women recruited between 2002 and 2007, from which an analytic sample of 73 308 participants remained after exclusions. Exposures Diet was assessed at baseline by a quantitative food frequency questionnaire and categorized into 5 dietary patterns: nonvegetarian, semi-vegetarian, pesco-vegetarian, lacto-ovo–vegetarian, and vegan. Main Outcome and Measure The relationship between vegetarian dietary patterns and all-cause and cause-specific mortality; deaths through 2009 were identified from the National Death Index. Results There were 2570 deaths among 73 308 participants during a mean follow-up time of 5.79 years. The mortality rate was 6.05 (95% CI, 5.82–6.29) deaths per 1000 person-years. The adjusted hazard ratio (HR) for all-cause mortality in all vegetarians combined vs non-vegetarians was 0.88 (95% CI, 0.80–0.97). The adjusted HR for all-cause mortality in vegans was 0.85 (95% CI, 0.73–1.01); in lacto-ovo–vegetarians, 0.91 (95% CI, 0.82–1.00); in pesco-vegetarians, 0.81 (95% CI, 0.69–0.94); and in semi-vegetarians, 0.92 (95% CI, 0.75–1.13) compared with nonvegetarians. Significant associations with vegetarian diets were detected for cardiovascular mortality, noncardiovascular noncancer mortality, renal mortality, and endocrine mortality. Associations in men were larger and more often significant than were those in women. Conclusions and Relevance Vegetarian diets are associated with lower all-cause mortality and with some

  12. Modeling human mortality using mixtures of bathtub shaped failure distributions.

    Science.gov (United States)

    Bebbington, Mark; Lai, Chin-Diew; Zitikis, Ricardas

    2007-04-07

    Aging and mortality is usually modeled by the Gompertz-Makeham distribution, where the mortality rate accelerates with age in adult humans. The resulting parameters are interpreted as the frailty and decrease in vitality with age. This fits well to life data from 'westernized' societies, where the data are accurate, of high resolution, and show the effects of high quality post-natal care. We show, however, that when the data are of lower resolution, and contain considerable structure in the infant mortality, the fit can be poor. Moreover, the Gompertz-Makeham distribution is consistent with neither the force of natural selection, nor the recently identified 'late life mortality deceleration'. Although actuarial models such as the Heligman-Pollard distribution can, in theory, achieve an improved fit, the lack of a closed form for the survival function makes fitting extremely arduous, and the biological interpretation can be lacking. We show, that a mixture, assigning mortality to exogenous or endogenous causes, using the reduced additive and flexible Weibull distributions, models well human mortality over the entire life span. The components of the mixture are asymptotically consistent with the reliability and biological theories of aging. The relative simplicity of the mixture distribution makes feasible a technique where the curvature functions of the corresponding survival and hazard rate functions are used to identify the beginning and the end of various life phases, such as infant mortality, the end of the force of natural selection, and late life mortality deceleration. We illustrate our results with a comparative analysis of Canadian and Indonesian mortality data.

  13. Geographical variation and factors associated with colorectal cancer mortality in a universal health care system.

    Science.gov (United States)

    Torabi, Mahmoud; Green, Christopher; Nugent, Zoann; Mahmud, Salaheddin; Demers, Alain; Griffith, Jane; Singh, Harminder

    2014-04-01

    To investigate the geographical variation and small geographical area level factors associated with colorectal cancer (CRC) mortality. Information regarding CRC mortality was obtained from the population-based Manitoba Cancer Registry, population counts were obtained from Manitoba's universal health care plan Registry and characteristics of the area of residence were obtained from the 2001 Canadian census. Bayesian spatial Poisson mixed models were used to evaluate the geographical variation of CRC mortality and Poisson regression models for determining associations with CRC mortality. Time trends of CRC mortality according to income group were plotted using joinpoint regression. The southeast (mortality rate ratio [MRR] 1.31 [95% CI 1.12 to 1.54) and southcentral (MRR 1.62 [95% CI 1.35 to 1.92]) regions of Manitoba had higher CRC mortality rates than suburban Winnipeg (Manitoba's capital city). Between 1985 and 1996, CRC mortality did not vary according to household income; however, between 1997 and 2009, individuals residing in the highest-income areas were less likely to die from CRC (MRR 0.77 [95% CI 0.65 to 0.89]). Divergence in CRC mortality among individuals residing in different income areas increased over time, with rising CRC mortality observed in the lowest income areas and declining CRC mortality observed in the higher income areas. Individuals residing in lower income neighbourhoods experienced rising CRC mortality despite residing in a jurisdiction with universal health care and should receive increased efforts to reduce CRC mortality. These findings should be of particular interest to the provincial CRC screening programs, which may be able to reduce the disparities in CRC mortality by reducing the disparities in CRC screening participation.

  14. Adherence to cancer prevention guidelines and cancer incidence, cancer mortality, and total mortality: a prospective cohort study1234

    Science.gov (United States)

    Kabat, Geoffrey C; Matthews, Charles E; Kamensky, Victor; Hollenbeck, Albert R; Rohan, Thomas E

    2015-01-01

    Background: Several health agencies have issued guidelines promoting behaviors to reduce chronic disease risk; however, little is known about the impact of such guidelines, particularly on cancer incidence. Objective: The objective was to determine whether greater adherence to the American Cancer Society (ACS) cancer prevention guidelines is associated with a reduction in cancer incidence, cancer mortality, and total mortality. Design: The NIH-AARP Diet and Health Study, a prospective cohort study of 566,401 adults aged 50–71 y at recruitment in 1995–1996, was followed for a median of 10.5 y for cancer incidence, 12.6 y for cancer mortality, and 13.6 y for total mortality. Participants who reported a history of cancer or who had missing data were excluded, yielding 476,396 subjects for analysis. We constructed a 5-level score measuring adherence to ACS guidelines, which included baseline body mass index, physical activity, alcohol intake, and several aspects of diet. Cox proportional hazards models were used to compute HRs and 95% CIs for the association of the adherence score with cancer incidence, cancer mortality, and total mortality. All analyses included fine adjustment for cigarette smoking. Results: Among 476,396 participants, 73,784 incident first cancers, 16,193 cancer deaths, and 81,433 deaths from all causes were identified in the cohort. Adherence to ACS guidelines was associated with reduced risk of all cancers combined: HRs (95% CIs) for the highest compared with the lowest level of adherence were 0.90 (0.87, 0.93) in men and 0.81 (0.77, 0.84) in women. Fourteen of 25 specific cancer sites showed a reduction in risk associated with increased adherence. Adherence was also associated with reduced cancer mortality [HRs (95% CIs) were 0.75 (0.70, 0.80) in men and 0.76 (0.70, 0.83) in women] and reduced all-cause mortality [HRs (95% CIs) were 0.74 (0.72, 0.76) in men and 0.67 (0.65, 0.70) in women]. Conclusions: In both men and women, adherence to the

  15. Adherence to cancer prevention guidelines and cancer incidence, cancer mortality, and total mortality: a prospective cohort study.

    Science.gov (United States)

    Kabat, Geoffrey C; Matthews, Charles E; Kamensky, Victor; Hollenbeck, Albert R; Rohan, Thomas E

    2015-03-01

    Several health agencies have issued guidelines promoting behaviors to reduce chronic disease risk; however, little is known about the impact of such guidelines, particularly on cancer incidence. The objective was to determine whether greater adherence to the American Cancer Society (ACS) cancer prevention guidelines is associated with a reduction in cancer incidence, cancer mortality, and total mortality. The NIH-AARP Diet and Health Study, a prospective cohort study of 566,401 adults aged 50-71 y at recruitment in 1995-1996, was followed for a median of 10.5 y for cancer incidence, 12.6 y for cancer mortality, and 13.6 y for total mortality. Participants who reported a history of cancer or who had missing data were excluded, yielding 476,396 subjects for analysis. We constructed a 5-level score measuring adherence to ACS guidelines, which included baseline body mass index, physical activity, alcohol intake, and several aspects of diet. Cox proportional hazards models were used to compute HRs and 95% CIs for the association of the adherence score with cancer incidence, cancer mortality, and total mortality. All analyses included fine adjustment for cigarette smoking. Among 476,396 participants, 73,784 incident first cancers, 16,193 cancer deaths, and 81,433 deaths from all causes were identified in the cohort. Adherence to ACS guidelines was associated with reduced risk of all cancers combined: HRs (95% CIs) for the highest compared with the lowest level of adherence were 0.90 (0.87, 0.93) in men and 0.81 (0.77, 0.84) in women. Fourteen of 25 specific cancer sites showed a reduction in risk associated with increased adherence. Adherence was also associated with reduced cancer mortality [HRs (95% CIs) were 0.75 (0.70, 0.80) in men and 0.76 (0.70, 0.83) in women] and reduced all-cause mortality [HRs (95% CIs) were 0.74 (0.72, 0.76) in men and 0.67 (0.65, 0.70) in women]. In both men and women, adherence to the ACS guidelines was associated with reductions in all

  16. Reducing sedentarism

    DEFF Research Database (Denmark)

    Brown, Wendy; Andersen, Lars Bo; Sigmund, Anderssen

    sedentary behaviour may be as effective as increasing physical activity. Some countries have already changed physical activity guidelines and included special recommendations related to sedentary time, but it is questionable if these changes are based on solid evidence. Lars B Andersen Sedentary behaviors...... include sitting during leisure time, at work, and during commuting. Sedentary behaviors such as TV viewing, using a computer or driving a car typically demands low levels of energy expenditure. Youth and adults spend most of their waking time sitting or doing light activities, and most of them do little...... of sitting, TV-viewing or other sedentary behaviours and different health outcomes. A meta-analysis recently showed that TV-viewing was associated with type 2 diabetes, cardiovascular disease and all-cause mortality. However, measures of sedentary behaviour may be surrogate measures for lack of physical...

