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Sample records for increased mortality reduced

  1. Economic impact of reduced mortality due to increased cycling.

    Rutter, Harry; Cavill, Nick; Racioppi, Francesca; Dinsdale, Hywell; Oja, Pekka; Kahlmeier, Sonja

    2013-01-01

    Increasing regular physical activity is a key public health goal. One strategy is to change the physical environment to encourage walking and cycling, requiring partnerships with the transport and urban planning sectors. Economic evaluation is an important factor in the decision to fund any new transport scheme, but techniques for assessing the economic value of the health benefits of cycling and walking have tended to be less sophisticated than the approaches used for assessing other benefits. This study aimed to produce a practical tool for estimating the economic impact of reduced mortality due to increased cycling. The tool was intended to be transparent, easy to use, reliable, and based on conservative assumptions and default values, which can be used in the absence of local data. It addressed the question: For a given volume of cycling within a defined population, what is the economic value of the health benefits? The authors used published estimates of relative risk of all-cause mortality among regular cyclists and applied these to levels of cycling defined by the user to produce an estimate of the number of deaths potentially averted because of regular cycling. The tool then calculates the economic value of the deaths averted using the "value of a statistical life." The outputs of the tool support decision making on cycle infrastructure or policies, or can be used as part of an integrated economic appraisal. The tool's unique contribution is that it takes a public health approach to a transport problem, addresses it in epidemiologic terms, and places the results back into the transport context. Examples of its use include its adoption by the English and Swedish departments of transport as the recommended methodologic approach for estimating the health impact of walking and cycling. Copyright © 2013 World Health Organization. Published by Elsevier Inc. All rights reserved.

  2. Increasing immunization, reducing child mortality in Haiti | IDRC ...

    2016-05-02

    May 2, 2016 ... A contributing factor is Haiti's extremely low rates of immunization—some of the lowest in ... of factors increased coverage, including greater parental awareness, ... Impact on health policy and practice. ... Canadian initiative leading the way for equitable health systems and improved maternal, child health.

  3. Power and death: Mortality salience increases power seeking while feeling powerful reduces death anxiety.

    Belmi, Peter; Pfeffer, Jeffrey

    2016-05-01

    According to Terror Management Theory, people respond to reminders of mortality by seeking psychological security and bolstering their self-esteem. Because previous research suggests that having power can provide individuals a sense of security and self-worth, we hypothesize that mortality salience leads to an increased motivation to acquire power, especially among men. Study 1 found that men (but not women) who wrote about their death reported more interest in acquiring power. Study 2A and Study 2B demonstrated that when primed with reminders of death, men (but not women) reported behaving more dominantly during the subsequent week, while both men and women reported behaving more prosocially during that week. Thus, mortality salience prompts people to respond in ways that help them manage their death anxiety but in ways consistent with normative gender expectations. Furthermore, Studies 3-5 showed that feeling powerful reduces anxiety when mortality is salient. Specifically, we found that when primed to feel more powerful, both men and women experienced less mortality anxiety. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  4. Reducing infant mortality.

    Johnson, T R

    1994-01-01

    Public health and social policies at the population level (e.g., oral rehydration therapy and immunization) are responsible for the major reduction in infant mortality worldwide. The gap in infant mortality rates between developing and developed regions is much less than that in maternal mortality rates. This indicates that maternal and child health (MCH) programs and women's health care should be combined. Since 1950, 66% of infant deaths occur in the 1st 28 days, indicating adverse prenatal and intrapartum events (e.g., congenital malformation and birth injuries). Infection, especially pneumonia and diarrhea, and low birth weight are the major causes of infant mortality worldwide. An estimated US$25 billion are needed to secure the resources to control major childhood diseases, reduce malnutrition 50%, reduce child deaths by 4 million/year, provide potable water and sanitation to all communities, provide basic education, and make family planning available to all. This cost for saving children's lives is lower than current expenditures for cigarettes (US$50 billion in Europe/year). Vitamin A supplementation, breast feeding, and prenatal diagnosis of congenital malformations are low-cost strategies that can significantly affect infant well-being and reduce child mortality in many developing countries. The US has a higher infant mortality rate than have other developed countries. The American College of Obstetricians and Gynecologists and the US National Institutes of Health are focusing on prematurity, low birth weight, multiple pregnancy, violence, alcohol abuse, and poverty to reduce infant mortality. Obstetricians should be important members of MCH teams, which also include traditional birth attendants, community health workers, nurses, midwives, and medical officers. We have the financial resources to allocate resources to improve MCH care and to reduce infant mortality.

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

    Nielsen, Bjarne; Madsen, Per; Henryon, Mark

    2012-01-01

    . The heritabilities of maternal effect on litter size were 0.079 and 0.095 in Landrace and Yorkshir e. The heritabilities of maternal effect on piglet-mortality rates were 0.069 and 0.082 in Landrace and Yorkshire. The genetic correlation between litter size and mortality rate were unfavourable; and the estimates......-netic gain has reduced the piglet mortality rate by 4 %-points in Landrace and Yorkshire from 2004 to 2010. The genetics gain was confirmed by decreased phenotypic annual mortality rates in the breeding and multiplier herds....

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

    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

  7. Fever Is Associated with Reduced, Hypothermia with Increased Mortality in Septic Patients: A Meta-Analysis of Clinical Trials.

    Rumbus, Zoltan; Matics, Robert; Hegyi, Peter; Zsiboras, Csaba; Szabo, Imre; Illes, Anita; Petervari, Erika; Balasko, Marta; Marta, Katalin; Miko, Alexandra; Parniczky, Andrea; Tenk, Judit; Rostas, Ildiko; Solymar, Margit; Garami, Andras

    2017-01-01

    Sepsis is usually accompanied by changes of body temperature (Tb), but whether fever and hypothermia predict mortality equally or differently is not fully clarified. We aimed to find an association between Tb and mortality in septic patients with meta-analysis of clinical trials. We searched the PubMed, EMBASE, and Cochrane Controlled Trials Registry databases (from inception to February 2016). Human studies reporting Tb and mortality of patients with sepsis were included in the analyses. Average Tb with SEM and mortality rate of septic patient groups were extracted by two authors independently. Forty-two studies reported Tb and mortality ratios in septic patients (n = 10,834). Pearson correlation analysis revealed weak negative linear correlation (R2 = 0.2794) between Tb and mortality. With forest plot analysis, we found a 22.2% (CI, 19.2-25.5) mortality rate in septic patients with fever (Tb > 38.0°C), which was higher, 31.2% (CI, 25.7-37.3), in normothermic patients, and it was the highest, 47.3% (CI, 38.9-55.7), in hypothermic patients (Tb 75%).

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

    Egeberg, Alexander; Skov, Lone; Andersen, Yuki M F

    2017-01-01

    Background 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.  Objective We investigated 10-year mortality after hospitalization for AD compared with psoriasis and the genera...

  9. Mortality risk in hemodialysis patients with increased arterial stiffness is reduced by attainment of classical clinical performance measures

    Scholze, Alexandra; Thies, Christina; Cheikhalfraj, Mohamed

    2009-01-01

    We determined whether attainment of classical clinical performance measures for hemodialysis care improves survival in hemodialysis patients with increased arterial stiffness.......We determined whether attainment of classical clinical performance measures for hemodialysis care improves survival in hemodialysis patients with increased arterial stiffness....

  10. 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

    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

  11. 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.

    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

  12. Increased Plasmodium chabaudi malaria mortality in mice with nutritional iron deficiency can be reduced by short-term adjunctive iron supplementation

    Castberg, Filip C; Maretty, Lasse; Staalsoe, Trine

    2018-01-01

    infected mice had extramedullary splenic haematopoiesis, and iron-supplemented mice had visually detectable intracellular iron stores. CONCLUSIONS: Blood transfusions are the only currently available means to correct severe anaemia in children with malaria. The potential of carefully timed, short...... parts of the world. This has rendered interventions against iron deficiency in malaria-endemic areas controversial. METHODS: The effect of nutritional iron deficiency on the clinical outcome of Plasmodium chabaudi AS infection in A/J mice and the impact of intravenous iron supplementation with ferric...... deficiency was associated with increased mortality from P. chabaudi malaria. This increased mortality could be partially offset by carefully timed, short-duration adjunctive iron supplementation. Moribund animals were characterized by low levels of hepcidin and high levels of fibroblast growth factor 23. All...

  13. Low dose irradiation reduces cancer mortality rates

    Luckey, T.D.

    2000-01-01

    Low doses of ionizing radiation stimulate development, growth, memory, sensual acuity, fecundity, and immunity (Luckey, T.D., ''Radiation Hormesis'', CRC Press, 1991). Increased immune competence reduces cancer mortality rates and provides increased average lifespan in animals. Decreased cancer mortality rates in atom bomb victims who received low dose irradiation makes it desirable to examine populations exposed to low dose irradiation. Studies with over 300,000 workers and 7 million person-years provide a valid comparison of radiation exposed and control unclear workers (Luckey, T.D., Nurture with Ionizing Radiation, Nutrition and Cancer, 34:1-11, 1999). Careful selection of controls eliminated any ''healthy worker effect''. The person-year corrected average indicated the cancer mortality rate of exposed workers was only 51% that of control workers. Lung cancer mortality rates showed a highly significant negative correlation with radon concentrations in 272,000 U.S. homes (Cohen, B.L., Health Physics 68:157-174, 1995). In contrast, radon concentrations showed no effect on lung cancer rates in miners from different countries (Lubin, J.H. Am. J. Epidemiology 140:323-332, 1994). This provides evidence that excessive lung cancer in miners is caused by particulates (the major factor) or toxic gases. The relative risk for cancer mortality was 3.7% in 10,000 Taiwanese exposed to low level of radiation from 60 Co in their steel supported homes (Luan, Y.C. et al., Am. Nuclear Soc. Trans. Boston, 1999). This remarkable finding needs further study. A major mechanism for reduced cancer mortality rates is increased immune competence; this includes both cell and humoral components. Low dose irradiation increases circulating lymphocytes. Macrophage and ''natural killer'' cells can destroy altered (cancer) cells before the mass becomes too large. Low dose irradiation also kills suppressor T-cells; this allows helper T-cells to activate killer cells and antibody producing cells

  14. Vitamin D with calcium reduces mortality

    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......,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...

  15. Mortality and reduced growth hormone secretion

    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 dise...

  16. Infection increases mortality in necrotizing pancreatitis

    Werge, Mikkel; Novovic, Srdjan; Schmidt, Palle N

    2016-01-01

    OBJECTIVES: To assess the influence of infection on mortality in necrotizing pancreatitis. METHODS: Eligible prospective and retrospective studies were identified through manual and electronic searches (August 2015). The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Meta...... sterile necrosis and organ failure was associated with a mortality of 19.8%. If the patients had infected necrosis without organ failure the mortality was 1.4%. CONCLUSIONS: Patients with necrotizing pancreatitis are more than twice as likely to die if the necrosis becomes infected. Both organ failure...... and infected necrosis increase mortality in necrotizing pancreatitis....

  17. 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.

    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. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Continuing increase in mesothelioma mortality in Britain.

    Peto, J; Hodgson, J T; Matthews, F E; Jones, J R

    1995-03-04

    Mesothelioma is closely related to exposure to asbestos, and mesothelioma mortality can be taken as an index of past exposure to asbestos in the population. We analysed mesothelioma mortality since 1968 to assess the current state of the mesothelioma epidemic, and to predict its future course. We found that rates of mesothelioma in men formed a clear pattern defined by age and date of birth. Rates rose steeply with age showing a very similar pattern in all five-year birth cohorts. By date of birth, rates increased from mid-1893 to mid-1948, and then fell. Relative to the 1943-48 cohort, the risk for the 1948-53 cohort is 0.79 and for the 1953-58 cohort 0.48. Despite these falls, if the age profile of rates for these cohorts follows the pattern of past cohorts, their predicted lifetime mesothelioma risks will be 1.3%, 1.0%, and 0.6%. Combining projections for all cohorts results in a peak of annual male mesothelioma deaths in about the year 2020 of between 2700 and 3300 deaths. If diagnostic trend is responsible for a 20% growth in recorded cases every 5 years--an extreme but arguable case--and if this trend has now ceased, the peak of annual male deaths will be reduced to 1300, reached around the year 2010. Analysis of occupations recorded on death certificates indicate that building workers, especially plumbers and gas fitters, carpenters and electricians are the largest high-risk group. These data indicate that mesothelioma deaths will continue to increase for at least 15 and more likely 25 years. For the worst affected cohorts--men born in the 1940s--mesothelioma may account for around 1% of all deaths. Asbestos exposure at work in construction and building maintenance will account for a large proportion of these deaths, and it is important that such workers should be aware of the risks and take appropriate precautions.

  19. Increased mortality among people with anxiety disorders

    Meier, Sandra M; Mattheisen, Manuel; Mors, Ole

    2016-01-01

    BACKGROUND: Anxiety disorders and depression are the most common mental disorders worldwide and have a striking impact on global disease burden. Although depression has consistently been found to increase mortality; the role of anxiety disorders in predicting mortality risk is unclear. AIMS......: To assess mortality risk in people with anxiety disorders. METHOD: We used nationwide Danish register data to conduct a prospective cohort study with over 30 million person-years of follow-up. RESULTS: In total, 1066 (2.1%) people with anxiety disorders died during an average follow-up of 9.7 years....... The risk of death by natural and unnatural causes was significantly higher among individuals with anxiety disorders (natural mortality rate ratio (MRR) = 1.39, 95% CI 1.28-1.51; unnatural MRR = 2.46, 95% CI 2.20-2.73) compared with the general population. Of those who died from unnatural causes, 16.5% had...

  20. Nutrient enrichment increases mortality of mangroves.

    Catherine E Lovelock

    Full Text Available Nutrient enrichment of the coastal zone places intense pressure on marine communities. Previous studies have shown that growth of intertidal mangrove forests is accelerated with enhanced nutrient availability. However, nutrient enrichment favours growth of shoots relative to roots, thus enhancing growth rates but increasing vulnerability to environmental stresses that adversely affect plant water relations. Two such stresses are high salinity and low humidity, both of which require greater investment in roots to meet the demands for water by the shoots. Here we present data from a global network of sites that documents enhanced mortality of mangroves with experimental nutrient enrichment at sites where high sediment salinity was coincident with low rainfall and low humidity. Thus the benefits of increased mangrove growth in response to coastal eutrophication is offset by the costs of decreased resilience due to mortality during drought, with mortality increasing with soil water salinity along climatic gradients.

  1. Low Nonfasting Triglycerides and Reduced All-Cause Mortality

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

    2014-01-01

    BACKGROUND: 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 associated with reduced all-cause mortality (n = 10 208). RESULTS: During a median 24 and 17 years of 100% complete follow-up, 9991...

  2. Alcohol dependence and physical comorbidity: Increased prevalence but reduced relevance of individual comorbidities for hospital-based mortality during a 12.5-year observation period in general hospital admissions in urban North-West England.

    Schoepf, D; Heun, R

    2015-06-01

    logistic regression analysis, accounting for possible associations of diseases, identified twenty-three physical comorbidities contributing to hospital-based mortality in individuals with AD. However, all these comorbidities had an equal or even lower impact on hospital-based mortality than in the comparison sample. The excess of in-hospital deaths in general hospitals in individuals with AD is due to an increase of multiple physical comorbidities, even though individual diseases have an equal or even reduced impact on general hospital-based mortality in individuals with AD compared to controls. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  3. National surgical mortality audit may be associated with reduced mortality after emergency admission.

    Kiermeier, Andreas; Babidge, Wendy J; McCulloch, Glenn A J; Maddern, Guy J; Watters, David A; Aitken, R James

    2017-10-01

    The Western Australian Audit of Surgical Mortality was established in 2002. A 10-year analysis suggested it was the primary driver in the subsequent fall in surgeon-related mortality. Between 2004 and 2010 the Royal Australasian College of Surgeons established mortality audits in other states. The aim of this study was to examine national data from the Australian Institute of Health and Welfare (AIHW) to determine if a similar fall in mortality was observed across Australia. The AIHW collects procedure and outcome data for all surgical admissions. AIHW data from 2005/2006 to 2012/2013 was used to assess changes in surgical mortality. Over the 8 years surgical admissions increased by 23%, while mortality fell by 18% and the mortality per admission fell by 33% (P audit was associated with a sharp decline in perioperative mortality. In the absence of any influences from other changes in clinical governance or new quality programmes it is probable it had a causal effect. The reduced mortality was most evident in high-risk patients. This study adds to the evidence that national audits are associated with improved outcomes. © 2017 Royal Australasian College of Surgeons.

  4. Action plan to reduce perinatal mortality.

    Bhakoo, O N; Kumar, R

    1990-01-01

    The government of India has set a goal of reducing perinatal mortality from its current rate of 48/1000 to 30-35/1000 by the year 2000. Perinatal deaths result from maternal malnutrition, inadequate prenatal care, complications of delivery, and infections in the postpartum period. Since reductions in perinatal mortality require attention to social, economic, and behavioral factors, as well as improvements in the health care delivery system, a comprehensive strategy is required. Social measures, such as raising the age at marriage to 18 years for females, improving the nutritional status of adolescent girls, reducing the strenuousness of work during pregnancy, improving female literacy, raising women's status in the society and thus in the family, and poverty alleviation programs, would all help eliminate the extent of complications of pregnancy. Measures required to enhance infant survival include improved prenatal care, prenatal tetanus toxoid immunization, use of sterile disposable cord care kits, the provision of mucus extractors and resuscitation materials to birth attendants, the creation of neonatal care units in health facilities, and more efficient referral of high-risk newborns and mothers. Since 90% of births in rural India take place at home priority must be given to training traditional birth attendants in the identification of high risk factors during pregnancy, delivery, and the newborn period.

  5. Poor Semen Quality Predicts Increased Mortality

    Jensen, Tina Kold; Bostofte, Erik; Jacobsen, Rune

    Objective: Over recent decades a possible decrease in semen quality and an increase in the incidence of testicular cancer have been reported. In addition, men with poor semen quality have been reported to be at increased risk of developing testicular cancer whereas the risk of other cancers...... is not increased. The long-term survival of men with poor semen quality is, however, unknown. We therefore studied the associations between semen characteristics and subsequent mortality. Back to Top Material and Methods: The Copenhagen Sperm Analysis Laboratory is one of several public semen analysis laboratories...... in Denmark and examines semen samples mostly from men in the area of Copenhagen. Men are referred to the clinic by general practitioners and urologists, and the investigations are paid for through the public health system. A total of 34.442 men had a semen analysis done at the laboratory during 1963 to 1995...

  6. Increasing sales by reducing procrastination

    Gjedrem, William Gilje

    2012-01-01

    Master's thesis in Finance In this paper I analyze whether an intervention program increases productivity and sales, by reducing potential procrastination problems that employees face at work. The intervention was introduced to stores in a large retail chain in Norway, and contained different tools that could lead to lower perceived costs of higher effort. In a difference-in-differences analysis I find that the intervention increases sales after a 14 weeks long implementation period. Fu...

  7. Alcohol Consumption Increases Post-Operative Infection but Not Mortality

    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-operative...... 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...

  8. Increasing Sex Mortality Differentials among Black Americans, 1950-1978.

    Gee, Ellen M.; Veevers, Jean E.

    1985-01-01

    In regard to sex differentials in mortality among Blacks, explores (1) age groups responsible for increasing the differential, (2) causes of death that have contributed to the increased differential, and (3) whether the phenomenon derives from decreased female mortality, increased male mortality, or both rates moving in the same direction at…

  9. [Family planning can reduce maternal mortality].

    Potts, M

    1987-01-01

    Although the maternal mortality rate receives no newspaper headlines, the number of mothers dying throughout the world is equivalent to a full jumbo jet crashing every 5 hours. Population surveys carried out between 1981-83 by Family Health International indicated maternal mortality rates of 1.9/1000 live births in Menoufia, Egypt, and 7.2/1000 in Bali, Indonesia. 20-25% of all deaths in women aged 15-49 were directly related to pregnancy and delivery, compared to 1% in western countries where there is better prenatal care, medical assistance in almost all deliveries, and elimination of most high risk pregnancies through voluntary fertility control. Maternal mortality could be controlled by teaching traditional midwives to identify high risk patients at the beginning of their pregnancies and to refer them to appropriate health services. Maternal survival would also be improved if all women were in good health at the beginning of pregnancy. Families should be taught to seek medical care for the mother in cases of prolonged labor; many women arrive at hospitals beyond hope of recovery after hours or days of futile labor. Health policy makers should set new priorities. Sri Lanka, for example, has a lower per capita income than Pakistan, but also a lower maternal mortality rate because of better use of family planning services, more emphasis on prenatal care, and a tradition of care and attention on the part of the public health services.

  10. Increased Mortality After Prosthetic Joint Infection in Primary THA.

    Gundtoft, Per Hviid; Pedersen, Alma Becic; Varnum, Claus; Overgaard, Søren

    2017-11-01

    patients who underwent revision for PJI died. The adjusted relative mortality risk for patients with revision for PJI was 2.18 (95% CI, 1.54-3.08) compared with the patients who did not undergo revision for any cause (p infected THA had a 3.10 (95% CI, 1.66-5.81) higher mortality risk than patients infected with other bacteria (p < 0.001). Revision for PJI within 1 year after primary THA induces an increased mortality risk during the first year after the revision surgery. This study should incentivize further studies on prevention of PJI and on risk to patients with the perspective to reduce mortality in patients who have had THA in general and for patients with PJI specifically. Level III, therapeutic study.

  11. Exercise Decreases and Smoking Increases Bladder Cancer Mortality.

    Liss, Michael A; White, Martha; Natarajan, Loki; Parsons, J Kellogg

    2017-06-01

    The aim of this study was to investigate modifiable lifestyle factors of smoking, exercise, and obesity with bladder cancer mortality. We used mortality-linked data from the National Health Information Survey from 1998 through 2006. The primary outcome was bladder cancer-specific mortality. The primary exposures were self-reported smoking status (never- vs. former vs. current smoker), self-reported exercise (dichotomized as "did no exercise" vs. "light, moderate, or vigorous exercise in ≥ 10-minute bouts"), and body mass index. We utilized multivariable adjusted Cox proportional hazards regression models, with delayed entry to account for age at survey interview. Complete data were available on 222,163 participants, of whom 96,715 (44%) were men and 146,014 (66%) were non-Hispanic whites, and among whom we identified 83 bladder cancer-specific deaths. In multivariate analyses, individuals who reported any exercise were 47% less likely (adjusted hazard ratio [HR adj ], 0.53; 95% confidence interval [CI], 0.29-0.96; P = .038) to die of bladder cancer than "no exercise". Compared with never-smokers, current (HR adj , 4.24; 95% CI, 1.89-9.65; P = .001) and former (HR adj , 2.95; 95% CI, 1.50-5.79; P = .002) smokers were 4 and 3 times more likely, respectively, to die of bladder cancer. There were no significant associations of body mass index with bladder cancer mortality. Exercise decreases and current smoking increases the risk of bladder cancer-specific mortality. These data suggest that exercise and smoking cessation interventions may reduce bladder cancer death. Published by Elsevier Inc.

  12. Statin use and reduced cancer-related mortality

    Nielsen, Sune F; Nordestgaard, Børge G; Bojesen, Stig E

    2012-01-01

    A reduction in the availability of cholesterol may limit the cellular proliferation required for cancer growth and metastasis. We tested the hypothesis that statin use begun before a cancer diagnosis is associated with reduced cancer-related mortality.......A reduction in the availability of cholesterol may limit the cellular proliferation required for cancer growth and metastasis. We tested the hypothesis that statin use begun before a cancer diagnosis is associated with reduced cancer-related mortality....

  13. Ocean warming and acidification synergistically increase coral mortality

    Prada, F.; Caroselli, E.; Mengoli, S.; Brizi, L.; Fantazzini, P.; Capaccioni, B.; Pasquini, L.; Fabricius, K. E.; Dubinsky, Z.; Falini, G.; Goffredo, S.

    2017-01-01

    Organisms that accumulate calcium carbonate structures are particularly vulnerable to ocean warming (OW) and ocean acidification (OA), potentially reducing the socioeconomic benefits of ecosystems reliant on these taxa. Since rising atmospheric CO2 is responsible for global warming and increasing ocean acidity, to correctly predict how OW and OA will affect marine organisms, their possible interactive effects must be assessed. Here we investigate, in the field, the combined temperature (range: 16-26 °C) and acidification (range: pHTS 8.1-7.4) effects on mortality and growth of Mediterranean coral species transplanted, in different seasonal periods, along a natural pH gradient generated by a CO2 vent. We show a synergistic adverse effect on mortality rates (up to 60%), for solitary and colonial, symbiotic and asymbiotic corals, suggesting that high seawater temperatures may have increased their metabolic rates which, in conjunction with decreasing pH, could have led to rapid deterioration of cellular processes and performance. The net calcification rate of the symbiotic species was not affected by decreasing pH, regardless of temperature, while in the two asymbiotic species it was negatively affected by increasing acidification and temperature, suggesting that symbiotic corals may be more tolerant to increasing warming and acidifying conditions compared to asymbiotic ones.

  14. Genetically low vitamin D concentrations and increased mortality

    Afzal, Shoaib; Brøndum-Jacobsen, Peter; Bojesen, Stig E

    2014-01-01

    adjusted hazard ratios for a 20 nmol/L lower plasma 25-hydroxyvitamin D concentration were 1.19 (95% confidence interval 1.14 to 1.25) for all cause mortality, 1.18 (1.09 to 1.28) for cardiovascular mortality, 1.12 (1.03 to 1.22) for cancer mortality, and 1.27 (1.15 to 1.40) for other mortality. Each...... increase in DHCR7/CYP2R1 allele score was associated with a 1.9 nmol/L lower plasma 25-hydroxyvitamin D concentration and with increased all cause, cancer, and other mortality but not with cardiovascular mortality. The odds ratio for a genetically determined 20 nmol/L lower plasma 25-hydroxyvitamin D...

  15. Increased mortality in bulimia nervosa and other eating disorders.

    Crow, Scott J; Peterson, Carol B; Swanson, Sonja A; Raymond, Nancy C; Specker, Sheila; Eckert, Elke D; Mitchell, James E

    2009-12-01

    Anorexia nervosa has been consistently associated with increased mortality, but whether this is true for other types of eating disorders is unclear. The goal of this study was to determine whether anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified are associated with increased all-cause mortality or suicide mortality. Using computerized record linkage to the National Death Index, the authors conducted a longitudinal assessment of mortality over 8 to 25 years in 1,885 individuals with anorexia nervosa (N=177), bulimia nervosa (N=906), or eating disorder not otherwise specified (N=802) who presented for treatment at a specialized eating disorders clinic in an academic medical center. Crude mortality rates were 4.0% for anorexia nervosa, 3.9% for bulimia nervosa, and 5.2% for eating disorder not otherwise specified. All-cause standardized mortality ratios were significantly elevated for bulimia nervosa and eating disorder not otherwise specified; suicide standardized mortality ratios were elevated for bulimia nervosa and eating disorder not otherwise specified. Individuals with eating disorder not otherwise specified, which is sometimes viewed as a "less severe" eating disorder, had elevated mortality risks, similar to those found in anorexia nervosa. This study also demonstrated an increased risk of suicide across eating disorder diagnoses.

  16. Interstitial lung abnormalities are associated with increased mortality in smokers

    Hoyer, Nils; Wille, Mathilde M W; Thomsen, Laura H

    2018-01-01

    OBJECTIVE: The aim of this study was to investigate whether smokers with incidental findings of interstitial lung abnormalities have an increased mortality during long-term follow-up, and review the contributing causes of death. METHODS: Baseline CT scans of 1990 participants from the Danish Lung...... in this lung cancer screening population of relatively healthy smokers and were associated with mortality regardless of the interstitial morphological phenotype. The increased mortality was partly due to an association with lung cancer and non-pulmonary malignancies....

  17. Autumn Weather and Winter Increase in Cerebrovascular Disease Mortality

    McDonagh, R

    2016-11-01

    Mortality from cerebrovascular disease increases in winter but the cause is unclear. Ireland’s oceanic climate means that it infrequently experiences extremes of weather. We examined how weather patterns relate to stroke mortality in Ireland. Seasonal data for Sunshine (% of average), Rainfall (% of average) and Temperature (degrees Celsius above average) were collected for autumn (September-November) and winter (December-February) using official Irish Meteorological Office data. National cerebrovascular mortality data was obtained from Quarterly Vital Statistics. Excess winter deaths were calculated by subtracting (nadir) 3rd quarter mortality data from subsequent 1st quarter data. Data for 12 years were analysed, 2002-2014. Mean winter mortality excess was 24.7%. Winter mortality correlated with temperature (r=.60, p=0.04). Rise in winter mortality correlated strongly with the weather in the preceding autumn (Rainfall: r=-0.19 p=0.53, Temperature: r=-0.60, p=0.03, Sunshine, r=0.58, p=0.04). Winter cerebrovascular disease mortality appears higher following cool, sunny autum

  18. Mortality risk factor analysis in colonic perforation: would retroperitoneal contamination increase mortality in colonic perforation?

    Yoo, Ri Na; Kye, Bong-Hyeon; Kim, Gun; Kim, Hyung Jin; Cho, Hyeon-Min

    2017-10-01

    Colonic perforation is a lethal condition presenting high morbidity and mortality in spite of urgent surgical treatment. This study investigated the surgical outcome of patients with colonic perforation associated with retroperitoneal contamination. Retrospective analysis was performed for 30 patients diagnosed with colonic perforation caused by either inflammation or ischemia who underwent urgent surgical treatment in our facility from January 2005 to December 2014. Patient characteristics were analyzed to find risk factors correlated with increased postoperative mortality. Using the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) audit system, the mortality and morbidity rates were estimated to verify the surgical outcomes. Patients with retroperitoneal contamination, defined by the presence of retroperitoneal air in the preoperative abdominopelvic CT, were compared to those without retroperitoneal contamination. Eight out of 30 patients (26.7%) with colonic perforation had died after urgent surgical treatment. Factors associated with mortality included age, American Society of Anesthesiologists (ASA) physical status classification, and the ischemic cause of colonic perforation. Three out of 6 patients (50%) who presented retroperitoneal contamination were deceased. Although the patients with retroperitoneal contamination did not show significant increase in the mortality rate, they showed significantly higher ASA physical status classification than those without retroperitoneal contamination. The mortality rate predicted from Portsmouth POSSUM was higher in the patients with retroperitoneal contamination. Patients presenting colonic perforation along with retroperitoneal contamination demonstrated severe comorbidity. However, retroperitoneal contamination was not found to be correlated with the mortality rate.

  19. Mortality salience increases personal relevance of the norm of reciprocity.

    Schindler, Simon; Reinhard, Marc-André; Stahlberg, Dagmar

    2012-10-01

    Research on terror management theory found evidence that people under mortality salience strive to live up to salient cultural norms and values, like egalitarianism, pacifism, or helpfulness. A basic, strongly internalized norm in most human societies is the norm of reciprocity: people should support those who supported them (i.e., positive reciprocity), and people should injure those who injured them (i.e., negative reciprocity), respectively. In an experiment (N = 98; 47 women, 51 men), mortality salience overall significantly increased personal relevance of the norm of reciprocity (M = 4.45, SD = 0.65) compared to a control condition (M = 4.19, SD = 0.59). Specifically, under mortality salience there was higher motivation to punish those who treated them unfavourably (negative norm of reciprocity). Unexpectedly, relevance of the norm of positive reciprocity remained unaffected by mortality salience. Implications and limitations are discussed.

  20. Orthogeriatric Service Reduces Mortality in Patients With Hip Fracture

    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 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...... = .009) after orthogeriatrics. However, when adjusting for age, gender, and American Society of Anaesthesiologists (ASA) score in a multivariate analysis, including all patients with hip fracture, we find significantly reduced mortality inhospital (odds ratio [OR] 0.35), after 30 [OR 0.66] and 90 days...

  1. Increased Mortality After Prosthetic Joint Infection in Primary THA

    Gundtoft, Per Hviid; Pedersen, Alma Becic; Varnum, Claus

    2017-01-01

    among patients with PJI that are associated with an increased risk of death? Methods: This population-based cohort study was based on the longitudinally maintained Danish Hip Arthroplasty Register on primary THA performed in Denmark from 2005 to 2014. Data from the Danish Hip Arthroplasty Register were......Background: Revision for prosthetic joint infection (PJI) has a major effect on patients’ health but it remains unclear if early PJI after primary THA is associated with a high mortality. Questions/Purposes: (1) Do patients with a revision for PJI within 1 year of primary THA have increased...... mortality compared with patients who do not undergo revision for any reason within 1 year of primary THA? (2) Do patients who undergo a revision for PJI within 1 year of primary THA have an increased mortality risk compared with patients who undergo an aseptic revision? (3) Are there particular bacteria...

  2. Increasing Neonatal Mortality among Palestine Refugees in the Gaza Strip

    van den Berg, Maartje M.; Madi, Haifa H.; Khader, Ali; Hababeh, Majed; Zeidan, Wafa’a; Wesley, Hannah; Abd El-Kader, Mariam; Maqadma, Mohamed; Seita, Akihiro

    2015-01-01

    Background The United Nations Relief and Works Agency for Palestine refugees in the Near East (UNRWA) has periodically estimated infant mortality rates among Palestine refugees in Gaza. These surveys have recorded a decline from 127 per 1000 live births in 1960 to 20.2 in 2008. Methods We used the same preceding-birth technique as in previous surveys. All multiparous mothers who came to the 22 UNRWA health centres to register their last-born child for immunization were asked if their preceding child was alive or dead. We based our target sample size on the infant mortality rate in 2008 and included 3128 mothers from August until October 2013. We used multiple logistic regression analyses to identify predictors of infant mortality. Findings Infant mortality in 2013 was 22.4 per 1000 live births compared with 20.2 in 2008 (p = 0.61), and this change reflected a statistically significant increase in neonatal mortality (from 12.0 to 20.3 per 1000 live births, p = 0.01). The main causes of the 65 infant deaths were preterm birth (n = 25, 39%), congenital anomalies (n = 19, 29%), and infections (n = 12, 19%). Risk factors for infant death were preterm birth (OR 9.88, 3.98–24.85), consanguinity (2.41, 1.35–4.30) and high-risk pregnancies (3.09, 1.46–6.53). Conclusion For the first time in five decades, mortality rates have increased among Palestine refugee newborns in Gaza. The possible causes of this trend may include inadequate neonatal care. We will estimate infant and neonatal mortality rates again in 2015 to see if this trend continues and, if so, to assess how it can be reversed. PMID:26241479

  3. Temperature extremes reduce seagrass growth and induce mortality

    Collier, C.J.; Waycott, M.

    2014-01-01

    Highlights: • Temperature extremes occur during low tide in shallow seagrass meadows. • The effects of temperature extremes were tested experimentally at 35 °C, 40 °C and 43 °C. • 40 °C was a critical threshold with a large impact on growth and mortality. • At 43 °C there was complete mortality after 2–3 days. • Lower light conditions (e.g. poor water quality) led to a greater negative impact. - Abstract: Extreme heating (up to 43 °C measured from five-year temperature records) occurs in shallow coastal seagrass meadows of the Great Barrier Reef at low tide. We measured effective quantum yield (ϕ PSII ), growth, senescence and mortality in four tropical seagrasses to experimental short-duration (2.5 h) spikes in water temperature to 35 °C, 40 °C and 43 °C, for 6 days followed by one day at ambient temperature. Increasing temperature to 35 °C had positive effects on ϕ PSII (the magnitude varied between days and was highly correlated with PPFD), with no effects on growth or mortality. 40 °C represented a critical threshold as there were strong species differences and there was a large impact on growth and mortality. At 43 °C there was complete mortality after 2–3 days. These findings indicate that increasing duration (more days in a row) of thermal events above 40 °C is likely to affect the ecological function of tropical seagrass meadows

  4. Increased mortality risk in women with depression and diabetes mellitus

    Pan, An; Lucas, Michel; Sun, Qi; van Dam, Rob M.; Franco, Oscar H.; Willett, Walter C.; Manson, JoAnn E.; Rexrode, Kathryn M.; Ascherio, Alberto; Hu, Frank B.

    2011-01-01

    Context Both depression and diabetes have been associated with an increased risk of all-cause and cardiovascular diseases (CVD) mortality. However, data evaluating the joint effects of these two conditions on mortality are sparse. Objectives To evaluate the individual and joint effects of depression and diabetes on all-cause and CVD mortality in a prospective cohort study. Design, Settings and Participants A total of 78282 female participants in the Nurses' Health Study aged 54-79 years at baseline in 2000 were followed until 2006. Depression was defined as having self-reported diagnosed depression, treatment with antidepressant medications, or a score indicating severe depressive symptomatology, i.e., a five-item Mental Health Index score ≤52. Self-reported type 2 diabetes was confirmed using a supplementary questionnaire. Main outcome measures All-cause and CVD-specific mortality. Results During 6 years of follow-up (433066 person-years), 4654 deaths were documented, including 979 deaths from CVD. Compared to participants without either condition, the age-adjusted relative risks (95% confidence interval, CI) for all-cause mortality were 1.76 (1.64-1.89) for women with depression only, 1.71 (1.54-1.89) for individuals with diabetes only, and 3.11 (2.70-3.58) for those with both conditions. The corresponding age-adjusted relative risks of CVD mortality were 1.81 (1.54-2.13), 2.67 (2.20-3.23), and 5.38 (4.19-6.91), respectively. These associations were attenuated after multivariate adjustment for other demographic variables, body mass index, smoking status, alcohol intake, physical activity, and major comorbidities (including hypertension, hypercholesterolemia, heart diseases, stroke and cancer) but remained significant, with the highest relative risks for all-cause and CVD mortality found in those with both conditions (2.07 [95% CI, 1.79-2.40] and 2.72 [95% CI, 2.09-3.54], respectively). Furthermore, the combination of depression with a long duration of diabetes

  5. Increased backcrossing has reduced the usefulness of ...

    Increased backcrossing has reduced the usefulness of morphological and allozyme data for identifying Oreochromis niloticus , O. mossambicus (Teleostei: Cichlidae) and their hybrids in the Pafuri reach of the Luvuvhu River in the Kruger National Park, South Africa.

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

    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.

  7. Temperature extremes reduce seagrass growth and induce mortality.

    Collier, C J; Waycott, M

    2014-06-30

    Extreme heating (up to 43 °C measured from five-year temperature records) occurs in shallow coastal seagrass meadows of the Great Barrier Reef at low tide. We measured effective quantum yield (ϕPSII), growth, senescence and mortality in four tropical seagrasses to experimental short-duration (2.5h) spikes in water temperature to 35 °C, 40 °C and 43 °C, for 6 days followed by one day at ambient temperature. Increasing temperature to 35 °C had positive effects on ϕPSII (the magnitude varied between days and was highly correlated with PPFD), with no effects on growth or mortality. 40 °C represented a critical threshold as there were strong species differences and there was a large impact on growth and mortality. At 43 °C there was complete mortality after 2-3 days. These findings indicate that increasing duration (more days in a row) of thermal events above 40 °C is likely to affect the ecological function of tropical seagrass meadows. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Success factors for reducing maternal and child mortality.

    Kuruvilla, Shyama; Schweitzer, Julian; Bishai, David; Chowdhury, Sadia; Caramani, Daniele; Frost, Laura; Cortez, Rafael; Daelmans, Bernadette; de Francisco, Andres; Adam, Taghreed; Cohen, Robert; Alfonso, Y Natalia; Franz-Vasdeki, Jennifer; Saadat, Seemeen; Pratt, Beth Anne; Eugster, Beatrice; Bandali, Sarah; Venkatachalam, Pritha; Hinton, Rachael; Murray, John; Arscott-Mills, Sharon; Axelson, Henrik; Maliqi, Blerta; Sarker, Intissar; Lakshminarayanan, Rama; Jacobs, Troy; Jack, Susan; Jacks, Susan; Mason, Elizabeth; Ghaffar, Abdul; Mays, Nicholas; Presern, Carole; Bustreo, Flavia

    2014-07-01

    Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women's and Children's Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula--fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches in addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society, using timely, robust evidence for decision-making and accountability and a triple planning approach to consider immediate needs, long-term vision and adaptation to change. Third, the countries establish guiding principles that orient progress, align stakeholder action and achieve results over time. This evidence synthesis contributes to global learning on accelerating improvements in women's and children's health towards 2015 and beyond.

  9. Taking Exception. Reduced mortality leads to population growth: an inconvenient truth.

    Shelton, James D

    2014-05-01

    Reduced mortality has been the predominant cause of the marked global population growth over the last 3/4 of a century. While improved child survival increases motivation to reduce fertility, it comes too little and too late to forestall substantial population growth. And, beyond motivation, couples need effective means to control their fertility. It is an inconvenient truth that reducing child mortality contributes considerably to the population growth destined to compromise the quality of life of many, particularly in sub-Saharan Africa. Vigorous child survival programming is of course imperative. Wide access to voluntary family planning can help mitigate that growth and provide many other benefits.