  17. Smoking reduction, smoking cessation, and mortality

    DEFF Research Database (Denmark)

    Godtfredsen, Nina S; Holst, Claus; Prescott, Eva

    2002-01-01

    The authors investigated the association between changes in smoking habits and mortality by pooling data from three large cohort studies conducted in Copenhagen, Denmark. The study included a total of 19,732 persons who had been examined between 1967 and 1988, with reexaminations at 5- to 10-year...... intervals and a mean follow-up of 15.5 years. Date of death and cause of death were obtained by record linkage with nationwide registers. By means of Cox proportional hazards models, heavy smokers (>or=15 cigarettes/day) who reduced their daily tobacco intake by at least 50% without quitting between...... the first two examinations and participants who quit smoking were compared with persons who continued to smoke heavily. After exclusion of deaths occurring in the first 2 years of follow-up, the authors found the following adjusted hazard ratios for subjects who reduced their smoking: for cardiovascular...

  18. Universal mortality law and immortality

    Science.gov (United States)

    Azbel', Mark Ya.

    2004-10-01

    Well-protected human and laboratory animal populations with abundant resources are evolutionarily unprecedented. Physical approach, which takes advantage of their extensively quantified mortality, establishes that its dominant fraction yields the exact law, which is universal for all animals from yeast to humans. Singularities of the law demonstrate new kinds of stepwise adaptation. The law proves that universal mortality is an evolutionary by-product, which at any given age is reversible, independent of previous life history, and disposable. Life expectancy may be extended, arguably to immortality, by minor biological amendments in the animals. Indeed, in nematodes with a small number of perturbed genes and tissues it increased 6-fold (to 430 years in human terms), with no apparent loss in health and vitality. The law relates universal mortality to specific processes in cells and their genetic regulation.

  19. Electrocardiographic Predictors of Cardiovascular Mortality

    Directory of Open Access Journals (Sweden)

    Ioana Mozos

    2015-01-01

    Full Text Available Cardiovascular diseases are the main causes of mortality. Sudden cardiac death may also appear in athletes, due to underlying congenital or inherited cardiac abnormalities. The electrocardiogram is used in clinical practice and clinical trials, as a valid, reliable, accessible, inexpensive method. The aim of the present paper was to review electrocardiographic (ECG signs associated with cardiovascular mortality and the mechanisms underlying those associations, providing a brief description of the main studies in this area, and consider their implication for clinical practice in the general population and athletes. The main ECG parameters associated with cardiovascular mortality in the present paper are the P wave (duration, interatrial block, and deep terminal negativity of the P wave in V1, prolonged QT and Tpeak-Tend intervals, QRS duration and fragmentation, bundle branch block, ST segment depression and elevation, T waves (inverted, T wave axes, spatial angles between QRS and T vectors, premature ventricular contractions, and ECG hypertrophy criteria.

  20. Decline in breast cancer mortality

    DEFF Research Database (Denmark)

    Njor, Sisse Helle; Schwartz, Walter; Blichert-Toft, Mogens

    2015-01-01

    OBJECTIVES: When estimating the decline in breast cancer mortality attributable to screening, the challenge is to provide valid comparison groups and to distinguish the screening effect from other effects. In Funen, Denmark, multidisciplinary breast cancer management teams started before screening...... was introduced; both activities came later in the rest of Denmark. Because Denmark had national protocols for breast cancer treatment, but hardly any opportunistic screening, Funen formed a "natural experiment", providing valid comparison groups and enabling the separation of the effect of screening from other...... factors. METHODS: Using Poisson regression we compared the observed breast cancer mortality rate in Funen after implementation of screening with the expected rate without screening. The latter was estimated from breast cancer mortality in the rest of Denmark controlled for historical differences between...

  1. Mortality rates among wild chimpanzees.

    Science.gov (United States)

    Hill, K; Boesch, C; Goodall, J; Pusey, A; Williams, J; Wrangham, R

    2001-05-01

    In order to compare evolved human and chimpanzees' life histories we present a synthetic life table for free-living chimpanzees, derived from data collected in five study populations (Gombe, Taï, Kibale, Mahale, Bossou). The combined data from all populations represent 3711 chimpanzee years at risk and 278 deaths. Males show higher mortality than females and data suggest some inter-site variation in mortality. Despite this variation, however, wild chimpanzees generally have a life expectancy at birth of less than 15 years and mean adult lifespan (after sexual maturity) is only about 15 years. This is considerably lower survival than that reported for chimpanzees in zoos or captive breeding colonies, or that measured among modern human hunter-gatherers. The low mortality rate of human foragers relative to chimpanzees in the early adult years may partially explain why humans have evolved to senesce later than chimpanzees, and have a longer juvenile period.

  2. Antiretroviral treatment scale-up and tuberculosis mortality in high TB/HIV burden countries: An econometric analysis

    NARCIS (Netherlands)

    I. Yan (Isabel); A. Bendavid (Avrom); E.L. Korenromp (Eline)

    2016-01-01

    textabstractIntroduction Antiretroviral therapy (ART) reduces mortality in patients with active tuberculosis (TB), but the population-level relationship between ART coverage and TB mortality is untested. We estimated the reduction in population-level TB mortality that can be attributed to increasing

  3. Fine and Gray competing risk regression model to study the cause-specific under-five child mortality in Bangladesh

    National Research Council Canada - National Science Library

    Mohammad, Khandoker Akib; Fatima-Tuz-Zahura, Most; Bari, Wasimul

    2017-01-01

    ... present mortality level, one in every 19 children dies before reaching his or her fifth birthday. However, in Bangladesh under-five mortality has long been very high as compared to the other countries in this South Asia. Though Bangladesh has made significant progress in reducing under-five mortality in recent years, it is still far below the related ...

  4. Antiretroviral treatment scale-up and tuberculosis mortality in high TB/HIV burden countries: An econometric analysis

    NARCIS (Netherlands)

    I. Yan (Isabel); A. Bendavid (Avrom); E.L. Korenromp (Eline)

    2016-01-01

    textabstractIntroduction Antiretroviral therapy (ART) reduces mortality in patients with active tuberculosis (TB), but the population-level relationship between ART coverage and TB mortality is untested. We estimated the reduction in population-level TB mortality that can be attributed to increasing

  5. Is cancer mortality increasing in France?

    OpenAIRE

    Hill, C.; Jan, P; Doyon, F

    2001-01-01

    Long-term trends in cancer mortality are reported by site. Overall, cancer mortality has been decreasing in France since 1987 in the male population and since 1968 in the female population. Improvement in treatments and diagnosis should lead to persistently declining mortality rates, unless the tobacco epidemic reverses the trend in female mortality. © 2001 Cancer Research Campaign http://www.bjcancer.com

  6. Mortality in adult congenital heart disease

    NARCIS (Netherlands)

    Verheugt, Carianne L.; Uiterwaal, Cuno S. P. M.; van der Velde, Enno T.; Meijboom, Folkert J.; Pieper, Petronella G.; van Dijk, Arie P. J.; Vliegen, Hubert W.; Grobbee, Diederick E.; Mulder, Barbara J. M.

    2010-01-01

    Mortality in adults with congenital heart disease is known to be increased, yet its extent and the major mortality risks are unclear. The Dutch CONCOR national registry for adult congenital heart disease was linked to the national mortality registry. Cox's regression was used to assess mortality pre

  7. Mortality among ethylene oxide workers.

    Science.gov (United States)

    Morgan, R W; Claxton, K W; Divine, B J; Kaplan, S D; Harris, V B

    1981-11-01

    Because of reports linking an increased risk of leukemia with exposure to ethylene oxide, a mortality study of workers with potential exposure to ethylene oxide at the Texaco Chemical Company Plant in Port Neches, Tex., was undertaken. A total of 767 males with potential exposure to ethylene oxide were identified. Forty-six deaths occurred in this cohort with 80 expected (standardized mortality ratio; SMR = 58). No deaths from leukemia were seen, nor were there any statistically significant excesses from any specific causes of death.

  8. Impact of vitamin A supplementation on infant and childhood mortality

    Directory of Open Access Journals (Sweden)

    Black Robert E

    2011-04-01

    Full Text Available Abstract Introduction Vitamin A is important for the integrity and regeneration of respiratory and gastrointestinal epithelia and is involved in regulating human immune function. It has been shown previously that vitamin A has a preventive effect on all-cause and disease specific mortality in children under five. The purpose of this paper was to get a point estimate of efficacy of vitamin A supplementation in reducing cause specific mortality by using Child Health Epidemiology Reference Group (CHERG guidelines. Methods A literature search was done on PubMed, Cochrane Library and WHO regional data bases using various free and Mesh terms for vitamin A and mortality. Data were abstracted into standardized forms and quality of studies was assessed according to standardized guidelines. Pooled estimates were generated for preventive effect of vitamin A supplementation on all-cause and disease specific mortality of diarrhea, measles, pneumonia, meningitis and sepsis. We did a subgroup analysis for vitamin A supplementation in neonates, infants 1-6 months and children aged 6-59 months. In this paper we have focused on estimation of efficacy of vitamin A supplementation in children 6-59 months of age. Results for neonatal vitamin A supplementation have been presented, however no recommendations are made as more evidence on it would be available soon. Results There were 21 studies evaluating preventive effect of vitamin A supplementation in community settings which reported all-cause mortality. Twelve of these also reported cause specific mortality for diarrhea and pneumonia and six reported measles specific mortality. Combined results from six studies showed that neonatal vitamin A supplementation reduced all-cause mortality by 12 % [Relative risk (RR 0.88; 95 % confidence interval (CI 0.79-0.98]. There was no effect of vitamin A supplementation in reducing all-cause mortality in infants 1-6 months of age [RR 1.05; 95 % CI 0.88-1.26]. Pooled results for

  9. Iron supplementation and mortality in incident dialysis patients: an observational study.

    Directory of Open Access Journals (Sweden)

    Emanuel Zitt

    Full Text Available Studies on the association between iron supplementation and mortality in dialysis patients are rare and conflicting.In our observational single-center cohort study (INVOR study we prospectively studied 235 incident dialysis patients. Time-dependent Cox proportional hazards models using all measured laboratory values for up to 7.6 years were applied to study the association between iron supplementation and all-cause mortality, cardiovascular and sepsis-related mortality. Furthermore, the time-dependent association of ferritin levels with mortality in patients with normal C-reactive protein (CRP levels (800 ng/mL were linked with increased mortality.Iron supplementation is associated with reduced all-cause mortality in incident dialysis patients. While serum ferritin levels up to 800 ng/mL appear to be safe, higher ferritin levels are associated with increased mortality in the setting of concomitant inflammation.

  10. Affordability of alcohol and alcohol-related mortality in Belarus.

    Science.gov (United States)

    Razvodovsky, Yury E

    2013-01-01

    Alcohol abuse has numerous adverse health and social consequences. The consumer response to changes in alcohol affordability is an important issue on alcohol policy debates. Studies from many countries have shown an inverse relationship between alcohol prices and alcohol consumption in the population. There are, however, suggestions that increasing the price of alcohol by rising taxes may have limited effect on alcohol-related problems, associated with long-term heavy drinking. The aim of the present study was to evaluate the relationship between alcohol affordability and alcohol-related mortality rates in post-Soviet Belarus. For this purpose trends in alcohol-related mortality rates (mortality from liver cirrhosis, pancreatitis, alcoholism and alcohol psychoses) and affordability of vodka between 1990 and 2010 were compared. The time series analysis revealed that 1% increase in vodka affordability is associated with an increase in liver cirrhosis mortality of 0,77%, an increase in pancreatitis mortality of 0.53%, an increase in mortality from alcoholism and alcohol psychoses of 0,70%. The major conclusion emerging from this study is that affordability of alcohol is one of the most important predictor of alcohol-related problems in a population. These findings provide additional evidence that decreasing in affordability of alcohol is an effective strategy for reducing alcohol consumption and alcohol-related harm.

  11. Bird Mortality in Oil Field Wastewater Disposal Facilities

    Science.gov (United States)

    Ramirez, Pedro

    2010-11-01

    Commercial and centralized oilfield wastewater disposal facilities (COWDFs) are used in the Western United States for the disposal of formation water produced from oil and natural gas wells. In Colorado, New Mexico, Utah, and Wyoming, COWDFs use large evaporation ponds to dispose of the wastewater. Birds are attracted to these large evaporation ponds which, if not managed properly, can cause wildlife mortality. The U.S. Fish and Wildlife Service (USFWS) and the U.S. Environmental Protection Agency (EPA) conducted 154 field inspections of 28 COWDFs in Wyoming from March 1998 through September 2008 and documented mortality of birds and other wildlife in 9 COWDFs. Of 269 bird carcasses recovered from COWDFs, grebes (Family Podicipedidae) and waterfowl (Anatidae) were the most frequent casualties. Most mortalities were attributed to oil on evaporation ponds, but sodium toxicity and surfactants were the suspected causes of mortality at three COWDFs. Although the oil industry and state and federal regulators have made much progress in reducing bird mortality in oil and gas production facilities, significant mortality incidents continue in COWDFs, particularly older facilities permitted in the early 1980’s. Inadequate operation and management of these COWDFs generally results in the discharge of oil into the large evaporation ponds which poses a risk for birds and other wildlife.

  12. The Diabetic Postoperative Mortality and Morbidity (DIPOM) trial

    DEFF Research Database (Denmark)

    Juul, Anne Benedicte; Wetterslev, Jørn; Kofoed-Enevoldsen, Allan;

    2004-01-01

    Recent trials suggest that perioperative beta-blockade reduces the risk of cardiac events in patients with a risk of myocardial ischemia who are undergoing noncardiac surgery. Patients with diabetes mellitus are at a high-risk for postoperative cardiac morbidity and mortality. They may, therefore...

  13. Conquering maternal mortality: skill development in medical curriculum

    Directory of Open Access Journals (Sweden)

    Parimala A

    2016-02-01

    Conclusion: Skill Development in conduct of labour helps medical students to understand the clinical implications better. A well trained medical student can thus help to reduce maternal mortality rate in developing countries. [Int J Reprod Contracept Obstet Gynecol 2016; 5(2.000: 441-444

  14. Child mortality in rural India

    NARCIS (Netherlands)

    B. van der Klaauw (Bas); L. Wang (Lihong)

    2011-01-01

    textabstractThis paper focuses on infant and child mortality in rural areas of India. We construct a flexible duration model, which allows for frailty at multiple levels and interactions between the child's age and individual, socioeconomic, and environmental characteristics. The model is estimated

  15. America's Infant-Mortality Puzzle.

    Science.gov (United States)

    Eberstadt, Nicholas

    1991-01-01

    Conventional explanations attributing the high infant mortality rate in United States to the prevalence of poverty and lack of adequate health care do not tell the whole story. Contributions of parental behavior, lifestyles, and public health care availability versus utilization must be examined in determining public policies to address the…

  16. Infant Mortality: The Shared Concern.

    Science.gov (United States)

    Heagarty, Margaret C.

    1990-01-01

    Addresses the causes for and implications of infant mortality. Besides the more immediate causes such as disease, nutrition, and lifestyle, there are the additional hurdles of government bureaucracy, lack of funds, and institutional attitudes that block access to prenatal care. Suggests structural solutions, including a consistent, individual,…

  17. Morbidity and Mortality in Sarcoidosis

    Science.gov (United States)

    Gerke, Alicia K.

    2015-01-01

    Purpose of Review Chronic sarcoidosis is a complex disease with numerous comorbid conditions and can be fatal in some cases. Recognizing causes of morbidity and mortality is important to effectively select treatments, manage symptoms, and improve outcomes. The purpose of this review is to examine emerging knowledge on morbidity and mortality in sarcoidosis. Recent Findings Approximately one to five percent of patients with sarcoidosis die from complications of sarcoidosis. Recent population studies indicate that mortality may be increasing over the past decade. The reasons behind these trends are unclear, but could include increasing incidence, detection rates, severity of disease, or age of the population. Morbidity of sarcoidosis is reflected by a trend of increased hospitalizations over recent years and increased use of healthcare resources. Morbidity can be caused by organ damage from granulomatous inflammation, treatment complications, and psychosocial effects of the disease. Recent studies are focused on morbidity related to cardiopulmonary complications, bone health, and aging within the sarcoidosis population. Last, sarcoidosis is associated with autoimmune diseases, pulmonary embolism, and malignancy; however, the underlying mechanisms linking diseases continue to be debated. Summary Morbidity in sarcoidosis is significant and multifactorial. Mortality is infrequent, but may be increasing over the years. PMID:25029298

  18. Predictors of paediatric injury mortality

    African Journals Online (AJOL)

    Department of Paediatrics and Child Health, Wesley Guild Hospital Unit, Obafemi Awolowo University ... 90% of global deaths due to injuries in children occur in low-income ... sought and obtained by carefully explaining the purpose and benefits ..... terms of mortality and development of neurological sequelae.4-7,16 In.

  19. Excess mortality following hip fracture

    DEFF Research Database (Denmark)

    Abrahamsen, B; van Staa, T; Ariely, R;

    2009-01-01

    Summary This systematic literature review has shown that patients experiencing hip fracture after low-impact trauma are at considerable excess risk for death compared with nonhip fracture/community control populations. The increased mortality risk may persist for several years thereafter, highlig...

  20. Changes in mortality inequalities over two decades: register based study of European countries

    OpenAIRE

    Mackenbach, Johan P; Kulhánová, Ivana; Artnik, Barbara; Bopp, Matthias; Borrell, Carme; Strand, Bjørn Heine

    2016-01-01

    Objective To determine whether government efforts in reducing inequalities in health in European countries have actually made a difference to mortality inequalities by socioeconomic group. Design Register based study. Data source Mortality data by level of education and occupational class in the period 1990-2010, usually collected in a census linked longitudinal study design. We compared changes in mortality between the lowest and highest socioeconomic groups, and calculated their effect on a...

  1. Contextual determinants of maternal mortality in rural Pakistan.

    Science.gov (United States)

    Midhet, F; Becker, S; Berendes, H W

    1998-06-01

    Maternal mortality is high in Pakistan, particularly in the rural areas which have poor access to health services. We investigated the risk factors associated with maternal mortality in sixteen rural districts of Balochistan and the North-West Frontier (NWFP) provinces of Pakistan. We designed a nested case-control study comprising 261 cases (maternal deaths reported during last five years) and 9135 controls (women who survived a pregnancy during last five years). Using contextual analysis, we estimated the interactions between the biological risk factors of maternal mortality and the district-level indicators of health services. Women under 19 or over 39 yr of age, those having their first birth, and those having a previous history of fetal loss were at greater risk of maternal death. Staffing patterns of peripheral health facilities in the district and accessibility of essential obstetric care (EOC) were significantly associated with maternal mortality. These indicators also modified the effects of the biological risk factors of maternal mortality. For example, nulliparous women living in the under-served districts were at greater risk than those living in the better-served districts. Our results are consistent with several studies which have pointed out the role of health services in the causation of maternal mortality. Many such studies have implicated distance to hospital (an indicator of access to EOC) and lack of prenatal care as major determinants of maternal mortality. We conclude that better staffing of peripheral health facilities and improved access to EOC could reduce the risk of maternal mortality among women in rural Balochistan and the NWFP.

  2. Socioeconomic development, health interventions and mortality decline in Costa Rica.

    Science.gov (United States)

    Rosero-Bixby, L

    1991-01-01

    Costa Rica, whose life expectancy was 74 years by 1985, has reached a health level comparable to a developed country. The health achievements of this country are product of political and socioeconomic circumstances as well as of right public health policies. Until about 1970 the features of Costa Rica mortality, although somewhat better than the Latin American average, evolved in a similar way to the rest of the region. In particular, the decades of 1940s and 1950s saw dramatic improvements in life expectancy, thanks mainly to the import of low-cost, high-effectiveness health technologies. In the 1970s, however, Costa Rica departed from a regional pattern of stagnation and managed to close the gap with developed countries in terms of mortality levels. A dramatic decline in the infant mortality rate from 60 to 19 per 1,000 took place in this decade. The main determinants of this breakthrough were health interventions, notably a primary health care program, even though favorable socioeconomic conditions and a reduced fertility also played a role. Ecological data and other evidence suggest that up to three fourths of the mortality decline was accounted for contemporary improvements in public health services, with about 40 percent attributable to primary health care interventions. Furthermore, by targeting interventions on the less privileged population, these interventions had the merit of reducing geographic and socioeconomic differentials in child mortality.