  10. Mobile phone intervention reduces perinatal mortality in zanzibar

    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...

  11. Nutrition deficiency increases the risk of stomach cancer mortality

    Da Li Qing

    2012-07-01

    Full Text Available Abstract Background The purpose of the study is to determine whether exposure to malnutrition during early life is associated with increased risk of stomach cancer in later life. Methods The design protocol included analyzing the trend of gastric cancer mortality and nutrition and evaluating the association between nutrient deficiency in early life and the risk of gastric cancer by hierarchical age–period–birth cohort (APC analysis using general log-linear Poisson models and to compare the difference between birth cohorts who were exposed to the 1959–1961 Chinese famine and those who were not exposed to the famine. Data on stomach cancer mortality from 1970 to 2009 and the dietary patterns from 1955 to 1985 which included the 1959–1961 Chinese famine period in the Zhaoyuan County population were obtained. The nutrition information was collected 15 years prior to the mortality data as based on the latest reference of disease incubation. Results APC analysis revealed that severe nutrition deficiency during early life may increase the risk of stomach cancer. Compared with the 1960–1964 birth cohort, the risk for stomach cancer in all birth cohorts from 1900 to 1959 significantly increased; compared with the 1970–1974 cohort, the risk for stomach cancer in the 1975–1979 cohort significantly increased, whereas the others had a steadily decreased risk; compared with 85–89 age group in the 2005–2009 death survey, the ORs decreased with younger age and reached significant levels for the 50–54 age group after adjusting the confounding factors. The 1930 to 1964 group (exposed to famine had a higher mortality rate than the 1965 to 1999 group (not exposed to famine. For males, the relative risk (RR was 2.39 and the 95% confidence interval (CI was 1.51 to 3.77. For females, RR was 1.64 and 95% CI was 1.02 to 2.62. Conclusion The results of the present study suggested that prolonged malnutrition during early life may increase the risk of

  12. Inotropes do not increase mortality in advanced heart failure

    Guglin M

    2014-05-01

    Full Text Available Maya Guglin, Marc KaufmanUniversity of South Florida, Tampa, FL, USAAbstract: Inotrope use is one of the most controversial topics in the management of heart failure. While the heart failure community utilizes them and recognizes the state of inotrope dependency, retrospective analyses and registry data have overwhelmingly suggested high mortality, which is logically to be expected given the advanced disease states of those requiring their use. Currently, there is a relative paucity of randomized control trials due to the ethical dilemma of creating control groups by withholding inotropes from patients who require them. Nonetheless, results of such trials have been mixed. Many were also performed with agents no longer in use, on patients without an indication for inotropes, or at a time before automatic cardio-defibrillators were recommended for primary prevention. Thus, their results may not be generalizable to current clinical practice. In this review, we discuss current indications for inotrope use, specifically dobutamine and milrinone, depicting their mechanisms of action, delineating their patterns of use in clinical practice, defining the state of inotrope dependency, and ultimately examining the literature to ascertain whether evidence is sufficient to support the current view that these agents increase mortality in patients with heart failure. Our conclusion is that the evidence is insufficient to link inotropes and increased mortality in low output heart failure.Keywords: inotropes, dobutamine, milrinone, heart failure

  13. Increasingly strong reduction in breast cancer mortality due to screening

    van Schoor, G; Moss, S M; Otten, J D M; Donders, R; Paap, E; den Heeten, G J; Holland, R; Broeders, M J M; Verbeek, A L M

    2011-01-01

    Background: Favourable outcomes of breast cancer screening trials in the 1970s and 1980s resulted in the launch of population-based service screening programmes in many Western countries. We investigated whether improvements in mammography and treatment modalities have had an influence on the effectiveness of breast cancer screening from 1975 to 2008. Methods: In Nijmegen, the Netherlands, 55 529 women received an invitation for screening between 1975 and 2008. We designed a case–referent study to evaluate the impact of mammographic screening on breast cancer mortality over time from 1975 to 2008. A total number of 282 breast cancer deaths were identified, and 1410 referents aged 50–69 were sampled from the population invited for screening. We estimated the effectiveness by calculating the odds ratio (OR) indicating the breast cancer death rate for screened vs unscreened women. Results: The breast cancer death rate in the screened group over the complete period was 35% lower than in the unscreened group (OR=0.65; 95% CI=0.49–0.87). Analysis by calendar year showed an increasing effectiveness from a 28% reduction in breast cancer mortality in the period 1975–1991 (OR=0.72; 95% CI=0.47–1.09) to 65% in the period 1992–2008 (OR=0.35; 95% CI=0.19–0.64). Conclusion: Our results show an increasingly strong reduction in breast cancer mortality over time because of mammographic screening. PMID:21343930

  14. Hyponatremia improvement is associated with a reduced risk of mortality: evidence from a meta-analysis.

    Giovanni Corona

    Full Text Available Hyponatremia is the most common electrolyte disorder and it is associated with increased morbidity and mortality. However, there is no clear demonstration that the improvement of serum sodium concentration ([Na(+] counteracts the increased risk of mortality associated with hyponatremia. Thus, we performed a meta-analysis that included the published studies that addressed the effect of hyponatremia improvement on mortality.A Medline, Embase and Cochrane search was performed to retrieve all English-language studies of human subjects published up to June 30th 2014, using the following words: "hyponatremia", "hyponatraemia", "mortality", "morbidity" and "sodium". Fifteen studies satisfied inclusion criteria encompassing a total of 13,816 patients. The identification of relevant abstracts, the selection of studies and the subsequent data extraction were performed independently by two of the authors, and conflicts resolved by a third investigator. Across all fifteen studies, any improvement of hyponatremia was associated with a reduced risk of overall mortality (OR=0.57[0.40-0.81]. The association was even stronger when only those studies (n=8 reporting a threshold for serum [Na(+] improvement to >130 mmol/L were considered (OR=0.51[0.31-0.86]. The reduced mortality rate persisted at follow-up (OR=0.55[0.36-0.84] at 12 months. Meta-regression analyses showed that the reduced mortality associated with hyponatremia improvement was more evident in older subjects and in those with lower serum [Na(+] at enrollment.This meta-analysis documents for the first time that improvement in serum [Na(+] in hyponatremic patients is associated with a reduction of overall mortality.

  15. Strategies to reduce infant mortality rate in India.

    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

  16. Reduced Dietary Sodium Intake Increases Heart Rate

    Graudal, Niels A; Hubeck-Graudal, Thorbjørn; Jürgens, Gesche

    2016-01-01

    Reduced dietary sodium intake (sodium reduction) increases heart rate in some studies of animals and humans. As heart rate is independently associated with the development of heart failure and increased risk of premature death a potential increase in heart rate could be a harmful side......-effect of sodium reduction. The purpose of the present meta-analysis was to investigate the effect of sodium reduction on heart rate. Relevant studies were retrieved from an updated pool of 176 randomized controlled trials (RCTs) published in the period 1973-2014. Sixty-three of the RCTs including 72 study...... populations reported data on heart rate. In a meta-analysis of these data sodium reduction increased heart rate with 1.65 beats per minute [95% CI: 1.19, 2.11], p heart rate. This effect was independent of baseline blood pressure. In conclusion sodium reduction...

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

    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.

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

    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. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Increased Mortality in Elderly Patients with Sarcopenia and Acetabular Fractures.

    Deren, Matthew E; Babu, Jacob; Cohen, Eric M; Machan, Jason; Born, Christopher T; Hayda, Roman

    2017-02-01

    Sarcopenia is a condition of clinically relevant loss of muscle mass and function. Acetabular fractures in elderly patients are common and difficult to treat. This study aimed to determine if sarcopenia is common in elderly patients with acetabular fractures and correlates with lower-energy mechanisms of injury, higher rates of complications, and higher mortality than patients with normal muscle mass. The Rhode Island Hospital Trauma Database was queried for patients who were ≥60 years of age from 2005 to 2014 using the International Classification of Diseases, Ninth Revision, code for closed acetabular fracture, 808.0. Charts were retrospectively reviewed for demographic data, operative intervention, mechanism of injury, mortality, comorbidities, and other factors. Computed tomography (CT) was used to determine the muscle cross-sectional area and to calculate the skeletal muscle index. The database revealed 192 patients coded for acetabular fracture; of these, 181 were correctly diagnosed. Ninety-nine patients had recorded body mass index (BMI) and adequate CT scans to measure the skeletal muscle index. Forty-two patients (42.4%) had sarcopenia, and 57 patients (57.6%) did not have sarcopenia. There were no significant differences in demographic characteristics between the groups with the exception of BMI and sex. BMI was higher in patients who did not have sarcopenia (31.7 kg/m) than it was in patients with sarcopenia (23.6 kg/m) (p sarcopenia at 76.2% (32 of 42 patients) than in patients without sarcopenia at 50.9% (29 of 57 patients). Fractures in patients without sarcopenia were associated with a higher-energy mechanism of injury in 78.9% of cases compared with 52.4% of cases of patients with sarcopenia (p = 0.005). Sarcopenia was significantly associated (p = 0.0419) with increased 1-year mortality (28.6%) compared with the absence of sarcopenia (12.3%). This association was even stronger if in-hospital mortality was excluded (p = 0.00074). Finally

  20. Increasing mortality burden among adults with complex congenital heart disease.

    Greutmann, Matthias; Tobler, Daniel; Kovacs, Adrienne H; Greutmann-Yantiri, Mehtap; Haile, Sarah R; Held, Leonhard; Ivanov, Joan; Williams, William G; Oechslin, Erwin N; Silversides, Candice K; Colman, Jack M

    2015-01-01

    Progress in management of congenital heart disease has shifted mortality largely to adulthood. However, adult survivors with complex congenital heart disease are not cured and remain at risk of premature death as young adults. Thus, our aim was to describe the evolution and mortality risk of adult patient cohorts with complex congenital heart disease. Among 12,644 adults with congenital heart disease followed at a single center from 1980 to 2009, 176 had Eisenmenger syndrome, 76 had unrepaired cyanotic defects, 221 had atrial switch operations for transposition of the great arteries, 158 had congenitally corrected transposition of the great arteries, 227 had Fontan palliation, and 789 had repaired tetralogy of Fallot. We depict the 30-year evolution of these 6 patient cohorts, analyze survival probabilities in adulthood, and predict future number of deaths through 2029. Since 1980, there has been a steady increase in numbers of patients followed, except in cohorts with Eisenmenger syndrome and unrepaired cyanotic defects. Between 1980 and 2009, 308 patients in the study cohorts (19%) died. At the end of 2009, 85% of survivors were younger than 50 years. Survival estimates for all cohorts were markedly lower than for the general population, with important differences between cohorts. Over the upcoming two decades, we predict a substantial increase in numbers of deaths among young adults with subaortic right ventricles, Fontan palliation, and repaired tetralogy of Fallot. Anticipatory action is needed to prepare clinical services for increasing numbers of young adults at risk of dying from complex congenital heart disease. © 2014 The Authors. Congenital Heart Disease Published by Wiley Periodicals, Inc.

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

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

    2017-02-23

    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.

  2. Selective Decontamination of the Digestive Tract Reduces Pneumonia and Mortality

    Lenneke E. M. Haas

    2010-01-01

    Full Text Available Selective decontamination of the digestive tract (SDD has been subject of numerous randomized controlled trials in critically ill patients. Almost all clinical trials showed SDD to prevent pneumonia. Nevertheless, SDD has remained a controversial strategy. One reason for why clinicians remained reluctant to implement SDD into daily practice could be that mortality was reduced in only 2 trials. Another reason could be the heterogeneity of trials of SDD. Indeed, many different prophylactic antimicrobial regimes were tested, and dissimilar diagnostic criteria for pneumonia were applied amongst the trials. This heterogeneity impeded interpretation and comparison of trial results. Two other hampering factors for implementation of SDD have been concerns over the risk of antimicrobial resistance and fear for escalation of costs associated with the use of prophylactic antimicrobials. This paper describes the concept of SDD, summarizes the results of published trials of SDD in mixed medical-surgical intensive care units, and rationalizes the risk of antimicrobial resistance and rise of costs associated with this potentially life-saving preventive strategy.

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

    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

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

    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. Als......, screening leads to increased use of diagnostic and therapeutic interventions, which can be harmful as well as beneficial. It is, therefore, important to assess whether general health checks do more good than harm....

  5. Increasing immunization, reducing child mortality in Haiti | CRDI ...

    24 juin 2015 ... Renforcement des capacités de recherche associées aux essais cliniques en matière de prévention du VIH/sida. Relativement peu d'installations africaines disposent des capacités cliniques et de laboratoire nécessaires pour concevoir, gérer et mener des essais en matière de prévention du VIH/sida.

  6. The effects of price competition and reduced subsidies for uncompensated care on hospital mortality.

    Volpp, Kevin G M; Ketcham, Jonathan D; Epstein, Andrew J; Williams, Sankey V

    2005-08-01

    To determine whether hospital mortality rates changed in New Jersey after implementation of a law that changed hospital payment from a regulated system based on hospital cost to price competition with reduced subsidies for uncompensated care and whether changes in mortality rates were affected by hospital market conditions. State discharge data for New Jersey and New York from 1990 to 1996. Study Design. We used an interrupted time series design to compare risk-adjusted in-hospital mortality rates between states over time. We compared the effect sizes in markets with different levels of health maintenance organization penetration and hospital market concentration and tested the sensitivity of our results to different approaches to defining hospital markets. The study sample included all patients under age 65 admitted to New Jersey or New York hospitals with stroke, hip fracture, pneumonia, pulmonary embolism, congestive heart failure, hip fracture, or acute myocardial infarction (AMI). Mortality among patients in New Jersey improved less than in New York by 0.4 percentage points among the insured (p=.07) and 0.5 percentage points among the uninsured (p=.37). There was a relative increase in mortality for patients with AMI, congestive heart failure, and stroke, especially for uninsured patients with these conditions, but not for patients with the other four conditions we studied. Less competitive hospital markets were significantly associated with a relative decrease in mortality among insured patients. Market-based reforms may adversely affect mortality for some conditions but it appears the effects are not universal. Insured patients in less competitive markets fared better in the transition to price competition.

  7. Onset of mortality increase with age and age trajectories of mortality from all diseases in the four Nordic countries

    Dolejs J

    2017-01-01

    Full Text Available Josef Dolejs,1 Petra Marešová2 1Department of Informatics and Quantitative Methods, 2Department of Economics, Faculty of Informatics and Management, University of Hradec Králové, Hradec Králové, Czech Republic Background: The answer to the question “At what age does aging begin?” is tightly related to the question “Where is the onset of mortality increase with age?” Age affects mortality rates from all diseases differently than it affects mortality rates from nonbiological causes. Mortality increase with age in adult populations has been modeled by many authors, and little attention has been given to mortality decrease with age after birth.Materials and methods: Nonbiological causes are excluded, and the category “all diseases” is studied. It is analyzed in Denmark, Finland, Norway, and Sweden during the period 1994–2011, and all possible models are screened. Age trajectories of mortality are analyzed separately: before the age category where mortality reaches its minimal value and after the age category.Results: Resulting age trajectories from all diseases showed a strong minimum, which was hidden in total mortality. The inverse proportion between mortality and age fitted in 54 of 58 cases before mortality minimum. The Gompertz model with two parameters fitted as mortality increased with age in 17 of 58 cases after mortality minimum, and the Gompertz model with a small positive quadratic term fitted data in the remaining 41 cases. The mean age where mortality reached minimal value was 8 (95% confidence interval 7.05–8.95 years. The figures depict an age where the human population has a minimal risk of death from biological causes.Conclusion: Inverse proportion and the Gompertz model fitted data on both sides of the mortality minimum, and three parameters determined the shape of the age–mortality trajectory. Life expectancy should be determined by the two standard Gompertz parameters and also by the single parameter in

  8. Factors present on admission associated with increased mortality in ...

    centile has been shown to be an independent risk factor for mortality ... score quantifying organ dysfunction on admission or throughout the .... model. The Wald χ2 test was used to determine significance using a 5% significance level.

  9. Reduced Lung Cancer Mortality With Lower Atmospheric Pressure.

    Merrill, Ray M; Frutos, Aaron

    2018-01-01

    Research has shown that higher altitude is associated with lower risk of lung cancer and improved survival among patients. The current study assessed the influence of county-level atmospheric pressure (a measure reflecting both altitude and temperature) on age-adjusted lung cancer mortality rates in the contiguous United States, with 2 forms of spatial regression. Ordinary least squares regression and geographically weighted regression models were used to evaluate the impact of climate and other selected variables on lung cancer mortality, based on 2974 counties. Atmospheric pressure was significantly positively associated with lung cancer mortality, after controlling for sunlight, precipitation, PM2.5 (µg/m 3 ), current smoker, and other selected variables. Positive county-level β coefficient estimates ( P atmospheric pressure were observed throughout the United States, higher in the eastern half of the country. The spatial regression models showed that atmospheric pressure is positively associated with age-adjusted lung cancer mortality rates, after controlling for other selected variables.

  10. Review of Policies and Programs for Reducing Maternal Mortality ...

    The study was designed to determine the status of maternal health in Cross River State, a state in the Niger-Delta region of Nigeria with high rate of maternal mortality. The study consisted of analysis of clinical data, desk reviews of published and unpublished materials and interviews with policymakers and service providers ...

  11. Interaction Mortality: Senescence May Have Evolved because It Increases Lifespan

    Wensink, M. J.; Wrycza, T. F.; Baudisch, A.

    2014-01-01

    Given an extrinsic challenge, an organism may die or not depending on how the threat interacts with the organism's physiological state. To date, such interaction mortality has been only a minor factor in theoretical modeling of senescence. We describe a model of interaction mortality that does...... not involve specific functions, making only modest assumptions. Our model distinguishes explicitly between the physiological state of an organism and potential extrinsic, age-independent threats. The resulting mortality may change with age, depending on whether the organism's state changes with age. We find...... that depending on the physiological constraints, any outcome, be it 'no senescence' or 'high rate of senescence', can be found in any environment; that the highest optimal rate of senescence emerges for an intermediate physiological constraint, i.e. intermediate strength of trade-off; and that the optimal rate...

  12. Childhood height increases the risk of prostate cancer mortality

    Aarestrup, J; Gamborg, M; Cook, M B

    2015-01-01

    cancers. Cox proportional hazards regressions were performed. RESULTS: 630 men had prostate cancer recorded as the underlying cause of death. Childhood height at age 13years was positively associated with prostate cancer-specific mortality (hazard ratio [HR]per z-score=1.2, 95% confidence interval [CI]: 1.1-1.3......). Associations were significant at all other childhood ages. Growth analyses showed that height at age 13years had a stronger association with prostate cancer-specific mortality than height at age 7, suggesting the association at age 7 is largely mediated through later childhood height. The tallest boys at age...... 13years had a significantly worse survival, but only when restricted to a diagnosis at years of age (HRz-score of 1=1.7, 95% CI: 1.3-2.4). These associations were significant at all other childhood ages. Childhood BMI was not associated with prostate cancer mortality or survival. CONCLUSION...

  13. Increased mortality among persons infected with hepatitis C virus

    Omland, Lars Haukali Hvass; Jepsen, Peter; Krarup, Henrik

    2011-01-01

    Background & Aims The long-term mortality of patients infected with hepatitis C virus (HCV) is not known; few studies have controlled for potential confounders, investigated how mortality changes with age at diagnosis and length of follow-up period, provided absolute risk estimates of death......, or analyzed specific causes of death. Methods Using a Danish population, we compared mortality of a cohort of 10,991 HCV-infected patients with that of an age- and sex-matched cohort. Using regression analysis, we adjusted for municipality of residence, history of psychiatric illness, comorbidities, alcohol...... and drug abuse, and income. We analyzed causes of death and effects of HCV with age and length of follow-up period. Results HCV-infected patients had lower income levels and more comorbidities, psychiatric illnesses, and substance and alcohol abuse than the comparison cohort. The 10-year survival rate...

  14. Increased mortality in the elderly after emergency abdominal surgery

    Svenningsen, Peter; Manoharan, Thukirtha; Foss, Nicolai B

    2014-01-01

    was a retrospective analysis of patient charts and perioperative documentation in an unselected consecutive cohort of 131 patients. Covariates for survival outcomes were evaluated in a multivariate analysis. No external funding and no competing interests were declared. The study was approved by The Danish Data...... within 30 days post-operatively. CONCLUSION: Acute admission and emergency laparotomy is associated with a very high mortality, especially in elderly patients. However, delay in the surgical treatment exceeding six hours is not associated with a higher mortality. There may be a considerable potential...

  15. Does the Use of Diagnostic Technology Reduce Fetal Mortality?

    Grytten, Jostein; Skau, Irene; Sørensen, Rune; Eskild, Anne

    2018-01-19

    To examine the effect that the introduction of new diagnostic technology in obstetric care has had on fetal death. The Medical Birth Registry of Norway provided detailed medical information for approximately 1.2 million deliveries from 1967 to 1995. Information about diagnostic technology was collected directly from the maternity units, using a questionnaire. The data were analyzed using a hospital fixed-effects regression with fetal mortality as the outcome measure. The key independent variables were the introduction of ultrasound and electronic fetal monitoring at each maternity ward. Hospital-specific trends and risk factors of the mother were included as control variables. The richness of the data allowed us to perform several robustness tests. The introduction of ultrasound caused a significant drop in fetal mortality rate, while the introduction of electronic fetal monitoring had no effect on the rate. In the population as a whole, ultrasound contributed to a reduction in fetal deaths of nearly 20 percent. For post-term deliveries, the reduction was well over 50 percent. The introduction of ultrasound made a major contribution to the decline in fetal mortality at the end of the last century. © Health Research and Educational Trust.

  16. Lifestyle and reduced mortality among active California Mormons, 1980-2004.

    Enstrom, James E; Breslow, Lester

    2008-02-01

    The objective is to measure the relationship of several healthy characteristics of the Mormon lifestyle to mortality. We examined 9815 religiously active California Mormon adults followed for mortality during 1980-2004 and 15,832 representative U.S. white adults enrolled in the 1987 National Health Interview Survey (NHIS) and followed for mortality during 1988-1997. The standardized mortality ratio (SMR) and 95% confidence interval (CI) was calculated relative to U.S. whites defined to have a SMR of 1.00. Active California Mormons practice a healthy lifestyle advocated by their religion, which emphasizes a strong family life, education and abstention from tobacco and alcohol. Unusually low SMRs occurred among married never smokers who attended church weekly and had at least 12 years of education. For those aged 25-99 years at entry, the SMR for all causes of death was 0.45 (0.42-0.48) for males and 0.55 (0.51-0.59) for females. For those aged 25-64 years at entry, the SMR for all causes of death was 0.36 (0.32-0.41) for males and 0.46 (0.40-0.53) for females. Life expectancy from age 25 was 84 years for males and 86 years for females. These SMRs were largely replicated among similarly defined persons of all religions within the NHIS cohort. Several healthy characteristics of the Mormon lifestyle are associated with substantially reduced death rates and increased life expectancy.

  17. Widespread increase of tree mortality rates in the Western United States

    van Mantgem, P.J.; Stephenson, N.L.; Byrne, J.C.; Daniels, L.D.; Franklin, J.F.; Fule, P.Z.; Harmon, M.E.; Larson, A.J.; Smith, Joseph M.; Taylor, A.H.; Veblen, T.T.

    2009-01-01

    Persistent changes in tree mortality rates can alter forest structure, composition, and ecosystem services such as carbon sequestration. Our analyses of longitudinal data from unmanaged old forests in the western United States showed that background (noncatastrophic) mortality rates have increased rapidly in recent decades, with doubling periods ranging from 17 to 29 years among regions. Increases were also pervasive across elevations, tree sizes, dominant genera, and past fire histories. Forest density and basal area declined slightly, which suggests that increasing mortality was not caused by endogenous increases in competition. Because mortality increased in small trees, the overall increase in mortality rates cannot be attributed solely to aging of large trees. Regional warming and consequent increases in water deficits are likely contributors to the increases in tree mortality rates.

  18. INCREASE INCOME AND MORTALITY OF COLORRECTAL CANCER IN BRAZIL, 2001-2009

    Raphael Mendonca GUIMARAES

    2013-03-01

    Full Text Available Context Several international studies have observed a correlation between the improvement of socio-demographic indicators and rates of incidence and mortality from cancer of the colon and rectum. Objective The objective of this study is to estimate the correlation between average per capita income and the rate of colorectal cancer mortality in Brazil between 2001 and 2009. Methods We obtained data on income inequality (Gini index, population with low incomes (½ infer the minimum wage/month, average family income, per capita ICP and mortality from colon cancer and straight between 2001-2009 by DATASUS. A trend analysis was performed using linear regression, and correlation between variables by Pearson's correlation coefficient. Results There was a declining trend in poverty and income inequality, and growth in ICP per capita and median family income and standardized mortality rate for colorectal cancer in Brazil. There was also strong positive correlation between mortality from this site of cancer and inequality (men r = -0.30, P = 0.06, women r = -0.33, P = 0.05 income low income (men r = -0.80, P<0.001, women r = -0.76, P<0.001, median family income (men r = 0.79, P = 0.06, women r = 0.76, P<0.001 and ICP per capita (men r = 0.73, P<0.001, women r = 0.68, P<0.001 throughout the study period. Conclusion The increase of income and reducing inequality may partially explain the increased occurrence of colorectal cancer and this is possibly due to differential access to food recognized as a risk factor, such as red meat and high in fat. It is important therefore to assess the priority of public health programs addressing nutrition in countries of intermediate economy, as is the case of Brazil.

  19. High motility reduces grazing mortality of planktonic bacteria

    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...... size revealed highest grazing losses for moderately motile bacteria with a cell size between 0.2 and 0.4 mum(3). Grazing mortality was lowest for cells of >0.5 mum(3) and small, highly motile bacteria. Survival efficiencies of >95% for the ultramicrobacterial isolate CP-1 (less than or equal to0.1 mum......(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....

  20. Increased evaporation following widespread tree mortality limits streamflow response

    Biederman, J. A.; Harpold, A. A.; Gochis, D. J.; Ewers, B. E.; Reed, D. E.; Papuga, S. A.; Brooks, P. D.

    2014-07-01

    A North American epidemic of mountain pine beetle (MPB) has disturbed over 5 million ha of forest containing headwater catchments crucial to water resources. However, there are limited observations of MPB effects on partitioning of precipitation between vapor loss and streamflow, and to our knowledge these fluxes have not been observed simultaneously following disturbance. We combined eddy covariance vapor loss (V), catchment streamflow (Q), and stable isotope indicators of evaporation (E) to quantify hydrologic partitioning over 3 years in MPB-impacted and control sites. Annual control V was conservative, varying only from 573 to 623 mm, while MPB site V varied more widely from 570 to 700 mm. During wet periods, MPB site V was greater than control V in spite of similar above-canopy potential evapotranspiration (PET). During a wet year, annual MPB V was greater and annual Q was lower as compared to an average year, while in a dry year, essentially all water was partitioned to V. Ratios of 2H and 18O in stream and soil water showed no kinetic evaporation at the control site, while MPB isotope ratios fell below the local meteoric water line, indicating greater E and snowpack sublimation (Ss) counteracted reductions in transpiration (T) and sublimation of canopy-intercepted snow (Sc). Increased E was possibly driven by reduced canopy shading of shortwave radiation, which averaged 21 W m-2 during summer under control forest as compared to 66 W m-2 under MPB forest. These results show that abiotic vapor losses may limit widely expected streamflow increases.

  1. Absence of kynurenine 3-monooxygenase reduces mortality of acute viral myocarditis in mice.

    Kubo, Hisako; Hoshi, Masato; Mouri, Akihiro; Tashita, Chieko; Yamamoto, Yasuko; Nabeshima, Toshitaka; Saito, Kuniaki

    2017-01-01

    Infection of the encephalomyocarditis virus (EMCV) in mice is an established model for viral myocarditis. Previously, we have demonstrated that indoleamine 2,3-dioxygenase (IDO), an L-tryptophan - kynurenine pathway (KP) enzyme, affects acute viral myocarditis. However, the roles of KP metabolites in EMCV infection remain unclear. Kynurenine 3-monooxygenase (KMO) is one of the key regulatory enzymes, which metabolizes kynurenine to 3-hydroxykynurenine in the KP. Therefore, we examined the role of KMO in acute viral infection by comparing between KMO -/- mice and KMO +/+ mice. KMO deficiency resulted in suppressed mortality after EMCV infection. The number of infiltrating cells and F4/80 + cells in KMO -/- mice was suppressed compared with those in KMO +/+ mice. KMO -/- mice showed significantly increased levels of serum KP metabolites, and induction of KMO expression upon EMCV infection was involved in its effect on mortality through EMCV suppression. Furthermore, KMO -/- mice showed significantly suppression of CCL2, CCL3 and CCL4 on day 2 and CXCL1 on day 4 after infection. These results suggest that increased KP metabolites reduced chemokine production, resulting in suppressed mortality upon KMO knockdown in EMCV infection. KP metabolites may thus provide an effective strategy for treating acute viral myocarditis. Copyright © 2016 European Federation of Immunological Societies. Published by Elsevier B.V. All rights reserved.

  2. An examination of black/white differences in the rate of age-related mortality increase

    Andrew Fenelon

    2013-09-01

    Full Text Available BACKGROUND The rate of mortality increase with age among adults is typically used as a measure of the rate of functional decline associated with aging or senescence. While black and white populations differ in the level of mortality, mortality also rises less rapidly with age for blacks than for whites, leading to the well-known black/white mortality "crossover". OBJECTIVE This paper investigates black/white differences in the rate of mortality increase with age for major causes of death in order to examine the factors responsible for the black/white crossover. METHODS The analysis considers two explanations for the crossover: selective survival and age misreporting. Mortality is modeled using a Gompertz model for 11 causes of death from ages 50-84 among blacks and whites by sex. RESULTS Mortality increases more rapidly with age for whites than for blacks for nearly all causes of death considered. The all-cause mortality rate of mortality increase is nearly two percentage points higher for whites. The analysis finds evidence for both selective survival and age misreporting, although age misreporting is a more prominent explanation among women. CONCLUSIONS The black/white mortality crossover reflects large differences in the rate of age-related mortality increase. Instead of reflecting the impact of specific causes of death, this pattern exists across many disparate disease conditions, indicating the need for a broad explanation.

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

    Zeng, Yi; Chen, Huashuai; Ni, Ting

    2016-01-01

    Based on the genotypic/phenotypic data from Chinese Longitudinal Healthy Longevity Survey (CLHLS) and Cox proportional hazard model, the present study demonstrates that interactions between carrying FOXO1A-209 genotypes and tea drinking are significantly associated with lower risk of mortality...... 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...

  4. Reduced mortality among young endangered masked bobwhite quail fed oxytetracycline-supplemented diets

    Serafin, J.A.

    1982-01-01

    Two experiments were conducted to examine the effect of oxytetracycline-supplemented diets on mortality of young endangered masked bobwhite quail (Colinus virginianus ridgwayi). Inclusion of oxytetracycline at 200 g per ton in the feed for 6 weeks resulted in a marked, significant reduction in mortality of young masked bobwhite quail raised in captivity. Including the antibiotic in feed during the first week of life reduced mortality as effectively as feeding it for a longer period.

  5. Increased serum concentrations of soluble ST2 predict mortality after burn injury.

    Hacker, Stefan; Dieplinger, Benjamin; Werba, Gregor; Nickl, Stefanie; Roth, Georg A; Krenn, Claus G; Mueller, Thomas; Ankersmit, Hendrik J; Haider, Thomas

    2018-06-27

    Large burn injuries induce a systemic response in affected patients. Soluble ST2 (sST2) acts as a decoy receptor for interleukin-33 (IL-33) and has immunosuppressive effects. sST2 has been described previously as a prognostic serum marker. Our aim was to evaluate serum concentrations of sST2 and IL-33 after thermal injury and elucidate whether sST2 is associated with mortality in these patients. We included 32 burn patients (total body surface area [TBSA] >10%) admitted to our burn intensive care unit and compared them to eight healthy probands. Serum concentrations of sST2 and IL-33 were measured serially using an enzyme-linked immunosorbent assay (ELISA) technique. The mean TBSA was 32.5%±19.6%. Six patients (18.8%) died during the hospital stay. Serum analyses showed significantly increased concentrations of sST2 and reduced concentrations of IL-33 in burn patients compared to healthy controls. In our study cohort, higher serum concentrations of sST2 were a strong independent predictor of mortality. Burn injuries cause an increment of sST2 serum concentrations with a concomitant reduction of IL-33. Higher concentrations of sST2 are associated with increased in-hospital mortality in burn patients.

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

    Erim, Daniel O; Resch, Stephen C; Goldie, Sue J

    2012-09-14

    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. 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. 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. 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).

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

    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.

  8. The Prevention of Prematurity: A Strategy to Reduce Infant Mortality in the District of Columbia.

    Maxwell, Joan

    The infant mortality rate in the District of Columbia is higher than that for any other state. This high rate stems from the great number of infants born seriously underweight and reflects the area's high percentage of births to impoverished black women. Efforts to reduce the mortality rate have centered around the medical treatment approach,…

  9. Early tracheostomy in severe traumatic brain injury: evidence for decreased mechanical ventilation and increased hospital mortality

    Dunham, C Michael; Cutrona, Anthony F; Gruber, Brian S; Calderon, Javier E; Ransom, Kenneth J; Flowers, Laurie L

    2014-01-01

    tracheostomy (OR 1.97; p tracheostomy. Further, this study implies that mechanical ventilation is reduced with early tracheostomy. Both the randomized trial and retrospective meta-analysis indicate that risk for hospital death increases with early tracheostomy. Findings imply that early tracheostomy for severe brain injury is not a prudent routine policy. PMID:24624310

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

    2015-10-01

    RHOB, RRAS, RHOA, PLAU, RHOF, ITGB5, ITGB3 Methylglyoxal degradation III 2.17Eþ00 1.30E01 AKR1C1/AKR1C2, AKR1C3, AKR1C4 Dopamine degradation...2007;25: 2921–7. 6. Bober SL, Recklitis CJ, Bakan J, Garber JE, Patenaude AF. Addressing sexual dysfunction after risk-reducing salpingo-oophorectomy

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

    2017-12-01

    removed by Picard Tools, and base quality score recalibration and Indel (insert/deletion) realignment using the Genome Analysis Toolkit GATK (McKenna et...Analysis Toolkit : a MapReduce framework for analyzing next-generation DNA sequencing data. Genome research 20, 1297-1303. McLean, C. Y., Bristor, D...CA151683), a Department of Defense Career Development award (CA130247), and grants from Gabrielle’s Angel Foundation and Concern Foundation. GGW is also

  12. Mortality rate will likely increase under Senate healthcare bill

    Robbins RA

    2017-06-01

    Full Text Available No abstract available. Article truncated after 150 words. Today (6/27/17 an article was published in the Annals of Internal Medicine by Steffie Woolhandler and David Himmelstein from New York University on the effects of health insurance on mortality (1. The article has special significance because of pending healthcare legislation in the Senate. The Annals article concludes that the odds of dying among the insured relative to the uninsured is 0.71 to 0.97. However, the authors acknowledge that this is a very difficult study to conduct because of the nonrandomized, observational nature of the studies and lack of a strict separation between covered and uncovered Americans. For example, many people cycle in and out of insurance diluting differences between groups. Of course, what is needed is a randomized trial, and surprisingly, one does exist which is discussed in the Annals article (1,2. In 2008, Oregon initiated a limited expansion of its Medicaid program for about 6,000 poor, able-bodied, uninsured …

  13. Myriocin significantly increases the mortality of a non-mammalian model host during Candida pathogenesis.

    Nadja Rodrigues de Melo

    Full Text Available Candida albicans is a major human pathogen whose treatment is challenging due to antifungal drug toxicity, drug resistance and paucity of antifungal agents available. Myrocin (MYR inhibits sphingosine synthesis, a precursor of sphingolipids, an important cell membrane and signaling molecule component. MYR also has dual immune suppressive and antifungal properties, potentially modulating mammalian immunity and simultaneously reducing fungal infection risk. Wax moth (Galleria mellonella larvae, alternatives to mice, were used to establish if MYR suppressed insect immunity and increased survival of C. albicans-infected insects. MYR effects were studied in vivo and in vitro, and compared alone and combined with those of approved antifungal drugs, fluconazole (FLC and amphotericin B (AMPH. Insect immune defenses failed to inhibit C. albicans with high mortalities. In insects pretreated with the drug followed by C. albicans inoculation, MYR+C. albicans significantly increased mortality to 93% from 67% with C. albicans alone 48 h post-infection whilst AMPH+C. albicans and FLC+C. albicans only showed 26% and 0% mortalities, respectively. MYR combinations with other antifungal drugs in vivo also enhanced larval mortalities, contrasting the synergistic antifungal effect of the MYR+AMPH combination in vitro. MYR treatment influenced immunity and stress management gene expression during C. albicans pathogenesis, modulating transcripts putatively associated with signal transduction/regulation of cytokines, I-kappaB kinase/NF-kappaB cascade, G-protein coupled receptor and inflammation. In contrast, all stress management gene expression was down-regulated in FLC and AMPH pretreated C. albicans-infected insects. Results are discussed with their implications for clinical use of MYR to treat sphingolipid-associated disorders.

  14. Reduced lung cancer mortality in dairy farmers: is endotoxin exposure the key factor?

    Mastrangelo, G; Marzia, V; Marcer, G

    1996-11-01

    From two areas in the Province of Padova, we selected 2,283 male farmers who worked either in cattle raising or in crop/orchard cultivation. There were 422 cohort deaths from 1970 to 1992. Using the regional population as a reference, the standardized mortality ratio (SMR) was calculated, with 95% confidence intervals (CI) based on the Poisson distribution. Cancer mortality was significantly reduced among the 1,561 dairy farmers (SMR = 0.65; CI = 0.53-0.81); there was a significant decrease in lung cancer (SMR = 0.49; CI = 0.31-0.74), whereas a significant increase from brain tumors was found (SMR = 2.83; CI = 1.04-6.17). Neither overall cancer mortality nor the lung cancer SMR deviated significantly from unity for the 722 crop/orchard farmers. Among dairy farmers, moreover, lung cancer SMRs showed a significant downward trend across the quartiles of increasing length of work, 0.96 in the first quartile, and 0.48, 0.40, and 0.25 in the second, third, and fourth quartiles, respectively. Moreover, lung cancer risk decreased with increasing farm land area, with SMRs in the quartiles of 0.89, 0.37, 0.41 and 0.19. This decrease cannot be attributed to either a selection (healthy worker effect) or a confounding (lower percentage of smokers) bias. Nor was it due to an artifact introduced by differences in age distribution among the quartiles. Dairy farmers are known to be exposed to higher airborne endotoxin concentrations; reasonably, this cumulative exposure increases further with years of work and area of farm. Endotoxins may have protected the dairy farmers against lung cancer through the tumor necrosis factor produced by alveolar macrophages.

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

    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.

  16. Risk Factors Associated with Mortality and Increased Drug Costs in Nonvariceal Upper Gastrointestinal Bleeding.

    Lu, Mingliang; Sun, Gang; Zhang, Xiu-li; Zhang, Xiao-mei; Liu, Qing-sen; Huang, Qi-yang; Lau, James W Y; Yang, Yun-sheng

    2015-06-01

    To determine risk factors associated with mortality and increased drug costs in patients with nonvariceal upper gastrointestinal bleeding. We retrospectively analyzed data from patients hospitalized with nonvariceal upper gastrointestinal bleeding between January 2001-December 2011. Demographic and clinical characteristics and drug costs were documented. Univariate analysis determined possible risk factors for mortality. Statistically significant variables were analyzed using a logistic regression model. Multiple linear regression analyzed factors influencing drug costs. p study included data from 627 patients. Risk factors associated with increased mortality were age > 60, systolic blood pressurebleeding rate is 11.20% and mortality is 5.74%. The mortality risk in patients with comorbidities was higher than in patients without comorbidities, and was higher in patients requiring blood transfusion than in patients not requiring transfusion. Rebleeding was associ-ated with mortality. Rebleeding, blood transfusion, and prolonged hospital stay were associated with increased drug costs, whereas bleeding from lesions in the esophagus and duodenum was associated with lower drug costs.

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

    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...

  18. Is diphtheria-tetanus-pertussis (DTP) associated with increased female mortality?

    Aaby, Peter; Ravn, Henrik; Fisker, Ane B

    2016-01-01

    BACKGROUND: Ten years ago, we formulated two hypotheses about whole-cell diphtheria-tetanus-pertussis (DTP) vaccination: first, when given after BCG, DTP increases mortality in girls and, second, following DTP there is an increase in the female/male mortality rate ratio (MRR). A recent review...

  19. Directly observed therapy reduces tuberculosis-specific mortality: a population-based follow-up study in Taipei, Taiwan.