  3. Peptic ulcers: mortality and hospitalization.

    Science.gov (United States)

    Riley, R

    1991-01-01

    This study analyzes data on peptic ulcer disease based on deaths for 1951-1988 and hospital separations for 1969-1988. The source of the data are mortality and morbidity statistics provided to Statistics Canada by the provinces. The age-standardized mortality rates (ASMR) for peptic ulcer disease decreased from 1951 to 1988 by 69.4% for men (8.5 to 2.6 per 100,000 population), and 31.8% for women (2.2 to 1.5). Separation rates from hospitals during 1969-1988 for peptic ulcer disease also decreased by 59.8% for men (242.7 to 97.6 per 100,000 population) and 35.6% for women (103.2 to 66.5). Age-specific rates for both mortality and hospital separations increased with age. Epidemiological studies indicate that the incidence of peptic ulcer disease is declining in the general population. The downward trends in mortality and hospitalization rates for peptic ulcer disease reflect this change in incidence, but additional factors probably contribute as well to this decline. Male rates for both mortality and hospital separations were much higher than female rates at the beginning of the study period; but toward the end, the gap between the sexes narrowed considerably, mainly because the male rates declined substantially while the female rates decline moderately. The slower decline in the rates for women may be related to such factors as the increasing labour force participation among women and the slower decline in the population of female smokers.

  4. Homoarginine, cardiovascular risk, and mortality.

    Science.gov (United States)

    März, Winfried; Meinitzer, Andreas; Drechsler, Christiane; Pilz, Stefan; Krane, Vera; Kleber, Marcus E; Fischer, Joachim; Winkelmann, Bernhard R; Böhm, Bernhard O; Ritz, Eberhard; Wanner, Christoph

    2010-09-07

    Homoarginine is an amino acid derivative that may increase nitric oxide availability and enhance endothelial function. The effect of the level of homoarginine on cardiovascular outcome and mortality is unknown. We assessed cardiovascular and all-cause mortality according to homoarginine levels in a cohort of 3,305 subjects referred for coronary angiography from the LUdwigshafen RIsk and Cardiovascular Health (LURIC) Study. After investigating the relation of homoarginine with kidney function and markers of endothelial dysfunction, we explored its effects on adverse outcomes in a second high-risk cohort of 1244 patients with type 2 diabetes mellitus receiving maintenance hemodialysis (4D study [Die Deutsche Diabetes Dialyse Studie]). In the LURIC study, mean serum homoarginine levels were 2.6+/-1.1 micromol/L. During a median follow-up of 7.7 years, 766 patients died. After adjustments for age and sex, patients in the lowest quartile (4-fold higher rate of dying of cardiovascular disease (hazard ratio 4.1, 95% confidence interval 3.0 to 5.7) than patients in the highest quartile (>3.1 micromol/L). Lower homoarginine levels were associated with lower estimated glomerular filtration rate and higher levels of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1. Hemodialysed patients had lower mean homoarginine levels of 1.2+/-0.5 micromol/L and experienced a 5-fold increased mortality rate compared with LURIC patients (608 deaths during a median follow-up of 4 years). Homoarginine consistently affected mortality, which was 2-fold higher in 4D study patients in the lowest quartile (1.4 micromol/L). Homoarginine levels are independently associated with cardiovascular and all-cause mortality in patients referred for coronary angiography and in patients undergoing hemodialysis. Future studies are needed to elucidate the underlying pathomechanisms.

  5. Primary Health Care and Cervical Cancer Mortality Rates in Brazil

    Science.gov (United States)

    Rocha, Thiago Augusto Hernandes; da Silva, Núbia Cristina; Thomaz, Erika Bárbara Abreu Fonseca; Queiroz, Rejane Christine de Sousa; de Souza, Marta Rovery; Lein, Adriana; Alvares, Viviane; de Almeida, Dante Grapiuna; Barbosa, Allan Claudius Queiroz; Thumé, Elaine; Staton, Catherine; Vissoci, João Ricardo Nickenig; Facchini, Luiz Augusto

    2017-01-01

    Cervical cancer is a common neoplasm that is responsible for nearly 230 000 deaths annually in Brazil. Despite this burden, cervical cancer is considered preventable with appropriate care. We conducted a longitudinal ecological study from 2002 to 2012 to examine the relationship between the delivery of preventive primary care and cervical cancer mortality rates in Brazil. Brazilian states and the federal district were the unit of analysis (N = 27). Results suggest that primary health care has contributed to reducing cervical cancer mortality rates in Brazil; however, the full potential of preventive care has yet to be realized. PMID:28252500

  6. [Modifications by BCG of the mortality of the irradiated mouse].

    Science.gov (United States)

    Allain, P; Chaleil, D; Maingot, D; Larra, F

    1976-01-01

    Freeze-dried Bacillus Calmette Guerin (B.C.G.) of Institut Pasteur was given by intravenous route to mice at 1,2 and 4 mg/kg before and after gamma irradiation of animals by 1 000 rad. B.C.G. 1 mg/kg injected the day or the day after irradiation has a protective effect (mortality reduced from 77% for controls to 58% and 50% for treated mice). B.C.G. given before irradiation in single or double doses increased mortality.

  7. Comparing pandemic to seasonal influenza mortality: moderate impact overall but high mortality in young children.

    NARCIS (Netherlands)

    Wijngaard, C.C. van den; Asten, L. van; Koopmans, M.P.G.; Pelt, W. van; Nagelkerke, N.J.D.; Wielders, C.C.H.; Lier, A. van; Hoek, W. van der; Meijer, A.; Donker, G.A.; Dijkstra, F.; Harmsen, C.; Sande, M.A.B. van der; Kretzschmar, M.

    2012-01-01

    Background: We assessed the severity of the 2009 influenza pandemic by comparing pandemic mortality to seasonal influenza mortality. However, reported pandemic deaths were laboratory-confirmed - and thus an underestimation - whereas seasonal influenza mortality is often more inclusively estimated. F

  8. Mortality level, trends and differentials in Malawi.

    Science.gov (United States)

    Palamuleni, M E

    1994-01-01

    "This article examines the levels, and trends and differentials in mortality in Malawi.... The study has shown that (i) the level of mortality is very high in Malawi; (ii) mortality has declined during the period under review; (iii) there was reduction in the rate of mortality decline in the seventies; and (iv) [there are] interesting differences in mortality in terms of rural-urban localities, regions and age-sex differentials. The observed levels, trends and differentials in mortality are however consistent with the level of social and economic development in the country."

  9. Effect of organized screening on incidence and mortality of cervical cancer in Denmark

    DEFF Research Database (Denmark)

    Lynge, E; Madsen, Mette; Engholm, G

    1989-01-01

    multiplicative Poisson models on county-based incidence and mortality data for women aged 30-59 years in 1963-1982 showed a statistically significant effect of organized screening in reducing both the incidence (RR = 0.67; 95% CI, 0.61-0.73), and the mortality (RR = 0.68; 95% CI, 0.59-0.78) of cervical cancer...

  10. Impact of binge alcohol on mortality among people who inject drugs

    Directory of Open Access Journals (Sweden)

    Cheyenne Johnson

    2015-12-01

    Conclusions: Binge alcohol use was associated with time to all-cause mortality among PWID in this setting. Since alcohol use is often overlooked as a risk factor for mortality among this population, these findings highlight the continued need to incorporate addiction treatment and public health interventions and policies that address binge alcohol use to reduce alcohol related-harms.

  11. Traditional birth attendants and the problem of maternal mortality in Indonesia

    NARCIS (Netherlands)

    Niehof, A.

    2014-01-01

    Since the 1980s, maternal mortality in Indonesia has declined. However, it has always been high by regional standards, and its decline is now stalling. This makes it unlikely that by 2015 Indonesia will have reduced maternal mortality to the level set by the fifth United Nations Millennium Developme

  12. Traditional birth attendants and the problem of maternal mortality in Indonesia

    NARCIS (Netherlands)

    Niehof, A.

    2014-01-01

    Since the 1980s, maternal mortality in Indonesia has declined. However, it has always been high by regional standards, and its decline is now stalling. This makes it unlikely that by 2015 Indonesia will have reduced maternal mortality to the level set by the fifth United Nations Millennium

  13. Etiologic assessment of maternal mortality in west Azerbaijan, Iran: a retrospective descriptive study

    Directory of Open Access Journals (Sweden)

    Shiva Jabbari

    2016-06-01

    Conclusions: Maternal mortality is still considerably high in West Azerbaijan. Increasing the coverage and the quality of prenatal and postpartum care, family planning counseling, and improving the skills and knowledge of the medical and midwifery staff would be effective in reducing maternal mortality rates. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 1846-1850

  14. Short-term mortality in hip fracture patients admitted during weekends and holidays

    DEFF Research Database (Denmark)

    Foss, N B; Kehlet, H

    2006-01-01

    Acute surgical admission during weekends, with reduced staffing levels, has been associated with increased risk of mortality, but the effect of longer vacation/holiday periods has not been studied. We therefore examined early postoperative mortality in hip fracture patients admitted during weekends...

  15. Educational differences in cardiovascular mortality

    DEFF Research Database (Denmark)

    Kjøllesdal, M. K. R.; Ariansen, I.; Mortensen, L. H.

    2016-01-01

    Aims: To explore the confounding effects of early family factors shared by siblings and cardiovascular risk factors in midlife on the educational differences in mortality from cardiovascular disease (CVD). Methods: Data from national and regional health surveys in Norway (1974–2003) were linked...... with data from the Norwegian Family Based Life Course Study, the National Educational Registry and the Cause of Death Registry. The study population consisted of participants with at least one full sibling among the health survey participants (n=271,310). Data were available on CVD risk factors, including...... weight, height, blood pressure, total cholesterol and smoking. Results: The hazards ratio (HR) of CVD mortality was 3.44 (95% confidence interval (CI) 2.98–3.96) in the lowest educational group relative to the highest. The HRs were little altered in the within-sibship analyses. Adjusted for risk factors...

  16. Physical Inactivity and Mortality Risk

    Directory of Open Access Journals (Sweden)

    Peter Kokkinos

    2011-01-01

    Full Text Available In recent years a plethora of epidemiologic evidence accumulated supports a strong, independent and inverse, association between physical activity and the fitness status of an individual and mortality in apparently healthy individuals and diseased populations. These health benefits are realized at relatively low fitness levels and increase with higher physical activity patterns or fitness status in a dose-response fashion. The risk reduction is at least in part attributed to the favorable effect of exercise or physical activity on the cardiovascular risk factors, namely, blood pressure, diabetes mellitus and obesity. In this review, we examine evidence from epidemiologic and interventional studies in support of the association between exercise and physical activity and health. In addition, we present the exercise effects on the aforementioned risk factors. Finally, we include select dietary approaches and their impact on risk factors and overall mortality risk.

  17. Poverty and child mortality in different contexts: can Mozambique learn from the decline in mortality at the turn of the 19th century in Stockholm?

    Science.gov (United States)

    Macassa, Gloria; Burström, Bo

    2005-01-01

    Child mortality has declined in many low-income countries. However, in Sub-Saharan Africa, childhood mortality is still a major public health problem, which is worsening with some countries experiencing new increases in mortality due to HIV /AIDS. This lack of success in reducing child mortality is not only due to HIV /AIDS, but also to high numbers of deaths in other causes of death such as diarrhoea, pneumonia and neonatal causes, for which there are effective curative and preventative interventions. One problem seems to be in the access, coverage and implementation of these interventions, particularly among the poorer sections of the population. A related problem is the interventions that sometimes, when implemented, take place in environments in which they can only be expected to have limited effects. On the other hand in many developed countries infant and child mortality declined as social and economic changes of modernisation took place. However, the mechanisms that did bring about the decline are still not well understood. This paper discuss whether analyses of the historical decline of mortality in industrialised countries could contribute to knowledge in reducing the high child mortality in poor countries today, based on studies of child mortality in different social contexts in Mozambique 1973-1997 and Stockholm 1878-1925.

  18. Testosterone Therapy and Mortality Risk

    Science.gov (United States)

    Eisenberg, Michael L.; Li, Shufeng; Herder, Danielle; Lamb, Dolores J.; Lipshultz, Larry I.

    2014-01-01

    INTRODUCTION Recent data suggests and increased risk of cardiovascular events and mortality in men on testosterone therapy (TT). To date there are no long term, prospective studies to determine safety. In such cases, retrospective observational studies can be helpful. We examined our patient database to determine if TT altered a man’s risk of all cause mortality. METHODS We queried our hormone database for all men with a serum testosterone level and then examined charts to determine testosterone status. In all, 509 men had charts available for review. We linked our patient records to the National Death Index to determine morality. RESULTS Of the 509 men who met inclusion criteria, 284 were on testosterone therapy and 225 did not use testosterone. Age (mean 54 years) and follow up time (mean 10 years) were similar for both groups. In all, 19 men died—10 (4.4%) of the men not on TT and 9 (3.2%) of the men on TT. After adjusting for age and year of evaluation, there was no significant difference in the risk of death based on TT (HR 1.0, 95% CI 0.39 – 2.57, p=1.0). CONCLUSIONS There appears to be no change in mortality risk overall for men utilizing long-term testosterone therapy. PMID:25078049

  19. Anxiety Predicts Mortality in ICD Patients

    DEFF Research Database (Denmark)

    Kikkenborg Berg, Selina; Caspar Thygesen, Lau; Hastrup Svendsen, Jesper

    2014-01-01

    BACKGROUND: Although highly effective in preventing arrhythmic death, patients receiving an implantable cardioverter defibrillator (ICD) may still experience psychological difficulties such as anxiety, depression, and reduced quality of life. The objectives of this study were to describe patient...... receiving ICD between January 1, 2011 and June 30, 2011 (n = 499). The following instruments were used: SF-36, Hospital Anxiety and Depression Scale, HeartQoL, EQ-5D, and the Multidimensional Fatigue Inventory. RESULTS: The response rate was 72%. Mean age was 65.5 years and 82% patients were males. Fifty...... of perceived health, quality of life, and fatigue; for example, physical health 39.8 versus 44.3 points, compared to secondary prevention indication. Anxiety, poor perceived health, fatigue, and low quality of life were all predictors of mortality, anxiety being the strongest with an adjusted odds ratio of 4...

  20. The role of marriage in the causal pathway from economic conditions early in life to mortality.

    Science.gov (United States)

    van den Berg, Gerard J; Gupta, Sumedha

    2015-03-01

    This paper analyzes the interplay between early-life conditions and marital status, as determinants of adult mortality. We use individual data from Dutch registers (years 1815-2000), combined with business cycle conditions in childhood as indicators of early-life conditions. The empirical analysis estimates bivariate duration models of marriage and mortality, allowing for unobserved heterogeneity. Results show that conditions around birth and school going ages are important for marriage and mortality. Men typically enjoy a protective effect of marriage, whereas women suffer during childbearing ages. However, having been born under favorable economic conditions reduces female mortality during childbearing ages.

  1. Alcohol Consumption Increases Post-Operative Infection but Not Mortality

    DEFF Research Database (Denmark)

    Shabanzadeh, Daniel Mønsted; Sørensen, Lars Tue

    2015-01-01

    BACKGROUND: Alcohol consumption causes multiple comorbidities with potentially negative outcome after operations. The aims are to study the association between alcohol consumption and post-operative non-surgical site infections and mortality and to determine the impact of peri...... alcohol consumption and mortality was found. Meta-analyses of RCTs showed that interventions reduce infections but not mortality in patients with alcohol abuse. CONCLUSIONS: Consumption of more than two units of alcohol per day increases post-operative non-surgical site infections. Alcohol...... for observational studies and RCTs. RESULTS: Thirteen observational studies and five RCTs were identified. Meta-analyses of observational studies showed more infections in those consuming more than two units of alcohol per day compared with drinking less in both unadjusted and adjusted data. No association between...

  2. The business of preventing African-American infant mortality.

    Science.gov (United States)

    Gates-Williams, J; Jackson, M N; Jenkins-Monroe, V; Williams, L R

    1992-09-01

    African-American women are twice as likely as women from other ethnic groups to have babies with low birth weights and to experience the loss of infant death. The problem is so endemic in black communities in Alameda County, California, that numerous programs have been developed over the past decade to reduce maternal risk factors and eliminate barriers to prenatal care. Despite these efforts, African-American ethnicity continues to be a major risk factor for infant mortality for reasons that are poorly understood. We take a critical look at 3 types of studies characteristic of infant mortality research: epidemiologic, studies that advocate prenatal care, and ethnomedical (cultural). We argue that the assumptions informing this research restrict the thinking about infant mortality and the political issues involved in how prevention programs are developed and structured. The persistent focus on maternal behavioral characteristics limits more in-depth analysis of the micropolitics of perinatal bureaucracies established in response to this ongoing crisis.

  3. CDC WONDER: Mortality - Multiple Cause of Death

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Mortality - Multiple Cause of Death data on CDC WONDER are county-level national mortality and population data spanning the years 1999-2009. Data are based on...

  4. CDC WONDER: Mortality - Multiple Cause of Death

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Mortality - Multiple Cause of Death data on CDC WONDER are county-level national mortality and population data spanning the years 1999-2006. These data are...

  5. CDC WONDER: Mortality - Underlying Cause of Death

    Data.gov (United States)

    U.S. Department of Health & Human Services — The CDC WONDER Mortality - Underlying Cause of Death online database is a county-level national mortality and population database spanning the years since 1979. Data...

  6. Mortality hazard rates and life expectancy

    NARCIS (Netherlands)

    J.S. Cramer; R. Kaas

    2013-01-01

    We consider the relation between mortality hazards and life expectancy for men and women in the Netherlands and in England. Halving the lifetime mortality hazards increases life expectancy at birth by only 9%.

  7. Competing risks to breast cancer mortality.

    Science.gov (United States)

    Rosenberg, Marjorie A

    2006-01-01

    Simulation models analyzing the impact of treatment interventions and screening on the level of breast cancer mortality require an input of mortality from causes other than breast cancer, or competing risks. This chapter presents an actuarial method of creating cohort life tables using published data that removes breast cancer as a cause of death. Mortality from causes other than breast cancer as a percentage of all-cause mortality is smallest for women in their forties and fifties, as small as 85% of the all-cause rate, although the level and percentage of the impact varies by birth cohort. This method produces life tables by birth cohort and by age that are easily included as a common input by the various CISNET modeling groups to predict mortality from other causes. Attention to removing breast cancer mortality from all-cause mortality is worthwhile, because breast cancer mortality can be as high as 15% at some ages.

  8. Impact of the Grameen Bank on childhood mortality in Bangladesh.

    Science.gov (United States)

    Rahman, M; Davanzo, J; Sutradhar, S C

    1996-01-01

    The Grameen Bank (GB) is a highly innovative and well-supervised credit program for the rural poor in Bangladesh. About 95% of over 2 million participants are women. GB can positively affect child survival among its participants through its income-generation and consciousness-raising activities. The study examines if GB influences childhood mortality among its participants. An integrated family life survey was carried out during 1993-94 among about 2500 married women in landless households who are eligible for membership in GB. The survey was carried out among randomly selected married women regardless of GB membership in 3 thanas of Tangail district and 1 thana of Mymensingh district. The study permits an analysis in a "before-after" and "treatment-comparison" framework for measuring the impact of GB on childhood mortality. Estimation was done through proportional hazards models, where the effects of confounding factors like calendar year, maternal age, parity, maternal education, economic conditions, and areal variation were controlled for. There was a 34% and significant reduction in childhood (under-5) mortality after the mothers joined the GB. Similar effects of other NGOs on childhood mortality were also observed. Childhood mortality was similar between the GB members before joining the Bank and never-members, indicating that the GB members were not from a selective group. Childhood mortality was 21% and significantly lower among women who worked for income generation than those women who did not work. Income generation and social development programs modeled after the GB and other NGOs can reduce childhood mortality in Bangladesh and similar settings.

  9. Injury and mortality of warmwater fishes immobilized by electrofishing

    Science.gov (United States)

    Dolan, C.R.; Miranda, L.E.