    Yen, Yung-Feng; Yen, Muh-Yong; Lin, Yi-Ping; Shih, Hsiu-Chen; Li, Lan-Huei; Chou, Pesus; Deng, Chung-Yeh

    2013-01-01

    To determine the effect of directly observed therapy (DOT) on tuberculosis-specific mortality and non-TB-specific mortality and identify prognostic factors associated with mortality among adults with culture-positive pulmonary TB (PTB). All adult Taiwanese with PTB in Taipei, Taiwan were included in a retrospective cohort study in 2006-2010. Backward stepwise multinomial logistic regression was used to identify risk factors associated with each mortality outcome. Mean age of the 3,487 patients was 64.2 years and 70.4% were male. Among 2471 patients on DOT, 4.2% (105) died of TB-specific causes and 15.4% (381) died of non-TB-specific causes. Among 1016 patients on SAT, 4.4% (45) died of TB-specific causes and 11.8% (120) died of non-TB-specific causes. , After adjustment for potential confounders, the odds ratio for TB-specific mortality was 0.45 (95% CI: 0.30-0.69) among patients treated with DOT as compared with those on self-administered treatment. Independent predictors of TB-specific and non-TB-specific mortality included older age (ie, 65-79 and ≥80 years vs. 18-49 years), being unemployed, a positive sputum smear for acid-fast bacilli, and TB notification from a general ward or intensive care unit (reference: outpatient services). Male sex, end-stage renal disease requiring dialysis, malignancy, and pleural effusion on chest radiography were associated with increased risk of non-TB-specific mortality, while presence of lung cavities on chest radiography was associated with lower risk. DOT reduced TB-specific mortality by 55% among patients with PTB, after controlling for confounders. DOT should be given to all TB patients to further reduce TB-specific mortality.

  20. Reducing child mortality in Nigeria: a case study of immunization and systemic factors.

    Nwogu, Rufus; Ngowu, Rufus; Larson, James S; Kim, Min Su

    2008-07-01

    The purpose of the study is to assess the outcome of the Expanded Program on Immunization (EPI) in Nigeria, as well as to examine systemic factors influencing its high under-five mortality rate (UFMR). The principal objective of the EPI program when it was implemented in 1978 was to reduce mortality, morbidity and disability associated with six vaccine preventable diseases namely tuberculosis, tetanus, diphtheria, measles, pertussis and poliomyelitis. The methodological approach to this study is quantitative, using secondary time series data from 1970 to 2003. The study tested three hypotheses using time series multiple regression analysis with autocorrelation adjustment as a statistical model. The results showed that the EPI program had little effect on UFMR in Nigeria. Only the literacy rate and domestic spending on healthcare had statistically significant effects on the UFMR. The military government was not a significant factor in reducing or increasing the UFMR. It appears that Nigeria needs a unified approach to healthcare delivery, rather than fragmented programs, to overcome cultural and political divisions in society.

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

    Christensen, Mikkel; Lundh, Andreas

    2013-01-01

    Pharmacotherapy in the elderly population is complicated by several factors that increase the risk of drug related harms and poorer adherence. The concept of medication review is a key element in improving the quality of prescribing and the prevention of adverse drug events. While no generally...... 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...

  2. Sepsis Induces a Dysregulated Neutrophil Phenotype That Is Associated with Increased Mortality

    Jaimin M. Patel

    2018-01-01

    Full Text Available Background. Neutrophil dysfunction in sepsis has been implicated in the pathogenesis of multiorgan failure; however, the role of neutrophil extracellular traps (NETs remains uncertain. We aimed to determine the sequential changes in ex vivo NETosis and its relationship with mortality in patients with sepsis and severe sepsis. Methods. This was a prospective observational cohort study enrolling 21 healthy age-matched controls and 39 sepsis and 60 severe sepsis patients from acute admissions to two UK hospitals. Patients had sequential bloods for the ex vivo assessment of NETosis in response to phorbol-myristate acetate (PMA using a fluorometric technique and chemotaxis using time-lapse video microscopy. Continuous data was tested for normality, with appropriate parametric and nonparametric tests, whilst categorical data was analysed using a chi-squared test. Correlations were performed using Spearman’s rho. Results. Ex vivo NETosis was reduced in patients with severe sepsis, compared to patients with sepsis and controls (p=0.002. PMA NETosis from patients with septic shock was reduced further (p<0.001 compared to controls. The degree of metabolic acidosis correlated with reduced NETosis (p<0.001, and this was replicated when neutrophils from healthy donors were incubated in acidotic media. Reduced NETosis at baseline was associated with an increased 30-day (p=0.002 and 90-day mortality (p=0.014 in sepsis patients. These findings were accompanied by defects in neutrophil migration and delayed apoptosis. Resolution of sepsis was not associated with the return to baseline levels of NETosis or migration. Conclusions. Sepsis induces significant changes in neutrophil function with the degree of dysfunction corresponding to the severity of the septic insult which persists beyond physiological recovery from sepsis. The changes induced lead to the failure to effectively contain and eliminate the invading pathogens and contribute to sepsis

  3. The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico.

    Delphine Hu

    Full Text Available BACKGROUND: In Mexico, the lifetime risk of dying from maternal causes is 1 in 370 compared to 1 in 2,500 in the U.S. Although national efforts have been made to improve maternal services in the last decade, it is unclear if Millennium Development Goal 5--to reduce maternal mortality by three-quarters by 2015--will be met. METHODOLOGY/PRINCIPAL FINDINGS: We developed an empirically calibrated model that simulates the natural history of pregnancy and pregnancy-related complications in a cohort of 15-year-old women followed over their lifetime. After synthesizing national and sub-national trends in maternal mortality, the model was calibrated to current intervention-specific coverage levels and validated by comparing model-projected life expectancy, total fertility rate, crude birth rate and maternal mortality ratio with Mexico-specific data. Using both published and primary data, we assessed the comparative health and economic outcomes of alternative strategies to reduce maternal morbidity and mortality. A dual approach that increased coverage of family planning by 15%, and assured access to safe abortion for all women desiring elective termination of pregnancy, reduced mortality by 43% and was cost saving compared to current practice. The most effective strategy added a third component, enhanced access to comprehensive emergency obstetric care for at least 90% of women requiring referral. At a national level, this strategy reduced mortality by 75%, cost less than current practice, and had an incremental cost-effectiveness ratio of $300 per DALY relative to the next best strategy. Analyses conducted at the state level yielded similar results. CONCLUSIONS/SIGNIFICANCE: Increasing the provision of family planning and assuring access to safe abortion are feasible, complementary and cost-effective strategies that would provide the greatest benefit within a short-time frame. Incremental improvements in access to high-quality intrapartum and emergency

  4. Reducing mortality risk by targeting specific air pollution sources: Suva, Fiji.

    Isley, C F; Nelson, P F; Taylor, M P; Stelcer, E; Atanacio, A J; Cohen, D D; Mani, F S; Maata, M

    2018-01-15

    Health implications of air pollution vary dependent upon pollutant sources. This work determines the value, in terms of reduced mortality, of reducing ambient particulate matter (PM 2.5 : effective aerodynamic diameter 2.5μm or less) concentration due to different emission sources. Suva, a Pacific Island city with substantial input from combustion sources, is used as a case-study. Elemental concentration was determined, by ion beam analysis, for PM 2.5 samples from Suva, spanning one year. Sources of PM 2.5 have been quantified by positive matrix factorisation. A review of recent literature has been carried out to delineate the mortality risk associated with these sources. Risk factors have then been applied for Suva, to calculate the possible mortality reduction that may be achieved through reduction in pollutant levels. Higher risk ratios for black carbon and sulphur resulted in mortality predictions for PM 2.5 from fossil fuel combustion, road vehicle emissions and waste burning that surpass predictions for these sources based on health risk of PM 2.5 mass alone. Predicted mortality for Suva from fossil fuel smoke exceeds the national toll from road accidents in Fiji. The greatest benefit for Suva, in terms of reduced mortality, is likely to be accomplished by reducing emissions from fossil fuel combustion (diesel), vehicles and waste burning. Copyright © 2017. Published by Elsevier B.V.

  5. Increasing asthma mortality in Denmark 1969-88 not a result of a changed coding practice

    Juel, K; Pedersen, P A

    1992-01-01

    We have studied asthma mortality in Denmark from 1969 to 1988. Age standardized mortality rates calculated in three age groups, 10-34, 35-59, and greater than or equal to 60 years, disclosed similar trends. Increasing mortality from asthma in the mid-1970s to 1988 was seen in all three age groups...... with higher mortality in 1979-88 as compared with 1969-78 of 95%, 55%, and 69%, respectively. Since the eighth revision of the International Classification of Diseases (ICD8) was used in Denmark over the entire 20-year period, changes in coding practice due to change of classification system cannot explain...

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

    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.

  7. Post-operative delirium is associated with increased 5-year mortality.

    Moskowitz, Eliza E; Overbey, Douglas M; Jones, Teresa S; Jones, Edward L; Arcomano, Todd R; Moore, John T; Robinson, Thomas N

    2017-12-01

    Post-operative delirium is associated with increased short term morbidity and mortality. Limited data exists on long term outcomes for older adults with postoperative delirium. We hypothesize that postoperative delirium is associated with increased 5-year mortality. Patients ≥50 years undergoing elective operations with planned intensive care unit (ICU) admissions were prospectively enrolled. The Confusion Assessment Method ICU (CAM-ICU) was used to diagnose delirium. The primary outcome variable was 5-year mortality. 172 patients were enrolled with an average age of 64 years. The overall incidence of delirium was 44% (75/172). At 5-years post-operatively, mortality was higher (59%, 41/70) in patients with delirium compared to patients without delirium (13%, 12/94, p delirium were 7.35 fold greater (95% CI: 1.49-36.18). Postoperative delirium is associated with increased long term mortality. Published by Elsevier Inc.

  8. Mild renal insufficiency is associated with increased cardiovascular mortality: The Hoorn study

    Henry, Ronald M.A.; Kostense, Piet J.; Bos, Griêt; Dekker, Jacqueline M.; Nijpels, Giel; Heine, Robert J.; Bouter, Lex M.; Stehouwer, Coen D.A.

    2002-01-01

    BACKGROUND: Cardiovascular mortality is extremely high in end-stage renal disease. Cardiovascular mortality risk also is increased in selected (high-risk) individuals with mild to moderate impairment of renal function. It is not clear whether a similar association exists in the general population

  9. Widespread increase of tree mortality rates in the western United States

    Phillip J. van Mantgem; Nathan L. Stephenson; John C. Byrne; Lori D. Daniels; Jerry F. Franklin; Peter Z. Fule; Mark E. Harmon; Andrew J. Larson; Jeremy M. Smith; Alan H. Taylor; Thomas T. Veblen

    2009-01-01

    Persistent changes in tree mortality rates can alter forest structure, composition, and ecosystem services such as carbon sequestration. Our analyses of longitudinal data from unmanaged old forests in the western United States showed that background (noncatastrophic) mortality rates have increased rapidly in recent decades, with doubling periods ranging from 17 to 29...

  10. Increased mortality associated with extreme-heat exposure in King County, Washington, 1980-2010

    Isaksen, Tania Busch; Fenske, Richard A.; Hom, Elizabeth K.; Ren, You; Lyons, Hilary; Yost, Michael G.

    2016-01-01

    Extreme heat has been associated with increased mortality, particularly in temperate climates. Few epidemiologic studies have considered the Pacific Northwest region in their analyses. This study quantified the historical (May to September, 1980-2010) heat-mortality relationship in the most populous Pacific Northwest County, King County, Washington. A relative risk (RR) analysis was used to explore the relationship between heat and all-cause mortality on 99th percentile heat days, while a time series analysis, using a piece-wise linear model fit, was used to estimate the effect of heat intensity on mortality, adjusted for temporal trends. For all ages, all causes, we found a 10 % (1.10 (95 % confidence interval (CI), 1.06, 1.14)) increase in the risk of death on a heat day versus non-heat day. When considering the intensity effect of heat on all-cause mortality, we found a 1.69 % (95 % CI, 0.69, 2.70) increase in the risk of death per unit of humidex above 36.0 °C. Mortality stratified by cause and age produced statistically significant results using both types of analyses for: all-cause, non-traumatic, circulatory, cardiovascular, cerebrovascular, and diabetes causes of death. All-cause mortality was statistically significantly modified by the type of synoptic weather type. These results demonstrate that heat, expressed as humidex, is associated with increased mortality on heat days, and that risk increases with heat's intensity. While age was the only individual-level characteristic found to modify mortality risks, statistically significant increases in diabetes-related mortality for the 45-64 age group suggests that underlying health status may contribute to these risks.

  11. Achieving the Millennium Development Goal of reducing maternal mortality in rural Africa: an experience from Burundi.

    Tayler-Smith, K; Zachariah, R; Manzi, M; Van den Boogaard, W; Nyandwi, G; Reid, T; Van den Bergh, R; De Plecker, E; Lambert, V; Nicolai, M; Goetghebuer, S; Christaens, B; Ndelema, B; Kabangu, A; Manirampa, J

    2012-01-01

    OBJECTIVES: To estimate the reduction in maternal mortality associated with the emergency obstetric care provided by Médecins Sans Frontières (MSF) and to compare this to the fifth Millennium Development Goal of reducing maternal mortality. METHODS: The impact of MSF's intervention was approximated by estimating how many deaths were averted among women transferred to and treated at MSF's emergency obstetric care facility in Kabezi, Burundi, with a severe acute maternal morbidity. Using this e...

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

    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, ...

  13. Diabetes increases mortality after myocardial infarction by oxidizing CaMKII

    Luo, Min; Guan, Xiaoqun; Luczak, Elizabeth D.; Lang, Di; Kutschke, William; Gao, Zhan; Yang, Jinying; Glynn, Patric; Sossalla, Samuel; Swaminathan, Paari D.; Weiss, Robert M.; Yang, Baoli; Rokita, Adam G.; Maier, Lars S.; Efimov, Igor R.

    2013-01-01

    Diabetes increases oxidant stress and doubles the risk of dying after myocardial infarction, but the mechanisms underlying increased mortality are unknown. Mice with streptozotocin-induced diabetes developed profound heart rate slowing and doubled mortality compared with controls after myocardial infarction. Oxidized Ca2+/calmodulin-dependent protein kinase II (ox-CaMKII) was significantly increased in pacemaker tissues from diabetic patients compared with that in nondiabeti...

  14. Increasing educational disparities in premature adult mortality, Wisconsin, 1990-2000.

    Reither, Eric N; Peppard, Paul E; Remington, Patrick L; Kindig, David A

    2006-10-01

    Public health agencies have identified the elimination of health disparities as a major policy objective. The primary objective of this study is to assess changes in the association between education and premature adult mortality in Wisconsin, 1990-2000. Wisconsin death records (numerators) and US Census data (denominators) were compiled to estimate mortality rates among adults (25-64 years) in 1990 and 2000. Information on the educational status, sex, racial identification, and age of subjects was gathered from these sources. The effect of education on mortality rate ratios in 1990 and 2000 was assessed while adjusting for age, sex, and racial identification. Education exhibited a graded effect on mortality rates, which declined most among college graduates from 1990 to 2000. The relative rate of mortality among persons with less than a high school education compared to persons with a college degree increased from 2.4 to 3.1 from 1990-2000-an increase of 29%. Mortality disparities also increased, although to a lesser extent, among other educational groups. Despite renewed calls for the elimination of health disparities, evidence suggests that educational disparities in mortality increased from 1990 to 2000.

  15. Meta-analysis : High-dosage vitamin E supplementation may increase all-cause mortality

    Miller, ER; Pastor-Barriuso, R; Dalal, D; Riemersma, RA; Appel, LJ; Guallar, E

    2005-01-01

    Background: Experimental models and observational studies suggest that vitamin E supplementation may prevent cardiovascular disease and cancer. However, several trials of high-dosage vitamin E supplementation showed non-statistically significant increases in total mortality. Purpose: To perform a

  16. Increased mortality and comorbidity associated with Leber’s hereditary optic neuropathy

    Vestergaard, Nanna; Rosenberg, Thomas; Torp-Pedersen, Christian

    2017-01-01

    : This study, based on Danish nationwide health registries, included 141 patients diagnosed with LHON and 297 unaffected family members in the maternal line. The incidence of comorbidities and mortality for patients with LHON and unaffected family members was compared with that in the general population....... Results: Having LHON was associated with an almost 2-fold risk of mortality with a rate ratio (RR) of 1.95 (95% confidence interval [CI]: 1.47-2.59; P ... with increased mortality and increased incidence of several disorders including stroke, demyelinating disorder, dementia, and epilepsy....

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

    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.

  18. Increased inequality in mortality from road crashes among Arabs and Jews in Israel.

    Magid, Avi; Leibovitch-Zur, Shalhevet; Baron-Epel, Orna

    2015-01-01

    Previous studies in several countries have shown that the economically disadvantaged seem to have a greater risk of being involved in a car crash. The aim of the present study was to compare rates and trends in mortality and injury from road crashes by age among the Arab and Jewish populations in Israel. Data on road crashes with casualties (2003-2011) from the Israeli Central Bureau of Statistics were analyzed. Age-adjusted road crash injury rates and mortality rates for 2003 to 2011 were calculated and time trends for each age group and population group are presented. Time trend significance was evaluated by linear regression models. Arabs in Israel are at increased risk of injury and mortality from road crashes compared to Jews. Road crash injury rates have significantly decreased in both populations over the last decade, although the rates have been persistently higher among Arabs. Road crash mortality rates have also decreased significantly in the Jewish population but not in the Arab population. This implies an increase in the disparity in mortality between Jews and Arabs. The most prominent differences in road crash injury and mortality rates between Arabs and Jews can be observed in young adults and young children. The reduction in road crashes in the last decade is a positive achievement. However, the reductions are not equal among Arabs and Jews in Israel. Therefore, an increase in the disparities in mortality from road crashes is apparent. Public health efforts need to focus specifically on decreasing road crashes in the Arab community.

  19. Increasing educational attainment and mortality reduction: a systematic review and taxonomy.

    Byhoff, Elena; Hamati, Mary C; Power, Robyn; Burgard, Sarah A; Chopra, Vineet

    2017-09-18

    Understanding the relationship between increasing educational attainment and mortality reduction has important policy and public health implications. This systematic review of the literature establishes a taxonomy to facilitate evaluation of the association between educational attainment and early mortality. Following PRISMA guidelines, we searched Ovid Medline, Embase, PubMed and hand searches of references for English-language primary data analyses using education as an independent variable and mortality as a dependent variable. Initial searches were undertaken in February 2015 and updated in April 2016. One thousand, seven hundred and eleven unique articles were identified, 418 manuscripts were screened and 262 eligible studies were included in the review. After an iterative review process, the literature was divided into four study domains: (1) all-cause mortality (n = 68, 26.0%), (2) outcome-specific mortality (n = 89, 34.0%), (3) explanatory pathways (n = 51, 19.5%), and (4) trends over time (n = 54, 20.6%). These four domains comprise a novel taxonomy that can be implemented to better quantify the relationship between education and mortality. We propose an organizational taxonomy for the education-mortality literature based upon study characteristics that will allow for a more in-depth understanding of this association. Our review suggests that studies that include mediators or subgroups can explain part, but not all, of the relationship between education and early mortality. PROSPERO registration # CRD42015017182 .

  20. Widespread recent increases in county-level heart disease mortality across age groups.

    Vaughan, Adam S; Ritchey, Matthew D; Hannan, Judy; Kramer, Michael R; Casper, Michele

    2017-12-01

    Recent national trends show decelerating declines in heart disease mortality, especially among younger adults. National trends may mask variation by geography and age. We examined recent county-level trends in heart disease mortality by age group. Using a Bayesian statistical model and National Vital Statistics Systems data, we estimated overall rates and percent change in heart disease mortality from 2010 through 2015 for four age groups (35-44, 45-54, 55-64, and 65-74 years) in 3098 US counties. Nationally, heart disease mortality declined in every age group except ages 55-64 years. County-level trends by age group showed geographically widespread increases, with 52.3%, 58.5%, 69.1%, and 42.0% of counties experiencing increases with median percent changes of 0.6%, 2.2%, 4.6%, and -1.5% for ages 35-44, 45-54, 55-64, and 65-74 years, respectively. Increases were more likely in counties with initially high heart disease mortality and outside large metropolitan areas. Recent national trends have masked local increases in heart disease mortality. These increases, especially among adults younger than age 65 years, represent challenges to communities across the country. Reversing these trends may require intensification of primary and secondary prevention-focusing policies, strategies, and interventions on younger populations, especially those living in less urban counties. Published by Elsevier Inc.

  1. The increasing mortality advantage of the married: The role played by education

    Øystein Kravdal

    2018-02-01

    Full Text Available Background: In several European countries the excess mortality of nonmarried people relative to the married has increased. In this study we describe in detail the increasing mortality advantage of the married in Norway and investigate the extent to which changes in educational composition of marital-status groups can account for this increasing mortality gap. Methods: Using register data for the entire population of Norway, we estimated discrete-time hazard models for mortality at age 50-89 in years 1975-2008. We also estimated one-year death probabilities by age, period, marital status, education, and spouse's education. These were used to calculate period-specific age-standardized death probabilities for marital-status categories and hypothetical versions of these, assuming constant death probabilities in each educational group in each marital-status category or constant educational distributions. Hypothetical and observed versions were then compared. Results: The mortality of nonmarried people relative to married people increased sharply over the years 1975-2008. During the first part of this period, mortality was constant or even increasing among the never-married, who at the end of the period could be considered as lagging 30 years behind the married. Educational patterns have changed markedly, but this explains only up to 5Š of the increasing mortality disadvantage of the never-married. Educational changes have contributed more to the growing disadvantage of the widowed, while the picture is more mixed for the divorced. Conclusions: Contribution: We demonstrate that there has been a large widening in the marital-status differences in mortality in Norway since the 1970s and that little of this difference can be attributed to changes in educational distributions.

  2. Chronic ingestion of 2-deoxy-D-glucose induces cardiac vacuolization and increases mortality in rats

    Minor, Robin K.; Smith, Daniel L.; Sossong, Alex M.; Kaushik, Susmita; Poosala, Suresh; Spangler, Edward L.; Roth, George S.; Lane, Mark; Allison, David B.; Cabo, Rafael de; Ingram, Donald K.; Mattison, Julie A.

    2010-01-01

    Calorie restriction (CR), the purposeful reduction of energy intake with maintenance of adequate micronutrient intake, is well known to extend the lifespan of laboratory animals. Compounds like 2-deoxy-D-glucose (2DG) that can recapitulate the metabolic effects of CR are of great interest for their potential to extend lifespan. 2DG treatment has been shown to have potential therapeutic benefits for treating cancer and seizures. 2DG has also recapitulated some hallmarks of the CR phenotype including reduced body temperature and circulating insulin in short-term rodent trials, but one chronic feeding study in rats found toxic effects. The present studies were performed to further explore the long-term effects of 2DG in vivo. First we demonstrate that 2DG increases mortality of male Fischer-344 rats. Increased incidence of pheochromocytoma in the adrenal medulla was also noted in the 2DG treated rats. We reconfirm the cardiotoxicity of 2DG in a 6-week follow-up study evaluating male Brown Norway rats and a natural form of 2DG in addition to again examining effects in Fischer-344 rats and the original synthetic 2DG. High levels of both 2DG sources reduced weight gain secondary to reduced food intake in both strains. Histopathological analysis of the hearts revealed increasing vacuolarization of cardiac myocytes with dose, and tissue staining revealed the vacuoles were free of both glycogen and lipid. We did, however, observe higher expression of both cathepsin D and LC3 in the hearts of 2DG-treated rats which indicates an increase in autophagic flux. Although a remarkable CR-like phenotype can be reproduced with 2DG treatment, the ultimate toxicity of 2DG seriously challenges 2DG as a potential CR mimetic in mammals and also raises concerns about other therapeutic applications of the compound.

  3. Mortality in Graves' orbitopathy is increased and influenced by gender, age and pre-existing morbidity

    Schwensen, Charlotte F; Hjelm Brandt Kristensen, Frans; Hegedüs, Laszlo

    2017-01-01

    INTRODUCTION: It is unclear whether the excess mortality associated with Graves' disease differs between individuals with Graves' orbitopathy (GO) or without (GD). SUBJECTS AND METHODS: A nationwide, register-based cohort study in which all adult Danes diagnosed with GD (n = 28 461) and GO (n......-existing morbidity using the Charlson score. RESULTS: Adjusted mortality in Graves' disease overall (GD + GO) was significantly increased compared to that in the background population (HR = 1.18 (95% confidence interval: 1.15-1.21)). In GD and GO separately, adjusted mortality was also significantly higher than...

  4. Increased 30-day mortality in patients with diabetes undergoing surgery for colorectal cancer

    Fransgaard, T; Thygesen, L C; Gögenur, I

    2016-01-01

    with the use of antidiabetic drugs identified through the Danish National Prescription Registry and DCCG. The 30-day mortality was examined by the Kaplan-Meier method with the log-rank test and the Cox regression model used to test statistical significance. RESULTS: The study included 29 353 patients, of whom...... 3250 had preexisting diabetes. The 30-day mortality was significantly increased in patients with CRC and preexisting diabetes (adjusted hazard ratio 1.17, 95% CI 1.01-1.35, P = 0.03). The type of antidiabetic medication used was not associated with 30-day mortality. CONCLUSION: Preexisting diabetes...

  5. Major depressive symptoms increase 3-year mortality rate in patients with mild dementia

    Petersen, Jindong Ding; Waldorff, Frans Boch; Siersma, Volkert Dirk

    2017-01-01

    Depression and dementia are commonly concurrent and are both associated with increased mortality among older people. However, little is known about whether home-dwelling patients newly diagnosed with mild dementia coexisting with depressive symptoms have excess mortality. We conducted a post hoc...... analysis based on data from the Danish Alzheimer's Intervention Study of 330 individuals who were diagnosed with mild dementia within the past 12 months. Thirty-four patients were identified with major depressive symptoms (MD-S) at baseline. During the 3-year follow-up period, 56 patients died, and, among...... mortality as compared to the patients without or with only few depressive symptoms. Our result revealed that depression is possibly associated with increased mortality in patients with mild dementia. Given that depression is treatable, screening for depression and treatment of depression can be important...

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

    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...

  7. Statin use is associated with reduced all-cause mortality after endovascular abdominal aortic aneurysm repair.

    Leurs, L.J.; Visser, P.; Laheij, R.J.F.; Buth, J.; Harris, P.L.; Blankensteijn, J.D.

    2006-01-01

    It has been shown that preoperative statin therapy reduces all-cause and cardiovascular mortality in patients undergoing major noncardiac vascular surgery. In this report, we investigated the influence of statin use on early and late outcome following endovascular abdominal aortic aneurysm repair

  8. Urbanization is Associated with Increased Trends in Cardiovascular Mortality Among Indigenous Populations: the PAI Study

    Anderson da Costa Armstrong

    2018-02-01

    Full Text Available Abstract Background: The cardiovascular risk burden among diverse indigenous populations is not totally known and may be influenced by lifestyle changes related to the urbanization process. Objectives: To investigate the cardiovascular (CV mortality profile of indigenous populations during a rapid urbanization process largely influenced by governmental infrastructure interventions in Northeast Brazil. Methods: We assessed the mortality of indigenous populations (≥ 30 y/o from 2007 to 2011 in Northeast Brazil (Bahia and Pernambuco states. Cardiovascular mortality was considered if the cause of death was in the ICD-10 CV disease group or if registered as sudden death. The indigenous populations were then divided into two groups according to the degree of urbanization based on anthropological criteria:9,10 Group 1 - less urbanized tribes (Funi-ô, Pankararu, Kiriri, and Pankararé; and Group 2 - more urbanized tribes (Tuxá, Truká, and Tumbalalá. Mortality rates of highly urbanized cities (Petrolina and Juazeiro in the proximity of indigenous areas were also evaluated. The analysis explored trends in the percentage of CV mortality for each studied population. Statistical significance was established for p value < 0.05. Results: There were 1,333 indigenous deaths in tribes of Bahia and Pernambuco (2007-2011: 281 in Group 1 (1.8% of the 2012 group population and 73 in Group 2 (3.7% of the 2012 group population, CV mortality of 24% and 37%, respectively (p = 0.02. In 2007-2009, there were 133 deaths in Group 1 and 44 in Group 2, CV mortality of 23% and 34%, respectively. In 2009-2010, there were 148 deaths in Group 1 and 29 in Group 2, CV mortality of 25% and 41%, respectively. Conclusions: Urbanization appears to influence increases in CV mortality of indigenous peoples living in traditional tribes. Lifestyle and environmental changes due to urbanization added to suboptimal health care may increase CV risk in this population.

  9. Reduced plasma concentrations of vitamin B6 and increased ...

    Reduced plasma concentrations of vitamin B6 and increased plasma concentrations of the neurotoxin 3-hydroxykynurenine are associated with nodding syndrome: a case control study in Gulu and Amuru districts, Northern Uganda.

  10. Can Increases in CHIP Copayments Reduce Program Exp..

    U.S. Department of Health & Human Services — According to the article, Can increases in CHIP copayments reduce program expenditures on prescription drugs in Volume 4, Issue 2, of Medicare and Medicaid Research...

  11. Alcohol Abuse Increases Rebleeding Risk and Mortality in Patients with Non-variceal Upper Gastrointestinal Bleeding.

    Kärkkäinen, Jussi M; Miilunpohja, Sami; Rantanen, Tuomo; Koskela, Jenni M; Jyrkkä, Johanna; Hartikainen, Juha; Paajanen, Hannu

    2015-12-01

    No current data are available on rebleeding and mortality risk in patients who use alcohol excessively and are admitted for non-variceal upper gastrointestinal bleeding (NVUGIB). This information could help in planning interventions and follow-up protocols for these patients. This study provides contemporary data on the long-term outcome after first-time NVUGIB in alcohol abusers (AAs) compared to non-abusers (NAs). Consecutive patients hospitalized for their first acute gastrointestinal bleeding from 2009 through 2011 were retrospectively recorded and categorized as AA or NA. Risk factors for one-year mortality and rebleeding were identified, and patients were further monitored for long-term mortality until 2015. Alcohol abuse was identified in 19.7% of patients with NVUGIB (n = 518). The one-year rebleeding rate was 16.7% in AAs versus 9.1% in NAs (P = 0.027). Alcohol abuse was associated with a twofold increase in rebleeding risk (P = 0.025); the risk especially increased 6 months after the initial bleeding. The study groups did not differ significantly in 30-day (6.0%) or one-year mortality rates (20.5%). However, there was a tendency for higher overall mortality in AAs than NAs after adjustment of comorbidities. AAs with NVUGIB are at high risk of rebleeding, and mortality is increased in AA patients. A close follow-up strategy and long-term proton pump inhibitor therapy are recommended for AA patients with peptic ulcer or esophagitis.

  12. Low-Temperature Stress during Capped Brood Stage Increases Pupal Mortality, Misorientation and Adult Mortality in Honey Bees

    Wang, Qing; Xu, Xinjian; Zhu, Xiangjie; Chen, Lin; Zhou, Shujing; Huang, Zachary Y.; Zhou, Bingfeng

    2016-01-01

    Honey bees (Apis mellifera) are key pollinators, playing a vital role in ecosystem maintenance and stability of crop yields. Recently, reduced honey bee survival has attracted intensive attention. Among all other honey bee stresses, temperature is a fundamental ecological factor that has been shown to affect honey bee survival. Yet, the impact of low temperature stress during capped brood on brood mortality has not been systematically investigated. In addition, little was known about how low temperature exposure during capped brood affects subsequent adult longevity. In this study, capped worker broods at 12 different developmental stages were exposed to 20°C for 12, 24, 36, 48, 60, 72, 84 and 96 hours, followed by incubation at 35°C until emergence. We found that longer durations of low temperature during capped brood led to higher mortality, higher incidences of misorientation inside cells and shorter worker longevity. Capped brood as prepupae and near emergence were more sensitive to low-temperature exposure, while capped larvae and mid-pupal stages showed the highest resistance to low-temperature stress. Our results suggest that prepupae and pupae prior to eclosion are the most sensitive stages to low temperature stress, as they are to other stresses, presumably due to many physiological changes related to metamorphosis happening during these two stages. Understanding how low-temperature stress affects honey bee physiology and longevity can improve honey bee management strategies. PMID:27149383

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

    Callister, Lynn Clark; Edwards, Joan E

    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. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  14. Increased risk of peripartum perinatal mortality in unplanned births outside an institution: a retrospective population-based study.

    Engjom, Hilde M; Morken, Nils-Halvdan; Høydahl, Even; Norheim, Ole F; Klungsøyr, Kari

    2017-08-01

    Births in midwife-led institutions may reduce the frequency of medical interventions and provide cost-effective care, while larger institutions offer medically and technically advanced obstetric care. Unplanned births outside an institution and intrapartum stillbirths have frequently been excluded in previous studies on adverse outcomes by place of birth. The objective of the study was to assess peripartum mortality by place of birth and travel time to obstetric institutions, with the hypothesis that centralization reduces institution availability but improves mortality. This was a national population-based retrospective cohort study of all births in Norway from 1999 to 2009 (n = 648,555) using data from the Medical Birth Registry of Norway and Statistics Norway and including births from 22 gestational weeks or birthweight ≥500 g. Main exposures were travel time to the nearest obstetric institution and place of birth. The main clinical outcome was peripartum mortality, defined as death during birth or within 24 hours. Intrauterine fetal deaths prior to start of labor were excluded from the primary outcome. A total of 1586 peripartum deaths were identified (2.5 per 1000 births). Unplanned birth outside an institution had a 3 times higher mortality (8.4 per 1000) than institutional births (2.4 per 1000), relative risk, 3.5 (95% confidence interval, 2.5-4.9) and contributed 2% (95% confidence interval, 1.2-3.0%) of the peripartum mortality at the population level. The risk of unplanned birth outside an institution increased from 0.5% to 3.3% and 4.5% with travel time 2 hours, respectively. In obstetric institutions the mortality rate at term ranged from 0.7 per 1000 to 0.9 per 1000. Comparable mortality rates in different obstetric institutions indicated well-functioning routines for referral. Unplanned birth outside an institution was associated with increased peripartum mortality and with long travel time to obstetric institutions. Structural determinants have

  15. Type A personality and mortality: Competitiveness but not speed is associated with increased risk.

    Lohse, Tina; Rohrmann, Sabine; Richard, Aline; Bopp, Matthias; Faeh, David

    2017-07-01

    Type A behavior pattern (TABP) is a possible risk factor for cardiovascular disease (CVD). However, existing evidence is conflicting, also because studies did not examine underlying traits separately. In this study, we investigated whether all-cause and CVD mortality were associated with the Bortner Scale, a measure of TABP, in particular with its subscales competitiveness and speed. Information on Bortner Scale and covariates of 9921 participants was collected at baseline in two cross-sectional studies that were linked with mortality information, yielding a follow-up of up to 37 years. We analyzed the Bortner Scale and its two subscales competitiveness and speed. Applying Cox regression models, we investigated the association with all-cause, CVD, and specific CVD type mortality. During follow-up, 3469 deaths were observed (1118 CVD deaths). The total Bortner Scale was not associated with mortality, only its subscales. In women, competitiveness was positively associated with all-cause mortality (highest category vs. the lowest, HR 1.25 [95% CI 1.08,1.44]), CVD mortality (1.39 [1.07,1.81]), and ischemic heart disease mortality (intermediate category vs. the lowest, 1.46 [1.02,2.10]). In men, CVD mortality was inversely associated with speed (highest category vs. the lowest, 0.74 [0.59,0.93]). The subscales of the Bortner Scale may be associated with CVD in an opposed manner and may therefore have to be analyzed separately. More studies are needed to further investigate this association, also considering differences by sex. Persons scoring high in the competitiveness subscale ought to be screened and counselled in order to reduce their CVD risk. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Development, oviposition, and mortality of Neoseiulus fallacis (Acari: Phytoseiidae) in response to reduced-risk insecticides.

    Villanueva, Raul T; Walgenbach, James F

    2005-12-01

    Eight reduced-risk insecticides (acetamiprid, thiamethoxam, imidacloprid, thiacloprid, methoxyfenozide, pyriproxyfen, indoxacarb, and spinosad) and three conventional insecticides (azinphosmethyl, fenpropathrin, and esfenvalerate) were tested against Neoseiulus fallacis (Garman) (Acari: Phytoseiidae), the most abundant predacious mite in North Carolina apple (Malus spp.) orchards. To assess the effect of insecticides on development and mortality of N. fallacis immatures, 12-h-old eggs were individually placed on bean leaf disks previously dipped in insecticide solutions. Tetranychus urticae Koch (Acari: Tetranychidae) females were added as a food source. None of the reduced-risk insecticides significantly affected immature N. fallacis compared with the control; however, the pyrethroids esfenvalerate and fenpropathrin were highly toxic to immatures. To evaluate the effect of insecticides on mortality and oviposition of adult N. fallacis, 7- to 8-d-old females were confined on insecticide-treated bean leaves with Malephora crocea (Aizoaceae) pollen added as a food source. Spinosad resulted in the highest mortality, whereas azinphosmethyl, acetamiprid, fenpropathrin, and imidacloprid were moderately toxic, and mortality from esfenvalerate, indoxacarb, thiacloprid, methoxyfenozide, pyriproxyfen, and thiamethoxam did not differ significantly from the control. Oviposition was affected in a similar manner, with the exception of acetamiprid that did not affect oviposition, and thiamethoxam that reduced oviposition.

  17. Explaining the increase in coronary heart disease mortality in Syria between 1996 and 2006

    Rastam Samer

    2012-09-01

    Full Text Available Abstract Background Despite advances made in treating coronary heart disease (CHD, mortality due to CHD in Syria has been increasing for the past two decades. This study aims to assess CHD mortality trends in Syria between 1996 and 2006 and to investigate the main factors associated with them. Methods The IMPACT model was used to analyze CHD mortality trends in Syria based on numbers of CHD patients, utilization of specific treatments, trends in major cardiovascular risk factors in apparently healthy persons and CHD patients. Data sources for the IMPACT model included official statistics, published and unpublished surveys, data from neighboring countries, expert opinions, and randomized trials and meta-analyses. Results Between 1996 and 2006, CHD mortality rate in Syria increased by 64%, which translates into 6370 excess CHD deaths in 2006 as compared to the number expected had the 1996 baseline rate held constant. Using the IMPACT model, it was estimated that increases in cardiovascular risk factors could explain approximately 5140 (81% of the CHD deaths, while some 2145 deaths were prevented or postponed by medical and surgical treatments for CHD. Conclusion Most of the recent increase in CHD mortality in Syria is attributable to increases in major cardiovascular risk factors. Treatments for CHD were able to prevent about a quarter of excess CHD deaths, despite suboptimal implementation. These findings stress the importance of population-based primary prevention strategies targeting major risk factors for CHD, as well as policies aimed at improving access and adherence to modern treatments of CHD.

  18. Explaining the increase in coronary heart disease mortality in Syria between 1996 and 2006.

    Rastam, Samer; Al Ali, Radwan; Maziak, Wasim; Mzayek, Fawaz; Fouad, Fouad M; O'Flaherty, Martin; Capewell, Simon

    2012-09-09

    Despite advances made in treating coronary heart disease (CHD), mortality due to CHD in Syria has been increasing for the past two decades. This study aims to assess CHD mortality trends in Syria between 1996 and 2006 and to investigate the main factors associated with them. The IMPACT model was used to analyze CHD mortality trends in Syria based on numbers of CHD patients, utilization of specific treatments, trends in major cardiovascular risk factors in apparently healthy persons and CHD patients. Data sources for the IMPACT model included official statistics, published and unpublished surveys, data from neighboring countries, expert opinions, and randomized trials and meta-analyses. Between 1996 and 2006, CHD mortality rate in Syria increased by 64%, which translates into 6370 excess CHD deaths in 2006 as compared to the number expected had the 1996 baseline rate held constant. Using the IMPACT model, it was estimated that increases in cardiovascular risk factors could explain approximately 5140 (81%) of the CHD deaths, while some 2145 deaths were prevented or postponed by medical and surgical treatments for CHD. Most of the recent increase in CHD mortality in Syria is attributable to increases in major cardiovascular risk factors. Treatments for CHD were able to prevent about a quarter of excess CHD deaths, despite suboptimal implementation. These findings stress the importance of population-based primary prevention strategies targeting major risk factors for CHD, as well as policies aimed at improving access and adherence to modern treatments of CHD.

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

    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

  20. Does Increased Extraction of Natural Gas Reduce Carbon Emissions?

    Aune, F.R.; Golombek, R.; Kittelsen, S.A. C.