    2004-01-01

    Most studies of injury associated with electrofishing have focused on salmonids: few have given attention to warmwater fishes. Under controlled laboratory conditions, we treated bluegill Lepomis macrochirus, channel catfish Ictalurus punctatus, and largemouth bass Micropterus salmoides of various sizes to duty cycles ranging from 1.5% to 100%. This range of duty cycles represented continuous DC and pulsed-DC frequencies ranging from 15 to 110 Hz and pulse durations of 1 to 6 ms. At each duty cycle, fish were exposed to power densities in excess of those required to immobilize them within 3 s, and we subsequently determined the incidence of hemorrhage, spinal injury, and mortality. Incidence of hemorrhage averaged 3% (range, 0-25%), differed among species, and was not related to duty cycle or fish size. Incidence of spinal injury averaged 3% (range, 0-22%) and mortality averaged 10% (range, 0-75%); both differed among species and were related to duty cycle, fish size, and interactions among these variables. Largemouth bass was the species most vulnerable to hemorrhage, spinal injury, and mortality, channel catfish the least vulnerable; bluegills exhibited effects that were intermediate. Small centrarchids were especially susceptible to mortality. Fish tetanized by the electrical treatment were more likely to experience injury and mortality than fish that were only narcotized. However, mortality was not related to the injuries studied because hemorrhage and spinal injuries were similar in fish that survived electroshock and in those that died. We suggest that electrofishing with intermediate to high duty cycles could reduce electrofishing-induced injury and mortality to warmwater fish. Additionally, the power output and electrode system should be managed to induce narcosis and prevent tetany and to avoid the large peak powers required to immobilize small individuals.

  10. Piglet preweaning mortality in a commercial swine herd in Thailand.

    Science.gov (United States)

    Nuntapaitoon, Morakot; Tummaruk, Padet

    2015-12-01

    In the modern swine industry, the number of piglets born alive per litter is dramatically increasing due to genetic improvement of litter traits. However, knowledge on post-partum management is inadequate to reduce piglet preweaning mortality. The present study aimed to investigate piglet preweaning mortality in a commercial swine herd in Thailand in relation to the number of littermate pigs and piglet birth weight. Data included 11,154 litters from 3574 sows farrowed from January 2009 to December 2012. Littermate pig was defined as the number of piglets after cross-fostering. Number of littermate pigs was classified as 1-7, 8-10, 11-12, and 13-15 piglets per litter. Mean birth weight of the piglets was classified as low (Piglet preweaning mortality was calculated, logged transformed, and analyzed by general linear mixed models. On average, piglet preweaning mortality was 14.5 % (median = 10.0 %). Piglet preweaning mortality in the litter with 13-15 littermate pigs (24.1 %) was significantly higher than the litter with 1-7 (11.9 %, P piglet birth weight had a higher piglet preweaning mortality rate (18.8 %) than the litters with a medium (15.7 %, P piglet birth weight (12.1 %, P piglet preweaning mortality in commercial swine herds, special care needs to be taken in litters with more than 13 littermate pigs and with piglets with birth weight below 1.30 kg.

  11. The interaction between stress and positive affect in predicting mortality.

    Science.gov (United States)

    Okely, Judith A; Weiss, Alexander; Gale, Catharine R

    2017-09-01

    Positive affect is associated with longevity; according to the stress-buffering hypothesis, this is because positive affect reduces the health harming effects of psychological stress. If this mechanism plays a role, then the association between positive affect and mortality risk should be most apparent among individuals who report higher stress. Here, we test this hypothesis. The sample consisted of 8542 participants aged 32-86 from the National Health and Nutrition Examination Survey (NHANES I) Epidemiological Follow-up Study (NHEFS). We used Cox's proportional hazards regression to test for the main effects of and the interaction between positive affect and perceived stress in predicting mortality risk over a 10year follow up period. Greater positive affect was associated with lower mortality risk. We found a significant interaction between positive affect and perceived stress such that the association between positive affect and mortality risk was stronger in people reporting higher stress. In the fully adjusted model, a standard deviation increase in positive affect was associated with a 16% (HR=0.84; 95% CI=0.75, 0.95) reduction in mortality risk among participants who reported high levels of stress. The association between positive affect and mortality risk was weaker and not significant among participants who reported low levels of stress (HR=0.98; 95% CI=0.89, 1.08). Our results support the stress-buffering model and illustrate that the association between positive affect and reduced risk may be strongest under challenging circumstances. Copyright © 2017. Published by Elsevier Inc.

  12. Mortality versus Morbidity in the Demographic Transition

    OpenAIRE

    Aksan, Anna-Maria; Chakraborty, Shankha

    2014-01-01

    The link between the mortality and epidemiological transitions is used to identify the effect of the former on the fertility transition: a mortality transition that is not accompanied by improving morbidity causes slower demographic and economic change. In a model where children may die from infectious disease, childhood health affects human capital and noninfectious-disease-related adult mortality. When child mortality falls from lower prevalence, as it did in western Europe, labor productiv...

  13. [Regional inequalities in cervical cancer mortality in Brazil: trends and projections through to 2030].

    Science.gov (United States)

    Barbosa, Isabelle Ribeiro; Souza, Dyego Leandro Bezerra de; Bernal, María Milagros; Costa, Iris do Céu Clara

    2016-01-01

    The scope of this article is to analyze the temporal trends of cervical cancer mortality in Brazil and calculate the projection of mortality through to the year 2030. Deaths that occurred within the 1996-2010 period were analyzed (Mortality Information System). Mortality trend analysis utilized the Joinpoint regression, while Nordpred was utilized for the calculation of projections. For Brazil, decreasing trends were identified (APC = 1.7% CI95%-2.2; -1.1 p 2030 are explained, principally, by reductions in the risk of the disease. Cervical cancer mortality presents reducing trends, however these are unequally distributed throughout the country, where the North and Northeast regions present the highest mortality rates.

  14. Traffic injury mortality trends in children and adolescents in Lithuania among road users.

    Science.gov (United States)

    Strukcinskiene, Birute; Uğur-Baysal, Serpil; Raistenskis, Juozas

    2014-01-01

    This study analyzes traffic mortality trends among road users from 1998 to 2012 in children and adolescents aged 0-19 years in Lithuania. National mortality data of pedestrians, cyclists, motorcyclists, and car occupants were used to compare trend lines. The study revealed that 56% of the deceased in road traffic crashes were car occupants, while 24% were pedestrians. The incidence of death from traffic injury was 2.5 times higher in boys than girls. Traffic injury mortality and pedestrian mortality rates declined significantly in the total group. There was also a significant decline in mortality among cyclists for the total group and female subgroup. Trends in mortality rates among motorcyclists and car occupants showed no significant changes. A long-term decline is more likely to be affected by efforts in the promotion of sustainable and permanent road safety. The reduced risk exposure may also have been influenced by the economic recession.

  15. Potential Gains in Reproductive-Aged Life Expectancy by Eliminating Maternal Mortality

    DEFF Research Database (Denmark)

    Canudas-Romo, Vladimir; Liu, L; Zimmerman, L

    2014-01-01

    mortality rates. Associated single decrement life tables of causes of death other than maternal mortality are explored to assess the possible gains in RALE by reducing or eliminating maternal mortality. We used population-based data from the Human Mortality Database and the Demographic and Health Surveys......% of potential gains in RALE. Conclusions: Maternal mortality is a rare event, yet it is still a very important component of RALE. Averting the burden of maternal deaths could return a significant increase in the most productive ages of human life.......Objective: We assessed the change over time in the contribution of maternal mortality to a life expectancy calculated between ages 15 and 49, or Reproductive-Aged Life Expectancy (RALE). Our goal was to estimate the increase in RALE in developed countries over the twentieth century...

  16. Hypothermia and normothermia effects on mortality rate of cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Ali Rahdari

    2015-12-01

    Full Text Available Introduction: Cardiopulmonary bypass is associated with higher risk of mortality and morbidity, thus it should be investigated regarding the major risk factors. Temperature management have a significant role in postoperative cerebral and neurological complications; however the optimum temperature during cardiopulmonary surgery is not certainly detected. This systematic review has investigated the differences between hypothermia and normothermia regarding postoperative mortality. Method: PubMed was searched for the relevant articles. Only English language articles were included with no time limitation. Data regarding in-hospital patient deaths provided in each article mostly within 30 days after the surgery, were extracted and compared based on relative risk reduction (RRR, absolute risk reduction (ARR, and number needed to treat (NNT.Result: Totally, 28 articles were retrieved and extracted. The mortality rate was zero in hypothermic and normotehrmic groups of 8/28 included studies, thus the RRR, ARR, and NNT could not be calculated. There were no significant differences between investigated groups of each included studies regarding the patients’ age, gender, and preoperative conditions.Conclusions: No significant difference was obtained between two studied groups. Similar prevalence of death observed between hypothermic and normothermic groups might be due to the sample size of studies, or the subsequent cares performed in intensive care units that assist to reduce the postoperative mortality rate. According to the obtained results, both of these procedures might be similarly safe regarding mortality rate.

  17. Municipal distribution of ovarian cancer mortality in Spain

    Directory of Open Access Journals (Sweden)

    Vidal Enrique

    2008-09-01

    Full Text Available Abstract Background Spain was the country that registered the greatest increases in ovarian cancer mortality in Europe. This study describes the municipal distribution of ovarian cancer mortality in Spain using spatial models for small-area analysis. Methods Smoothed relative risks of ovarian cancer mortality were obtained, using the Besag, York and Molliè autoregressive spatial model. Standardised mortality ratios, smoothed relative risks, and distribution of the posterior probability of relative risks being greater than 1 were depicted on municipal maps. Results During the study period (1989–1998, 13,869 ovarian cancer deaths were registered in 2,718 Spanish towns, accounting for 4% of all cancer-related deaths among women. The highest relative risks were mainly concentrated in three areas, i.e., the interior of Barcelona and Gerona (north-east Spain, the north of Lugo and Asturias (north-west Spain and along the Seville-Huelva boundary (in the south-west. Eivissa (Balearic Islands and El Hierro (Canary Islands also registered increased risks. Conclusion Well established ovarian cancer risk factors might not contribute significantly to the municipal distribution of ovarian cancer mortality. Environmental and occupational exposures possibly linked to this pattern and prevalent in specific regions, are discussed in this paper. Small-area geographical studies are effective instruments for detecting risk areas that may otherwise remain concealed on a more reduced scale.

  18. Mortality resulting from head injury in professional boxing: case report.

    Science.gov (United States)

    Baird, Lissa C; Newman, C Benjamin; Volk, Hunter; Svinth, Joseph R; Conklin, Jordan; Levy, Michael L

    2010-08-01

    The majority of boxing-related fatalities result from traumatic brain injury. Biomechanical forces in boxing result in rotational acceleration with resultant subdural hematoma and diffuse axonal injury. Given the inherent risk and the ongoing criticism boxing has received, we evaluated mortalities associated with professional boxing. We used the Velazquez Fatality Collection of boxing injuries and supplementary sources to analyze mortality from 1950 to 2007. Variables evaluated included age at time of death, association with knockout or other outcome of match, rounds fought, weight class, location of fight, and location of preterminal event. There were 339 mortalities between 1950 and 2007 (mean age, 24 +/- 3.8 years); 64% were associated with knockout and 15% with technical knockout. A higher percentage occurred in the lower weight classes. The preterminal event occurred in the ring (61%), in the locker room (17%), and outside the arena (22%). We evaluated for significant changes after 1983 when championship bouts were reduced from 15 to 12 rounds. There was a significant decline in mortality after 1983. We found no significant variables to support that this decline is related to a reduction in rounds. Rather, we hypothesize the decline to be the result of a reduction in exposure to repetitive head trauma (shorter careers and fewer fights), along with increased medical oversight and stricter safety regulations. Increased efforts should be made to improve medical supervision of boxers. Mandatory central nervous system imaging after a knockout could lead to a significant reduction in associated mortality.

  19. Mortality resulting from head injury in professional boxing.

    Science.gov (United States)

    Baird, Lissa C; Newman, C Benjamin; Volk, Hunter; Svinth, Joseph R; Conklin, Jordan; Levy, Michael L

    2010-11-01

    The majority of boxing-related fatalities result from traumatic brain injury. Biomechanical forces in boxing result in rotational acceleration with resultant subdural hematoma and diffuse axonal injury. Given the inherent risk and the ongoing criticism boxing has received, we evaluated mortalities associated with professional boxing. We used the Velaquez Fatality Collection of boxing injuries and supplementary sources to analyze mortality from 1950 to 2007. Variables evaluated included age at time of death, association with knockout or other outcome of match, rounds fought, weight class, location of fight, and location of pretermial event. There were 339 mortalities between 1950 and 2007 (mean age, 24 ± 3.8 years); 64% were associated with knockout and 15% with technical knockout. A higher percentage occurred in the lower weight classes. The preterminal event occurred in the ring (61%), in the locker room (17%), and outside the arena (22%), We evaluated for significant changes after 1983 when championship bouts were reduced from 15 to 12 rounds. There was a significant decline in mortality after 1983. We found no significant variables to support that this decline is related to a reduction in rounds. Rather, we hypothesize the decline to be the result of a reduction in exposure to repetitive head trauma (shorter careers and fewer fights), along with increased medical oversight and stricter safety regulations. Increased efforts should be made to improve medical supervisions of boxers. Mandatory central nervous system imaging after a knockout could lead to a significant reduction in associated mortality.

  20. High mortality in the Thule cohort

    DEFF Research Database (Denmark)

    Juel, K

    1994-01-01

    The objective was to study mortality in the Thule cohort in order to clarify whether it is a selected population and to ascertain the possibility of misinterpretation when national mortality rates are used as reference in the analysis of occupational mortality....

  1. Advance Report of Final Mortality Statistics, 1985.

    Science.gov (United States)

    Monthly Vital Statistics Report, 1987

    1987-01-01

    This document presents mortality statistics for 1985 for the entire United States. Data analysis and discussion of these factors is included: death and death rates; death rates by age, sex, and race; expectation of life at birth and at specified ages; causes of death; infant mortality; and maternal mortality. Highlights reported include: (1) the…

  2. Human mortality improvement in evolutionary context

    DEFF Research Database (Denmark)

    Burger, Oskar; Baudisch, Annette; Vaupel, James W

    2012-01-01

    has not been placed in a broad evolutionary context. We quantify the rate and amount of mortality reduction by comparing a variety of human populations to the evolved human mortality profile, here estimated as the average mortality pattern for ethnographically observed hunter-gatherers. We show...

  3. Mortality in adult congenital heart disease

    NARCIS (Netherlands)

    C.L. Verheugt (Carianne); C.S.P.M. Uiterwaal (Cuno); E.T. van der Velde (Enno); F.J. Meijboom (Folkert); P.G. Pieper (Petronella); A.P.J. van Dijk (Arie); H.W. Vliegen (Hubert); D.E. Grobbee (Diederick); B.J.M. Mulder (Barbara)

    2010-01-01

    textabstractAimsMortality in adults with congenital heart disease is known to be increased, yet its extent and the major mortality risks are unclear.Methods and resultsThe Dutch CONCOR national registry for adult congenital heart disease was linked to the national mortality registry. Cox's regressio

  4. Mortality in adult congenital heart disease

    NARCIS (Netherlands)

    C.L. Verheugt (Carianne); C.S.P.M. Uiterwaal (Cuno); E.T. van der Velde (Enno); F.J. Meijboom (Folkert); P.G. Pieper (Petronella); A.P.J. van Dijk (Arie); H.W. Vliegen (Hubert); D.E. Grobbee (Diederick); B.J.M. Mulder (Barbara)

    2010-01-01

    textabstractAimsMortality in adults with congenital heart disease is known to be increased, yet its extent and the major mortality risks are unclear.Methods and resultsThe Dutch CONCOR national registry for adult congenital heart disease was linked to the national mortality registry. Cox's

  5. Mortality in adult congenital heart disease.

    NARCIS (Netherlands)

    Verheugt, C.L.; Uiterwaal, C.S.; Velde, E.T. van der; Meijboom, F.J.; Pieper, P.G.; Dijk, A.P.J. van; Vliegen, H.W.; Grobbee, D.E.; Mulder, B.J.

    2010-01-01

    AIMS: Mortality in adults with congenital heart disease is known to be increased, yet its extent and the major mortality risks are unclear. METHODS AND RESULTS: The Dutch CONCOR national registry for adult congenital heart disease was linked to the national mortality registry. Cox's regression was

  6. Management risk factors for calf mortality in intensive Italian dairy farms

    Directory of Open Access Journals (Sweden)

    Maddalena Zucali

    2013-04-01

    Full Text Available High calf mortality is an important factor of economic loss in dairy production. At present, limited data are available on calf rearing practices and calf mortality in Italian dairy farming. The aim of the study was to identify the most important management risk factors for preweaning calf mortality in Italian dairy farms. A group of 28 intensive dairy farms from Lombardy (Italy were visited to collect information about calf management and calf mortality. Female calf mortality showed high variability among herds and in many cases the percentage of calves dead within the preweaning period was very high. The average perinatal mortality (during calving and within 24 h after birth was 8.82% of total females born with a maximum value of 30.8%, whereas average early mortality (from 24 h to weaning was 8.9±7.9%, with a maximum value of 28%. The herd size did not significantly affect calf mortality although the number of calves cared per operator in the big farms was higher than in the small ones. Multivariate logistic analysis showed that feeding first colostrum meal beyond three hours after birth, group housing before 30 d of age and feeding daily less than 5 L of milk or milk replacer per calf multiply the risk to have early mortality higher than 10%. The study showed that early calf mortality could be strongly reduced by paying more attention to a very limited number of operations.

  7. Social inequality in infant mortality: what explains variation across low and middle income countries?

    Science.gov (United States)

    Hajizadeh, Mohammad; Nandi, Arijit; Heymann, Jody

    2014-01-01

    Growing work demonstrates social gradients in infant mortality within countries. However, few studies have compared the magnitude of these inequalities cross-nationally. Even fewer have assessed the determinants of social inequalities in infant mortality across countries. This study provides a comprehensive and comparative analysis of social inequalities in infant mortality in 53 low-and-middle-income countries (LMICs). We used the most recent nationally representative household samples (n = 874,207) collected through the Demographic Health Surveys (DHS) to calculate rates of infant mortality. The relative and absolute concentration indices were used to quantify social inequalities in infant mortality. Additionally, we used meta-regression analyses to examine whether levels of inequality in proximate determinants of infant mortality were associated with social inequalities in infant mortality across countries. Estimates of both the relative and the absolute concentration indices showed a substantial variation in social inequalities in infant mortality among LMICs. Meta-regression analyses showed that, across countries, the relative concentration of teenage pregnancy among poorer households was positively associated with the relative concentration of infant mortality among these groups (beta = 0.333, 95% CI = 0.115 0.551). Our results demonstrate that the concentration of infant deaths among socioeconomically disadvantaged households in the majority of LMICs remains an important health and social policy concern. The findings suggest that policies designed to reduce the concentration of teenage pregnancy among mothers in lower socioeconomic groups may mitigate social inequalities in infant mortality.

  8. Influence of mild therapeutic hypothermia after cardiac arrest on hospital mortality

    NARCIS (Netherlands)

    van der Wal, Greetje; Brinkman, Sylvia; Bisschops, Laurens L. A.; Hoedemaekers, Cornelia W.; van der Hoeven, Johannes G.; de Lange, Dylan W.; de Keizer, Nicolette F.; Pickkers, Peter

    2011-01-01

    Objective: Following two randomized controlled trials that demonstrated reduced mortality and better neurological outcome in cardiac arrest patients, mild therapeutic hypothermia was implemented in many intensive care units. Up to now, no large observational studies have confirmed the beneficial eff

  9. A mortality study of workers exposed to insoluble forms of beryllium.

    Science.gov (United States)

    Boffetta, Paolo; Fordyce, Tiffani; Mandel, Jack S

    2014-11-01

    This study investigated lung cancer and other diseases related to insoluble beryllium compounds. A cohort of 4950 workers from four US insoluble beryllium manufacturing facilities were followed through 2009. Expected deaths were calculated using local and national rates. On the basis of local rates, all-cause mortality was significantly reduced. Mortality from lung cancer (standardized mortality ratio 96.0; 95% confidence interval 80.0, 114.3) and from nonmalignant respiratory diseases was also reduced. There were no significant trends for either cause of death according to duration of employment or time since first employment. Uterine cancer among women was the only cause of death with a significantly increased standardized mortality ratio. Five of the seven women worked in office jobs. This study confirmed the lack of an increase in mortality from lung cancer and nonmalignant respiratory diseases related to insoluble beryllium compounds.