    2004-01-01

    Without an international climate agreement, extraction of more natural gas could reduce emissions of CO2 as more 'clean' natural gas may drive out ''dirty'' coal and oil. Using a computable equilibrium model for the Western European electricity and natural gas markets, we examine whether increased extraction of natural gas in Norway reduces global emissions of CO2. We find that both in the short run and in the long run total emissions are reduced if the additional quantity of natural gas is used in gas power production in Norway. If instead the additional quantity is exported directly, total emissions increase both in the short run and in the long run. However, if modest CO2-taxes are imposed, increased extraction of natural gas will reduce CO2 emissions also when the additional natural gas is exported directed

  1. Increased Vascular Disease Mortality Risk in Prediabetic Korean Adults Is Mainly Attributable to Ischemic Stroke.

    Kim, Nam Hoon; Kwon, Tae Yeon; Yu, Sungwook; Kim, Nan Hee; Choi, Kyung Mook; Baik, Sei Hyun; Park, Yousung; Kim, Sin Gon

    2017-04-01

    Prediabetes is a known risk factor for vascular diseases; however, its differential contribution to mortality risk from various vascular disease subtypes is not known. The subjects of the National Health Insurance Service in Korea (2002-2013) nationwide cohort were stratified into normal glucose tolerance (fasting glucose mortality risk for vascular disease and its subtypes-ischemic heart disease, ischemic stroke, and hemorrhagic stroke. When adjusted for age, sex, and body mass index, IFG stage 2, but not stage 1, was associated with significantly higher all-cause mortality (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.18-1.34) and vascular disease mortality (HR, 1.27; 95% CI, 1.08-1.49) compared with normal glucose tolerance. Among the vascular disease subtypes, mortality from ischemic stroke was significantly higher (HR, 1.60; 95% CI, 1.18-2.18) in subjects with IFG stage 2 but not from ischemic heart disease and hemorrhagic stroke. The ischemic stroke mortality associated with IFG stage 2 remained significantly high when adjusted other modifiable vascular disease risk factors (HR, 1.51; 95% CI: 1.10-2.09) and medical treatments (HR, 1.75; 95% CI, 1.19-2.57). Higher IFG degree (fasting glucose, 110-125 mg/dL) was associated with increased all-cause and vascular disease mortality. The increased vascular disease mortality in IFG stage 2 was attributable to ischemic stroke, but not ischemic heart disease or hemorrhagic stroke in Korean adults. © 2017 American Heart Association, Inc.

  2. Reducing Maternal Mortality in Papua New Guinea: Contextualizing Access to Safe Surgery and Anesthesia.

    Dennis, Alicia T

    2018-01-01

    Papua New Guinea has one of the world's highest maternal mortality rates with approximately 215 women dying per 100,000 live births. The sustainable development goals outline key priority areas for achieving a reduction in maternal mortality including a focus on universal health coverage with safe surgery and anesthesia for all pregnant women. This narrative review addresses the issue of reducing maternal mortality in Papua New Guinea by contextualizing the need for safe obstetric surgery and anesthesia within a structure of enabling environments at key times in a woman's life. The 3 pillars of enabling environments are as follows: a stable humanitarian government; a safe, secure, and clean environment; and a strong health system. Key times, and their associated specific issues, in a woman's life include prepregnancy, antenatal, birth and the postpartum period, childhood, adolescence and young womanhood, and the postchildbearing years.

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

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

    2005-01-01

    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...... 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...... as high risk. There was a significant interaction between risk status and effect of primary angioplasty (P=0.008). In the low-risk group, there was no difference in mortality (primary angioplasty, 8.0%; fibrinolysis, 5.6%; P=0.11); in the high-risk group, there was a significant reduction in mortality...

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

    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

  5. Dysthymia and depression increase risk of dementia and mortality among older veterans.

    Byers, Amy L; Covinsky, Kenneth E; Barnes, Deborah E; Yaffe, Kristine

    2012-08-01

    To determine whether less severe depression spectrum diagnoses such as dysthymia, as well as depression, are associated with risk of developing dementia and mortality in a "real-world" setting. Retrospective cohort study conducted using the Department of Veterans Affairs (VA) National Patient Care Database (1997-2007). VA medical centers in the United States. A total of 281,540 veterans aged 55 years and older without dementia at study baseline (1997-2000). Depression status and incident dementia were ascertained from International Classification of Diseases, Ninth Revision codes during study baseline (1997-2000) and follow-up (2001-2007), respectively. Mortality was ascertained by time of death dates in the VA Vital Status File. Ten percent of veterans had baseline diagnosis of depression and nearly 1% had dysthymia. The unadjusted incidence of dementia was 11.2% in veterans with depression, 10.2% with dysthymia and 6.4% with neither. After adjusting for demographics and comorbidities, patients diagnosed with dysthymia or depression were twice as likely to develop incident dementia compared with those with no dysthymia/depression (adjusted dysthymia hazard ratio [HR]: 1.96, 95% confidence interval [CI]: 1.71-2.25; and depression HR: 2.18, 95% CI: 2.08-2.28). Dysthymia and depression also were associated with increased risk of death (31.6% dysthymia and 32.9% depression versus 28.5% neither; adjusted dysthymia HR: 1.41, 95% CI: 1.31-1.53; and depression HR: 1.47, 95% CI: 1.43-1.51). Findings suggest that older adults with dysthymia or depression need to be monitored closely for adverse outcomes. Future studies should determine whether treatment of depression spectrum disorders may reduce risk of these outcomes.

  6. Reduced transpiration response to precipitation pulses precedes mortality in a piñon-juniper woodland subject to prolonged drought.

    Plaut, Jennifer A; Wadsworth, W Duncan; Pangle, Robert; Yepez, Enrico A; McDowell, Nate G; Pockman, William T

    2013-10-01

    Global climate change is predicted to alter the intensity and duration of droughts, but the effects of changing precipitation patterns on vegetation mortality are difficult to predict. Our objective was to determine whether prolonged drought or above-average precipitation altered the capacity to respond to the individual precipitation pulses that drive productivity and survival. We analyzed 5 yr of data from a rainfall manipulation experiment in piñon-juniper (Pinus edulis-Juniperus monosperma) woodland using mixed effects models of transpiration response to event size, antecedent soil moisture, and post-event vapor pressure deficit. Replicated treatments included irrigation, drought, ambient control and infrastructure control. Mortality was highest under drought, and the reduced post-pulse transpiration in the droughted trees that died was attributable to treatment effects beyond drier antecedent conditions and reduced event size. In particular, trees that died were nearly unresponsive to antecedent shallow soil moisture, suggesting reduced shallow absorbing root area. Irrigated trees showed an enhanced response to precipitation pulses. Prolonged drought initiates a downward spiral whereby trees are increasingly unable to utilize pulsed soil moisture. Thus, the additive effects of future, more frequent droughts may increase drought-related mortality. © 2013 The Authors. New Phytologist © 2013 New Phytologist Trust.

  7. Maternal endometrial oedema may increase perinatal mortality of cloned and transgenic piglets

    Schmidt, Mette; Winter, K.D.; Dantzer, Vibeke

    2011-01-01

    The perinatal mortality of cloned animals is a well-known problem. In the present retrospective study, we report on mortality of cloned transgenic or non-transgenic piglets produced as part of several investigations. Large White (LW) sows (n = 105) received hand-made cloned LW or minipig...... endometrial oedema in sows pregnant with cloned and transgenic piglets, as well as in empty recipients, at term. The growth of certain organs in some of the cloned piglets was reduced and the rate of stillborn piglets was greater in cloned and transgenic piglets delivered vaginally, possibly because of oedema...

  8. Dry paths effectively reduce road mortality of small and medium-sized terrestrial vertebrates.

    Niemi, Milla; Jääskeläinen, Niina C; Nummi, Petri; Mäkelä, Tiina; Norrdahl, Kai

    2014-11-01

    Wildlife passages are widely used mitigation measures designed to reduce the adverse impacts of roads on animals. We investigated whether road kills of small and medium-sized terrestrial vertebrates can be reduced by constructing dry paths adjacent to streams that pass under road bridges. The study was carried out in southern Finland during the summer of 2008. We selected ten road bridges with dry paths and ten bridges without them, and an individual dry land reference site for each study bridge on the basis of landscape and traffic features. A total of 307 dead terrestrial vertebrates were identified during the ten-week study period. The presence of dry paths decreased the amount of road-killed terrestrial vertebrates (Poisson GLMM; p road-kills on mammals was not such clear. In the mammal model, a lack of dry paths increased the amount of carcasses (p = 0.001) whereas the number of casualties at dry path bridges was comparable with dry land reference sites. A direct comparison of the dead ratios suggests an average efficiency of 79% for the dry paths. When considering amphibians and mammals alone, the computed effectiveness was 88 and 70%, respectively. Our results demonstrate that dry paths under road bridges can effectively reduce road-kills of small and medium-sized terrestrial vertebrates, even without guiding fences. Dry paths seemed to especially benefit amphibians which are a threatened species group worldwide and known to suffer high traffic mortality. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Associations between valve repair and reduced operative mortality in 21,056 mitral/tricuspid double valve procedures.

    Rankin, J Scott; Thourani, Vinod H; Suri, Rakesh M; He, Xia; O'Brien, Sean M; Vassileva, Christina M; Shah, Ashish S; Williams, Matthew

    2013-09-01

    Repair of either the mitral (M) or tricuspid (T) valve in single valve surgery is associated with reduced operative mortality. It is unclear, however, how valve repair influences mortality in combined MT procedures. This topic was evaluated in the Society of Thoracic Surgeons database. From 1993 through 2007, 21 056 patients underwent concomitant MT valve surgery. Group I had M&T replacement (n = 1130), Group II had M repair and T replacement (n = 216), Group III had M replacement and T repair (n = 11 448) and Group IV had both M&T repair (n = 8262). Unadjusted operative mortalities (UOMs) and morbidities of Groups I-IV were assessed, and logistic regression analysis adjusted for differences in baseline patient profiles. Surgical outcomes were expressed as UOMs, and also adjusted odds ratios (ORs) for mortality. Group IV was older with more coronary artery bypass grafting and generally less comorbidity, and Group I had more endocarditis, mitral stenosis and reoperation. UOM values were: Group I = 16.8, Group II = 10.2, Group III = 10.3 and Group IV = 8.0%. In the multivariable model, factors influencing mortality included: age (per 5-year increase, OR = 1.15), renal failure with dialysis (OR = 3.22), emergency status (OR = 3.14), second or more reoperations (OR = 1.92) and later surgical date (OR = 0.63). Both M and T repair were independently associated with lower operative mortalities vs prosthetic valve replacement (OR = 0.83 and 0.60, respectively, P replacement and, when feasible, multiple valve repair should be considered the optimal treatment. Within the limitations of observational analysis, these data support continued efforts to increase M&T repair rates.

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

    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.

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

    Liu, Suyang; Zhang, Kai

    2015-01-01

    Fine particulate matter (less than 2.5 μm in aerodynamic diameter; PM_2_._5) pollution poses a major environmental threat in Greater Houston due to rapid economic growth and the numerous PM_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_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_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_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"3), nitrate (0.487 μg/m"3), sulfate (2.245 μg/m"3), and vanadium (0.004 μg/m"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_2_._5 mass and mortality decreased during 2000–2011, however, the PM_2_._5 components showed no notable changes in mortality risk over time. Our study indicates that the short-term associations between PM_2_._5 and mortality differ across the PM_2_._5 components and suggests that future air pollution control measures should not only focus on mass but also pollutant sources. - Highlights: • PM_2_._5 concentrations were associated with increased mortality risk. • A few major PM_2_._5 components were associated with increased mortality risk. • Associations were generally strongest in winter in Greater

  12. Exploring exposure to Agent Orange and increased mortality due to bladder cancer.

    Mossanen, Matthew; Kibel, Adam S; Goldman, Rose H

    2017-11-01

    During the Vietnam War, many veterans were exposed to Agent Orange (AO), a chemical defoliant containing varying levels of the carcinogen dioxin. The health effects of AO exposure have been widely studied in the VA population. Here we review and interpret data regarding the association between AO exposure and bladder cancer (BC) mortality. Data evaluating the association between AO and BC is limited. Methods characterizing exposure have become more sophisticated over time. Several studies support the link between AO exposure and increased mortality due to BC, including the Korean Veterans Health Study. Available data suggest an association with exposure to AO and increased mortality due to BC. In patients exposed to AO, increased frequency of cystoscopic surveillance and potentially more aggressive therapy for those with BC may be warranted but utility of these strategies remains to be proven. Additional research is required to better understand the relationship between AO and BC. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Anthropogenic noise playback impairs embryonic development and increases mortality in a marine invertebrate

    Nedelec, Sophie L.; Radford, Andrew N.; Simpson, Stephen D.; Nedelec, Brendan; Lecchini, David; Mills, Suzanne C.

    2014-07-01

    Human activities can create noise pollution and there is increasing international concern about how this may impact wildlife. There is evidence that anthropogenic noise may have detrimental effects on behaviour and physiology in many species but there are few examples of experiments showing how fitness may be directly affected. Here we use a split-brood, counterbalanced, field experiment to investigate the effect of repeated boat-noise playback during early life on the development and survival of a marine invertebrate, the sea hare Stylocheilus striatus at Moorea Island (French Polynesia). We found that exposure to boat-noise playback, compared to ambient-noise playback, reduced successful development of embryos by 21% and additionally increased mortality of recently hatched larvae by 22%. Our work, on an understudied but ecologically and socio-economically important taxon, demonstrates that anthropogenic noise can affect individual fitness. Fitness costs early in life have a fundamental influence on population dynamics and resilience, with potential implications for community structure and function.

  14. Reduced Mortality in Maintenance Haemodialysis Patients on High versus Low Dialysate Magnesium: A Pilot Study

    Christoph Schmaderer

    2017-08-01

    Full Text Available Background: Although low magnesium levels have been associated with an increased mortality in dialysis patients, they are kept low by routinely-used dialysates containing 0.50 mmol/L magnesium. Thus, we investigated the impact of a higher dialysate magnesium concentration on mortality. Methods: 25 patients on high dialysate magnesium (HDM of 0.75 mmol/L were 1:2 matched to 50 patients on low dialysate magnesium (LDM of 0.50 mmol/L and followed up for 3 years with regards to all-cause and cardiovascular mortality. Patients were matched according to age, gender, a modified version of the Charlson Comorbidity Index (CCI, and smoking status. Results: During the follow-up period, five patients died in the HDM and 18 patients in the LDM group. Patients in the HDM group had significantly higher ionized serum magnesium levels than matched controls (0.64 ± 0.12 mmol/L vs. 0.57 ± 0.10 mmol/L, p = 0.034. Log rank test showed no difference between treatment groups for all-cause mortality. After adjustment for age and CCI, Cox proportional hazards regression showed that HDM independently predicted a 65% risk reduction for all-cause mortality (hazard ratio 0.35, 95% confidence interval [CI]: 0.13, 0.97. Estimated 3-year probability of death from a cardiovascular event was 14.5% (95% CI: 7.9, 25.8 in the LDM group vs. 0% in the HDM group. Log rank test found a significant group difference for cardiovascular mortality (χ2 = 4.15, p = 0.042. Conclusions: Our data suggests that there might be a beneficial effect of an increased dialysate magnesium on cardiovascular mortality in chronic dialysis patients.

  15. High Levels Of Bed Occupancy Associated With Increased Inpatient And Thirty-Day Hospital Mortality In Denmark

    Madsen, Flemming; Ladelund, Steen; Linneberg, Allan

    2014-01-01

    to low bed occupancy rates. Being admitted to a hospital outside of normal working hours or on a weekend or holiday was also significantly associated with increased mortality. The health risks of bed shortages, including mortality, could be better documented as a priority health issue. Resources should......High bed occupancy rates have been considered a matter of reduced patient comfort and privacy and an indicator of high productivity for hospitals. Hospitals with bed occupancy rates of above 85 percent are generally considered to have bed shortages. Little attention has been paid to the impact...... be allocated to researching the causes and effects of bed shortages, with the aim of creating greater interest in exploring new methods to avoid or reduce bed shortages....

  16. Increased short- and long-term mortality in 8146 hospitalised peptic ulcer patients.

    Malmi, H; Kautiainen, H; Virta, L J; Färkkilä, M A

    2016-08-01

    Incidence and complications of peptic ulcer disease (PUD) have declined, but mortality from peptic ulcer bleeding has remained unchanged. The few recent studies on mortality associated with both uncomplicated and complicated patients with peptic ulcer disease provide contradictory results. To evaluate short- and long-term mortality, and the main causes of death in peptic ulcer disease. In this retrospective epidemiologic cohort study, register data on 8146 adult patients hospitalised with peptic ulcer disease during 2000-2008 were collected in the capital region of Finland. All were followed in the National Cause of Death Register until the end of 2009. The data were linked with the nationwide Drug Purchase Register of the Finnish Social Insurance Institution. Mean follow-up time was 4.9 years. Overall mortality was substantially increased, standardised mortality ratio 2.53 (95% CI: 2.44-2.63); 3.7% died within 30 days, and 11.8% within 1 year. At 6 months, the survival of patients with perforated or bleeding ulcer was lower compared to those with uncomplicated ulcer; hazard ratios were 2.06 (1.68-2.04) and 1.32 (1.11-1.58), respectively. For perforated duodenal ulcers, both the short- and long-term survival was significantly impaired in women. The main causes of mortality at 1 year were malignancies and cardiovascular diseases. Previous use of statins was associated with significant reduction in all-cause mortality. One-year mortality in patients hospitalised with peptic ulcer disease remained high with no change. This peptic ulcer disease cohort had a clearly decreased survival rate up to 10 years, especially among women with a perforated duodenal ulcer, most likely explained by poorer survival due to underlying comorbidity. © 2016 John Wiley & Sons Ltd.

  17. Does increasing the minimum wage reduce poverty in developing countries?

    Gindling, T. H.

    2014-01-01

    Do minimum wage policies reduce poverty in developing countries? It depends. Raising the minimum wage could increase or decrease poverty, depending on labor market characteristics. Minimum wages target formal sector workers—a minority of workers in most developing countries—many of whom do not live in poor households. Whether raising minimum wages reduces poverty depends not only on whether formal sector workers lose jobs as a result, but also on whether low-wage workers live in poor househol...

  18. Fatness-Associated FTO Gene Variant Increases Mortality Independent of Fatness - in Cohorts of Danish Men

    Zimmermann, E; Kring, SI; Berentzen, TL

    2009-01-01

    The A-allele of the single nucleotide polymorphism (SNP), rs9939609, in the FTO gene is associated with increased fatness. We hypothesized that the SNP is associated with morbidity and mortality through the effect on fatness. METHODOLOGY/PRINCIPAL FINDINGS: In a population of 362,200 Danish young...... prior to death suggested a general protective effect of the TT genotype, whereas there were only weak associations with disease incidence, except for diseases of the nervous system. CONCLUSION: Independent of fatness, the A-allele of the FTO SNP appears to increase mortality of a magnitude similar...

  19. Increased mortality in patients hospitalized with primary hyperparathyroidism during the period 1977-1993 in Denmark

    Øgard, Christina G; Engholm, Gerda; Almdal, Thomas P

    2004-01-01

    The aim of the present study was to determine whether patients with the incident hospital diagnosis of primary hyperparathyroidism (PHPT) in Denmark during the period 1977-1993 had an increased mortality from cardiovascular disease and cancer compared to the rest of the Danish population. In a ra......The aim of the present study was to determine whether patients with the incident hospital diagnosis of primary hyperparathyroidism (PHPT) in Denmark during the period 1977-1993 had an increased mortality from cardiovascular disease and cancer compared to the rest of the Danish population...

  20. Short Term Advantages of a Public-Private Partnership for Tuberculosis in Guinea Bissau: Reduction of Mortality and increased Diagnostic Capacity

    Vieira, F; Sanha, M; Riccardi, F; Colombatti, R

    2014-01-01

    Background: Tuberculosis (TB) is widespread in Africa, but weak health systems in developing countries, often display poor quality of care with delays in case identification, irrational therapy and drug shortage, clinical mismanagement, unnecessary expenditures for patients, reduced adherence and increased mortality. Public-private partnership has demonstrated to increase TB case detection, but less is known about its effects on quality of care, mortality and costs for hospitalized TB patient...

  1. Transient postoperative atrial fibrillation after abdominal aortic aneurysm repair increases mortality risk

    Kothari, Anai N.; Halandras, Pegge M.; Drescher, Max; Blackwell, Robert H.; Graunke, Dawn M.; Kliethermes, Stephanie; Kuo, Paul C.; Cho, Jae S.

    2016-01-01

    Objective The purpose of this study was to determine whether new-onset transient postoperative atrial fibrillation (TPAF) affects mortality rates after abdominal aortic aneurysm (AAA) repair and to identify predictors for the development of TPAF. Methods Patients who underwent open aortic repair or endovascular aortic repair for a principal diagnosis AAA were retrospectively identified using the Healthcare Cost and Utilization Project-State Inpatient Database (Florida) for 2007 to 2011 and monitored longitudinally for 1 year. Inpatient and 1-year mortality rates were compared between those with and without TPAF. TPAF was defined as new-onset atrial fibrillation that developed in the postoperative period and subsequently resolved in patients without a history of atrial fibrillation. Cox proportional hazards models, adjusted for age, gender, comorbidities, rupture status, and repair method, were used to assess 1-year survival. Predictive models were built with preoperative patient factors using Chi-squared Automatic Interaction Detector decision trees and externally validated on patients from California. Results A 3.7% incidence of TPAF was identified among 15,148 patients who underwent AAA repair. The overall mortality rate was 4.3%. The inpatient mortality rate was 12.3% in patients with TPAF vs 4.0% in those without TPAF. In the ruptured setting, the difference in mortality was similar between groups (33.7% vs 39.9%, P = .3). After controlling for age, gender, comorbid disease severity, urgency (ruptured vs nonruptured), and repair method, TPAF was associated with increased 1-year postoperative mortality (hazard ratio, 1.48; P predict an individual's probability of developing TPAF at the point of care. Conclusions The development of TPAF is associated with an increased risk of mortality in patients undergoing repair of nonruptured AAA. Predictive modeling can be used to identify those patients at highest risk for developing TPAF and guide interventions to improve

  2. Intracerebral hemorrhage with intraventricular extension and no hydrocephalus may not increase mortality or severe disability.

    Mahta, Ali; Katz, Paul M; Kamel, Hooman; Azizi, S Ausim

    2016-08-01

    This paper aimed to test the hypothesis that intraventricular extension of spontaneous intracerebral hemorrhage (ICH) in the absence of hydrocephalus is not associated with increased mortality or severe disability. We performed a retrospective consecutive cohort study of patients with primary spontaneous ICH who were admitted to a single institution. Multivariate logistic regression analysis was used to assess the association of each variable with functional outcome as measured by the modified Rankin Scale (mRS). A total of 164 patients met our inclusion criteria and were included in the study. Only hydrocephalus (p=0.002) and hematoma volume (p=0.006) were significantly associated with mortality or poor functional outcome (mRS of 3 to 6). In contrast, the presence of intraventricular hematoma was not independently associated with poor functional outcome. The presence of intraventricular extension of ICH in the absence of hydrocephalus may not increase mortality or disability. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Continued improvement of cardiovascular mortality in Hungary - impact of increased cardio-metabolic prescriptions

    Jozan Peter

    2010-07-01

    Full Text Available Abstract Background During the last 35 years the poor ranking of Hungary on the list of life expectancy at birth among European countries, has not changed. In 1970 our lag behind the leading European countries was the smallest. The gap was growing between 1970 and 1993 but from 1994 onwards the life expectancy at birth in Hungary has increased continuously and somewhat faster than in other European countries. The aim of this study was to analyze the association between decreasing cardiovascular mortality rates, as a main cause of death and the increase in cardio-metabolic prescriptions and possible changes in lifestyle behavior. Methods Analyses were conducted on national data concerning cardiovascular mortality and the number of cardio-metabolic drug prescription per capita. The association between yearly rates of cardiovascular events and changes in antihypertensive, antilipidemic and antidiabetic prescription rates was analyzed. The changes in other cardiovascular risk factors, like lifestyle were also considered. Results We observed a remarkable decline of mortality due to stroke and acute myocardial infarction (AMI. The fall was significantly associated with all prescription rates. The proportion of each treatment type responsible for suppression of specific mortality rates is different. All treatment types comparably improved stroke mortality, while antilipidemic therapy improved AMI outcome. Conclusions These results emphasize the importance of a comprehensive strategy that maximizes the population coverage of effective treatments. Hungary appears to be at the beginning of the fourth stage of epidemiologic transition, i.e. it has entered the stage of delayed chronic noninfectious diseases.

  4. Macrolide therapy is associated with reduced mortality in acute respiratory distress syndrome (ARDS) patients

    de Iudicibus, Gianfranco; Cremer, Olaf L.; Ong, David S. Y.; van der Poll, Tom; Bos, Lieuwe D.; Schultz, Marcus J.

    2018-01-01

    Background Macrolides have been associated with favorable immunological effects in various inflammatory disease states. We investigated the association between macrolide therapy and mortality in patients with the acute respiratory distress syndrome (ARDS). Methods This was an unplanned secondary analysis of patients with ARDS within a large prospective observational study of critically ill patients in the intensive care units (ICUs) of two university-affiliated hospitals in the Netherlands. The exposure of interest was low-dose macrolide use prescribed for another reason than infection; we excluded patients who received high-dose macrolides for an infection. The primary endpoint was 30-day mortality. The association between macrolide therapy and mortality was determined in the whole cohort, as well as in a propensity score matched cohort; the association was compared between pulmonary versus non-pulmonary ARDS, and between two biological phenotypes based on plasma levels of 20 biomarkers. Results In total, 873 patients with ARDS were analyzed, of whom 158 patients (18%) received macrolide therapy during stay in ICU for a median duration of 3 (interquartile range, 1–4) days. Erythromycin was the most frequent prescribed macrolide (97%). Macrolide therapy was associated with reduced 30-day mortality in the whole cohort [22.8% vs. 31.6%; crude odds ratio (OR), 0.64 (interquartile range, 0.43–0.96), P=0.03]. The association in the propensity score matched cohort remained significant [22.8% vs. 32.9%; OR, 0.62 (interquartile range, 0.39–0.96), P=0.03]. Propensity matched associations with mortality were different in patients with non-pulmonary ARDS vs. pulmonary ARDS and also varied by biological phenotype. Conclusions These data together show that low-dose macrolide therapy prescribed for another reason than infection is associated with decreased mortality in patients with ARDS. PMID:29430441

  5. Macrolide therapy is associated with reduced mortality in acute respiratory distress syndrome (ARDS) patients.

    Simonis, Fabienne D; de Iudicibus, Gianfranco; Cremer, Olaf L; Ong, David S Y; van der Poll, Tom; Bos, Lieuwe D; Schultz, Marcus J

    2018-01-01

    Macrolides have been associated with favorable immunological effects in various inflammatory disease states. We investigated the association between macrolide therapy and mortality in patients with the acute respiratory distress syndrome (ARDS). This was an unplanned secondary analysis of patients with ARDS within a large prospective observational study of critically ill patients in the intensive care units (ICUs) of two university-affiliated hospitals in the Netherlands. The exposure of interest was low-dose macrolide use prescribed for another reason than infection; we excluded patients who received high-dose macrolides for an infection. The primary endpoint was 30-day mortality. The association between macrolide therapy and mortality was determined in the whole cohort, as well as in a propensity score matched cohort; the association was compared between pulmonary versus non-pulmonary ARDS, and between two biological phenotypes based on plasma levels of 20 biomarkers. In total, 873 patients with ARDS were analyzed, of whom 158 patients (18%) received macrolide therapy during stay in ICU for a median duration of 3 (interquartile range, 1-4) days. Erythromycin was the most frequent prescribed macrolide (97%). Macrolide therapy was associated with reduced 30-day mortality in the whole cohort [22.8% vs. 31.6%; crude odds ratio (OR), 0.64 (interquartile range, 0.43-0.96), P=0.03]. The association in the propensity score matched cohort remained significant [22.8% vs. 32.9%; OR, 0.62 (interquartile range, 0.39-0.96), P=0.03]. Propensity matched associations with mortality were different in patients with non-pulmonary ARDS vs. pulmonary ARDS and also varied by biological phenotype. These data together show that low-dose macrolide therapy prescribed for another reason than infection is associated with decreased mortality in patients with ARDS.

  6. Reducing under-five mortality through Hôpital Albert Schweitzer's integrated system in Haiti.

    Perry, Henry; Cayemittes, Michel; Philippe, Francois; Dowell, Duane; Dortonne, Jean Richard; Menager, Henri; Bottex, Erve; Berggren, Warren; Berggren, Gretchen

    2006-05-01

    The degree to which local health systems contribute to reductions in under-five mortality in severely impoverished settings has not been well documented. The current study compares the under-five mortality in the Hôpital Albert Schweitzer (HAS) Primary Health Care Service Area with that for Haiti in general. HAS provides an integrated system of community-based primary health care services, hospital care and community development. A sample of 10% of the women of reproductive age in the HAS service area was interviewed, and 2390 live births and 149 child deaths were documented for the period 1995-99. Under-five mortality rates were computed and compared with rates for Haiti. In addition, available data regarding inputs, processes and outputs for the HAS service area and for Haiti were assembled and compared. Under-five mortality was 58% less in the HAS service area, and mortality for children 12-59 months of age was 76% less. These results were achieved with an input of fewer physicians and hospital beds per capita than is available for Haiti nationwide, but with twice as many graduate nurses and auxiliary nurses per capita than are available nationwide, and with three cadres of health workers that do not exist nationwide: Physician Extenders, Health Agents and Community Health Volunteers. The population coverage of targeted child survival services was generally 1.5-2 times higher in the HAS service area than in rural Haiti. These findings support the conclusion that a well-developed system of primary health care, with outreach services to the household level, integrated with hospital referral care and community development programmes, can make a strong contribution to reducing infant and child mortality in severely impoverished settings.

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

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

    2016-01-01

    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...

  8. Receipt of a pediatric liver offer as the first offer reduces waitlist mortality for adult women.

    Ge, Jin; Gilroy, Richard; Lai, Jennifer C

    2018-03-31

    In liver transplantation, adults with small stature have a greater susceptibility to waitlist mortality. This may explain the persistent waitlist mortality disparity that exists for women. We hypothesized that women who receive early offers of pediatric donor livers have improved waitlist survival, and that preferentially offering these organs to women mitigates this sex-based disparity. We analyzed donor liver offers from 2010 to 2014. Adult candidates who received a first offer that ranked within the first three match run positions from the donors' perspective were classified based on gender and whether they received a pediatric versus adult offer. We used competing risks regression to associate first offer type and waitlist mortality. 8,101 waitlist candidates received a first offer that was ranked within the first three match run positions: 5.6% (293/5,202) men and 6.2% (179/2,899) women received a pediatric donor liver as their first offer. In multivariable analyses, compared to adult-first men, adult-first women (sHR1.33, 95%CI 1.17-1.51, p offer had a lower risk of waitlist mortality compared to those who receive adult offers. Our data provides a simple approach to mitigating the increased waitlist mortality experienced by women by incorporating donor and recipient size, as variables, into organ allocation. This article is protected by copyright. All rights reserved. © 2018 by the American Association for the Study of Liver Diseases.

  9. Are beta2-agonists responsible for increased mortality in heart failure?

    Bermingham, Margaret

    2012-02-01

    AIMS: Previous large-scale, retrospective studies have shown increased mortality in heart failure (HF) patients using beta2-agonists (B2As). We further examined the relationship between B2A use and mortality in a well-characterized population by adjusting for natriuretic peptide levels as a measure of HF severity. METHODS AND RESULTS: This was a retrospective cohort study of patients attending an HF Disease Management Programme with mean follow-up of 2.9 +\\/- 2.4 years. Chart review confirmed B2A use, dose and duration of use, and documented pulmonary function evaluation. The primary endpoint was the effect of B2A use compared with no B2A use on mortality using unadjusted and adjusted Kaplan-Meier survival curves. Data were available for 1294 patients (age 70.6 +\\/- 11.5 years) of whom 64% were male and 22.2% were taking B2As. beta2-Agonist users were older, more likely to be male, to have smoked, to have chronic obstructive pulmonary disease (COPD) and asthma, and less likely to take beta-blockers. Multivariable associates of mortality included: B-type natriuretic peptide (BNP), coronary artery disease, age, and beta-blocker use. Unadjusted mortality rates for B2A users were found to be significantly higher than non-B2A users [hazard ratio (HR) 1.304, 95% confidence interval (CI) 1.030-1.652, P= 0.028]. However, when adjusted for age, sex, medication, co-morbidity, smoking, COPD, and BNP differences, overall mortality rates were similar [HR 1.043, 95% CI (0.771-1.412), P= 0.783]. CONCLUSION: Unlike previous reports, this retrospective evaluation of B2A therapy in HF patients shows no relationship with long-term mortality when adjusted for population differences including BNP. Large, prospective studies are required to define the risk\\/benefit ratio of B2As in patients with heart failure.

  10. Anastomotic Leak Increases Distant Recurrence and Long-Term Mortality After Curative Resection for Colonic Cancer

    Krarup, Peter-Martin; Nordholm-Carstensen, Andreas; Jorgensen, Lars N

    2014-01-01

    OBJECTIVE: To investigate the impact of anastomotic leak (AL) on disease recurrence and long-term mortality in patients alive 120 days after curative resection for colonic cancer. BACKGROUND: There is no solid data as to whether AL after colonic cancer surgery increases the risk of disease...

  11. Alcohol Consumption Increases Post-Operative Infection but Not Mortality: A Systematic Review and Meta-Analysis.

    Shabanzadeh, Daniel Mønsted; Sørensen, Lars Tue

    2015-12-01

    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-operative interventions. MEDLINE, Embase, and The Cochrane Library were searched systematically. Observational studies reporting patients with a defined amount of alcohol consumption and randomized controlled trials (RCTs) aimed at reducing outcomes were included. Meta-analyses were performed separately for observational studies and RCTs. 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 alcohol consumption and mortality was found. Meta-analyses of RCTs showed that interventions reduce infections but not mortality in patients with alcohol abuse. Consumption of more than two units of alcohol per day increases post-operative non-surgical site infections. Alcohol-refraining interventions in patients with high daily alcohol consumption appear to reduce infections. The impact in patients with lesser intake is unknown. Further studies are needed.

  12. Sustainable Survival for adolescents living with HIV: do SDG-aligned provisions reduce potential mortality risk?

    Cluver, Lucie; Pantelic, Marija; Orkin, Mark; Toska, Elona; Medley, Sally; Sherr, Lorraine

    2018-02-01

    The Sustainable Development Goals (SDGs) present a groundbreaking global development agenda to protect the most vulnerable. Adolescents living with HIV in Sub-Saharan Africa continue to experience extreme health vulnerabilities, but we know little about the impacts of SDG-aligned provisions on their health. This study tests associations of provisions aligned with five SDGs with potential mortality risks. Clinical and interview data were gathered from N = 1060 adolescents living with HIV in rural and urban South Africa in 2014 to 2015. All ART-initiated adolescents from 53 government health facilities were identified, and traced in their communities to include those defaulting and lost-to-follow-up. Potential mortality risk was assessed as either: viral suppression failure (1000+ copies/ml) using patient file records, or adolescent self-report of diagnosed but untreated tuberculosis or symptomatic pulmonary tuberculosis. SDG-aligned provisions were measured through adolescent interviews. Provisions aligned with SDGs 1&2 (no poverty and zero hunger) were operationalized as access to basic necessities, social protection and food security; An SDG 3-aligned provision (ensure healthy lives) was having a healthy primary caregiver; An SDG 8-aligned provision (employment for all) was employment of a household member; An SDG 16-aligned provision (protection from violence) was protection from physical, sexual or emotional abuse. Research partners included the South African national government, UNICEF and Pediatric and Adolescent Treatment for Africa. 20.8% of adolescents living with HIV had potential mortality risk - i.e. viral suppression failure, symptomatic untreated TB, or both. All SDG-aligned provisions were significantly associated with reduced potential mortality risk: SDG 1&2 (OR 0.599 CI 0.361 to 0.994); SDG 3 (OR 0.577 CI 0.411 to 0.808); SDG 8 (OR 0.602 CI 0.440 to 0.823) and SDG 16 (OR 0.686 CI 0.505 to 0.933). Access to multiple SDG-aligned provisions showed a

  13. Sarcopenia increases risk of long-term mortality in elderly patients undergoing emergency abdominal surgery.

    Rangel, Erika L; Rios-Diaz, Arturo J; Uyeda, Jennifer W; Castillo-Angeles, Manuel; Cooper, Zara; Olufajo, Olubode A; Salim, Ali; Sodickson, Aaron D

    2017-12-01

    Frailty is associated with poor surgical outcomes in elderly patients but is difficult to measure in the emergency setting. Sarcopenia, or the loss of lean muscle mass, is a surrogate for frailty and can be measured using cross-sectional imaging. We sought to determine the impact of sarcopenia on 1-year mortality after emergency abdominal surgery in elderly patients. Sarcopenia was assessed in patients 70 years or older who underwent emergency abdominal surgery at a single hospital from 2006 to 2011. Average bilateral psoas muscle cross-sectional area at L3, normalized for height (Total Psoas Index [TPI]), was calculated using computed tomography. Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was mortality at 1 year. Secondary outcomes were in-hospital mortality and mortality at 30, 90, and 180 days. The association of sarcopenia with mortality was assessed using Cox proportional hazards regression and model performance judged using Harrell's C-statistic. Two hundred ninety-seven of 390 emergency abdominal surgery patients had preoperative imaging and height. The median age was 79 years, and 1-year mortality was 32%. Sarcopenic and nonsarcopenic patients were comparable in age, sex, race, comorbidities, American Society of Anesthesiologists classification, procedure urgency and type, operative severity, and need for discharge to a nursing facility. Sarcopenic patients had lower body mass index, greater need for intensive care, and longer hospital length of stay (p Sarcopenia was independently associated with increased in-hospital mortality (risk ratio, 2.6; 95% confidence interval [CI], 1.6-3.7) and mortality at 30 days (hazard ratio [HR], 3.7; 95% CI, 1.9-7.4), 90 days (HR, 3.3; 95% CI, 1.8-6.0), 180 days (HR, 2.5; 95% CI, 1.4-4.4), and 1 year (HR, 2.4; 95% CI, 1.4-3.9). Sarcopenia is associated with increased risk of mortality over 1 year in elderly patients undergoing emergency abdominal surgery. Sarcopenia defined by TPI is

  14. The Effect of an Increased Minimum Wage on Infant Mortality and Birth Weight.

    Komro, Kelli A; Livingston, Melvin D; Markowitz, Sara; Wagenaar, Alexander C

    2016-08-01

    To investigate the effects of state minimum wage laws on low birth weight and infant mortality in the United States. We estimated the effects of state-level minimum wage laws using a difference-in-differences approach on rates of low birth weight (minimum wage above the federal level was associated with a 1% to 2% decrease in low birth weight births and a 4% decrease in postneonatal mortality. If all states in 2014 had increased their minimum wages by 1 dollar, there would likely have been 2790 fewer low birth weight births and 518 fewer postneonatal deaths for the year.

  15. Deferoxamine compensates for decreases in B cell counts and reduces mortality in enterovirus 71-infected mice.

    Yang, Yajun; Ma, Jing; Xiu, Jinghui; Bai, Lin; Guan, Feifei; Zhang, Li; Liu, Jiangning; Zhang, Lianfeng

    2014-07-07

    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.

  16. Particulate air pollution and increased mortality: Biological plausibility for causal relationship

    Henderson, R.F.

    1995-01-01

    Recently, a number of epidemiological studies have concluded that ambient particulate exposure is associated with increased mortality and morbidity at PM concentrations well below those previously thought to affect human health. These studies have been conducted in several different geographical locations and have involved a range of populations. While the consistency of the findings and the presence of an apparent concentration response relationship provide a strong argument for causality, epidemiological studies can only conclude this based upon inference from statistical associations. The biological plausibility of a causal relationship between low concentrations of PM and daily mortality and morbidity rates is neither intuitively obvious nor expected based on past experimental studies on the toxicity of inhaled particles. Chronic toxicity from inhaled, poorly soluble particles has been observed based on the slow accumulation of large lung burdens of particles, not on small daily fluctuations in PM levels. Acute toxicity from inhaled particles is associated mainly with acidic particles and is observed at much higher concentrations than those observed in the epidemiology studies reporting an association between PM concentrations and morbidity/mortality. To approach the difficult problem of determining if the association between PM concentrations and daily morbidity and mortality is biologically plausible and causal, one must consider (1) the chemical and physical characteristics of the particles in the inhaled atmospheres, (2) the characteristics of the morbidity/mortality observed and the people who are affected, and (3) potential mechanisms that might link the two

  17. In a warmer Arctic, mosquitoes avoid increased mortality from predators by growing faster.

    Culler, Lauren E; Ayres, Matthew P; Virginia, Ross A

    2015-09-22

    Climate change is altering environmental temperature, a factor that influences ectothermic organisms by controlling rates of physiological processes. Demographic effects of warming, however, are determined by the expression of these physiological effects through predator-prey and other species interactions. Using field observations and controlled experiments, we measured how increasing temperatures in the Arctic affected development rates and mortality rates (from predation) of immature Arctic mosquitoes in western Greenland. We then developed and parametrized a demographic model to evaluate how temperature affects survival of mosquitoes from the immature to the adult stage. Our studies showed that warming increased development rate of immature mosquitoes (Q10 = 2.8) but also increased daily mortality from increased predation rates by a dytiscid beetle (Q10 = 1.2-1.5). Despite increased daily mortality, the model indicated that faster development and fewer days exposed to predators resulted in an increased probability of mosquito survival to the adult stage. Warming also advanced mosquito phenology, bringing mosquitoes into phenological synchrony with caribou. Increases in biting pests will have negative consequences for caribou and their role as a subsistence resource for local communities. Generalizable frameworks that account for multiple effects of temperature are needed to understand how climate change impacts coupled human-natural systems. © 2015 The Author(s).