  10. Reducing Resistance

    DEFF Research Database (Denmark)

    Lindell, Johanna

    care may influence decisions on antibiotic use. Based on video-and audio recordings of physician-patient consultations it is investigated how treatment recommendations are presented, can be changed, are forecast and explained, and finally, how they seemingly meet resistance and how this resistance......Antibiotic resistance is a growing public health problem both nationally and internationally, and efficient strategies are needed to reduce unnecessary use. This dissertation presents four research studies, which examine how communication between general practitioners and patients in Danish primary...... is responded to.The first study in the dissertation suggests that treatment recommendations on antibiotics are often done in a way that encourages patient acceptance. In extension of this, the second study of the dissertation examines a case, where acceptance of such a recommendation is changed into a shared...

  11. The mortality of elder mistreatment.

    Science.gov (United States)

    Lachs, M S; Williams, C S; O'Brien, S; Pillemer, K A; Charlson, M E

    1998-08-05

    Although elder mistreatment is suspected to be life threatening in some instances, little is known about the survival of elderly persons who have been mistreated. To estimate the independent contribution of reported elder abuse and neglect to all-cause mortality in an observational cohort of community-dwelling older adults. Prospective cohort study with at least 9 years of follow-up. The New Haven Established Population for Epidemiologic Studies in the Elderly cohort, which included 2812 community-dwelling adults who were older than 65 years in 1982, a subset of whom were referred to protective services for the elderly. All-cause mortality among (1) elderly persons for whom protective services were used for corroborated elder mistreatment (elder abuse, neglect, and/or exploitation), or (2) elderly persons for whom protective services were used for self-neglect. In the first 9 years after cohort inception, 176 cohort members were seen by elderly protective services for verified allegations; 10 (5.7%) of these were for abuse, 30 (17.0%) for neglect, 8 (4.5%) for exploitation, and 128 (72.7%) for self-neglect. At the end of a 13-year follow-up period from cohort inception, cohort members seen for elder mistreatment at any time during the follow-up had poorer survival (9%) than either those seen for self-neglect (17%) or other noninvestigated cohort members (40%) (Pself-neglect (odds ratio, 1.7; 95% confidence interval, 1.2-2.5), when compared with other members of the cohort. Reported and corroborated elder mistreatment and self-neglect are associated with shorter survival after adjusting for other factors associated with increased mortality in older adults.

  12. Spatial patterns of mortality in Bangladesh.

    Science.gov (United States)

    Sharif, A H; Huq, S M; Mesbah-us-Saleheen

    1993-05-01

    This paper depicts the spatial patterns of mortality of the administrative upazilas of Bangladesh. Due to the absence of adequate data on mortality rates from across the country, the mortality rates of the upazilas are calculated from the age sex structure of the population of the respective upazilas employing the standardized mortality rates of divisional headquarters. Crude death rates are used to determine spatial patterns of mortality in Bangladesh. The patterns portray strong regional differences. Such differentiation is accounted for by traditional differences in demographic and socio-economic factors. Also, regression analysis is used to assist in explaining spatial variations.

  13. Phenomenological theory of mortality and aginge

    Science.gov (United States)

    Azbel', Mark Ya.

    There are many theories of mortality, but no consensus even on the basic problem: is it genetically determined? In a general case, the problem is mathematically unsolvable. Yet, in the case of mortality, a physical approach yields its universal law. The law predicts, e.g., that mortality and senescence may decrease with age. Experiments verify it. I suggest experiments, which are supposed to produce genetic Methuselas, who live, e.g., over 20 η ( η is the mean life span), but whose biological age is less than η/2. If the universal mortality law is convincingly proven, it may lead to a quantitative model and theory of mortality and aging.

  14. True bug (Heteroptera) impact on cocoa fruit mortality and productivity.

    Science.gov (United States)

    Yede; Babin, R; Djieto-Lordon, C; Cilas, C; Dibog, L; Mahob, R; Bilong, C F Bilong

    2012-08-01

    The real impact of true bug damage on cocoa pods has never been assessed precisely. We conducted a 2-yr study on 1,080 cocoa trees on 36 farms in Cameroon to assess the contribution of true bugs to fruit mortality and production loss. The cocoa fruiting cycle, fruit mortality, and damage caused by true bugs as well as other pests and diseases were monitored on a weekly basis. True bug damage also was described on 2,500 ripe pods per year. Pod weight, bean number, and bean weight were measured and compared for different degrees and types of damage on the ripe pods. Our results showed that true bugs were the main external cause of young fruit abortion. They reduced the abundance of young fruit by up to 10%. In contrast, although one-third of the ripe pods sampled had true bug lesions, only 4% were moderately to heavily damaged. The mean weight of ripe pods was reduced by 12% when there was medium to heavy damage. While the mean weight of wet beans was reduced significantly (by 3-10%), the number of beans per pod was not changed by damage. Despite the reduction in mean weight, the overall weight of beans for the pods sampled was reduced by fruit mortality.

  15. Mortality Attributable to Low Levels of Education in the United States

    Science.gov (United States)

    Krueger, Patrick M.; Tran, Melanie K.; Hummer, Robert A.; Chang, Virginia W.

    2015-01-01

    education and mortality is causal. Thus, policies that increase education could significantly reduce adult mortality. PMID:26153885

  16. An update on maternal mortality and morbidity in the United States.

    Science.gov (United States)

    Edwards, Joan E; Hanke, June C

    2013-10-01

    Significant strides have been made in recent years to reduce maternal morbidity and mortality rates around the world. But in the United States, maternal mortality rates have increased from 6.6/100,000 live births in the 1980s and 1990s to somewhere between 13.3/100,000 live births, as reported by the Centers for Disease Control and Prevention, and 21/100,000 live births, as reported by the World Health Organization. This article discusses factors influencing this trend, and explores organizations, systems and programs that have shown promise for reducing maternal morbidity and mortality.

  17. Migrant mortality from diabetes mellitus across Europe

    DEFF Research Database (Denmark)

    Vandenheede, Hadewijch; Deboosere, Patrick; Stirbu, Irina

    2012-01-01

    mortality registers. Subsequently, to examine the second hypothesis, we introduced gross domestic product (GDP) per capita of COB in the models, as an indicator of socio-economic circumstances. The overall pattern shows higher diabetes mortality in migrant populations compared to local-born populations....... Mortality rate ratios (MRRs) were highest in migrants originating from either the Caribbean or South Asia. MRRs for the migrant population as a whole were 1.9 (95% CI 1.8-2.0) and 2.2 (95% CI 2.1-2.3) for men and women respectively. We furthermore found a consistently inverse association between GDP of COB...... and diabetes mortality. Most migrant groups have higher diabetes mortality rates than the local-born populations. Mortality rates are particularly high in migrants from North Africa, the Caribbean, South Asia or low-GDP countries. The inverse association between GDP of COB and diabetes mortality suggests...

  18. [Mortality by poisoning in children].

    Science.gov (United States)

    Híjar, M; Blanco, J; Carrillo, C; Rascón, A

    1998-01-01

    To determine the standing of mortality by poisoning in children in the Mexican Republic, in the years from 1979-1994. Secondary sources were employed. Analyzed variables were: age, sex, year, external cause of trauma and poisoning according to the 9th International Classification of Diseases: E850-E858, E860-E869 and E905. Tendencies by specific causes were analyzed with a Poisson regression model and relative risk by age, sex and district were obtained. A total of 11,272 children under 15 years of age were recorded. The main causes were poisoning and toxic reactions caused by venomous plants or animals (E905); accidental poisoning by household gas or carbon monoxide (E868); and accidental poisoning by other drugs (E858). The relative risk was highest in age group Aguascalientes consistently presented the highest risk values and the state of Nuevo Leon, the lowest. Poisoning is an important cause of child mortality. Considering that most of these deaths can potentially be prevented since they occur at home it is recommended that responsible adults can build protection into their environment and into the way society operates. Prevention should involve a multidisciplinary approach since the phenomenon has multiple causes and possible solutions.

  19. Factors associated with mortality in tuberculosis patients

    Directory of Open Access Journals (Sweden)

    Roya Alavi-Naini

    2013-01-01

    Full Text Available Background: Tuberculosis (TB is one of the main causes of morbidity and mortality in different societies. Understanding factors leading to death following diagnosis of TB is important to predict prognosis in TB patients. The aim of this study was to identify common risk factors associated with death in patients with an in-hospital diagnosis of TB, in a city in Iran with the highest prevalence and incidence of TB in the country. Materials and Methods: A retrospective study was conducted at a university-affiliated hospital, Zahedan, in the south-east of Iran, which is a referral center for TB. To identify factors leading to death, medical records of 715 patients ≥15 years old with pulmonary TB from February 2002 to February 2011 have been evaluated. Registered factors included smoking, human immune deficiency virus (HIV infection, using drugs, lung cancer, drug hepatitis following anti-TB medications, diabetes mellitus, previous TB treatment, anemia; and results of sputum smears. Univariate comparison and multiple logistic regression were performed to identify factors associated with mortality in TB patients. Results: Among 715 registered TB patients, 375 (52.5% patients were male; among those, 334 (53% were in the alive group and 41 (54% in the death group. Seventy-five (10.5% of the total number of TB patients died during TB treatment. The multivariate model showed that anemia (AOR: 19.8, 95% CI: 5.6-35.5, positive sputum smear (AOR: 13.4, 95% CI: 6.8-33.6, smoking (AOR: 12.9, 95% CI: 3.9-27.3, drug hepatitis (AOR: 12.3, 95% CI: 6.7-24.7, diabetes mellitus (AOR: 9.7, 95% CI: 2.9-32.0, drug use (AOR: 7.8, 95% CI: 2.4-25.5, and history of previous TB (AOR: 6.8, 95% CI: 2.2-21.3 were major risk factors for death in TB patients. Conclusion: Monitoring co-morbid conditions like diabetes mellitus and anemia are important to reduce death rate in TB patients. Preventive measures for smoking and drug addiction also play an important role to decrease

  20. Diabetes and perinatal mortality in twin pregnancies.

    Directory of Open Access Journals (Sweden)

    Zhong-Cheng Luo

    Full Text Available BACKGROUND: Diabetes in pregnancy has been associated with a paradoxically reduced risk of neonatal death in twin pregnancies. Risk "shift" may be a concern in that the reduction in neonatal deaths may be due to an increase in fetal deaths (stillbirths. This study aimed to clarify the impact of diabetes on the risk of perinatal death (neonatal death plus stillbirth