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

    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

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

    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

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

    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

  1. Reduced Mortality With Partial-Breast Irradiation for Early Breast Cancer: A Meta-Analysis of Randomized Trials

    Vaidya, Jayant S., E-mail: jayant.vaidya@ucl.ac.uk [Division of Surgery and Interventional Science, University College London, London (United Kingdom); Department of Surgery, Royal Free Hospital, London (United Kingdom); Department of Surgery, Whittington Health, London (United Kingdom); Bulsara, Max [Department of Biostatistics, University of Notre Dame, Fremantle, WA (Australia); Wenz, Frederik [Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Mannheim (Germany); Coombs, Nathan [Department of Surgery, Great Western Hospital, Swindon (United Kingdom); Singer, Julian [Department of Clinical Oncology, The Princess Alexandra Hospital, Harlow (United Kingdom); Ebbs, Stephen [Croydon University Hospital, Croydon (United Kingdom); Massarut, Samuele [National Cancer Institute, Centro di Riferimento Oncologico, Aviano (Italy); Saunders, Christobel [School of Surgery, University of Western Australia, Perth, WA (Australia); Douek, Michael [Department of Surgery, Kings College London, London (United Kingdom); Williams, Norman R. [Division of Surgery and Interventional Science, University College London, London (United Kingdom); Joseph, David [Departments of Radiation Oncology, and Surgery, Sir Charles Gairdner Hospital, Perth, WA (Australia); Tobias, Jeffrey S. [Department of Clinical Oncology, University College London Hospitals, London (United Kingdom); Baum, Michael [Division of Surgery and Interventional Science, University College London, London (United Kingdom)

    2016-10-01

    Purpose: With earlier detection and more effective treatment, mortality from breast cancer continues to fall and it has become increasingly important to reduce the toxicity of treatments. Partial-breast radiation therapy, which focuses radiation to the tumor bed, may achieve this aim. We analyzed mortality differences in randomized trials of partial-breast irradiation (PBI). Methods and Materials: We included data from published randomized trials of PBI (alone or as part of a risk-adapted approach) versus whole-breast irradiation (WBI) for invasive breast cancer suitable for breast-conserving therapy. We identified trials using PubMed and Google searches with the terms “partial breast irradiation” OR “intraoperative radiotherapy” OR “IMRT” OR (“accelerated” AND “radiation”) AND “randomised/randomized,” as well as through discussion with colleagues in the field. We calculated the proportion of patients who had events in each randomized arm at 5 years' follow-up and created a forest plot using Stata, version 14.1. Results: We identified 9 randomized trials of PBI versus WBI in invasive breast cancer; 5-year outcomes were available for non–breast cancer mortality in 5 trials (n=4489) and for breast cancer mortality in 4 trials (n=4231). The overall mortality was 4.9%. There was no detectable heterogeneity between the trials for any of the outcomes. There was no difference in the proportion of patients dying of breast cancer (difference, 0.000% [95% confidence interval (CI), −0.7 to +0.7]; P=.999). Non–breast cancer mortality with PBI was lower than with WBI (difference, 1.1% [95% CI, −2.1% to −0.2%]; P=.023). Total mortality with PBI was also lower than with WBI (difference, 1.3% [95% CI, −2.5% to 0.0%]; P=.05). Conclusions: Use of PBI instead of WBI in selected patients results in a lower 5-year non–breast cancer and overall mortality, amounting to a 25% reduction in relative terms. This information should be included when

  2. Reduced Mortality With Partial-Breast Irradiation for Early Breast Cancer: A Meta-Analysis of Randomized Trials

    Vaidya, Jayant S.; Bulsara, Max; Wenz, Frederik; Coombs, Nathan; Singer, Julian; Ebbs, Stephen; Massarut, Samuele; Saunders, Christobel; Douek, Michael; Williams, Norman R.; Joseph, David; Tobias, Jeffrey S.; Baum, Michael

    2016-01-01

    Purpose: With earlier detection and more effective treatment, mortality from breast cancer continues to fall and it has become increasingly important to reduce the toxicity of treatments. Partial-breast radiation therapy, which focuses radiation to the tumor bed, may achieve this aim. We analyzed mortality differences in randomized trials of partial-breast irradiation (PBI). Methods and Materials: We included data from published randomized trials of PBI (alone or as part of a risk-adapted approach) versus whole-breast irradiation (WBI) for invasive breast cancer suitable for breast-conserving therapy. We identified trials using PubMed and Google searches with the terms “partial breast irradiation” OR “intraoperative radiotherapy” OR “IMRT” OR (“accelerated” AND “radiation”) AND “randomised/randomized,” as well as through discussion with colleagues in the field. We calculated the proportion of patients who had events in each randomized arm at 5 years' follow-up and created a forest plot using Stata, version 14.1. Results: We identified 9 randomized trials of PBI versus WBI in invasive breast cancer; 5-year outcomes were available for non–breast cancer mortality in 5 trials (n=4489) and for breast cancer mortality in 4 trials (n=4231). The overall mortality was 4.9%. There was no detectable heterogeneity between the trials for any of the outcomes. There was no difference in the proportion of patients dying of breast cancer (difference, 0.000% [95% confidence interval (CI), −0.7 to +0.7]; P=.999). Non–breast cancer mortality with PBI was lower than with WBI (difference, 1.1% [95% CI, −2.1% to −0.2%]; P=.023). Total mortality with PBI was also lower than with WBI (difference, 1.3% [95% CI, −2.5% to 0.0%]; P=.05). Conclusions: Use of PBI instead of WBI in selected patients results in a lower 5-year non–breast cancer and overall mortality, amounting to a 25% reduction in relative terms. This information should be included when

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

    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.

  4. Is there evidence showing that salt intake reduction reduces cardiovascular morbidity and mortality risk?

    Fernando Lanas

    2012-02-01

    Full Text Available A recent systematic review of Cochrane collaboration about the effect of reducing dietary salt concluded that “there is still insufficient power to exclude clinically important effects of reduced dietary salt on mortality or cardiovascular morbidity in normotensive or hypertensive populations”. This conclusion has generated an important debate, because the estimation that salt reduction can prevent 24% of strokes and 18% of myocardial infarctions has decided the health authorities of several nations to implement salt consumption reduction programs. The review of ecological studies and clinical trials allow to conclude that a reduction in salt consumption reduces blood pressure and methodological well conducted cohort studies has shown that cardiovascular events risk decreases progressively with lower levels of blood pressure. Combining this two finding we can assume that population should benefice from a decrease on salt consumption although there are no studies that shown a reduction in cardiovascular events in population with high sodium intake when dietary salt is reduced.

  5. Pretransplant cachexia and morbid obesity are predictors of increased mortality after heart transplantation.

    Lietz, K; John, R; Burke, E A; Ankersmit, J H; McCue, J D; Naka, Y; Oz, M C; Mancini, D M; Edwards, N M

    2001-07-27

    Extremes in body weight are a relative contraindication to cardiac transplantation. We retrospectively reviewed 474 consecutive adult patients (377 male, 97 female, mean age 50.3+/-12.2 years), who received 444 primary and 30 heart retransplants between January of 1992 and January of 1999. Of these, 68 cachectic (body mass index [BMI]27-30 kg/m2), and 55 morbidly obese (BMI>30 kg/m2) patients were compared with 238 normal-weight recipients (BMI=20-27 kg/m2). We evaluated the influence of pretransplant BMI on morbidity and mortality after cardiac transplantation. Kaplan-Meier survival distribution and Cox proportional hazards model were used for statistical analyses. Morbidly obese as well as cachectic recipients demonstrated nearly twice the 5-year mortality of normal-weight or overweight recipients (53% vs. 27%, respectively, P=0.001). An increase in mortality was seen at 30 days for morbidly obese and cachectic recipients (12.7% and 17.7%, respectively) versus a 30-day mortality rate of 7.6% in normal-weight recipients. Morbidly obese recipients experienced a shorter time to high-grade acute rejection (P=0.004) as well as an increased annual high-grade rejection frequency when compared with normal-weight recipients (P=0.001). By multivariable analysis, the incidence of transplant-related coronary artery disease (TCAD) was not increased in morbidly obese patients but cachectic patients had a significantly lower incidence of TCAD (P=0.05). Cachectic patients receiving oversized donor hearts had a significantly higher postoperative mortality (P=0.02). The risks of cardiac transplantation are increased in both morbidly obese and cachectic patients compared with normal-weight recipients. However, the results of cardiac transplantation in overweight patients is comparable to that in normal-weight patients. Recipient size should be kept in mind while selecting patients and the use of oversized donors in cachectic recipients should be avoided.

  6. Journey to top performance: a multipronged quality improvement approach to reducing cardiac surgery mortality.

    Scheinerman, S Jacob; Dlugacz, Yosef D; Hartman, Alan R; Moravick, Donna; Nelson, Karen L; Scanlon, Kerri Anne; Stier, Lori

    2015-02-01

    In 2006, leadership at Long Island Jewish Medical Center (New Hyde Park, New York) noted significantly higher cardiac surgery mortality rates for isolated valve and valve/coronary artery bypass graft procedures compared to the New York State Department of Health's Cardiac Surgery Reporting System statewide average. Long Island Jewish Medical Center, a 583-bed nonprofit, tertiary care teaching hospital, is one of the clinical and academic hubs of North Shore-LIJ Health System. Senior leadership launched an evaluation of the cardiac surgery program to determine why cardiac surgery mortality rates were higher than expected. As a result, the cardiac surgery program was redesigned, and interventions were implemented related to preoperative care, intraoperative monitoring, postoperative care, and the cardiac surgery quality management program. According to the most recent New York State Department of Health reporting period (2009-2011), Long Island Jewish Medical Center had the lowest risk-adjusted mortality rate in New York State for adult patients undergoing surgeries to repair or replace heart valves and for adult patients in need of valve/coronary artery bypass graft surgery. The medical center has sustained significantly lower mortality rates compared to the statewide average for the past three cardiac surgery reporting periods. Cardiac surgery mortality rates can be significantly reduced and sustained below comparative norms when the organization is committed to clinical excellence and quality and is involved in continuously assessing organizational performance. The evaluation launched at Long Island Jewish Medical Center led to the redesign of the cardiac surgery program and prompted widespread improvement efforts and cultural change across the entire organization.

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

    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.

  8. A health partnership to reduce neonatal mortality in four hospitals in Rwanda.

    Ntigurirwa, Placide; Mellor, Kathy; Langer, Daniel; Evans, Mari; Robertson, Emily; Tuyisenge, Lisine; Groves, Alan; Lissauer, Tom

    2017-06-01

    A health partnership to improve hospital based neonatal care in Rwanda to reduce neonatal mortality was requested by the Rwandan Ministry of Health. Although many health system improvements have been made, there is a severe shortage of health professionals with neonatal training. Following a needs assessment, a health partnership grant for 2 years was obtained. A team of volunteer neonatologists and paediatricians, neonatal nurses, lactation consultants and technicians with experience in Rwanda or low-income countries was assembled. A neonatal training program was provided in four hospitals (the 2 University hospitals and 2 district hospitals), which focused on nutrition, provision of basic respiratory support with nasal CPAP (Continuous Positive Airway Pressure), enhanced record keeping, thermoregulation, vital signs monitoring and infection control. To identify if care delivery improved, audits of nutritional support, CPAP use and its complications, and documentation in newly developed neonatal medical records were conducted. Mortality data of neonatal admissions was obtained. Intensive neonatal training was provided on 27 short-term visits by 10 specialist health professionals. In addition, a paediatric doctor spent 3 months and two spent 6 months each providing training. A total of 472 training days was conducted in the neonatal units. For nutritional support, significant improvements were demonstrated in reduction in time to initiation of enteral feeds and to achieve full milk feeds, in reduction in maximum postnatal weight loss, but not in days for regaining birth weight. Respiratory support with bubble CPAP was applied to 365 infants in the first 18 months. There were no significant technical problems, but tissue damage, usually transient, to the nose and face was recorded in 13%. New medical records improved documentation by doctors, but nursing staff were reluctant to use them. Mortality for University teaching hospital admissions was reduced from 23

  9. Higher glucocorticoid replacement doses are associated with increased mortality in patients with pituitary adenoma.

    Hammarstrand, Casper; Ragnarsson, Oskar; Hallén, Tobias; Andersson, Eva; Skoglund, Thomas; Nilsson, Anna G; Johannsson, Gudmundur; Olsson, Daniel S

    2017-09-01

    Patients with secondary adrenal insufficiency (AI) have an excess mortality. The objective was to investigate the impact of the daily glucocorticoid replacement dose on mortality in patients with hypopituitarism due to non-functioning pituitary adenoma (NFPA). Patients with NFPA were followed between years 1997 and 2014 and cross-referenced with the National Swedish Death Register. Standardized mortality ratio (SMR) was calculated with the general population as reference and Cox-regression was used to analyse the mortality. The analysis included 392 patients (140 women) with NFPA. Mean ± s.d. age at diagnosis was 58.7 ± 14.6 years and mean follow-up was 12.7 ± 7.2 years. AI was present in 193 patients, receiving a mean daily hydrocortisone equivalent (HCeq) dose of 20 ± 6 mg. SMR (95% confidence interval (CI)) for patients with AI was similar to that for patients without, 0.88 (0.68-1.12) and 0.87 (0.63-1.18) respectively. SMR was higher for patients with a daily HCeq dose of >20 mg (1.42 (0.88-2.17)) than that in patients with a daily HCeq dose of 20 mg (0.71 (0.49-0.99)), P  = 0.017. In a Cox-regression analysis, a daily HCeq dose of >20 mg was independently associated with a higher mortality (HR: 1.88 (1.06-3.33)). Patients with daily HCeq doses of ≤20 mg had a mortality risk comparable to patients without glucocorticoid replacement and to the general population. Patients with NFPA and AI receiving more than 20 mg HCeq per day have an increased mortality. Our data also show that mortality in patients substituted with 20 mg HCeq per day or less is not increased. © 2017 European Society of Endocrinology.

  10. Developing a statewide public health initiative to reduce infant mortality in Oklahoma.

    Dooley, Suzanna; Patrick, Paul; Lincoln, Alicia; Cline, Janette

    2014-01-01

    The Preparing for a Lifetime, It's Everyone's Responsibility initiative was developed to improve the health and well- being of Oklahoma's mothers and infants. The development phase included systematic data collection, extensive data analysis, and multi-disciplinary partnership development. In total, seven issues (preconception/interconception health, tobacco use, postpartum depression, breastfeeding, infant safe sleep, preterm birth, and infant injury prevention) were identified as crucial to addressing infant mortality in Oklahoma. Workgroups were created to focus on each issue. Data and media communications workgroups were added to further partner commitment and support for policy and programmatic changes across multiple agencies and programs. Leadership support, partnership, evaluation, and celebrating small successes were important factors that lead to large scale adoption and support for the state-wide initiative to reduce infant mortality.

  11. Music reduces pain and increases functional mobility in fibromyalgia

    Garza-Villarreal, Eduardo A.; Wilson, Andrew D; Vase, Lene

    2014-01-01

    task (not during), therefore the effect cannot be explained merely by motor entrainment to a fast rhythm. Cognitive and emotional mechanisms seem to be central to music-induced analgesia. Our findings encourage the use of music as a treatment adjuvant to reduce chronic pain in FM and increase......The pain in Fibromyalgia (FM) is difficult to treat and functional mobility seems to be an important comorbidity in these patients that could evolve into a disability. In this study we wanted to investigate the analgesic effects of music in FM pain. Twenty-two FM patients were passively exposed...... to (1) self-chosen, relaxing, pleasant music, and to (2) a control auditory condition (pink noise). They rated pain and performed the “timed-up & go task (TUG)” to measure functional mobility after each auditory condition. Listening to relaxing, pleasant, self-chosen music reduced pain and increased...

  12. Mortality increase in late-middle and early-old age: heterogeneity in death processes as a new explanation.

    Li, Ting; Yang, Yang Claire; Anderson, James J

    2013-10-01

    Deviations from the Gompertz law of exponential mortality increases in late-middle and early-old age are commonly neglected in overall mortality analyses. In this study, we examined mortality increase patterns between ages 40 and 85 in 16 low-mortality countries and demonstrated sex differences in these patterns, which also changed across period and cohort. These results suggest that the interaction between aging and death is more complicated than what is usually assumed from the Gompertz law and also challenge existing biodemographic hypotheses about the origin and mechanisms of sex differences in mortality. We propose a two-mortality model that explains these patterns as the change in the composition of intrinsic and extrinsic death rates with age. We show that the age pattern of overall mortality and the population heterogeneity therein are possibly generated by multiple dynamics specified by a two-mortality model instead of a uniform process throughout most adult ages.

  13. Increasing Running Step Rate Reduces Patellofemoral Joint Forces

    Lenhart, Rachel L.; Thelen, Darryl G.; Wille, Christa M.; Chumanov, Elizabeth S.; Heiderscheit, Bryan C.

    2013-01-01

    Purpose Increasing step rate has been shown to elicit changes in joint kinematics and kinetics during running, and has been suggested as a possible rehabilitation strategy for runners with patellofemoral pain. The purpose of this study was to determine how altering step rate affects internal muscle forces and patellofemoral joint loads, and then to determine what kinematic and kinetic factors best predict changes in joint loading. Methods We recorded whole body kinematics of 30 healthy adults running on an instrumented treadmill at three step rate conditions (90%, 100%, and 110% of preferred step rate). We then used a 3D lower extremity musculoskeletal model to estimate muscle, patellar tendon, and patellofemoral joint forces throughout the running gait cycles. Additionally, linear regression analysis allowed us to ascertain the relative influence of limb posture and external loads on patellofemoral joint force. Results Increasing step rate to 110% of preferred reduced peak patellofemoral joint force by 14%. Peak muscle forces were also altered as a result of the increased step rate with hip, knee and ankle extensor forces, and hip abductor forces all reduced in mid-stance. Compared to the 90% step rate condition, there was a concomitant increase in peak rectus femoris and hamstring loads during early and late swing, respectively, at higher step rates. Peak stance phase knee flexion decreased with increasing step rate, and was found to be the most important predictor of the reduction in patellofemoral joint loading. Conclusion Increasing step rate is an effective strategy to reduce patellofemoral joint forces and could be effective in modulating biomechanical factors that can contribute to patellofemoral pain. PMID:23917470

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

    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.

  15. A high dietary glycemic index increases total mortality in a Mediterranean population at high cardiovascular risk.

    Itandehui Castro-Quezada

    Full Text Available OBJECTIVE: Different types of carbohydrates have diverse glycemic response, thus glycemic index (GI and glycemic load (GL are used to assess this variation. The impact of dietary GI and GL in all-cause mortality is unknown. The objective of this study was to estimate the association between dietary GI and GL and risk of all-cause mortality in the PREDIMED study. MATERIAL AND METHODS: The PREDIMED study is a randomized nutritional intervention trial for primary cardiovascular prevention based on community-dwelling men and women at high risk of cardiovascular disease. Dietary information was collected at baseline and yearly using a validated 137-item food frequency questionnaire (FFQ. We assigned GI values of each item by a 5-step methodology, using the International Tables of GI and GL Values. Deaths were ascertained through contact with families and general practitioners, review of medical records and consultation of the National Death Index. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HR and their 95% CI for mortality, according to quartiles of energy-adjusted dietary GI/GL. To assess repeated measures of exposure, we updated GI and GL intakes from the yearly FFQs and used Cox models with time-dependent exposures. RESULTS: We followed 3,583 non-diabetic subjects (4.7 years of follow-up, 123 deaths. As compared to participants in the lowest quartile of baseline dietary GI, those in the highest quartile showed an increased risk of all-cause mortality [HR = 2.15 (95% CI: 1.15-4.04; P for trend  = 0.012]. In the repeated-measures analyses using as exposure the yearly updated information on GI, we observed a similar association. Dietary GL was associated with all-cause mortality only when subjects were younger than 75 years. CONCLUSIONS: High dietary GI was positively associated with all-cause mortality in elderly population at high cardiovascular risk.

  16. Music reduces pain and increases functional mobility in fibromyalgia

    Garza-Villarreal, Eduardo A.; Wilson, Andrew D.; Vase, Lene; Brattico, Elvira; Barrios, Fernando A.; Jensen, Troels S.; Romero-Romo, Juan I.; Vuust, Peter

    2014-01-01

    The pain in Fibromyalgia (FM) is difficult to treat and functional mobility seems to be an important comorbidity in these patients that could evolve into a disability. In this study we wanted to investigate the analgesic effects of music in FM pain. Twenty-two FM patients were passively exposed to (1) self-chosen, relaxing, pleasant music, and to (2) a control auditory condition (pink noise). They rated pain and performed the “timed-up & go task (TUG)” to measure functional mobility after each auditory condition. Listening to relaxing, pleasant, self-chosen music reduced pain and increased functional mobility significantly in our FM patients. The music-induced analgesia was significantly correlated with the TUG scores; thereby suggesting that the reduction in pain unpleasantness increased functional mobility. Notably, this mobility improvement was obtained with music played prior to the motor task (not during), therefore the effect cannot be explained merely by motor entrainment to a fast rhythm. Cognitive and emotional mechanisms seem to be central to music-induced analgesia. Our findings encourage the use of music as a treatment adjuvant to reduce chronic pain in FM and increase functional mobility thereby reducing the risk of disability. PMID:24575066

  17. Prevention of lymphocyte apoptosis in septic mice with cancer increases mortality.

    Fox, Amy C; Breed, Elise R; Liang, Zhe; Clark, Andrew T; Zee-Cheng, Brendan R; Chang, Katherine C; Dominguez, Jessica A; Jung, Enjae; Dunne, W Michael; Burd, Eileen M; Farris, Alton B; Linehan, David C; Coopersmith, Craig M

    2011-08-15

    Lymphocyte apoptosis is thought to have a major role in the pathophysiology of sepsis. However, there is a disconnect between animal models of sepsis and patients with the disease, because the former use subjects that were healthy prior to the onset of infection while most patients have underlying comorbidities. The purpose of this study was to determine whether lymphocyte apoptosis prevention is effective in preventing mortality in septic mice with preexisting cancer. Mice with lymphocyte Bcl-2 overexpression (Bcl-2-Ig) and wild type (WT) mice were injected with a transplantable pancreatic adenocarcinoma cell line. Three weeks later, after development of palpable tumors, all animals received an intratracheal injection of Pseudomonas aeruginosa. Despite having decreased sepsis-induced T and B lymphocyte apoptosis, Bcl-2-Ig mice had markedly increased mortality compared with WT mice following P. aeruginosa pneumonia (85 versus 44% 7-d mortality; p = 0.004). The worsened survival in Bcl-2-Ig mice was associated with increases in Th1 cytokines TNF-α and IFN-γ in bronchoalveolar lavage fluid and decreased production of the Th2 cytokine IL-10 in stimulated splenocytes. There were no differences in tumor size or pulmonary pathology between Bcl-2-Ig and WT mice. To verify that the mortality difference was not specific to Bcl-2 overexpression, similar experiments were performed in Bim(-/-) mice. Septic Bim(-/-) mice with cancer also had increased mortality compared with septic WT mice with cancer. These data demonstrate that, despite overwhelming evidence that prevention of lymphocyte apoptosis is beneficial in septic hosts without comorbidities, the same strategy worsens survival in mice with cancer that are given pneumonia.

  18. Impact of public health strategies on reducing AIDS mortality in southern Brazil.

    Raboni, Sonia M; Ribeiro, Clea E; Almeida, Sergio M; Telles, João Paulo M; Azevedo, Marcos; Schaitza, Gustavo A

    2017-01-01

    In Brazil, all patients who fulfill the criteria for AIDS have had free access to antiretroviral therapy since 1996. We performed this cross-sectional study to evaluate the causes of death among 643 HIV-infected patients over three non-consecutive years (2000, 2006, and 2010), using their epidemiological, clinical, and laboratory data. The causes of death were classified as AIDS-defining or non-AIDS-defining conditions. We observed a progressive increase in the prevalence of HIV infection over the study period, although there was also a decrease in the mortality rate for various groups, and especially among pediatric patients. An AIDS-defining condition was recorded as the cause of death for approximately 30% of the patients. There was also a high frequency (>70%) of infectious and parasitic diseases, including opportunistic infections, and the most common diagnoses were septicemia, pneumonia, tuberculosis, and pneumocystosis. Acute respiratory failure was the underlying cause of death in 30% of these cases. Despite advances in HIV therapy, the mortality rate remains high in Brazil. As few Brazilian studies have investigated HIV/AIDS-related mortality, it is important to evaluate and improve the mortality notification databases, in order to provide information regarding the effects of HIV and to guide the implementation of appropriate healthcare measures.

  19. A review of the evidence for and against increased mortality in hypothyroidism

    Thvilum, Marianne; Brandt, Frans; Brix, Thomas H

    2012-01-01

    The lifetime risk of overt hypothyroidism is around 5%, and this disease is usually preceded by subclinical hypothyroidism, which has an even higher prevalence (estimated to be up to 9%). Hypothyroidism has been linked with cardiac dysfunction, atherosclerosis, hypertension and coagulopathy....... Intuitively, this increased morbidity is expected to shorten patients' lifespan, but definitive data are lacking on whether either of these hypothyroid states (particularly overt hypothyroidism) increase mortality. Study findings are inconsistent and, overall, the pooled data do not demonstrate increased...... mortality in patients with either subclinical or overt hypothyroidism. However, none of the available studies was adequately designed to answer this question. This Review discusses major shortcomings in those studies, such as population dissimilarities, hypothyroid state classification and misclassification...

  20. Obesity-induced oxidative stress, accelerated functional decline with age and increased mortality in mice.

    Zhang, Yiqiang; Fischer, Kathleen E; Soto, Vanessa; Liu, Yuhong; Sosnowska, Danuta; Richardson, Arlan; Salmon, Adam B

    2015-06-15

    Obesity is a serious chronic disease that increases the risk of numerous co-morbidities including metabolic syndrome, cardiovascular disease and cancer as well as increases risk of mortality, leading some to suggest this condition represents accelerated aging. Obesity is associated with significant increases in oxidative stress in vivo and, despite the well-explored relationship between oxidative stress and aging, the role this plays in the increased mortality of obese subjects remains an unanswered question. Here, we addressed this by undertaking a comprehensive, longitudinal study of a group of high fat-fed obese mice and assessed both their changes in oxidative stress and in their performance in physiological assays known to decline with aging. In female C57BL/6J mice fed a high-fat diet starting in adulthood, mortality was significantly increased as was oxidative damage in vivo. High fat-feeding significantly accelerated the decline in performance in several assays, including activity, gait, and rotarod. However, we also found that obesity had little effect on other markers of function and actually improved performance in grip strength, a marker of muscular function. Together, this first comprehensive assessment of longitudinal, functional changes in high fat-fed mice suggests that obesity may induce segmental acceleration of some of the aging process. Published by Elsevier Inc.

  1. A new challenge for Africa: to reduce maternal mortality by half over the next decade.

    Ladjali, M

    1989-04-01

    This publication reviews the 1989 conference on safe motherhood in Niamey, Niger. Statistics regarding the situation in Africa reveal that 150,000 of the 1/2 million yearly maternal deaths worldwide occur in Africa, and 1 woman in 20 risks dying of pregnancy-related causes. Other maternal deaths are distributed as follows: 300,000 in South and West Asia, 34,000 in Latin America, 12,000 in East Asia and 6000 in all developed countries. The main causes of maternal deaths in Africa were identified as medical factors, among them lack of access to family planning, and socioeconomic and cultural factors, such as sexual discrimination against women and inferior social status. African girls are weaned earlier, receive a lower caloric intake, and work 4 times as long as boys. African women work 2490 hours per year, compared to 1400 hours for men. In a discussion of traditional practices related to maternal and child health, early marriage and genital mutilation, which are perpetuated by illiteracy, were deemed dangerous. The need for non-medical strategies and actions to improve the status of women, recognize their economic role and give them equal opportunities was acknowledged. Fertility control was identified as a determining factor in helping to reinforce these strategies, as unwanted pregnancies increase the risk of maternal death through abortion attempts. An important aspect of the conference was the identification of women as full-time partners of the health services rather than passive beneficiaries. Participants called for a reduction in women's domestic workload and the abolition of genital mutilation. They also agreed to promote exchange of information between African governments on research and positive developments. The World Bank called for more incisive efforts to reduce infant mortality and for population issues to be included in the economic debate.

  2. Increasing preferred step rate during running reduces plantar pressures.

    Gerrard, James M; Bonanno, Daniel R

    2018-01-01

    Increasing preferred step rate during running is a commonly used strategy in the management of running-related injuries. This study investigated the effect of different step rates on plantar pressures during running. Thirty-two healthy runners ran at a comfortable speed on a treadmill at five step rates (preferred, ±5%, and ±10%). For each step rate, plantar pressure data were collected using the pedar-X in-shoe system. Compared to running with a preferred step rate, a 10% increase in step rate significantly reduced peak pressure (144.5±46.5 vs 129.3±51 kPa; P=.033) and maximum force (382.3±157.6 vs 334.0±159.8 N; P=.021) at the rearfoot, and reduced maximum force (426.4±130.4 vs 400.0±116.6 N; P=.001) at the midfoot. In contrast, a 10% decrease in step rate significantly increased peak pressure (144.5±46.5 vs 161.5±49.3 kPa; P=.011) and maximum force (382.3±157.6 vs 425.4±155.3 N; P=.032) at the rearfoot. Changing step rate by 5% provided no effect on plantar pressures, and no differences in plantar pressures were observed at the medial forefoot, lateral forefoot or hallux between the step rates. This study's findings indicate that increasing preferred step rate by 10% during running will reduce plantar pressures at the rearfoot and midfoot, while decreasing step rate by 10% will increase plantar pressures at the rearfoot. However, changing preferred step rate by 5% will provide no effect on plantar pressures, and forefoot pressures are unaffected by changes in step rate. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Increased Mortality in Schizophrenia Due to Cardiovascular Disease – A Non-Systematic Review of Epidemiology, Possible Causes, and Interventions

    Ringen, Petter Andreas; Engh, John A.; Birkenaes, Astrid B.; Dieset, Ingrid; Andreassen, Ole A.

    2014-01-01

    Background: Schizophrenia is among the major causes of disability worldwide and the mortality from cardiovascular disease (CVD) is significantly elevated. There is a growing concern that this health challenge is not fully understood and efficiently addressed. Methods: Non-systematic review using searches in PubMed on relevant topics as well as selection of references based on the authors’ experience from clinical work and research in the field. Results: In most countries, the standardized mortality rate in schizophrenia is about 2.5, leading to a reduction in life expectancy between 15 and 20 years. A major contributor of the increased mortality is due to CVD, with CVD mortality ranging from 40 to 50% in most studies. Important causal factors are related to lifestyle, including poor diet, lack of physical activity, smoking, and substance abuse. Recent findings suggest that there are overlapping pathophysiology and genetics between schizophrenia and CVD-risk factors, further increasing the liability to CVD in schizophrenia. Many pharmacological agents used for treating psychotic disorders have side effects augmenting CVD risk. Although several CVD-risk factors can be effectively prevented and treated, the provision of somatic health services to people with schizophrenia seems inadequate. Further, there is a sparseness of studies investigating the effects of lifestyle interventions in schizophrenia, and there is little knowledge about effective programs targeting physical health in this population. Discussion: The risk for CVD and CVD-related deaths in people with schizophrenia is increased, but the underlying mechanisms are not fully known. Coordinated interventions in different health care settings could probably reduce the risk. There is an urgent need to develop and implement effective programs to increase life expectancy in schizophrenia, and we argue that mental health workers should be more involved in this important task. PMID:25309466

  4. Increased mortality in schizophrenia due to cardiovascular disease – a non-systematic review of epidemiology, possible causes and interventions

    Petter Andreas eRingen

    2014-09-01

    Full Text Available Background: Schizophrenia is among the major causes of disability worldwide and the mortality from cardiovascular disease (CVD is significantly elevated. There is a growing concern that this health challenge is not fully understood and efficiently addressed.Methods: Non-systematic review using searches in PubMed on relevant topics as well as selection of references based on the authors experience from clinical work and research in the field.Results: In most countries, the standardized mortality rate (SMR in schizophrenia is about 2.5, leading to a reduction in life expectancy between 15 and 20 years. A major contributor of the increased mortality is due to CVD, with CVD mortality ranging from 40-50% in most studies. Important causal factors are related to lifestyle, including poor diet, lack of physical activity, smoking and substance abuse. Recent findings suggest that there are overlapping pathophysiology and genetics between schizophrenia and CVD risk factors, further increasing the liability to CVD in schizophrenia. Many pharmacological agents used for treating psychotic disorders have side effects augmenting CVD risk. Although several CVD risk factors can be effectively prevented and treated, the provision of somatic health services to people with schizophrenia seems inadequate. Further, there is a sparseness of studies investigating the effects of life-style interventions in schizophrenia, and there is little knowledge about effective programs targeting physical health in this population. Discussion: The risk for CVD and CVD-related deaths in people with schizophrenia is increased, but the underlying mechanisms are not fully known. Coordinated interventions in different health care settings could probably reduce the risk. There is an urgent need to develop and implement effective programs to increase life expectancy in schizophrenia, and we argue that mental health workers should be more involved in this important task.

  5. Increased mortality in schizophrenia due to cardiovascular disease - a non-systematic review of epidemiology, possible causes, and interventions.

    Ringen, Petter Andreas; Engh, John A; Birkenaes, Astrid B; Dieset, Ingrid; Andreassen, Ole A

    2014-01-01

    Schizophrenia is among the major causes of disability worldwide and the mortality from cardiovascular disease (CVD) is significantly elevated. There is a growing concern that this health challenge is not fully understood and efficiently addressed. Non-systematic review using searches in PubMed on relevant topics as well as selection of references based on the authors' experience from clinical work and research in the field. In most countries, the standardized mortality rate in schizophrenia is about 2.5, leading to a reduction in life expectancy between 15 and 20 years. A major contributor of the increased mortality is due to CVD, with CVD mortality ranging from 40 to 50% in most studies. Important causal factors are related to lifestyle, including poor diet, lack of physical activity, smoking, and substance abuse. Recent findings suggest that there are overlapping pathophysiology and genetics between schizophrenia and CVD-risk factors, further increasing the liability to CVD in schizophrenia. Many pharmacological agents used for treating psychotic disorders have side effects augmenting CVD risk. Although several CVD-risk factors can be effectively prevented and treated, the provision of somatic health services to people with schizophrenia seems inadequate. Further, there is a sparseness of studies investigating the effects of lifestyle interventions in schizophrenia, and there is little knowledge about effective programs targeting physical health in this population. The risk for CVD and CVD-related deaths in people with schizophrenia is increased, but the underlying mechanisms are not fully known. Coordinated interventions in different health care settings could probably reduce the risk. There is an urgent need to develop and implement effective programs to increase life expectancy in schizophrenia, and we argue that mental health workers should be more involved in this important task.

  6. Association Between Hospitals Caring for a Disproportionately High Percentage of Minority Trauma Patients and Increased Mortality

    Haider, Adil H.; Ong’uti, Sharon; Efron, David T.; Oyetunji, Tolulope A.; Crandall, Marie L.; Scott, Valerie K.; Haut, Elliott R.; Schneider, Eric B.; Powe, Neil R.; Cooper, Lisa A.; Cornwell, Edward E.

    2012-01-01

    Objective To determine whether there is an increased odds of mortality among trauma patients treated at hospitals with higher proportions of minority patients (ie, black and Hispanic patients combined). Design Hospitals were categorized on the basis of the percentage of minority patients admitted with trauma. The adjusted odds of in-hospital mortality were compared between hospitals with less than 25% of patients who were minorities (the reference group) and hospitals with 25% to 50% of patients who were minorities and hospitals with more than 50% of patients who were minorities. Multivariate logistic regression (with generalized linear modeling and a cluster-correlated robust estimate of variance) was used to control for multiple patient and injury severity characteristics. Setting A total of 434 hospitals in the National Trauma Data Bank. Participants Patients aged 18 to 64 years whose medical records were included in the National Trauma Data Bank for the years 2007 and 2008 with an Injury Severity Score of 9 or greater and who were white, black, or Hispanic. Main Outcome Measures Crude mortality and adjusted odds of in-hospital mortality. Results A total of 311 568 patients were examined. Hospitals in which the percentage of minority patients was more than 50% also had younger patients, fewer female patients, more patients with penetrating trauma, and the highest crude mortality. After adjustment for potential confounders, patients treated at hospitals in which the percentage of minority patients was 25% to 50% and at hospitals in which the percentage of minority patients was more than 50% demonstrated increased odds of death (adjusted odds ratio, 1.16 [95% confidence interval, 1.01–1.34] and adjusted odds ratio, 1.37 [95% confidence interval, 1.16–1.61], respectively), compared with the reference group. This disparity increased further on subset analysis of patients with a blunt injury. Uninsured patients had significantly increased odds of mortality within

  7. Vitamin D deficiency in elderly people in Swedish nursing homes is associated with increased mortality.

    Samefors, Maria; Östgren, Carl Johan; Mölstad, Sigvard; Lannering, Christina; Midlöv, Patrik; Tengblad, Anders

    2014-05-01

    Institutionalised elderly people at northern latitudes may be at elevated risk for vitamin D deficiency. In addition to osteoporosis-related disorders, vitamin D deficiency may influence several medical conditions conferring an increased mortality risk. The aim of this study was to explore the prevalence of vitamin D deficiency and its association with mortality. The Study of Health and Drugs in the Elderly (SHADES) is a prospective cohort study among elderly people (>65 years) in 11 nursing homes in Sweden. We analysed the levels of 25-hydroxyvitamin D₃ (25(OH)D₃) at baseline. Vital status of the subjects was ascertained and hazard ratios (HRs) for mortality according to 25(OH)D₃ quartiles were calculated. We examined 333 study participants with a mean follow-up of 3 years. A total of 147 (44%) patients died within this period. Compared with the subjects in Q4 (25(OH)D₃ >48  nmol/l), HR (with 95% CI) for mortality was 2.02 (1.31-3.12) in Q1 (25(OH)D₃ D₃ 30-37  nmol/l) (PD₃ 38-47  nmol/l) (PD₃ concentration was 40.2  nmol/l (S.D. 16.0) and 80% had 25(OH)D₃ below 50  nmol/l. The vitamin D levels decreased from baseline to the second and third measurements. Vitamin D deficiency was highly prevalent and associated with increased mortality among the elderly in Swedish nursing homes. Strategies are needed to prevent, and maybe treat, vitamin D deficiency in the elderly in nursing homes and the benefit of vitamin D supplementation should be evaluated in randomised clinical trials.

  8. Is it possible to reduce the surgical mortality and morbidity of peptic ulcer perforations?

    Hut, Adnan; Tatar, Cihad; Yıldırım, Doğan; Dönmez, Turgut; Ünal, Akın; Kocakuşak, Ahmet; Akıncı, Muzaffer

    2017-01-01

    Peptic ulcer perforation is a life-threatening situation requiring urgent surgical treatment. A novel vision in peptic ulcer perforation is necessary to fill the gaps created by antiulcer medication, aging of the patients, and presentation of resistant cases in our era. In this study, we aimed to share our findings regarding the effects of various risk factors and operative techniques on the mortality and morbidity of patients with peptic ulcer perforation. Data from 112 patients presenting at our Training and Research Hospital Emergency Surgery Department between January 2010 and December 2015 who were diagnosed with PUP through physical examination and laboratory and radiological tests and operated at the hospital have been retrospectively analyzed. Patients were divided into three groups based on morbidity (Group 1), mortality (Group 2), and no complication (Group 3). Of the 112 patients included in the study, morbidity was observed in 21 (18.8%), mortality in 11 (9.8%), and no complication was observed in 80 (71.4%), who were discharged with cure. The differences between group for the average values of the perforation diameter and American Society of Anesthesiologists, Acute Physiology and Chronic Health Evaluation II, and Mannheim Peritonitis Index scores were statistically significant (p<0.001 for each). The average values for the group with mortality were significantly higher than those of the other groups. In this study where we investigated risk factors for increased morbidity and mortality in PUPs, there was statistically significant difference between the average values for age, body mass index, perforation diameter, and Acute Physiology and Chronic Health Evaluation II and Mannheim Peritonitis Index scores among the three groups, whereas the amount of subdiaphragmatic free air did not differ.

  9. Increasing NADH oxidation reduces overflow metabolism in Saccharomyces cerevisiae

    Vemuri, Goutham; Eiteman, M.A; McEwen, J.E

    2007-01-01

    effect is due to limited respiratory capacity or is caused by glucose-mediated repression of respiration. When respiration in S. cerevisiae was increased by introducing a heterologous alternative oxidase, we observed reduced aerobic ethanol formation. In contrast, increasing nonrespiratory NADH oxidation...... Crabtree effect.’’ The yeast Saccharomyces cerevisiae has served as an important model organism for studying the Crabtree effect. When subjected to increasing glycolytic fluxes under aerobic conditions, there is a threshold value of the glucose uptake rate at which the metabolism shifts from purely...... respiratory to mixed respiratory and fermentative. It is well known that glucose repression of respiratory pathways occurs at high glycolytic fluxes, resulting in a decrease in respiratory capacity. Despite many years of detailed studies on this subject, it is not known whether the onset of the Crabtree...

  10. Association of subdural hematoma with increased mortality in lobar intracerebral hemorrhage.

    Patel, Pratik V; FitzMaurice, Emilie; Nandigam, R N Kaveer; Auluck, Pavan; Viswanathan, Anand; Goldstein, Joshua N; Rosand, Jonathan; Greenberg, Steven M; Smith, Eric E

    2009-01-01

    To determine the prevalence of subdural hematoma (SDH) in patients presenting with primary nontraumatic lobar intracerebral hemorrhage (ICH) and characteristics associated with the presence of SDH. Retrospective analysis of data collected in a prospective cohort study. Hospital. Consecutive sample of 200 patients with primary lobar ICH and 75 patients with deep hemispheric ICH. Presence of SDH and mortality. Subdural hematoma was present in 40 of 200 patients (20%) with primary lobar ICH. By contrast, SDH was not present in any of 75 consecutive patients with deep hemispheric ICH (P Subdural hematoma thickness more than 5 mm was an independent predictor of increased 30-day mortality (OR, 7.60; 95% CI, 1.86-30.99; P = .005) after controlling for other factors including ICH volume. Further analysis showed that the effect of SDH on mortality depended on ICH volume, with larger odds for mortality in those with low ICH volume (OR, 12.85; 95% CI, 2.42-68.23; P = .003 for those with ICH volume subdural space, may be the pathogenic mechanism.

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

    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. PMID:27326377

  12. Aldosterone Blockade Reduces Mortality without Changing Cardiac Remodeling in Spontaneously Hypertensive Rats

    Marcelo D.M. Cezar

    2013-11-01

    Full Text Available Background: The role of aldosterone blockers during transition from long-term compensated hypertrophy to dilated failure is not completely understood. In this study we evaluated the effects of early administration of spironolactone on cardiac remodeling, myocardial function, and mortality in spontaneously hypertensive rats (SHR. Methods: Sixteen-month-old SHR received no treatment (SHR-C, n=72 or spironolactone (SHR-SPR, 20 mg/kg/day, n=34 for six months. Echocardiogram was performed before and after treatment. Myocardial function was analyzed in left ventricular (LV papillary muscle preparations. Myocardial collagen and hydroxyproline concentration were evaluated by morphometry and spectrophotometry, respectively. LV gene expression was assessed by real time RT-PCR. Statistics: Student's t test; Log rank test (Kaplan Meyer. Results: SHR-C and SHR-SPR presented mortality rates of 71 and 38%, respectively (p=0.004. Systolic arterial pressure did not differ between groups (SHR-C 199±43; SHR-SPR 200±35 mmHg. Initial and final echocardiograms did not show significant differences in cardiac structures or LV function between groups. Myocardial function was similar between groups at basal and after inotropic stimulation. Collagen fractional area, hydroxyproline concentration, gene expression for α- and β-myosin heavy chain, atrial natriuretic peptide, and Serca2a were not different between groups. Conclusion: Early spironolactone administration reduces mortality without changing cardiac remodeling in spontaneous hypertensive rats.

  13. Semiconductor technology for reducing emissions and increasing efficiency

    Duffin, B.; Frank, R. [Motorola Semiconductor Products Sector, Phoenix, AZ (United States)

    1997-12-31

    The cooperation and support of all industries are required to significantly impact a worldwide reduction in gaseous emissions that may contribute to climate change. Each industry also is striving to more efficiently utilize the resources that it consumes since this is both conservation for good citizenship and an intelligent approach to business. The semiconductor industry is also extremely concerned with these issues. However, semiconductor manufacturer`s products provide solutions for reduced emissions and increased efficiency in their industry, other industries and areas that can realize significant improvements through control technology. This paper will focus on semiconductor technologies of digital control, power switching and sensing to improve efficiency and reduce emissions in automotive, industrial, and office/home applications. 10 refs., 13 figs.

  14. High local unemployment and increased mortality in Danish adults; results from a prospective multilevel study

    Osler, M; Christensen, Ulla; Lund, Rikke

    2003-01-01

    registers. Data were pooled data from two population studies conducted in Copenhagen, Denmark. The association between unemployment at parish level and mortality was examined in Cox proportional hazard analysis. A total of 15 980 men and women, aged 20-67 years and employed at 1 January 1980, were studied...... was also a risk factor (hazard ratio(yes/no) 1.38:1.16-1.64). These estimates attenuated somewhat when other social and behavioural covariates were taken into account. The effects were similar in men and women, but the influence of individuals' unemployment experience during one and five years decreased...... gradually with increasing age. CONCLUSION: This prospective study suggests that high local unemployment and individuals' experience of unemployment increase mortality risk, even after adjustment for other social and behavioural factors....

  15. Increased all-cause mortality with psychotropic medication in Parkinson's disease and controls

    Frandsen, Rune; Baandrup, Lone; Kjellberg, Jakob

    2014-01-01

    AIM: Use of medication and polypharmacy is common as the population ages and its disease burden increases. We evaluated the association of antidepressants, benzodiazepines, antipsychotics and combinations of psychotropic drugs with all-cause mortality in patients with Parkinson's disease (PD...... of psychotropic medication in PD patients and controls. Hazard ratios were as follows for the medication types: selective serotonin reuptake inhibitors or serotonin-noradrenalin reuptake inhibitors, PD HR = 1.19, 95% CI = 1.04-1.36; Control HR = 1.77, 95% CI = 1.64-1.91; benzodiazepines, PD HR = 1.17, 95% CI = 0.......20-1.76; Control HR = 2.00, 95% CI 1.66-2.43; and combinations of these drugs compared with non-medicated PD patients and controls. Discontinuation of medication was associated with decreased mortality in both groups. CONCLUSIONS: The use of psychotropic medication in the elderly is associated with increased...

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

    Oellgaard, Jens; Gæde, Peter; Rossing, Peter

    2016-01-01

    -label trial. Duration of the intervention was 8 years, where after all patients were recommended intensified treatment. Total follow-up of up to 21 years of 24 hour urinary albumin excretion rate and GFR (51Cr-EDTA-clearance) assessed at 6 study visits. Information on end stage renal disease (ESRD......) and mortality was obtained from national registries. Outcome measures were progression to macroalbuminuria (>300 mg/24h), decline-rates of GFR and progression to end stage renal disease (ESRD) or death. Results: Progression to macroalbuminuria was reduced in the original intensive-therapy group with a hazard...

  17. In a warmer Arctic, mosquitoes avoid increased mortality from predators by growing faster

    Culler, Lauren E.; Ayres, Matthew P.; Virginia, Ross A.

    2015-01-01

    Climate change is altering environmental temperature, a factor that influences ectothermic organisms by controlling rates of physiological processes. Demographic effects of warming, however, are determined by the expression of these physiological effects through predator–prey and other species interactions. Using field observations and controlled experiments, we measured how increasing temperatures in the Arctic affected development rates and mortality rates (from predation) of immature Arcti...

  18. Abrupt increases in Amazonian tree mortality due to drought–fire interactions

    Brando, Paulo Monteiro; Balch, Jennifer K.; Nepstad, Daniel C.; Morton, Douglas C.; Putz, Francis E.; Coe, Michael T.; Silvério, Divino; Macedo, Marcia N.; Davidson, Eric A.; Nóbrega, Caroline C.; Alencar, Ane; Soares-Filho, Britaldo S.

    2014-01-01

    Climate change alone is unlikely to drive severe tropical forest degradation in the next few decades, but an alternative process associated with severe weather and forest fires is already operating in southeastern Amazonia. Recent droughts caused greatly elevated fire-induced tree mortality in a fire experiment and widespread regional forest fires that burned 5–12% of southeastern Amazon forests. These results suggest that feedbacks between fires and extreme climatic conditions could increase...

  19. Increase in overall mortality risk in patients with type 2 diabetes receiving different oral diabetes drugs

    E A Pigarova

    2012-12-01

    Full Text Available Реферат по статье: Pantalone KM, Kattan MW, Yu C, Wells BJ, Arrigain S, Jain A, Atreja A, Zimmerman RS. Increase in overall mortality risk in patients with type 2 diabetes receiving glipizide, glyburide or glimepiride monotherapy versus metformin: a retrospective analysis. Diabetes Obes Metab. 2012 Sep;14(9:803-809.

  20. Can better infrastructure and quality reduce hospital infant mortality rates in Mexico?

    Aguilera, Nelly; Marrufo, Grecia M

    2007-02-01

    Preliminary evidence from hospital discharges hints enormous disparities in infant hospital mortality rates. At the same time, public health agencies acknowledge severe deficiencies and variations in the quality of medical services across public hospitals. Despite these concerns, there is limited evidence of the contribution of hospital infrastructure and quality in explaining variations in outcomes among those who have access to medical services provided at public hospitals. This paper provides evidence to address this question. We use probabilistic econometric methods to estimate the impact of material and human resources and hospital quality on the probability that an infant dies controlling for socioeconomic, maternal and reproductive risk factors. As a measure of quality, we calculate for the first time for Mexico patient safety indicators developed by the AHRQ. We find that the probability to die is affected by hospital infrastructure and by quality. In this last regard, having been treated in a hospital with the worse quality incidence doubles the probability to die. This paper also presents evidence on the contribution of other risk factors on perinatal mortality rates. The conclusions of this paper suggest that lower infant mortality rates can be reached by implementing a set of coherent public policy actions including an increase and reorganization of hospital infrastructure, quality improvement, and increasing demand for health by poor families.

  1. Method of increased bioethanol concentration with reduced heat consumption

    Bremers, G.; Blija, A.

    2003-01-01

    Ethanol dehydration applying method of non-reflux saline distillation was conduced on a laboratory scale and in bigger pilot equipment. Results make possible recommend new method for the increased of ethanol concentration. Heat consumption reduced by 50% and cooling water consumption by 90 % when the non-reflux distillation was applied. Reflux flow in the column is replacing with contact mass, which consist from saline layer and seclude medium. Basis diagram of ethanol non-reflux saline distillation was established. Distillation equipment and number of plates in the column can calculate using basis diagram. Absolute ethanol can obtain with non-reflux saline distillation. Absolute ethanol use in produce of biofuel (author)

  2. Decrease of old age population mortality in Yugoslavia: Chance to increase anticipated life expectancy

    Radivojević Biljana M.

    2002-01-01

    Full Text Available This study analyzes the level and structure of old age population mortality in Yugoslavia with an aim to determine the intensity of realized changes and to provide an answer to how much they are significant and to approach the positive trends noted in developed countries in the latest period. Although it was insufficiently represented in the demographic analysis, the analysis of mortality in old people is gaining importance in the world. Apart from the reasons which result from the increase in the number of old people and thus their greater participation in the total number of deceased, enviable results have been achieved in decreasing old age mortality, which are more and more in focus of interest. While earlier research reported on the dominant influence of the decrease of younger age mortality to the increase of the expectation of life at birth, recent analysis precisely confirm the importance of decreasing mortality in old people. In mortality conditions from 1997/98, an additional 13.4 years of life in average is expected for men in Yugoslavia, and 15.2 for women. During more than five decades, the anticipated life expectancy for people over the age of 65 increased for only 1.2 years for men and 1.9 years for women. Out of that, the greatest increase was realized in the period 1950/51 - 1960/61 in both sexes. A small decrease in the average life expectancy was marked with men in the period 1960/61 - 1970/71, and with women in the latest period. Otherwise, all up to the eighties, the annual rate of increase was considerably lower than the rate of increase for zero year. It was only in the period 1980/81-1990/91 that faster growth had an anticipated life expectancy for the 65 years old. However, during the nineties unfavorable changes continued with the older, especially, female population. When comparing the values of the average life expectancy for people over 65 in Yugoslavia with corresponding values in developed countries, the lagging in

  3. Strategies to reduce disparities in maternal morbidity and mortality: Patient and provider education.

    Jain, Joses; Moroz, Leslie

    2017-08-01

    A reduction in racial disparities in maternal morbidity and mortality requires effective education of both patients and providers. Although providers seem to recognize that disparities exist, there is a widespread need for improving our understanding differences in health care and outcomes and the factors that contribute to them. There are increasingly more educational materials available for the purpose of augmenting disparities education among patients and providers. However, it is important to incorporate contemporary learning methodologies and technologies to address our current knowledge deficit. Collaborative educational models with a multi-disciplinary approach to patient education will be essential. Ultimately, the comprehensive education of providers and patients will require efforts on the part of numerous stakeholders within patient care delivery models. Further investigation will be necessary to determine how best to disseminate this information to maximize the impact of patient and provider educations with the goal of eliminating disparities in maternal morbidity and mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Low to moderate alcohol intake is not associated with increased mortality after breast cancer.

    Flatt, Shirley W; Thomson, Cynthia A; Gold, Ellen B; Natarajan, Loki; Rock, Cheryl L; Al-Delaimy, Wael K; Patterson, Ruth E; Saquib, Nazmus; Caan, Bette J; Pierce, John P

    2010-03-01

    Both alcohol consumption and obesity have been linked with breast cancer morbidity and mortality. An inverse association between alcohol intake and obesity suggests possible confounding between these variables (and perhaps other factors) with breast cancer outcomes. Alcohol intake (beer, wine, spirits, and total) was examined in 3,088 women previously diagnosed and treated for breast cancer within an intervention trial that targeted vegetables, fiber, and fat but not alcohol or weight loss. Factors associated with baseline alcohol intake were included in Cox proportional hazards models for recurrence and mortality. Alcohol intake was significantly associated with higher education and physical activity levels. Neither light alcohol intake nor obesity was significantly associated with breast cancer recurrence, but moderate alcohol intake >300 g/mo was protective against all-cause mortality (hazard ratio, 0.69; 95% confidence intervals, 0.49-0.97) in a proportional hazards model adjusted for obesity. Obese women were 61% more likely to be nondrinkers than drinkers, and 76% more likely to be light drinkers than moderate/heavy drinkers. In nonobese women, alcohol intake >10 g/mo was associated with lower risk of all-cause mortality (hazard ratio, 0.68; 95% confidence intervals, 0.51-0.91). Light alcohol intake, regardless of body weight, did not increase the risk of breast cancer recurrence or all-cause mortality in this cohort of middle-aged women previously diagnosed with breast cancer. Alcohol intake was associated with other favorable prognostic indicators, which may explain its apparent protective effect in nonobese women.

  5. Depression increasingly predicts mortality in the course of congestive heart failure.

    Jünger, Jana; Schellberg, Dieter; Müller-Tasch, Thomas; Raupp, Georg; Zugck, Christian; Haunstetter, Armin; Zipfel, Stephan; Herzog, Wolfgang; Haass, Markus

    2005-03-02

    Congestive heart failure (CHF) is frequently associated with depression. However, the impact of depression on prognosis has not yet been sufficiently established. To prospectively investigate the influence of depression on mortality in patients with CHF. In 209 CHF patients depression was assessed by the Hospital Anxiety and Depression Scale (HADS-D). Compared to survivors (n=164), non-survivors (n=45) were characterized by a higher New York Heart Association (NYHA) functional class (2.8+/-0.7 vs. 2.5+/-0.6), and a lower left ventricular ejection fraction (LVEF) (18+/-8 vs. 23+/-10%) and peakVO(2) (13.1+/-4.5 vs. 15.4+/-5.2 ml/kg/min) at baseline. Furthermore, non-survivors had a higher depression score (7.5+/-4.0 vs. 6.1+/-4.3) (all P<0.05). After a mean follow-up of 24.8 months the depression score was identified as a significant indicator of mortality (P<0.01). In multivariate analysis the depression score predicted mortality independent from NYHA functional class, LVEF and peakVO(2). Combination of depression score, LVEF and peakVO(2) allowed for a better risk stratification than combination of LVEF and peakVO(2) alone. The risk ratio for mortality in patients with an elevated depression score (i.e. above the median) rose over time to 8.2 after 30 months (CI 2.62-25.84). The depression score predicts mortality independent of somatic parameters in CHF patients not treated for depression. Its prognostic power increases over time and should, thus, be accounted for in risk stratification and therapy.

  6. Reducing negative affect and increasing rapport improve interracial mentorship outcomes.

    Leitner, Jordan B; Ayduk, Özlem; Boykin, C Malik; Mendoza-Denton, Rodolfo

    2018-01-01

    Research suggests that interracial mentoring relationships are strained by negative affect and low rapport. As such, it stands to reason that strategies that decrease negative affect and increase rapport should improve these relationships. However, previous research has not tested this possibility. In video-chats (Studies 1 and 2) and face-to-face meetings (Study 3), we manipulated the degree of mutual self-disclosure between mentees and mentors, a strategy that has been shown to reduce negative affect and increase rapport. We then measured negative affect and rapport as mediators, and mentee performance (quality of speech delivered; Studies 1 and 3) and mentor performance (warmth and helpfulness; Studies 2 and 3) as key outcomes. Results revealed that increased self-disclosure decreased negative affect and increased rapport for both mentees and mentors. Among mentees, decreased negative affect predicted better performance (Studies 1 and 3). Among mentors, increased rapport predicted warmer feedback (Studies 2 and 3). These effects remained significant when we meta-analyzed data across studies (Study 4), and also revealed the relationship of rapport to more helpful feedback. Findings suggest that affect and rapport are key features in facilitating positive outcomes in interracial mentoring relationships.

  7. Elevated TSH in adults treated for hypothyroidism is associated with increased mortality.

    Akirov, Amit; Gimbel, Hannah; Grossman, Alon; Shochat, Tzipora; Shimon, Ilan

    2017-01-01

    Numerous studies investigated the link between hypothyroidism and mortality, but a definite conclusion is hard to reach as these were limited by a number of factors, including age of participants, comorbidities and single measurement of thyroid function. To evaluate the association between TSH and fT4 levels and mortality in patients with levothyroxine-treated hypothyroidism. Observational data of hospitalized patients (2011-2014). TSH and fT4 levels obtained between at least 30 days after discharge and until death or end of follow-up were collected. Median TSH and fT4 levels were stratified into categories. In total, 611 patients with treated hypothyroidism, aged 60-80 years (72% females, mean age 71 ± 6 years) were included in the study. All-cause mortality up to 66 months after discharge, by TSH and fT4 categories. During follow-up, the average numbers of TSH and fT4 measurements were 5.5 ± 3.8 and 2.5 ± 4.2 per patient respectively. Mortality rates were 28%, 29% and 54% with median TSH of 0.5-2.5, 2.5-5.0 and 5.0-10.0 IU/L respectively. Adjusted hazard ratios for mortality with median TSH between 5.0 and 10.0 IU/L were 2.3 (95% CI: 1.6-3.4) and 2.2 (95% CI: 1.6-3.2) compared with patients with TSH between 0.5-2.5 IU/L and 2.5-5 IU/L respectively. There was no difference in mortality between patients with median fT4 10-15 or 15-20 pmol/L. In treated hypothyroid adult patients and serial measurements of thyroid function tests, median TSH levels of 5-10 IU/L are associated with increased mortality with no effect of fT4 levels. Treatment should aim at achieving euthyroidism to improve survival. © 2017 European Society of Endocrinology.

  8. Reduced brain/serum glucose ratios predict cerebral metabolic distress and mortality after severe brain injury.

    Kurtz, Pedro; Claassen, Jan; Schmidt, J Michael; Helbok, Raimund; Hanafy, Khalid A; Presciutti, Mary; Lantigua, Hector; Connolly, E Sander; Lee, Kiwon; Badjatia, Neeraj; Mayer, Stephan A

    2013-12-01

    The brain is dependent on glucose to meet its energy demands. We sought to evaluate the potential importance of impaired glucose transport by assessing the relationship between brain/serum glucose ratios, cerebral metabolic distress, and mortality after severe brain injury. We studied 46 consecutive comatose patients with subarachnoid or intracerebral hemorrhage, traumatic brain injury, or cardiac arrest who underwent cerebral microdialysis and intracranial pressure monitoring. Continuous insulin infusion was used to maintain target serum glucose levels of 80-120 mg/dL (4.4-6.7 mmol/L). General linear models of logistic function utilizing generalized estimating equations were used to relate predictors of cerebral metabolic distress (defined as a lactate/pyruvate ratio [LPR] ≥ 40) and mortality. A total of 5,187 neuromonitoring hours over 300 days were analyzed. Mean serum glucose was 133 mg/dL (7.4 mmol/L). The median brain/serum glucose ratio, calculated hourly, was substantially lower (0.12) than the expected normal ratio of 0.40 (brain 2.0 and serum 5.0 mmol/L). In addition to low cerebral perfusion pressure (P = 0.05) and baseline Glasgow Coma Scale score (P brain/serum glucose ratios below the median of 0.12 were independently associated with an increased risk of metabolic distress (adjusted OR = 1.4 [1.2-1.7], P brain/serum glucose ratios were also independently associated with in-hospital mortality (adjusted OR = 6.7 [1.2-38.9], P brain/serum glucose ratios, consistent with impaired glucose transport across the blood brain barrier, are associated with cerebral metabolic distress and increased mortality after severe brain injury.

  9. Reduced Time in Therapeutic Range and Higher Mortality in Atrial Fibrillation Patients Taking Acenocoumarol.

    Rivera-Caravaca, José Miguel; Roldán, Vanessa; Esteve-Pastor, María Asunción; Valdés, Mariano; Vicente, Vicente; Marín, Francisco; Lip, Gregory Y H

    2018-01-01

    . Even in a cohort with good anticoagulation control, the risk for mortality and clinically significant events increases with every point deterioration of TTR. Copyright © 2018 Elsevier HS Journals, Inc. All rights reserved.

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

    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.

  11. Abrupt increases in Amazonian tree mortality due to drought–fire interactions

    Brando, Paulo Monteiro; Balch, Jennifer K.; Nepstad, Daniel C.; Morton, Douglas C.; Putz, Francis E.; Coe, Michael T.; Silvério, Divino; Macedo, Marcia N.; Davidson, Eric A.; Nóbrega, Caroline C.; Alencar, Ane; Soares-Filho, Britaldo S.

    2014-01-01

    Interactions between climate and land-use change may drive widespread degradation of Amazonian forests. High-intensity fires associated with extreme weather events could accelerate this degradation by abruptly increasing tree mortality, but this process remains poorly understood. Here we present, to our knowledge, the first field-based evidence of a tipping point in Amazon forests due to altered fire regimes. Based on results of a large-scale, long-term experiment with annual and triennial burn regimes (B1yr and B3yr, respectively) in the Amazon, we found abrupt increases in fire-induced tree mortality (226 and 462%) during a severe drought event, when fuel loads and air temperatures were substantially higher and relative humidity was lower than long-term averages. This threshold mortality response had a cascading effect, causing sharp declines in canopy cover (23 and 31%) and aboveground live biomass (12 and 30%) and favoring widespread invasion by flammable grasses across the forest edge area (80 and 63%), where fires were most intense (e.g., 220 and 820 kW⋅m−1). During the droughts of 2007 and 2010, regional forest fires burned 12 and 5% of southeastern Amazon forests, respectively, compared with Amazon forests. Future projections of vegetation responses to climate change across drier portions of the Amazon require more than simulation of global climate forcing alone and must also include interactions of extreme weather events, fire, and land-use change. PMID:24733937

  12. Cumulative dosages of antipsychotic drugs are associated with increased mortality rate in patients with Alzheimer's dementia

    Nielsen, R E; Lolk, A; Valentin, J B

    2016-01-01

    OBJECTIVE: We wished to investigate the effects of cumulative dosages of antipsychotic drug in Alzheimer's dementia, when controlling for known risk factors, including current antipsychotic exposure, on all-cause mortality. METHOD: We utilized a nationwide, population-based, retrospective cohort...... study design with mortality as outcome in individual patients diagnosed with Alzheimer's dementia. RESULTS: We included a total of 45 894 patients and followed them for 3 803 996 person-years in total, presenting 27 894 deaths in the study population. Cumulative antipsychotic exposure increased...... or equal to 730 DDDs: HR 1.06, 95% CI (0.95-1.18), P = 0.322, when controlling for proxy markers of severity, somatic and mental comorbid disorders. CONCLUSION: In this nationwide cohort study of 45 894 patients diagnosed with Alzheimer's dementia, we found that cumulative dosages of antipsychotic drugs...

  13. Procalcitonin increase in early identification of critically ill patients at high risk of mortality

    Jensen, Jens Ulrik; Heslet, L; Jensen, TH

    2006-01-01

    OBJECTIVE: To investigate day-by-day changes in procalcitonin and maximum obtained levels as predictors of mortality in critically ill patients. DESIGN: Prospective observational cohort study. SETTING:: Multidisciplinary intensive care unit at Rigshospitalet, Copenhagen University Hospital......, a tertiary reference hospital in Denmark. PATIENTS: Four hundred seventy-two patients with diverse comorbidity and age admitted to this intensive care unit. INTERVENTIONS: Equal in all patient groups: antimicrobial treatment adjusted according to the procalcitonin level. MEASUREMENTS AND MAIN RESULTS: Daily...... in the intensive care unit and in a 30-day follow-up period. A total of 3,642 procalcitonin measurements were evaluated in 472 critically ill patients. We found that a high maximum procalcitonin level and a procalcitonin increase for 1 day were independent predictors of 90-day all-cause mortality...

  14. Comorbidity in multiple sclerosis is associated with diagnostic delays and increased mortality

    Thormann, Anja; Sorensen, Per Soelberg; Koch-Henriksen, Nils

    2017-01-01

    Objective: To investigate the effect of chronic comorbidity on the time of diagnosis of multiple sclerosis (MS) and on mortality in MS. Methods: We conducted a population-based, nationwide cohort study including all incident MS cases in Denmark with first MS symptom between 1980 and 2005. To inve......Objective: To investigate the effect of chronic comorbidity on the time of diagnosis of multiple sclerosis (MS) and on mortality in MS. Methods: We conducted a population-based, nationwide cohort study including all incident MS cases in Denmark with first MS symptom between 1980 and 2005.......007). Conclusions: An increased awareness of both the necessity of neurologic evaluation of new neurologic symptoms in persons with preexisting chronic disease and of optimum treatment of comorbidity in MS is critical....

  15. Rotavirus Gastroenteritis is Associated with Increased Morbidity and Mortality in Children with Inherited Metabolic Disorders

    Smith, A

    2017-04-01

    Rotavirus is the leading cause of infantile diarrhoea worldwide in children <5 years1. Although mortality rates are low in Ireland, certain populations are more susceptible to the associated morbidity and mortality of infection. A retrospective chart review of 14 patients with confirmed IMDs who were admitted to Temple Street Children’s Hospital between 2010 to 2015 with rotavirus infection were compared with 14 randomly selected age matched controls. The median length of stay was 7 days (SD25.3) in IMD patients versus 1.5 days (SD 2.1) in the controls. IV fluids were required on average for 4.5 days (range 0-17) in IMD patients versus 0.63 days (range 0-3) in controls. This report highlights the increased morbidity of rotavirus infection in patients with IMD compared to healthy children. This vulnerable population are likely to benefit from the recent introduction of the rotavirus oral vaccination in October 2016.

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

    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.

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

    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

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

    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.

  19. Terminal illness and the increased mortality risk of conventional antipsychotics in observational studies: a systematic review.

    Luijendijk, Hendrika J; de Bruin, Niels C; Hulshof, Tessa A; Koolman, Xander

    2016-02-01

    Numerous large observational studies have shown an increased risk of mortality in elderly users of conventional antipsychotics. Health authorities have warned against use of these drugs. However, terminal illness is a potentially strong confounder of the observational findings. So, the objective of this study was to systematically assess whether terminal illness may have biased the observational association between conventional antipsychotics and risk of mortality in elderly patients. Studies were searched in PubMed, CINAHL, Embase, the references of selected studies and articles referring to selected studies (Web of Science). Inclusion criteria were (i) observational studies that estimated (ii) the risk of all-cause mortality in (iii) new elderly users of (iv) conventional antipsychotics compared with atypical antipsychotics or no use. Two investigators assessed the characteristics of the exposure and reference groups, main results, measured confounders and methods used to adjust for unmeasured confounders. We identified 21 studies. All studies were based on administrative medical and pharmaceutical databases. Sicker and older patients received conventional antipsychotics more often than new antipsychotics. The risk of dying was especially high in the first month of use, and when haloperidol was administered per injection or in high doses. Terminal illness was not measured in any study. Instrumental variables that were used were also confounded by terminal illness. We conclude that terminal illness has not been adjusted for in observational studies that reported an increased risk of mortality risk in elderly users of conventional antipsychotics. As the validity of the evidence is questionable, so is the warning based on it. Copyright © 2015 John Wiley & Sons, Ltd.

  20. The implications of increased survivorship for mortality variation in aging populations

    Engelman, Michal; Canudas-Romo, Vladimir; Agree, Emily M

    2010-01-01

    The remarkable growth in life expectancy during the twentieth century inspired predictions of a future in which all people, not just a fortunate few, will live long lives ending at or near the maximum human life span. We show that increased longevity has been accompanied by less variation in ages...... at death, but survivors to the oldest ages have grown increasingly heterogeneous in their mortality risks. These trends are consistent across countries, and apply even to populations with record-low variability in the length of life. We argue that as a result of continuing improvements in survival, delayed...

  1. Increased mortality in the year following discharge from a paediatric ward in Bissau, Guinea-Bissau

    Veirum, Jens Erik; Sodeman, Morten; Biai, Sidu

    2007-01-01

    -hospital and 12-month posthospital mortality was 20%. Compared to the mortality level in the community and controlled for other determinants of childhood mortality, children discharged from hospital had 12 times higher risk of dying during the first 2 weeks after discharge. The mortality rate ratio (MR) was 6...... for postdischarge mortality included ethnic group, housing quality and maternal education, and were similar to risk factors for community mortality. The same diagnoses that had high acute mortality, including anaemia, diarrhoea and 'other', were also associated with high postdischarge mortality. CONCLUSION......BACKGROUND: Few studies in developing countries have examined posthospital mortality and little is known about the magnitude of posthospital mortality and risk factors for long-term survival. A better understanding of the determinants of posthospital mortality could help improve discharge policies...

  2. Does concomitant tricuspid annuloplasty increase perioperative mortality and morbidity when correcting left-sided valve disease?

    Zhu, Tie-Yuan; Wang, Jian-Gang; Meng, Xu

    2015-01-01

    A best evidence topic in adult valvular surgery was written according to a structured protocol. The question addressed was 'Does concomitant tricuspid annuloplasty increase the perioperative mortality and morbidity when correcting left-sided valve disease?' A total of 561 papers were found using the reported search, of which 12 presented the best evidence to answer the clinical question. The authors, country, journal, date of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Among these 12 papers, there were nine retrospective studies, two cohort studies and one randomized controlled trial (RCT). Overall, additional tricuspid valve (TV) repair takes more time during operations, particularly with a ring annuloplasty method. The mean aortic cross-clamping times were 57-83 min without associated tricuspid repair and 62-100 min with, and cardiopulmonary bypass times without and with repair were 82-124 and 90-174 min, respectively. A study of 624 patients who had undergone isolated mitral valve (MV) surgery and MV surgery plus TV repair showed more female and atrial fibrillation patients in the tricuspid valve plasty (TVP) group, but no increase in the 30-day mortality was found. One RCT, presenting similar patient baseline characteristics, also found no difference in the hospital mortality rates between the TVP group and the non-TVP group. Another 10 studies also demonstrated no statistically significant differences in perioperative mortality. In a cohort study of 311 patients undergoing MV repair with or without tricuspid annuloplasty, postoperative complications, such as bleeding, stroke, pacemaker, haemofiltration and myocardial infarction, all showed no statistically significant differences in the two groups. One study retrospectively analysed a large number of patients undergoing either isolated left-sided valve surgery or a concomitant TV repair, and there were no statistically significant differences

  3. Predator Exclosures Enhance Reproductive Success but Increase Adult Mortality of Piping Plovers (Charadrius melodus

    Colleen Barber

    2010-12-01

    Full Text Available Piping Plovers (Charadrius melodus are listed as endangered throughout Canada and the United States Great Lakes region. Most attempts to increase their numbers have focused on enhancing reproductive success. Using 22 years of data collected by Parks Canada in Prince Edward Island National Park of Canada, we examined whether predator exclosures installed around Piping Plover nests increased nest success and hatching and fledging success when compared to nests without exclosures. Nests with exclosures were significantly more likely to hatch at least one egg than nests without exclosures, and they hatched a significantly greater number of young. The greater reproductive success observed in exclosed nests is likely due to the increased protection from predators that the exclosures conferred; significantly fewer exclosed nests were depredated than nonexclosed nests. However, significantly more exclosed than nonexclosed nests were abandoned by adults, and they had significantly greater adult mortality. Whether benefits of increased reproductive success from exclosures outweigh costs of increased abandonment and adult mortality remains unknown, but must be considered.

  4. [A possible objective from now to the year 2000: reducing infant mortality by one half in Third World countries].

    Berthet, E

    1984-06-01

    Every day 40.000 children die throughout the world. Most of them in developing countries. There is a close relationship between infant mortality, life expectancy at birth, the adult illiteracy rate and national income per capita. Why such huge differences between the infant mortality rate of 7 per 1.000 (live births) in Sweden and 208 in Upper Volta? The four scourges which afflict developing countries: hunger (malnutrition), disease, ignorance and poverty are responsible for this state of affairs. The author suggests that coordinated action by governments and International Agencies should be taken to halve the infant mortality rate by the year 2.000. He notes that in the past three mistakes were made which should not be repeated. The first was to improve the living conditions of the population. The green Revolution in India provides a striking example of an important progress which benefited only the wealthier farmers. A second mistake was to believe that only a medical approach reduce the infant mortality rate. A third error was to overlook the importance of health education and not to seek the active participation of the people concerned. The author recalls that the International Union for Health Education carried out a sanitary and social programme from 1975 to 1978 in Africa, south of the Sahara. To this effect, the IUHE had to find out what the people really wanted, could be motivated, to increase the welfare of the villagers by measures adapted to existing possibilities, to study how the people could recruit among the villagers health workers and train them, to create village health committees.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Celiac disease and alcohol use disorders: increased length of hospital stay, overexpenditures and attributable mortality

    Miguel Gili

    2013-10-01

    Full Text Available Background and objectives: alcohol use disorders are associated with a greater incidence of certain comorbidities in patients with celiac disease. Currently there is no available information about the impact that these disorders may have on length of hospital stays, overexpenditures during hospital stays, and excess mortality in these patients. Methods: a case-control study was conducted with a selection of patients 18 years and older hospitalized during 2008-2010 in 87 hospitals in Spain. Estimations of excess length of stays, costs, and attributable mortality were calculated using a multivariate analysis of covariance, which included age, gender, hospital group, alcohol use disorders, tobacco related disease and 30 other comorbidities. Results: patients who had both celiac disease and alcohol use disorders had an increased length of hospital stay, an average of 3.1 days longer in women, and 1.7 days longer in men. Excess costs per stay ranged from 838.7 euros in female patients, to 389.1 euros in male patients. Excess attributable mortality was 15.1% in women, 12.2% in men. Conclusions: apart from a gluten-free diet and other medical measures, the prevention of alcohol abuse is indicated in these patients. Patients hospitalized who present these disorders should receive specialized attention after leaving the hospital. Early detection and treatment should be used to prevent the appearance of organic lesions and should not be solely focused on male patients.

  6. Cutaneous squamous cell carcinoma in norway 1963–2011: increasing incidence and stable mortality

    Robsahm, Trude E; Helsing, Per; Veierød, Marit B

    2015-01-01

    The incidence of cutaneous squamous cell carcinoma (SCC) is rapidly increasing in white populations, causing high morbidity and health-care costs. Few studies, however, have described the trends for SCC, as population-based data with a long follow-up are limited. In Norway we have this opportunity and we aimed to describe SCC incidence, mortality and survival rates, according to sex, age, stage, primary anatomical location, and geographical region, for the period 1963–2011, for estimation of future health-care needs. Data were retrieved from the Cancer Registry of Norway. Age-adjusted SCC incidence and mortality rates and 5-year relative survival (in percent) were calculated for 5-year calendar periods. A joinpoint regression model identified the annual percentage change (APC) in rates over the 50-year period. The age-adjusted incidence rate increased ninefold in females and sixfold in males from 1963 to 2011, with APCs of 5.6% (95% confidence interval, CI 4.5, 7.3) and 3.3% (95% CI 1.3, 5.3) in females and males, respectively. SCC incidence rose in all age groups, anatomical locations (except ears in females), and geographical regions, though restricted to localized tumors. Most striking increase was seen in the age group 70–79, in face and head locations and among residents in southern Norway. SCC mortality and survival rates remained relatively stable. Our findings underline an increasing need for SCC treatment in Norway, especially considering the aging population. The findings also call for the creation of particular guidelines for primary prevention of SCC

  7. Natural mortality: Its ecology, how it shapes fish life histories, and why it may be increased by fishing

    Jørgensen, Christian; Holt, Rebecca E.

    2013-01-01

    A stronger focus on natural mortality may be required to better understand contemporary changes in fish life histories and behaviour and their responses to anthropogenic drivers. Firstly, natural mortality is the selection under which fish evolved in the first place, so a theoretical understanding of effects of natural mortality alone is needed. Secondly, due to trade-offs, most organismal functions can only be achieved at some cost in terms of survival. Several trade-offs might need to be analysed simultaneously with effects on natural mortality being a common currency. Thirdly, there is scattered evidence that natural mortality has been increasing, some would say dramatically, in some fished stocks, which begs explanations. Fourthly, natural mortality most often implies transfer of mass and energy from one species to another, and therefore has foodweb and ecosystem consequences. We therefore analyse a model for evolution of fish life histories and behaviour, where state-dependent energy-allocation and growth strategies are found by optimization. Natural mortality is split into five different components, each specified as the outcome of individual traits and ecological trade-offs: a fixed baseline mortality; size-dependent predation; risk-dependent growth strategy; a fixed mortality when sexually mature; and mortality increasing with reproductive investment. The analysis is repeated with and without fishing. Each component of natural mortality has consequences for optimal life history strategies. Beyond earlier models, we show i) how the two types of reproductive mortality sometimes have similar and sometimes contrasting effects on life history evolution, ii) how ecosystem properties such as food availability and predation levels have stronger effects on optimal strategies than changing other mortality components, and iii) how expected changes in risk-dependent growth strategies are highly variable depending on the type of mortality changed.

  8. Increased mortality associated with HTLV-II infection in blood donors: a prospective cohort study

    Smith James W

    2004-03-01

    Full Text Available Abstract Background HTLV-I is associated with adult T-cell leukemia, and both HTLV-I and -II are associated with HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP. Several published reports suggest that HTLV-I may lead to decreased survival, but HTLV-II has not previously been associated with mortality. Results We examined deaths among 138 HTLV-I, 358 HTLV-II, and 759 uninfected controls enrolled in a prospective cohort study of U.S. blood donors followed biannually since 1992. Proportional hazards models yielded hazard ratios (HRs for the association between mortality and HTLV infection, controlling for sex, race/ethnicity, age, income, educational level, blood center, smoking, injection drug use history, alcohol intake, hepatitis C status and autologous donation. After a median follow-up of 8.6 years, there were 45 confirmed subject deaths. HTLV-I infection did not convey a statistically significant excess risk of mortality (unadjusted HR 1.9, 95%CI 0.8–4.4; adjusted HR 1.9, 95%CI 0.8–4.6. HTLV-II was associated with death in both the unadjusted model (HR 2.8, 95%CI 1.5–5.5 and in the adjusted model (HR 2.3, 95%CI 1.1–4.9. No single cause of death appeared responsible for the HTLV-II effect. Conclusions After adjusting for known and potential confounders, HTLV-II infection is associated with increased mortality among healthy blood donors. If replicated in other cohorts, this finding has implications for both HTLV pathogenesis and counseling of infected persons.

  9. Mobile phone intervention reduces perinatal mortality in zanzibar: secondary outcomes of a cluster randomized controlled trial.

    Lund, Stine; Rasch, Vibeke; Hemed, Maryam; Boas, Ida Marie; Said, Azzah; Said, Khadija; Makundu, Mkoko Hassan; Nielsen, Birgitte Bruun

    2014-03-26

    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. We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting. This study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities in Zanzibar as the unit of randomization. At their first antenatal care visit, 2550 pregnant women (1311 interventions and 1239 controls) who attended antenatal care at selected primary health care facilities were included in this study and followed until 42 days after delivery. Twenty-four primary health 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 as a proxy of neonatal mortality. Within the first 42 days of life, 2482 children were born alive, 54 were stillborn, and 36 died. The overall perinatal mortality rate in the study was 27 per 1000 total births. The rate was lower in the intervention clusters, 19 per 1000 births, than in the control clusters, 36 per 1000 births. The intervention was associated with a significant reduction in perinatal mortality with an odds ratio (OR) of 0.50 (95% CI 0.27-0.93). Other secondary outcomes showed an insignificant reduction in stillbirth (OR 0.65, 95% CI 0.34-1.24) and an insignificant reduction in death within the first 42 days of life (OR 0.79, 95% CI 0.36-1.74). Mobile phone applications may contribute to improved health of the newborn and should be considered by policy makers in resource-limited settings. Clinical

  10. Elevated lactate dehydrogenase activity and increased cardiovascular mortality in the arsenic-endemic areas of southwestern Taiwan

    Liao, Ya-Tang [Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Taiwan (China); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan (China); Genomics Research Center, Academia Sinica, Taiwan (China); Chen, Chien-Jen [Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan (China); Genomics Research Center, Academia Sinica, Taiwan (China); Li, Wan-Fen [Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Taiwan (China); Hsu, Ling-I [Genomics Research Center, Academia Sinica, Taiwan (China); Tsai, Li-Yu; Huang, Yeou-Lih [Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Taiwan (China); Sun, Chien-Wen [Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Taiwan (China); Chen, Wei J., E-mail: wjchen@ntu.edu.tw [Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan (China); Genetic Epidemiology Core Laboratory, National Taiwan University Center for Genomic Medicine, Taiwan (China); Wang, Shu-Li, E-mail: slwang@nhri.org.tw [Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Taiwan (China); Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan (China)

    2012-08-01

    Arsenic ingestion has been linked to increasing global prevalence of and mortality from cardiovascular disease (CVD); arsenic can be removed from drinking water to reduce related health effects. Lactate dehydrogenase (LDH) is used for the evaluation of acute arsenic toxicity in vivo and in vitro, but it is not validated for the evaluation of long-term, chronic arsenic exposure. The present study examined the long-term effect of chronic arsenic exposure on CVD and serum LDH levels, after consideration of arsenic metabolism capacity. A total of 380 subjects from an arseniasis-endemic area and 303 from a non-endemic area of southwestern Taiwan were recruited in 2002. Various urinary arsenic species were analyzed using high-performance liquid chromatography (HPLC) and hydride generation systems. Fasting serum was used for quantitative determination of the total LDH activity. A significant dose–response relationship was observed between arsenic exposure and LDH elevation, independent of urinary arsenic profiles (P < 0.001). Furthermore, abnormal LDH elevation was associated with CVD mortality after adjustment for Framingham risk scores for 10-year CVD and arsenic exposure (hazard ratio, 3.98; 95% confidence interval, 1.07–14.81). LDH was elevated in subjects with arsenic exposure in a dose-dependent manner. LDH is a marker of arsenic toxicity associated with CVD mortality. Results of this study have important implications for use in ascertaining long-term arsenic exposure risk of CVD. -- Highlights: ► We showed that arsenic exposure was correlated with LDH elevation. ► LDH elevation was related to arsenic methylation capacity. ► Abnormal LDH elevation can be a marker of susceptibility to CVD mortality.

  11. Elevated lactate dehydrogenase activity and increased cardiovascular mortality in the arsenic-endemic areas of southwestern Taiwan

    Liao, Ya-Tang; Chen, Chien-Jen; Li, Wan-Fen; Hsu, Ling-I; Tsai, Li-Yu; Huang, Yeou-Lih; Sun, Chien-Wen; Chen, Wei J.; Wang, Shu-Li

    2012-01-01

    Arsenic ingestion has been linked to increasing global prevalence of and mortality from cardiovascular disease (CVD); arsenic can be removed from drinking water to reduce related health effects. Lactate dehydrogenase (LDH) is used for the evaluation of acute arsenic toxicity in vivo and in vitro, but it is not validated for the evaluation of long-term, chronic arsenic exposure. The present study examined the long-term effect of chronic arsenic exposure on CVD and serum LDH levels, after consideration of arsenic metabolism capacity. A total of 380 subjects from an arseniasis-endemic area and 303 from a non-endemic area of southwestern Taiwan were recruited in 2002. Various urinary arsenic species were analyzed using high-performance liquid chromatography (HPLC) and hydride generation systems. Fasting serum was used for quantitative determination of the total LDH activity. A significant dose–response relationship was observed between arsenic exposure and LDH elevation, independent of urinary arsenic profiles (P < 0.001). Furthermore, abnormal LDH elevation was associated with CVD mortality after adjustment for Framingham risk scores for 10-year CVD and arsenic exposure (hazard ratio, 3.98; 95% confidence interval, 1.07–14.81). LDH was elevated in subjects with arsenic exposure in a dose-dependent manner. LDH is a marker of arsenic toxicity associated with CVD mortality. Results of this study have important implications for use in ascertaining long-term arsenic exposure risk of CVD. -- Highlights: ► We showed that arsenic exposure was correlated with LDH elevation. ► LDH elevation was related to arsenic methylation capacity. ► Abnormal LDH elevation can be a marker of susceptibility to CVD mortality.

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

    Newman, John C; Covarrubias, Anthony J; Zhao, Minghao; Yu, Xinxing; Gut, Philipp; 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.

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

    Krupp, Karl; Madhivanan, Purnima

    2009-02-27

    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.

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

    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. Recurrent exposure to subclinical lipopolysaccharide increases mortality and induces cardiac fibrosis in mice.

    Wilbur Y W Lew

    Full Text Available BACKGROUND: Circulating subclinical lipopolysaccharide (LPS occurs in health and disease. Ingesting high fatty meals increases LPS that cause metabolic endotoxemia. Subclinical LPS in periodontal disease may impair endothelial function. The heart may be targeted as cardiac cells express TLR4, the LPS receptor. It was hypothesized that recurrent exposure to subclinical LPS increases mortality and causes cardiac fibrosis. METHODS: C57Bl/6 mice were injected with intraperitoneal saline (control, low dose LPS (0.1 or 1 mg/kg, or moderate dose LPS (10 or 20 mg/kg, once a week for 3 months. Left ventricular (LV function (echocardiography, hemodynamics (tail cuff pressure and electrocardiograms (telemetry were measured. Cardiac fibrosis was assessed by picrosirius red staining and LV expression of fibrosis related genes (QRT-PCR. Adult cardiac fibroblasts were isolated and exposed to LPS. RESULTS: LPS injections transiently increased heart rate and blood pressure (<6 hours and mildly decreased LV function with full recovery by 24 hours. Mice tolerated weekly LPS for 2-3 months with no change in activity, appearance, appetite, weight, blood pressure, LV function, oximetry, or blood chemistries. Mortality increased after 60-90 days with moderate, but not low dose LPS. Arrhythmias occurred a few hours before death. LV collagen fraction area increased dose-dependently from 3.0±0.5% (SEM in the saline control group, to 5.6±0.5% with low dose LPS and 9.7±0.9% with moderate dose LPS (P<0.05 moderate vs low dose LPS, and each LPS dose vs control. LPS increased LV expression of collagen Iα1, collagen IIIα1, MMP2, MMP9, TIMP1, periostin and IL-6 (P<0.05 moderate vs low dose LPS and vs control. LPS increased α-SMA immunostaining of myofibroblasts. LPS dose-dependently increased IL-6 in isolated adult cardiac fibroblasts. CONCLUSIONS: Recurrent exposure to subclinical LPS increases mortality and induces cardiac fibrosis.

  16. Extreme Geohazards: Reducing the Disaster Risk and Increasing Resilience

    Plag, Hans-Peter; Stein, Seth; Brocklebank, Sean; Jules-Plag, Shelley; Marsh, Stuart; Campus, Paola

    2013-04-01

    Extreme geohazards have the potential to escalate the global sustainability crisis and put us close to the boundaries of the safe operating space for humanity. Exposure of human assets to geohazards has increased dramatically in recent decades, and the sensitivity of the built environment and the embedded socio-economic fabric have changed. We are putting the urban environment, including megacities, in harm's way. Paradoxically, innovation during recent decades, in particular, urban innovation, has increased the disaster risk and coupled this risk to the sustainability crisis. Only more innovation can reduce disaster risk and lead us out of the sustainability crisis. Extreme geohazards (volcanic eruptions, earthquakes, tsunamis) that occurred regularly throughout the last few millennia mostly did not cause major disasters because population density was low and the built environment was not sprawling into hazardous areas to the same extent as today. Similar extreme events today would cause unparalleled damage on a global scale and could worsen the sustainability crisis. Simulation of these extreme hazards under present conditions can help to assess the disaster risk. The Geohazards Community of Practice of the Group on Earth Observations (GEO) with support from the European Science Foundation is preparing a white paper assessing the contemporary disaster risks associated with extreme geohazards and developing a vision for science and society to engage in deliberations addressing this risk (see http://www.geohazcop.org/projects/extgeowp). Risk awareness and monitoring is highly uneven across the world, and this creates two kinds of problems. Firstly, potential hazards are much more closely monitored in wealthy countries than in the developing world. But the largest hazards are global in nature, and it is critical to get as much forewarning as possible to develop an effective response. The disasters and near-misses of the past show that adherence to scientific

  17. Combined effect of lung function level and decline increases morbidity and mortality risks

    Baughman, Penelope; Marott, Jacob Louis; Lange, Peter

    2012-01-01

    obstructive pulmonary disease (COPD) morbidity, COPD or coronary heart disease mor- tality, and all-cause mortality were estimated from com- bined effects of level and decline in forced expiratory volume in one second (FEV1). Risks were evaluated using Cox proportional hazards models for individuals grouped...... by combinations of baseline predicted FEV1 and quartiles of slope. Hazard ratios (HR) and 95 % con¿dence intervals (CI) were estimated using strati¿ed analysis by gender, smoking status, and baseline age (B45 and [45). For COPD morbidity, quartiles of increasing FEV1 decline increased HRs (95 % CI......) for individuals with FEV1 at or above the lower limit of normal (LLN) but below 100 % predicted, reaching 5.11 (2.58–10.13) for males, 11.63 (4.75–28.46) for females, and 3.09 (0.88–10.86) for never smokers in the quartile of steepest decline. Signi¿cant increasing trends were also observed for mortality...

  18. Naked mole-rat mortality rates defy Gompertzian laws by not increasing with age

    Ruby, J Graham; Smith, Megan

    2018-01-01

    The longest-lived rodent, the naked mole-rat (Heterocephalus glaber), has a reported maximum lifespan of >30 years and exhibits delayed and/or attenuated age-associated physiological declines. We questioned whether these mouse-sized, eusocial rodents conform to Gompertzian mortality laws by experiencing an exponentially increasing risk of death as they get older. We compiled and analyzed a large compendium of historical naked mole-rat lifespan data with >3000 data points. Kaplan-Meier analyses revealed a substantial portion of the population to have survived at 30 years of age. Moreover, unlike all other mammals studied to date, and regardless of sex or breeding-status, the age-specific hazard of mortality did not increase with age, even at ages 25-fold past their time to reproductive maturity. This absence of hazard increase with age, in defiance of Gompertz’s law, uniquely identifies the naked mole-rat as a non-aging mammal, confirming its status as an exceptional model for biogerontology. PMID:29364116

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

    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.

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

    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...

  1. Does routine gowning reduce nosocomial infection and mortality rates in a neonatal nursery? A Singapore experience.

    Tan, S G; Lim, S H; Malathi, I

    1995-11-01

    A 1 year prospective study on routine gowning before entering a neonatal unit was conducted in a maternity hospital in Singapore. This study was done based on previous work by Donowitz, Haque and Chagla and Agbayani et al., as there have been no known studies done in Singapore. The aim of the study was to test the hypothesis that routine gowning before entering a neonatal nursery does not reduce nosocomial infection and mortality rate. A total of 212 neonates from the neonatal intensive care unit (NICU) and 1694 neonates from the neonatal special care unit (NSCU) were studied. Neonates admitted during the 1 year study were assigned to the gowning (control) and no routine gowning (trial) group on every alternate 2 months. The hospital infection control nurse provided data on nosocomial infection. The overall nosocomial infection rate in the NICU was 24% (25 of 104 admissions) during gowning periods compared to 16.6% (18 of 108 admissions) when plastic aprons were not worn before entry. In the NSCU, the overall infection rate was 1.5% (12 of 800 admissions) during gowning periods compared to 2.1% (19 of 894 admissions) when no gown was worn before entry. Results of the study found no significant differences in the incidences of nosocomial infection and mortality in the neonates. The cost of gowns used during the no routine gowning periods was S$2012.8 compared to S$3708 used during the routine gowning procedure. The investigators recommend that routine gowning before entering a neonatal unit is not essential and cost effective for the purpose of reducing infection. Rather the focus should be on adequate handwashing by all hospital personnel and visitors before handling neonates.

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

    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

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

    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 cancer present with advanced disease. There are several ways of trying to diagnose oral cancer in a lower tumor stage, being 1) mass screening or screening in selected patients, 2) reduction of patients’ delay, and 3) reduction of doctors’ delay. Oral cancer population-based screening (“mass screening”) programs do not meet the guidelines for a successful outcome. There may be some benefit when focusing on high-risk groups, such as heavy smokers and heavy drinkers. Reported reasons for patients’ delay range from fear of a diagnosis of cancer, limited accessibility of primary health care, to unawareness of the possibility of malignant oral diseases. Apparently, information campaigns in news programs and TV have little effect on patients’ delay. Mouth self-examination may have some value in reducing patients’ delay. Doctors’ delay includes dentists’ delay and diagnostic delay caused by other medical and dental health care professionals. Doctors’ delay may vary from almost zero days up to more than six months. Usually, morbidity of cancer treatment is measured by quality of life (QoL) questionnaires. In the past decades this topic has drawn a lot of attention worldwide. It is a challenge to decrease the morbidity that is associated with the various treatment modalities that are used in oral cancer without substantially compromising the survival rate. Smoking cessation contributes to reducing the risk of oral cancers, with a 50% reduction in risk within five years. Indeed, risk factor reduction seems to be the most effective tool in an attempt to decrease the morbidity and mortality of oral cancer. Key words:Oral cancer, early diagnosis, quality of life

  4. Increase in waist circumference over 6 years predicts subsequent cardiovascular disease and total mortality in nordic women

    Klingberg, Sofia; Mehlig, Kirsten; Lanfer, Anne

    2015-01-01

    -shaped association. Associations between increase in WC and outcomes were restricted to women with normal weight at baseline and to ever-smokers. CONCLUSIONS: In contrast to changes in HC which did not predict mortality and CVD, a 6-year increase in WC is strongly predictive, particularly among initially lean women...... and cardiovascular disease (CVD) mortality in women but that gain or loss in HC was unrelated to these outcomes. This study examines whether a 6-year change in waist circumference (WC) predicts mortality and CVD in the same study sample. METHODS: Baseline WC and 6-year change in WC as predictors of mortality and CVD...... were analyzed in 2,492 women from the Danish MONICA study and the Prospective Population Study of Women in Gothenburg, Sweden. RESULTS: Increase in WC was significantly associated with increased subsequent mortality and CVD adjusting for BMI and other covariates, with some evidence of a J...

  5. Janani Suraksha Yojana: the conditional cash transfer scheme to reduce maternal mortality in India - a need for reassessment.

    Rai, Rajesh Kumar; Singh, Prashant Kumar

    2012-01-01

    Alongside endorsing Millennium Development Goal 5 in 2000, India launched its National Population Policy in 2000 and the National Health Policy in 2002. However, these have failed thus far to reduce the maternal mortality ratio (MMR) by the targeted 5.5% per annum. Under the banner of the National Rural Health Mission, the Government of India launched a national conditional cash transfer (CCT) scheme in 2005 called Janani Suraksha Yojana (JSY), aimed to encourage women to give birth in health facilities which, in turn, should reduce maternal deaths. Poor prenatal care in general, and postnatal care in particular, could be considered the causes of the high number of maternal deaths in India (the highest in the world). Undoubtedly, institutional delivery in India has increased and MMR has reduced over time as a result of socioeconomic development coupled with advancement in health care including improved women's education, awareness and availability of health services. However, in the light of its performance, we argue that the JSY scheme was not well enough designed to be considered as an effective pathway to reduce MMR. We propose that the service-based CCT is not the solution to avoid/reduce maternal deaths and that policy-makers and programme managers should reconsider the 'package' of continuum of care and maternal health services to ensure that they start from adolescence and the pre-pregnancy period, and extend to delivery, postnatal and continued maternal health care.

  6. Association Between Coffee Intake After Diagnosis of Colorectal Cancer and Reduced Mortality.

    Hu, Yang; Ding, Ming; Yuan, Chen; Wu, Kana; Smith-Warner, Stephanie A; Hu, Frank B; Chan, Andrew T; Meyerhardt, Jeffrey A; Ogino, Shuji; Fuchs, Charles S; Giovannucci, Edward L; Song, Mingyang

    2018-03-01

    Few studies have examined the association between coffee intake and survival after diagnosis of colorectal cancer (CRC). We performed a prospective study to investigate the association between coffee intake after a diagnosis of CRC and mortality. We collected data from the Nurses' Health Study (1984-2012) and Health Professionals Follow-up Study (1986-2012), following 1599 patients diagnosed with stage 1, 2, or 3 CRC. CRC was reported on questionnaires and ascertained by review of medical records and pathology reports; intake of food and beverages was determined from responses to semi-quantitative food frequency questionnaires. Participants were asked how often during the previous year that they consumed coffee, with 1 cup as the standard portion size. The first questionnaire response collected at least 6 months but not more than 4 years after diagnosis was used for assessment of post-diagnostic intake (median time from diagnosis to the dietary assessment, 2.2 years). The last semi-quantitative food frequency questionnaire prior to diagnosis was used to assess pre-diagnostic dietary intake. During a median of 7.8 years of follow-up, we documented 803 deaths, of which 188 were because of CRC. In the multivariable adjusted models, compared with nondrinkers, patients who consumed at least 4 cups of coffee per day had a 52% lower risk of CRC-specific death (hazard ratio [HR] 0.48; 95% CI, 0.28-0.83; P for trend=.003) and 30% reduced risk of all-cause death (HR, 0.70; 95% CI, 0.54-0.91; P for trend coffee (2 or more cups/day) was associated with lower risk of CRC-specific mortality and all-cause mortality. When coffee intake before vs after CRC diagnosis were examined, compared with patients consistently consuming low amounts (less than 2 cups/day), those who maintained a high intake (2 or more cups/day) had a significantly lower risk of CRC-specific death (multivariable HR, 0.63; 95% CI, 0.44-0.89) and death from any cause (multivariable HR, 0.71; 95% CI, 0

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

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

    2015-01-01

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

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

    Santos, Marcelo Rodrigues dos; Sayegh, Ana Luiza Carrari; Groehs, Raphaela Vilar Ramalho; Fonseca, Guilherme [Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo (Brazil); Trombetta, Ivani Credidio [Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo (Brazil); Universidade Nove de Julho (UNINOVE) (Brazil); Barretto, Antônio Carlos Pereira [Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo (Brazil); Arap, Marco Antônio [Faculdade de medicina da Universidade de São Paulo - Urologia (Brazil); Negrão, Carlos Eduardo [Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo (Brazil); Escola de Educação Física e Esporte da Universidade de São Paulo, São Paulo, SP (Brazil); Middlekauff, Holly R. [Division of Cardiology - David Geffen School of Medicine - University of California (United States); Alves, Maria-Janieire de Nazaré Nunes, E-mail: janieire.alves@incor.usp.br [Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo (Brazil)

    2015-09-15

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

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

    Marcelo Rodrigues dos Santos

    2015-01-01

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

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

    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.

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

    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.

  12. Reduced disease in black abalone following mass mortality: phage therapy and natural selection.

    Friedman, Carolyn S; Wight, Nathan; Crosson, Lisa M; Vanblaricom, Glenn R; Lafferty, Kevin D

    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.

  13. Laparotomy during endovascular repair of ruptured abdominal aortic aneurysms increases mortality.

    Adkar, Shaunak S; Turley, Ryan S; Benrashid, Ehsan; Cox, Mitchell W; Mureebe, Leila; Shortell, Cynthia K

    2017-02-01

    Subset analyses from small case series suggest patients requiring laparotomy during endovascular repair of ruptured abdominal aortic aneurysms (REVAR) have worse survival than those undergoing REVAR without laparotomy. Most concomitant laparotomies are performed for abdominal compartment syndrome. This study used data from the American College of Surgeons National Surgical Quality Improvement Program to determine whether the need for laparotomy during REVAR is associated with increased mortality. Data were obtained from the 2005 to 2013 National Surgical Quality Improvement Program participant user files based on Current Procedural Terminology (American Medical Association, Chicago, Ill) and International Classification of Diseases-9 Edition coding. Patient and procedure-related characteristics and 30-day postoperative outcomes were compared using Pearson χ 2 tests for categoric variables and Wilcoxon rank sum tests for continuous variables. A backward-stepwise multivariable logistic regression model was used to identify patient- and procedure-related factors associated with increased death after REVAR. We identified 1241 patients who underwent REVAR, and 91 (7.3%) required concomitant laparotomy. The 30-day mortality was 60% in the laparotomy group and 21% in the standard REVAR group (P < .001). The major complication rate was also higher in the laparotomy group (88% vs 63%; P < .001). Multivariable analysis showed laparotomy was strongly associated with 30-day mortality (odds ratio, 5.91; 95% confidence interval, 3.62-9.62; P < .001). Laparotomy during REVAR is a commonly used technique for the management of elevated intra-abdominal pressure and abdominal compartment syndrome development. The results of this study strongly confirm findings from smaller studies that the need for laparotomy during REVAR is associated with significantly worse 30-day survival. Copyright © 2016. Published by Elsevier Inc.

  14. Subclinical hypothyroidism is associated with increased risk for all-cause and cardiovascular mortality in adults.

    Tseng, Fen-Yu; Lin, Wen-Yuan; Lin, Cheng-Chieh; Lee, Long-Teng; Li, Tsai-Chung; Sung, Pei-Kun; Huang, Kuo-Chin

    2012-08-21

    This study sought to evaluate the relationship between subclinical hypothyroidism (SCH) and all-cause and cardiovascular disease (CVD) mortality. SCH may increase the risks of hypercholesterolemia and atherosclerosis. The associations between SCH and all-cause or CVD mortality are uncertain, on the basis of the results of previous studies. A baseline cohort of 115,746 participants without a history of thyroid disease, ≥20 years of age, was recruited in Taiwan. SCH was defined as a serum thyroid-stimulating hormone (TSH) level of 5.0 to 19.96 mIU/l with normal total thyroxine concentrations. Euthyroidism was defined as a serum TSH level of 0.47 to 4.9 mIU/l. Cox proportional hazards regression analysis was used to estimate the relative risks (RRs) of death from all-cause and CVD for adults with SCH during a 10-year follow-up period. There were 3,669 deaths during the follow-up period; 680 deaths were due to CVD. Compared with subjects with euthyroidism, after adjustment for age, sex, body mass index, diabetes, hypertension, dyslipidemia, smoking, alcohol consumption, betel nut chewing, physical activity, income, and education level, the RRs (95% confidence interval) of deaths from all-cause and CVD among subjects with SCH were 1.30 (1.02 to 1.66), and 1.68 (1.02 to 2.76), respectively. Adult Taiwanese with SCH had an increased risk for all-cause mortality and CVD death. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  15. Analysis of Potentials to Increase Iranian life Expectancy with Removing the Leading Causes of Mortality in 2010

    Mohammad Sasanipour

    2016-08-01

    Full Text Available Introduction: Recent studies on Iranian mortality clearly underscore the role of cardiovascular diseases, unintentional injuries, and cancers as three leading causes of reduced life expectancy during the last three decades. The purpose of current study is to measure the effect of these causes on 2010 life table for Iran. Materials & Method:The number of registered death by age and sex and death distribution by cause for Iran in 2010 are obtained from death registration system operated by the Ministry of Health and to know more about the population at risk population forecast information of the Statistical Centre of Iran (SCI is used. The obtained data are analyzed using Multiple Decrement Life Table and Kitagava analysis method. Results: The results show that three leading causes of death are account for 13 years potential lost life of Iranian men and women. More detailed results indicate that cardiovascular diseases, cancers, and unintentional injuries play larger roles in this regard while men are more likely to die by unintentional injuries than women. Life expectancy of middle aged men are more affected by unintentional injuries while old aged women are more affected by cardiovascular diseases. Conclusion: Particular consideration of risk factors of cardiovascular diseases of both sexes and males death by unintentional injuries is of utmost importance in reducing mortality rate and increasing life expectancy as a result.

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

    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....

  17. Intestine-specific deletion of microsomal triglyceride transfer protein increases mortality in aged mice.

    Liang, Zhe; Xie, Yan; Dominguez, Jessica A; Breed, Elise R; Yoseph, Benyam P; Burd, Eileen M; Farris, Alton B; Davidson, Nicholas O; Coopersmith, Craig M

    2014-01-01

    Mice with conditional, intestine-specific deletion of microsomal triglyceride transfer protein (Mttp-IKO) exhibit a complete block in chylomicron assembly together with lipid malabsorption. Young (8-10 week) Mttp-IKO mice have improved survival when subjected to a murine model of Pseudomonas aeruginosa-induced sepsis. However, 80% of deaths in sepsis occur in patients over age 65. The purpose of this study was to determine whether age impacts outcome in Mttp-IKO mice subjected to sepsis. Aged (20-24 months) Mttp-IKO mice and WT mice underwent intratracheal injection with P. aeruginosa. Mice were either sacrificed 24 hours post-operatively for mechanistic studies or followed seven days for survival. In contrast to young septic Mttp-IKO mice, aged septic Mttp-IKO mice had a significantly higher mortality than aged septic WT mice (80% vs. 39%, p = 0.005). Aged septic Mttp-IKO mice exhibited increased gut epithelial apoptosis, increased jejunal Bax/Bcl-2 and Bax/Bcl-XL ratios yet simultaneously demonstrated increased crypt proliferation and villus length. Aged septic Mttp-IKO mice also manifested increased pulmonary myeloperoxidase levels, suggesting increased neutrophil infiltration, as well as decreased systemic TNFα compared to aged septic WT mice. Blocking intestinal chylomicron secretion alters mortality following sepsis in an age-dependent manner. Increases in gut apoptosis and pulmonary neutrophil infiltration, and decreased systemic TNFα represent potential mechanisms for why intestine-specific Mttp deletion is beneficial in young septic mice but harmful in aged mice as each of these parameters are altered differently in young and aged septic WT and Mttp-IKO mice.

  18. Intestine-specific deletion of microsomal triglyceride transfer protein increases mortality in aged mice.

    Zhe Liang

    Full Text Available Mice with conditional, intestine-specific deletion of microsomal triglyceride transfer protein (Mttp-IKO exhibit a complete block in chylomicron assembly together with lipid malabsorption. Young (8-10 week Mttp-IKO mice have improved survival when subjected to a murine model of Pseudomonas aeruginosa-induced sepsis. However, 80% of deaths in sepsis occur in patients over age 65. The purpose of this study was to determine whether age impacts outcome in Mttp-IKO mice subjected to sepsis.Aged (20-24 months Mttp-IKO mice and WT mice underwent intratracheal injection with P. aeruginosa. Mice were either sacrificed 24 hours post-operatively for mechanistic studies or followed seven days for survival.In contrast to young septic Mttp-IKO mice, aged septic Mttp-IKO mice had a significantly higher mortality than aged septic WT mice (80% vs. 39%, p = 0.005. Aged septic Mttp-IKO mice exhibited increased gut epithelial apoptosis, increased jejunal Bax/Bcl-2 and Bax/Bcl-XL ratios yet simultaneously demonstrated increased crypt proliferation and villus length. Aged septic Mttp-IKO mice also manifested increased pulmonary myeloperoxidase levels, suggesting increased neutrophil infiltration, as well as decreased systemic TNFα compared to aged septic WT mice.Blocking intestinal chylomicron secretion alters mortality following sepsis in an age-dependent manner. Increases in gut apoptosis and pulmonary neutrophil infiltration, and decreased systemic TNFα represent potential mechanisms for why intestine-specific Mttp deletion is beneficial in young septic mice but harmful in aged mice as each of these parameters are altered differently in young and aged septic WT and Mttp-IKO mice.

  19. Skipping one or more dialysis sessions significantly increases mortality: measuring the impact of non-adherence

    Eduardo Gottlieb

    2014-06-01

    Full Text Available Introduction: Non-adherence to the prescribed dialysis sessions frequency ranges from 2% to 50% of patients. The objective of this study was to evaluate the impact of detecting and measuring the non-adherence to the prescribed dialysis frequency and to determine the importance of a multidisciplinary approach with the aim of improving adherence. Methods: longitudinal cohort study including 8,164 prevalent hemodialysis patients in April 2010, with more than 90 days of treatment, in Fresenius Medical Care Argentina units that were monitored for 3 years. The survey evaluated: interruption of at least one dialysis session in a month or reduction at least 10 minutes of a dialysis session in a month, during 6 months prior to the survey. Relative mortality risks were evaluated among groups. Results: 648 patients (7.9% interrupted dialysis sessions: 320 (3.9% interrupted one session per month and 328 (4.01% interrupted more than one session per month. After 3 years monitoring, 349 patients (53.8 % remained active in hemodialysis and 299 were inactive due to different reasons: 206 deceased (31.8 %, 47 transfers or monitoring losses (7.25 %, 36 transplanted (5.55 %, 8 changes to PD modality (1.2% and 2 recovered their kidney function (0.3 %.Interrupting one session per month significantly increased the mortality risk comparing both groups (interrupters and non-interrupters: RR 2.65 (IC 95% 2.24 – 3.14. Interrupting more than one dialysis session also increased significantly mortality risk comparing to the non-interrupters: RR 2.8 (IC 95% 2.39 – 3.28. After 3 years monitoring, 41.6 % of interrupters at the beginning had improved their adherence through a multidisciplinary program of quality improvement. Conclusion: Global mortality was greater among patients who interrupted dialysis sessions. A considerable proportion of interrupter patients at the beginning modified their behavior through the implementation of a multidisciplinary program of quality

  20. Parental age and offspring mortality: Negative effects of reproductive ageing may be counterbalanced by secular increases in longevity.

    Barclay, Kieron; Myrskylä, Mikko

    2018-07-01

    As parental ages at birth continue to rise, concerns about the effects of fertility postponement on offspring are increasing. Due to reproductive ageing, advanced parental ages have been associated with negative health outcomes for offspring, including decreased longevity. The literature, however, has neglected to examine the potential benefits of being born at a later date. Secular declines in mortality mean that later birth cohorts are living longer. We analyse mortality over ages 30-74 among 1.9 million Swedish men and women born 1938-60, and use a sibling comparison design that accounts for all time-invariant factors shared by the siblings. When incorporating cohort improvements in mortality, we find that those born to older mothers do not suffer any significant mortality disadvantage, and that those born to older fathers have lower mortality. These findings are likely to be explained by secular declines in mortality counterbalancing the negative effects of reproductive ageing.

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

    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

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

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

    2012-01-01

    The influenza A (H1N1) pandemic swept across the globe from April 2009 to August 2010 affecting millions. Many WHO Member States relied on antiviral drugs, specifically neuraminidase inhibitors (NAIs) oseltamivir and zanamivir, to treat influenza patients in critical condition. Such drugs have been found to be effective in reducing severity and duration of influenza illness, and likely reduced morbidity during the pandemic. However, it is less clear whether NAIs used during the pandemic reduced H1N1 mortality. Country-level data on supply of oseltamivir and zanamivir were used to predict H1N1 mortality (per 100,000 people) from July 2009 to August 2010 in forty-two WHO Member States. Poisson regression was used to model the association between NAI supply and H1N1 mortality, with adjustment for economic, demographic, and health-related confounders. After adjustment for potential confounders, 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). While the supply of zanamivir was considerably less than that of oseltamivir in each Member State, 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 there are limitations to the ecologic nature of these data, 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.

  3. Cancer causes increased mortality and is associated with altered apoptosis in murine sepsis.

    Fox, Amy C; Robertson, Charles M; Belt, Brian; Clark, Andrew T; Chang, Katherine C; Leathersich, Ann M; Dominguez, Jessica A; Perrone, Erin E; Dunne, W Michael; Hotchkiss, Richard S; Buchman, Timothy G; Linehan, David C; Coopersmith, Craig M

    2010-03-01

    Whereas most septic patients have an underlying comorbidity, most animal models of sepsis use mice that were healthy before the onset of infection. Malignancy is the most common comorbidity associated with sepsis. The purpose of this study was to determine whether mice with cancer have a different response to sepsis than healthy animals. Prospective, randomized controlled study. Animal laboratory in a university medical center. C57Bl/6 mice. Animals received a subcutaneous injection of either 250,000 cells of the transplantable pancreatic adenocarcinoma cell line Pan02 (cancer) or phosphate-buffered saline (healthy). Three weeks later, mice given Pan02 cells had reproducible, nonmetastatic tumors. Both groups of mice then underwent intratracheal injection of either Pseudomonas aeruginosa (septic) or 0.9% NaCl (sham). Animals were killed 24 hrs postoperatively or followed-up 7 days for survival. Mice with cancer and healthy mice appeared similar when subjected to sham operation, although cancer animals had lower levels of T- and B-lymphocyte apoptosis. Septic mice with cancer had increased mortality compared to previously healthy septic mice subjected to the identical injury (52% vs. 28%; p = .04). This was associated with increased bacteremia but no difference in local pulmonary infection. Septic mice with cancer also had increased intestinal epithelial apoptosis. Although sepsis induced an increase in T- and B-lymphocyte apoptosis in all animals, septic mice with cancer had decreased T- and B-lymphocyte apoptosis compared to previously healthy septic mice. Serum and pulmonary cytokines, lung histology, complete blood counts, and intestinal proliferation were similar between septic mice with cancer and previously healthy septic mice. When subjected to the same septic insult, mice with cancer have increased mortality compared to previously healthy animals. Decreased systemic bacterial clearance and alterations in intestinal epithelial and lymphocyte apoptosis may

  4. What is the association of smoking and alcohol use with the increase in social inequality in mortality in Denmark?

    Koch, Mette Bjerrum; Diderichsen, Finn; Grønbæk, Morten

    2015-01-01

    . In women the increase was mainly caused by smoking. CONCLUSIONS: The main explanation for the increase in social inequality in mortality since the mid-1980s is smoking and alcohol use. A significant reduction in the social inequality in mortality can only happen if the prevention of smoking and alcohol use......OBJECTIVES: The aim of this paper is to estimate the impact of smoking and alcohol use on the increase in social inequality in mortality in Denmark in the period 1985-2009. DESIGN: A nationwide register-based study. SETTING: Denmark. PARTICIPANTS: The whole Danish population aged 30 years or more...... in the period 1985-2009. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome is mortality rates in relation to educational attainments calculated with and without deaths related to smoking and alcohol use. An absolute measure of inequality in mortality is applied along with a result on the direct...

  5. Increased Mortality in Relation to Insomnia and Obstructive Sleep Apnea in Korean Patients Studied with Nocturnal Polysomnography.

    Choi, Jae-Won; Song, Ji Soo; Lee, Yu Jin; Won, Tae-Bin; Jeong, Do-Un

    2017-01-15

    To elucidate the links between the two most prevalent sleep disorders, insomnia and obstructive sleep apnea (OSA), and mortality. We studied 4,225 subjects who were referred to the Center for Sleep and Chronobiology, Seoul National University Hospital, from January 1994 to December 2008. We divided the subjects into five groups: mild OSA (5 ≤ AHI insomnia, and a no-sleep-disorder group consisting of subjects without sleep disorders. Standardized mortality ratio (SMR), hazard ratio, and the survival rates of the five groups were calculated and evaluated. The SMR of all-cause mortality was significantly higher in the severe OSA group than in the general population (1.52, 95% CI 1.23-1.85, p cause mortality (HR 3.50, 95% CI 1.03-11.91, p = 0.045) and cardiovascular mortality (HR 17.16, 95% CI 2.29-128.83, p = 0.006). Cardiovascular mortality was also significantly elevated in the insomnia group (HR 8.11, 95% CI 1.03-63.58, p = 0.046). Severe OSA was associated with increased all-cause mortality and cardiovascular mortality compared to the no-sleep-disorder group. Insomnia was associated with increased cardiovascular mortality compared to the no-sleep-disorder group. © 2017 American Academy of Sleep Medicine

  6. Mortality in patients treated for Cushing's disease is increased, compared with patients treated for nonfunctioning pituitary macroadenoma

    Dekkers, O. M.; Biermasz, N. R.; Pereira, A. M.; Roelfsema, F.; van Aken, M. O.; Voormolen, J. H. C.; Romijn, J. A.

    2007-01-01

    Increased mortality in patients with pituitary tumors after surgical treatment has been reported. However, it is unknown to what extent excess mortality is caused by pituitary tumors and their treatment in general and to what extent by previous exposure to hormonal overproduction. The aim of the

  7. Increasing ethnic differences in mortality in Estonia after the collapse of the Soviet Union

    Leinsalu, Mall; Vågerö, Denny; Kunst, Anton E.

    2004-01-01

    STUDY OBJECTIVE: This study examined the change in ethnic differences in mortality in Estonia 1989-2000. DESIGN: Two unlinked cross sectional census based analyses were compared. Total and cause specific mortality was analysed for ethnic Estonians and Russians. The absolute differences in mortality

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

    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.

  9. Training traditional birth attendants on the WHO Essential Newborn Care reduces perinatal mortality.

    Garcés, Ana; McClure, Elizabeth M; Hambidge, Michael; Krebs, Nancy F; Mazariegos, Manolo; Wright, Linda L; Moore, Janet; Carlo, Waldemar A

    2012-05-01

    To evaluate the impact of birth attendant training using the World Health Organization Essential Newborn Care (ENC) course among traditional birth attendants, with a particular emphasis on the effect of acquisition of skills on perinatal outcomes. Population-based, prospective, interventional pre-post design study. 11 rural clusters in Chimaltenango, Guatemala. Health care providers. This study analyzed the effect of training and implementation of the ENC health care provider training course between September 2005 and December 2006. The primary outcome measure was the rate of death from all causes in the first seven days after birth in fetuses/infants ≥1500g. Secondary outcome measures were overall rate of stillbirth, rate of perinatal death, which included stillbirths plus neonatal deaths in the first seven days in fetuses/infants ≥1500g. Perinatal mortality decreased from 39.5/1000 pre-ENC to 26.4 post-ENC (RR 0.72; 95%CI 0.54-0.97). This reduction was attributable almost entirely to a decrease in the stillbirth rate of 21.4/1000 pre-Essential Newborn Care to 7.9/1000 post-ENC (RR 0.40; 95%CI 0.25-0.64). Seven-day neonatal mortality did not decrease (18.3/1000 to 18.6/1000; RR 1.05; 95%CI 0.70-1.57). Essential Newborn Care training reduced stillbirths in a population-based controlled study with deliveries conducted almost exclusively by traditional birth attendants. Scale-up of this intervention in other settings might help assess reproducibility and sustainability. © Published [2012]. This article is a U.S. Government work and is in the public domain in the USA. Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

  10. Tigecycline reduced tumor necrosis factor alpha level and inhospital mortality in spontaneous supratentorial intracerebral hemorrhage

    Mohamad Saekhu

    2016-07-01

    Full Text Available Background: The outcome of patients with spontaneous supratentorial intracerebral hemorrhage (SSICH is unsatisfactory. Inflammatory response secondary to brain injury as well as those resulted from surgical procedure were considered responsible of this outcome. This study was intended to elucidate the anti-inflammatory activity of tigecycline by measuring TNF-α level and its neuroprotective effect as represented by inhospital mortality rate.Methods: Patients with SSICH who were prepared for hematoma evacuation were randomized to receive either tigecycline (n=35 or fosfomycine (n=37 as prophylactic antibiotic. TNF-α level was measured in all subjects before surgery and postoperatively on day-1 and day-7. A repeated brain CT Scan was performed on postoperative day-7. The Glasgow outcome scale (GOS and length of stay (LOS were recorded at the time of hospital discharge. Data were analyzed using Mann-Whitney and Chi square test. Relative clinical effectiveness was measured by calculating the number needed to treat (NNT.Results: There was a significant difference regarding the proportion of subject who had  reduced TNF-α level on postoperative day-7 between the groups receiving tigecycline and fosfomycine (62% vs 29%, p=0.022. Decrease brain edema on CT control (86% vs 80%, p=0.580. Tigecycline administration showed a tendency of better clinical effectiveness in lowering inhospital mortality (17% vs 35%; p=0.083; OR=0.49; NNT=5 and worse clinical outcome / GOS ≤ 2 (20% vs 38% ; p=0.096; OR=0.41; NNT=6. LOS ≥ 15 hari ( 40% vs 27%; p=0.243; OR=1.81; NNT=8.Conclusion: Tigecycline showed anti-inflammatory and neuroprotective activities. These activities were associated with improved clinical outcome in patients with SSICH after hematoma evacuation.

  11. Chronic alcohol ingestion increases mortality and organ injury in a murine model of septic peritonitis.

    Yoseph, Benyam P; Breed, Elise; Overgaard, Christian E; Ward, Christina J; Liang, Zhe; Wagener, Maylene E; Lexcen, Daniel R; Lusczek, Elizabeth R; Beilman, Greg J; Burd, Eileen M; Farris, Alton B; Guidot, David M; Koval, Michael; Ford, Mandy L; Coopersmith, Craig M

    2013-01-01

    Patients admitted to the intensive care unit with alcohol use disorders have increased morbidity and mortality. The purpose of this study was to determine how chronic alcohol ingestion alters the host response to sepsis in mice. Mice were randomized to receive either alcohol or water for 12 weeks and then subjected to cecal ligation and puncture. Mice were sacrificed 24 hours post-operatively or followed seven days for survival. Septic alcohol-fed mice had a significantly higher mortality than septic water-fed mice (74% vs. 41%, p = 0.01). This was associated with worsened gut integrity in alcohol-fed mice with elevated intestinal epithelial apoptosis, decreased crypt proliferation and shortened villus length. Further, alcohol-fed mice had higher intestinal permeability with decreased ZO-1 and occludin protein expression in the intestinal tight junction. The frequency of splenic and bone marrow CD4+ T cells was similar between groups; however, splenic CD4+ T cells in septic alcohol-fed mice had a marked increase in both TNF and IFN-γ production following ex vivo stimulation. Neither the frequency nor function of CD8+ T cells differed between alcohol-fed and water-fed septic mice. NK cells were decreased in both the spleen and bone marrow of alcohol-fed septic mice. Pulmonary myeloperoxidase levels and BAL levels of G-CSF and TFG-β were higher in alcohol-fed mice. Pancreatic metabolomics demonstrated increased acetate, adenosine, xanthine, acetoacetate, 3-hydroxybutyrate and betaine in alcohol-fed mice and decreased cytidine, uracil, fumarate, creatine phosphate, creatine, and choline. Serum and peritoneal cytokines were generally similar between alcohol-fed and water-fed mice, and there were no differences in bacteremia, lung wet to dry weight, or pulmonary, liver or splenic histology. When subjected to the same septic insult, mice with chronic alcohol ingestion have increased mortality. Alterations in intestinal integrity, the host immune response, and

  12. Chronic alcohol ingestion increases mortality and organ injury in a murine model of septic peritonitis.

    Benyam P Yoseph

    Full Text Available Patients admitted to the intensive care unit with alcohol use disorders have increased morbidity and mortality. The purpose of this study was to determine how chronic alcohol ingestion alters the host response to sepsis in mice.Mice were randomized to receive either alcohol or water for 12 weeks and then subjected to cecal ligation and puncture. Mice were sacrificed 24 hours post-operatively or followed seven days for survival.Septic alcohol-fed mice had a significantly higher mortality than septic water-fed mice (74% vs. 41%, p = 0.01. This was associated with worsened gut integrity in alcohol-fed mice with elevated intestinal epithelial apoptosis, decreased crypt proliferation and shortened villus length. Further, alcohol-fed mice had higher intestinal permeability with decreased ZO-1 and occludin protein expression in the intestinal tight junction. The frequency of splenic and bone marrow CD4+ T cells was similar between groups; however, splenic CD4+ T cells in septic alcohol-fed mice had a marked increase in both TNF and IFN-γ production following ex vivo stimulation. Neither the frequency nor function of CD8+ T cells differed between alcohol-fed and water-fed septic mice. NK cells were decreased in both the spleen and bone marrow of alcohol-fed septic mice. Pulmonary myeloperoxidase levels and BAL levels of G-CSF and TFG-β were higher in alcohol-fed mice. Pancreatic metabolomics demonstrated increased acetate, adenosine, xanthine, acetoacetate, 3-hydroxybutyrate and betaine in alcohol-fed mice and decreased cytidine, uracil, fumarate, creatine phosphate, creatine, and choline. Serum and peritoneal cytokines were generally similar between alcohol-fed and water-fed mice, and there were no differences in bacteremia, lung wet to dry weight, or pulmonary, liver or splenic histology.When subjected to the same septic insult, mice with chronic alcohol ingestion have increased mortality. Alterations in intestinal integrity, the host immune

  13. Can increasing adult vaccination rates reduce lost time and increase productivity?

    Rittle, Chad

    2014-12-01

    This article addresses limited vaccination coverage by providing an overview of the epidemiology of influenza, pertussis, and pneumonia, and the impact these diseases have on work attendance for the worker, the worker's family, and employer profit. Studies focused on the cost of vaccination programs, lost work time, lost employee productivity and acute disease treatment are discussed, as well as strategies for increasing vaccination coverage to reduce overall health care costs for employers. Communicating the benefits of universal vaccination for employees and their families and combating vaccine misinformation among employees are outlined. Copyright 2014, SLACK Incorporated.

  14. Malnutrition is associated with increased mortality in older adults regardless of the cause of death.

    Söderström, Lisa; Rosenblad, Andreas; Thors Adolfsson, Eva; Bergkvist, Leif

    2017-02-01

    Malnutrition predicts preterm death, but whether this is valid irrespective of the cause of death is unknown. The aim of the present study was to determine whether malnutrition is associated with cause-specific mortality in older adults. This cohort study was conducted in Sweden and included 1767 individuals aged ≥65 years admitted to hospital in 2008-2009. On the basis of the Mini Nutritional Assessment instrument, nutritional risk was assessed as well nourished (score 24-30), at risk of malnutrition (score 17-23·5) or malnourished (score malnutrition, and 9·4 % of the participants were malnourished. During a median follow-up of 5·1 years, 839 participants (47·5 %) died. The multiple Cox regression model identified significant associations (hazard ratio (HR)) between malnutrition and risk of malnutrition, respectively, and death due to neoplasms (HR 2·43 and 1·32); mental or behavioural disorders (HR 5·73 and 5·44); diseases of the nervous (HR 4·39 and 2·08), circulatory (HR 1·95 and 1·57) or respiratory system (HR 2·19 and 1·49); and symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (HR 2·23 and 1·43). Malnutrition and risk of malnutrition are associated with increased mortality regardless of the cause of death, which emphasises the need for nutritional screening to identify older adults who may require nutritional support in order to avoid preterm death.

  15. Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type

    Chammas, N. K.; Hill, R. L. R.; Edmonds, M. E.

    2016-01-01

    Diabetic foot ulcer (DFU) patients have a greater than twofold increase in mortality compared with nonulcerated diabetic patients. We investigated (a) cause of death in DFU patients, (b) age at death, and (c) relationship between cause of death and ulcer type. This was an eleven-year retrospective study on DFU patients who attended King's College Hospital Foot Clinic and subsequently died. A control group of nonulcerated diabetic patients was matched for age and type of diabetes mellitus. The cause of death was identified from death certificates (DC) and postmortem (PM) examinations. There were 243 DFU patient deaths during this period. Ischaemic heart disease (IHD) was the major cause of death in 62.5% on PM compared to 45.7% on DC. Mean age at death from IHD on PM was 5 years lower in DFU patients compared to controls (68.2 ± 8.7 years versus 73.1 ± 8.0 years, P = 0.015). IHD as a cause of death at PM was significantly linked to neuropathic foot ulcers (OR 3.064, 95% CI 1.003–9.366, and P = 0.049). Conclusions. IHD is the major cause of premature mortality in DFU patients with the neuropathic foot ulcer patients being at a greater risk. PMID:27213157

  16. Reducing mortality from childhood pneumonia: The leading priority is also the greatest opportunity

    Igor Rudan

    2013-06-01

    Full Text Available Pneumonia and diarrhoea have been the leading causes of global child mortality for many decades. The work of Child Health Epidemiology Reference Group (CHERG has been pivotal in raising awareness that the UN's Millennium Development Goal 4 cannot be achieved without increased focus on preventing and treating the two diseases in low– and middle–income countries. Global Action Plan for Pneumonia (GAPP and Diarrhoea Global Action Plan (DGAP groups recently concluded that addressing childhood pneumonia and diarrhoea is not only the leading priority but also the greatest opportunity in global health today: scaling up of existing highly cost–effective interventions could prevent 95% of diarrhoea deaths and 67% of pneumonia deaths in children younger than 5 years by the year 2025. The cost of such effort was estimated at about US$ 6.7 billion.

  17. Inadvertent Splenectomy During Resection for Colorectal Cancer Does Not Increase Long-term Mortality in a Propensity Score Model: A Nationwide Cohort Study.

    Lolle, Ida; Pommergaard, Hans-Christian; Schefte, David F; Bulut, Orhan; Krarup, Peter-Martin; Rosenstock, Steffen J

    2016-12-01

    Previous studies suggest that long-term mortality is increased in patients who undergo splenectomy during surgery for colorectal cancer. The reason for this association remains unclear. The purpose of this study was to investigate the association between inadvertent splenectomy attributed to iatrogenic lesion to the spleen during colorectal cancer resections and long-term mortality in a national cohort of unselected patients. This was a retrospective, nationwide cohort study. Data were collected from the database of the Danish Colorectal Cancer Group and merged with data from the National Patient Registry and the National Pathology Databank. Danish patients with colorectal cancer undergoing curatively intended resection between 2001 and 2011 were included in the study. The primary outcome was long-term mortality for patients surviving 30 days after surgery. Secondary outcomes were 30-day mortality and risk factors for inadvertent splenectomy. Multivariable and propensity-score matched Cox regression analyses were used to adjust for potential confounding. In total, 23,727 patients were included, of which 277 (1.2%) underwent inadvertent splenectomy. There was no association between inadvertent splenectomy and long-term mortality (adjusted HR = 1.15 (95% CI, 0.95-1.40); p = 0.16) in the propensity score-matched model, whereas 30-day mortality was significantly increased (adjusted HR = 2.31 (95% CI, 1.71-3.11); p splenectomy was most often seen during left hemicolectomy (left hemicolectomy vs right hemicolectomy: OR = 24.76 (95% CI, 15.30-40.06); p splenectomy during resection for colorectal cancer does not seem to increase long-term mortality. The previously reported reduced overall survival after inadvertent splenectomy may be explained by excess mortality in the immediate postoperative period.

  18. Increasing induction motors efficiency by reducing electromagnetic loads

    Olivian Chiver

    2014-12-01

    Full Text Available The efficiency of any device is a major problem today. The design and construction of high efficiency motors is strongly required from the viewpoint of reducing energy consumption and protecting the environment. This paper deal with the problem of improving efficiency by reducing electrical and magnetic loads of these motors. Using the finite elements method (FEM, the authors will study the influence of these changes on the parameters and characteristics of the initial motor.

  19. Reducing consistency in human realism increases the uncanny valley effect; increasing category uncertainty does not.

    MacDorman, Karl F; Chattopadhyay, Debaleena

    2016-01-01

    Human replicas may elicit unintended cold, eerie feelings in viewers, an effect known as the uncanny valley. Masahiro Mori, who proposed the effect in 1970, attributed it to inconsistencies in the replica's realism with some of its features perceived as human and others as nonhuman. This study aims to determine whether reducing realism consistency in visual features increases the uncanny valley effect. In three rounds of experiments, 548 participants categorized and rated humans, animals, and objects that varied from computer animated to real. Two sets of features were manipulated to reduce realism consistency. (For humans, the sets were eyes-eyelashes-mouth and skin-nose-eyebrows.) Reducing realism consistency caused humans and animals, but not objects, to appear eerier and colder. However, the predictions of a competing theory, proposed by Ernst Jentsch in 1906, were not supported: The most ambiguous representations-those eliciting the greatest category uncertainty-were neither the eeriest nor the coldest. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

  20. Telephone delivered interventions for reducing morbidity and mortality in people with HIV infection.

    Gentry, Sarah; van-Velthoven, Michelle H M M T; Tudor Car, Lorainne; Car, Josip

    2013-05-31

    This is one of three Cochrane reviews examining the role of the telephone in HIV/AIDS services. Telephone interventions, delivered either by landline or mobile phone, may be useful in the management of people living with HIV (PLHIV) in many situations. Telephone delivered interventions have the potential to reduce costs, save time and facilitate more support for PLHIV. To assess the effectiveness of voice landline and mobile telephone delivered interventions for reducing morbidity and mortality in people with HIV infection. We searched The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed Central, EMBASE, PsycINFO, ISI Web of Science, Cumulative Index to Nursing & Allied Health, World Health Organisation's The Global Health Library and Current Controlled Trials from 1980 to June 2011. We searched the following grey literature sources: Dissertation Abstracts International, Centre for Agriculture Bioscience International Direct Global Health database, The System for Information on Grey Literature Europe, The Healthcare Management Information Consortium database, Google Scholar, Conference on Retroviruses and Opportunistic Infections, International AIDS Society, AIDS Educational Global Information System and reference lists of articles. Randomised controlled trials (RCTs), quasi-randomised controlled trials, controlled before and after studies, and interrupted time series studies comparing the effectiveness of telephone delivered interventions for reducing morbidity and mortality in persons with HIV infection versus in-person interventions or usual care, regardless of demographic characteristics and in all settings. Both mobile and landline telephone interventions were included, but mobile phone messaging interventions were excluded. Two reviewers independently searched, screened, assessed study quality and extracted data. Primary outcomes were change in behaviour, healthcare uptake or clinical outcomes. Secondary outcomes were appropriateness of the

  1. Increasing fill volume reduces cardiac performance in peritoneal dialysis

    Ivarsen, Per; Povlsen, Johan V; Jensen, Jens Dam

    2007-01-01

    BACKGROUND: It is generally accepted that peritoneal dialysis (PD) affects systemic haemodynamics less than haemodialysis, but little is known about changes in haemodynamics during PD. It is unknown if increasing PD volume causes changes in cardiovascular haemodynamics possibly increasing...

  2. Noncommunicable Diseases: Three Decades Of Global Data Show A Mixture Of Increases And Decreases In Mortality Rates.

    Ali, Mohammed K; Jaacks, Lindsay M; Kowalski, Alysse J; Siegel, Karen R; Ezzati, Majid

    2015-09-01

    Noncommunicable diseases are the leading health concerns of the modern era, accounting for two-thirds of global deaths, half of all disability, and rapidly growing costs. To provide a contemporary overview of the burdens caused by noncommunicable diseases, we compiled mortality data reported by authorities in forty-nine countries for atherosclerotic cardiovascular diseases; diabetes; chronic respiratory diseases; and lung, colon, breast, cervical, liver, and stomach cancers. From 1980 to 2012, on average across all countries, mortality for cardiovascular disease, stomach cancer, and cervical cancer declined, while mortality for diabetes, liver cancer, and female chronic respiratory disease and lung cancer increased. In contrast to the relatively steep cardiovascular and cancer mortality declines observed in high-income countries, mortality for cardiovascular disease and chronic respiratory disease was flat in most low- and middle-income countries, which also experienced increasing breast and colon cancer mortality. These divergent mortality patterns likely reflect differences in timing and magnitude of risk exposures, health care, and policies to counteract the diseases. Improving both the coverage and the accuracy of mortality documentation in populous low- and middle-income countries is a priority, as is the need to rigorously evaluate societal-level interventions. Furthermore, given the complex, chronic, and progressive nature of noncommunicable diseases, policies and programs to prevent and control them need to be multifaceted and long-term, as returns on investment accrue with time. Project HOPE—The People-to-People Health Foundation, Inc.

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

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

    2012-01-01

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

  4. Locally increased mortality of harbour seals (Phoca vitulina) in the Danish Limfjord

    Jensen, Trine Hammer; Krog, Jesper Schak; Hjulsager, Charlotte Kristiane

    2014-01-01

    At the end of August 2014 an aerial seal counting was done by Aarhus University (Galatius, A) and increased mortality was observed on a small island Ejerslev Røn (56° 56’N 0, 8° 57’Ø) and a sand bank Blinderøn about 4 km south-east of Ejserslev Røn. Both islands/sandbanks are protected nature...... reserves. The islands were inspected the following day by boat/walking. In total, 56 dead seals were found on Ejerslev Røn and Blinderøn. Four were shot due to severe respiratory symptoms and these four seals did not escape into the water when approached. All 60 seals except one with fishing net around...

  5. Increased Mortality in Relation to Insomnia and Obstructive Sleep Apnea in Korean Patients Studied with Nocturnal Polysomnography

    Choi, Jae-Won; Song, Ji Soo; Lee, Yu Jin; Won, Tae-Bin; Jeong, Do-Un

    2017-01-01

    Study Objectives: To elucidate the links between the two most prevalent sleep disorders, insomnia and obstructive sleep apnea (OSA), and mortality. Methods: We studied 4,225 subjects who were referred to the Center for Sleep and Chronobiology, Seoul National University Hospital, from January 1994 to December 2008. We divided the subjects into five groups: mild OSA (5 ≤ AHI insomnia, and a no-sleep-disorder group consisting of subjects without sleep disorders. Standardized mortality ratio (SMR), hazard ratio, and the survival rates of the five groups were calculated and evaluated. Results: The SMR of all-cause mortality was significantly higher in the severe OSA group than in the general population (1.52, 95% CI 1.23–1.85, p cause mortality (HR 3.50, 95% CI 1.03–11.91, p = 0.045) and cardiovascular mortality (HR 17.16, 95% CI 2.29–128.83, p = 0.006). Cardiovascular mortality was also significantly elevated in the insomnia group (HR 8.11, 95% CI 1.03–63.58, p = 0.046). Conclusions: Severe OSA was associated with increased all-cause mortality and cardiovascular mortality compared to the no-sleep-disorder group. Insomnia was associated with increased cardiovascular mortality compared to the no-sleep-disorder group. Citation: Choi JW, Song JS, Lee YJ, Won TB, Jeong DU. Increased mortality in relation to insomnia and obstructive sleep apnea in Korean patients studied with nocturnal polysomnography. J Clin Sleep Med. 2017;13(1):49–56. PMID:27655449

  6. Lack of chemokine signaling through CXCR5 causes increased mortality, ventricular dilatation and deranged matrix during cardiac pressure overload.

    Anne Waehre

    Full Text Available RATIONALE: Inflammatory mechanisms have been suggested to play a role in the development of heart failure (HF, but a role for chemokines is largely unknown. Based on their role in inflammation and matrix remodeling in other tissues, we hypothesized that CXCL13 and CXCR5 could be involved in cardiac remodeling during HF. OBJECTIVE: We sought to analyze the role of the chemokine CXCL13 and its receptor CXCR5 in cardiac pathophysiology leading to HF. METHODS AND RESULTS: Mice harboring a systemic knockout of the CXCR5 (CXCR5(-/- displayed increased mortality during a follow-up of 80 days after aortic banding (AB. Following three weeks of AB, CXCR5(-/- developed significant left ventricular (LV dilatation compared to wild type (WT mice. Microarray analysis revealed altered expression of several small leucine-rich proteoglycans (SLRPs that bind to collagen and modulate fibril assembly. Protein levels of fibromodulin, decorin and lumican (all SLRPs were significantly reduced in AB CXCR5(-/- compared to AB WT mice. Electron microscopy revealed loosely packed extracellular matrix with individual collagen fibers and small networks of proteoglycans in AB CXCR5(-/- mice. Addition of CXCL13 to cultured cardiac fibroblasts enhanced the expression of SLRPs. In patients with HF, we observed increased myocardial levels of CXCR5 and SLRPs, which was reversed following LV assist device treatment. CONCLUSIONS: Lack of CXCR5 leads to LV dilatation and increased mortality during pressure overload, possibly via lack of an increase in SLRPs. This study demonstrates a critical role of the chemokine CXCL13 and CXCR5 in survival and maintaining of cardiac structure upon pressure overload, by regulating proteoglycans essential for correct collagen assembly.

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

    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

  8. Attributable risk and potential impact of interventions to reduce household air pollution associated with under-five mortality in South Asia.

    Naz, Sabrina; Page, Andrew; Agho, Kingsley Emwinyore

    2018-01-01

    Solid fuel use is the major source of household air pollution (HAP) and accounts for a substantial burden of morbidity and mortality in low and middle income countries. To evaluate and compare childhood mortality attributable to HAP in four South Asian countries. A series of Demographic and Health Survey (DHS) datasets for Bangladesh, India, Nepal and Pakistan were used for analysis. Estimates of relative risk and exposure prevalence relating to use of cooking fuel and under-five mortality were used to calculate population attributable fractions (PAFs) for each country. Potential impact fractions (PIFs) were also calculated assessing theoretical scenarios based on published interventions aiming to reduce exposure prevalence. There are an increased risk of under-five mortality in those exposed to cooking fuel compared to those not exposed in the four South Asian countries (OR = 1.30, 95% CI = 1.07-1.57, P  = 0.007). Combined PAF estimates for South Asia found that 66% (95% CI: 43.1-81.5%) of the 13,290 estimated cases of under-five mortality was attributable to HAP. Joint PIF estimates (assuming achievable reductions in HAP reported in intervention studies conducted in South Asia) indicates 47% of neonatal and 43% of under-five mortality cases associated with HAP could be avoidable in the four South Asian countries studied. Elimination of exposure to use of cooking fuel in the household targeting valuable intervention strategies (such as cooking in separate kitchen, improved cook stoves) could reduce substantially under-five mortality in South Asian countries.

  9. Amphibian embryo and parental defenses and a larval predator reduce egg mortality from water mold.

    Gomez-Mestre, Ivan; Touchon, Justin C; Warkentin, Karen M

    2006-10-01

    Water molds attack aquatic eggs worldwide and have been associated with major mortality events in some cases, but typically only in association with additional stressors. We combined field observations and laboratory experiments to study egg stage defenses against pathogenic water mold in three temperate amphibians. Spotted salamanders (Ambystoma maculatum) wrap their eggs in a protective jelly layer that prevents mold from reaching the embryos. Wood frog (Rana sylvatica) egg masses have less jelly but are laid while ponds are still cold and mold growth is slow. American toad (Bufo americanus) eggs experience the highest infection levels. They are surrounded by thin jelly and are laid when ponds have warmed and mold grows rapidly. Eggs of all three species hatched early when infected, yielding smaller and less developed hatchlings. This response was strongest in B. americanus. Precocious hatching increased vulnerability of wood frog hatchlings to invertebrate predators. Finally, despite being potential toad hatchling predators, R. sylvatica tadpoles can have a positive effect on B. americanus eggs. They eat water mold off infected toad clutches, increasing their hatching success.

  10. Vascular injury is associated with increased mortality in winter sports trauma.

    Eun, John C; Bronsert, Michael; Hansen, Kristine; Moulton, Steven L; Jazaeri, Omid; Nehler, Mark; Greenberg, Joshua I

    2015-01-01

    Trauma is the leading cause of injury and death for individuals aged 1-44 years. Up to 8% of the US population participates in winter sports, and although vascular injuries are uncommon in these activities, little is published in this area. We sought to identify the incidence, injury patterns, and outcomes of vascular injuries resulting from winter sports trauma. Patients with winter sports trauma and the subset with vascular injuries were identified by accessing the National Trauma Data Bank querying years 2007-2010. Patients with and without vascular injuries were then compared. Admission variables included transport time, emergency department hypotension (systolic blood pressure Injury Severity Score ≥ 25, fractures, solid organ injury, and vascular injury. Outcomes were analyzed and associations with vascular injuries were determined. A total of 2,298 patients were identified with winter sports-related trauma and 28 (1.2%) had associated vascular injuries. Overall, the top 3 injuries were head trauma (16.7%), thoracic vertebral fractures (5.5%), and lumbar vertebral fractures (5.1%). The most common associated vascular injures were to the popliteal artery (17.7%), splenic artery (14.7%), and brachial blood vessels (14.7%). In the entire cohort, 1 patient (0.04%) suffered an amputation and 15 patients (0.7%) died. There were no amputations in the vascular injury group. Mortality was 0.6% in patients without a vascular injury compared with 7.1% of those with a vascular injury (P = 0.01). Although vascular injury is an uncommon associated finding in winter sports trauma, it is associated with a significant increase in mortality. These findings highlight the need for rapid identification of traumatic vascular injuries, which predicts worse overall outcomes in this patient population. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Does gender inequity increase men's mortality risk in the United States? A multilevel analysis of data from the National Longitudinal Mortality Study.

    Kavanagh, Shane A; Shelley, Julia M; Stevenson, Christopher

    2017-12-01

    A number of theoretical approaches suggest that gender inequity may give rise to health risks for men. This study undertook a multilevel analysis to ascertain if state-level measures of gender inequity are predictors of men's mortality in the United States. Data for the analysis were taken primarily from the National Longitudinal Mortality Study, which is based on a random sample of the non-institutionalised population. The full data set included 174,703 individuals nested within 50 states and had a six-year follow-up for mortality. Gender inequity was measured by nine variables: higher education, reproductive rights, abortion provider access, elected office, management, business ownership, labour force participation, earnings and relative poverty. Covariates at the individual level were age, income, education, race/ethnicity, marital status and employment status. Covariates at the state level were income inequality and per capita gross domestic product. The results of logistic multilevel modelling showed a number of measures of state-level gender inequity were significantly associated with men's mortality. In all of these cases greater gender inequity was associated with an increased mortality risk. In fully adjusted models for all-age adult men the elected office (OR 1.05 95% CI 1.01-1.09), business ownership (OR 1.04 95% CI 1.01-1.08), earnings (OR 1.04 95% CI 1.01-1.08) and relative poverty (OR 1.07 95% CI 1.03-1.10) measures all showed statistically significant effects for each 1 standard deviation increase in the gender inequity z -score. Similar effects were seen for working-age men. In older men (65+ years) only the earnings and relative poverty measures were statistically significant. This study provides evidence that gender inequity may increase men's health risks. The effect sizes while small are large enough across the range of gender inequity identified to have important population health implications.

  12. Procalcitonin increase in early identification of critically ill patients at high risk of mortality

    Jensen, Jens Ulrik; Heslet, Lars; Jensen, Tom Hartvig

    2006-01-01

    To investigate day-by-day changes in procalcitonin and maximum obtained levels as predictors of mortality in critically ill patients.......To investigate day-by-day changes in procalcitonin and maximum obtained levels as predictors of mortality in critically ill patients....

  13. Lung Irradiation Increases Mortality After Influenza A Virus Challenge Occurring Late After Exposure

    Manning, Casey M. [Department of Environmental Medicine, University of Rochester Medical Center, Rochester, New York (United States); Johnston, Carl J. [Department of Environmental Medicine, University of Rochester Medical Center, Rochester, New York (United States); Department of Pediatrics, University of Rochester Medical Center, Rochester, New York (United States); Reed, Christina K. [Department of Pediatrics, University of Rochester Medical Center, Rochester, New York (United States); Lawrence, B. Paige [Department of Environmental Medicine, University of Rochester Medical Center, Rochester, New York (United States); Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York (United States); Williams, Jacqueline P. [Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York (United States); Finkelstein, Jacob N., E-mail: Jacob_Finkelstein@urmc.rochester.edu [Department of Environmental Medicine, University of Rochester Medical Center, Rochester, New York (United States); Department of Pediatrics, University of Rochester Medical Center, Rochester, New York (United States); Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York (United States)

    2013-05-01

    Purpose: To address whether irradiation-induced changes in the lung environment alter responses to a viral challenge delivered late after exposure but before the appearance of late lung radiation injury. Methods and Materials: C57BL/6J mice received either lung alone or combined lung and whole-body irradiation (0-15 Gy). At 10 weeks after irradiation, animals were infected with 120 HAU influenza virus strain A/HKx31. Innate and adaptive immune cell recruitment was determined using flow cytometry. Cytokine and chemokine production and protein leakage into the lung after infection were assessed. Results: Prior irradiation led to a dose-dependent failure to regain body weight after infection and exacerbated mortality, but it did not affect virus-specific immune responses or virus clearance. Surviving irradiated animals displayed a persistent increase in total protein in bronchoalveolar lavage fluid and edema. Conclusions: Lung irradiation increased susceptibility to death after infection with influenza virus and impaired the ability to complete recovery. This altered response does not seem to be due to a radiation effect on the immune response, but it may possibly be an effect on epithelial repair.

  14. Can exercise increase fitness and reduce weight in patients with schizophrenia and depression?

    Jesper eKrogh

    2014-07-01

    Full Text Available BackgroundPsychiatric patients have a reduced life expectancy of 15 to 20 years compared to the general population. Most years of lost life are due to excess mortality from somatic diseases. Sedentary lifestyle and medication is partly responsible for the high frequency of metabolic syndrome in this patient group and low levels of physical activity is associated with increased risk of cardiovascular disease, diabetes and all-cause mortality. This study aimed to review trials allocating patients with either schizophrenia or depression to exercise interventions for effect on cardiovascular fitness, strength and weight.MethodsWe searched Pubmed, Embase, and Psycinfo including randomized clinical trial allocating patients with either schizophrenia or depression to isolated exercise interventions.ResultsWe identified five trials including patients with schizophrenia and found little evidence that exercise could increase cardiovascular fitness or decrease weight. Nine exercise trials for patients with depression were identified increasing cardiovascular fitness by 11-30% and strength by 33-37%. No evidence in favor of exercise for weight reduction was found.ConclusionBased on the current evidence isolated exercise interventions are unlikely to improve cardiovascular fitness or induce weight loss in patients with schizophrenia. In patients with depression exercise interventions are likely to induce clinically relevant short term effects, however, due to lack of reporting little is known about the effect on cardiovascular fitness beyond the intervention and weight reduction. Future exercise trials regarding patients with mental illness should preferably measure changes in cardiovascular strength, repetition maximum and anthropometric outcomes. Ideally participants should be assessed beyond the intervention

  15. Streamlining: Reducing costs and increasing STS operations effectiveness

    Petersburg, R. K.

    1985-01-01

    The development of streamlining as a concept, its inclusion in the space transportation system engineering and operations support (STSEOS) contract, and how it serves as an incentive to management and technical support personnel is discussed. The mechanics of encouraging and processing streamlining suggestions, reviews, feedback to submitters, recognition, and how individual employee performance evaluations are used to motivation are discussed. Several items that were implemented are mentioned. Information reported and the methodology of determining estimated dollar savings are outlined. The overall effect of this activity on the ability of the McDonnell Douglas flight preparation and mission operations team to support a rapidly increasing flight rate without a proportional increase in cost is illustrated.

  16. Interventions to reduce neonatal mortality: a mathematical model to evaluate impact of interventions in sub-Saharan Africa.

    Griffin, Jennifer B; McClure, Elizabeth M; Kamath-Rayne, Beena D; Hepler, Bonnie M; Rouse, Doris J; Jobe, Alan H; Goldenberg, Robert L

    2017-08-01

    To determine which interventions would have the greatest impact on reducing neonatal mortality in sub-Saharan Africa in 2012. We used MANDATE, a mathematical model, to evaluate scenarios for the impact of available interventions on neonatal deaths from primary causes, including: (i) for birth asphyxia - obstetric care preventing intrapartum asphyxia, newborn resuscitation and treatment of asphyxiated infants; (ii) for preterm birth - corticosteroids, oxygen, continuous positive air pressure and surfactant; and, (iii) for serious newborn infection - clean delivery, chlorhexidine cord care and antibiotics. Reductions in infection-related mortality have occurred. Between 80 and 90% of deaths currently occurring from infections and asphyxia can be averted from available interventions, as can 58% of mortality from preterm birth. More than 200 000 neonatal deaths can each be averted from asphyxia, preterm birth and infections. Using available interventions, more than 80% of the neonatal deaths occurring today could be prevented in sub-Saharan Africa. Reducing neonatal deaths from asphyxia require improvements in infrastructure and obstetric care to manage maternal conditions such as obstructed labour and preeclampsia. Reducing deaths from preterm birth would also necessitate improved infrastructure and training for preterm infant care. Reducing infection-related mortality requires less infrastructure and lower-level providers. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  17. Higher Mortality in registrants with sudden model for end-stage liver disease increase: Disadvantaged by the current allocation policy.

    Massie, Allan B; Luo, Xun; Alejo, Jennifer L; Poon, Anna K; Cameron, Andrew M; Segev, Dorry L

    2015-05-01

    Liver allocation is based on current Model for End-Stage Liver Disease (MELD) scores, with priority in the case of a tie being given to those waiting the longest with a given MELD score. We hypothesized that this priority might not reflect risk: registrants whose MELD score has recently increased receive lower priority but might have higher wait-list mortality. We studied wait-list and posttransplant mortality in 69,643 adult registrants from 2002 to 2013. By likelihood maximization, we empirically defined a MELD spike as a MELD increase ≥ 30% over the previous 7 days. At any given time, only 0.6% of wait-list patients experienced a spike; however, these patients accounted for 25% of all wait-list deaths. Registrants who reached a given MELD score after a spike had higher wait-list mortality in the ensuing 7 days than those with the same resulting MELD score who did not spike, but they had no difference in posttransplant mortality. The spike-associated wait-list mortality increase was highest for registrants with medium MELD scores: specifically, 2.3-fold higher (spike versus no spike) for a MELD score of 10, 4.0-fold higher for a MELD score of 20, and 2.5-fold higher for a MELD score of 30. A model incorporating the MELD score and spikes predicted wait-list mortality risk much better than a model incorporating only the MELD score. Registrants with a sudden MELD increase have a higher risk of short-term wait-list mortality than is indicated by their current MELD score but have no increased risk of posttransplant mortality; allocation policy should be adjusted accordingly. © 2015 American Association for the Study of Liver Diseases.

  18. Macrolide therapy is associated with reduced mortality in acute respiratory distress syndrome (ARDS) patients

    Simonis, Fabienne D.; de Iudicibus, Gianfranco; Cremer, Olaf L.; Ong, David S.Y.; van der Poll, Tom; Bos, Lieuwe D.; Schultz, Marcus J.

    Background: Macrolides have been associated with favorable immunological effects in various inflammatory disease states. We investigated the association between macrolide therapy and mortality in patients with the acute respiratory distress syndrome (ARDS). Methods: This was an unplanned secondary

  19. The bioimpedance phase angle predicts low muscle strength, impaired quality of life, and increased mortality in old patients with cancer.

    Norman, Kristina; Wirth, Rainer; Neubauer, Maxi; Eckardt, Rahel; Stobäus, Nicole

    2015-02-01

    We investigated the impact of low phase angle (PhA) values on muscle strength, quality of life, symptom severity, and 1-year mortality in older cancer patients. Prospective study with 1-year follow-up. Cancer patients aged >60 years. PhA was derived from whole body impedance analysis. The fifth percentile of age-, sex-, and body mass index-stratified reference values were used as cut-off. Quality of life was determined with the European Organization of Research and Treatment in Cancer questionnaire, reflecting both several function scales and symptom severity. Muscle strength was assessed by hand grip strength, knee extension strength, and peak expiratory flow. 433 cancer patients, aged 60-95 years, were recruited. Patients with low PhA (n = 197) exhibited decreased muscle strength compared with patients with normal PhA (hand grip strength: 22 ± 8.6 vs 28.9 ± 8.9 kg, knee extension strength: 20.8 ± 11.8 vs 28.1 ± 14.9 kg, and peak expiratory flow: 301.1 ± 118 vs 401.7 ± 142.6 L/min, P Cancer questionnaire were reduced, and most symptoms (fatigue, anorexia, pain, and dyspnea) increased in patients with low PhA (P quality of life, and increased mortality in old patients with cancer and should be evaluated in routine assessment. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  20. Leisure-Time Physical Activity Is Associated With Reduced Risk of Dementia-Related Mortality in Adults With and Without Psychological Distress: The Cohort of Norway.

    Zotcheva, Ekaterina; Selbæk, Geir; Bjertness, Espen; Ernstsen, Linda; Strand, Bjørn H

    2018-01-01

    Background: Leisure-time physical activity (PA) has been proposed as a protective factor against dementia, whereas psychological distress is associated with an increased risk of dementia. We investigated the associations of leisure-time PA and psychological distress with dementia-related mortality, and whether the association between leisure-time PA and dementia-related mortality differs according to level of psychological distress. Methods: 36,945 individuals from the Cohort of Norway aged 50-74 years at baseline (1994-2002) were included and followed up until January 1st 2015. Leisure-time PA and psychological distress were assessed through questionnaires, whereas dementia-related mortality was obtained through the Norwegian Cause of Death Registry. Adjusted Cox regression analyses were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI). Results: Compared to inactivity, leisure-time PA was associated with a decreased risk of dementia-related mortality; low intensity leisure-time PA (HR = 0.73, 95% CI 0.59-0.89); high intensity leisure-time PA (HR = 0.61, 95%CI 0.49-0.77). A statistically significant difference in dementia-related mortality risk was observed between low and high intensity leisure-time PA ( p leisure-time PA was associated with a decreased dementia-related mortality risk; low intensity leisure-time PA (HR = 0.77, 95% CI 0.61-0.97); high intensity leisure-time PA (HR = 0.65, 95% CI 0.51-0.84). The same applied for those with psychological distress; low intensity leisure-time PA (HR = 0.57, 95% CI 0.35-0.94); high intensity leisure-time PA (HR = 0.42, 95% CI 0.22-0.82). The interaction between leisure-time PA and psychological distress on dementia-related mortality was not statistically significant ( p = 0.38). Conclusions: Participating in leisure-time PA was associated with a reduced risk of dementia-related mortality, whereas psychological distress was associated with an increased risk of dementia-related mortality. Leisure

  1. Buddhist concepts as implicitly reducing prejudice and increasing prosociality.

    Clobert, Magali; Saroglou, Vassilis; Hwang, Kwang-Kuo

    2015-04-01

    Does Buddhism really promote tolerance? Based on cross-cultural and cross-religious evidence, we hypothesized that Buddhist concepts, possibly differing from Christian concepts, activate not only prosociality but also tolerance. Subliminally priming Buddhist concepts, compared with neutral or Christian concepts, decreased explicit prejudice against ethnic, ideological, and moral outgroups among Western Buddhists who valued universalism (Experiment 1, N = 116). It also increased spontaneous prosociality, and decreased, among low authoritarians or high universalists, implicit religious and ethnic prejudice among Westerners of Christian background (Experiment 2, N = 128) and Taiwanese of Buddhist/Taoist background (Experiment 3, N = 122). Increased compassion and tolerance of contradiction occasionally mediated some of the effects. The general idea that religion promotes (ingroup) prosociality and outgroup prejudice, based on research in monotheistic contexts, lacks cross-cultural sensitivity; Buddhist concepts activate extended prosociality and tolerance of outgroups, at least among those with socio-cognitive and moral openness. © 2015 by the Society for Personality and Social Psychology, Inc.

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

    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)

  3. Leisure-time running reduces all-cause and cardiovascular mortality risk.

    Lee, Duck-Chul; Pate, Russell R; Lavie, Carl J; Sui, Xuemei; Church, Timothy S; Blair, Steven N

    2014-08-05

    Although running is a popular leisure-time physical activity, little is known about the long-term effects of running on mortality. The dose-response relations between running, as well as the change in running behaviors over time, and mortality remain uncertain. We examined the associations of running with all-cause and cardiovascular mortality risks in 55,137 adults, 18 to 100 years of age (mean age 44 years). Running was assessed on a medical history questionnaire by leisure-time activity. During a mean follow-up of 15 years, 3,413 all-cause and 1,217 cardiovascular deaths occurred. Approximately 24% of adults participated in running in this population. Compared with nonrunners, runners had 30% and 45% lower adjusted risks of all-cause and cardiovascular mortality, respectively, with a 3-year life expectancy benefit. In dose-response analyses, the mortality benefits in runners were similar across quintiles of running time, distance, frequency, amount, and speed, compared with nonrunners. Weekly running even benefits, with 29% and 50% lower risks of all-cause and cardiovascular mortality, respectively, compared with never-runners. Running, even 5 to 10 min/day and at slow speeds benefits. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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

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

    2016-04-23

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

  5. Mycobacterium tuberculosis PPE18 Protein Reduces Inflammation and Increases Survival in Animal Model of Sepsis.

    Ahmed, Asma; Dolasia, Komal; Mukhopadhyay, Sangita

    2018-04-18

    Mycobacterium tuberculosis PPE18 is a member of the PPE family. Previous studies have shown that recombinant PPE18 (rPPE18) protein binds to TLR2 and triggers a signaling cascade which reduces levels of TNF-α and IL-12, and increases IL-10 in macrophages. Because TNF-α is a major mediator of the pathophysiology of sepsis and blocking inflammation is a possible line of therapy in such circumstances, we tested the efficacy of rPPE18 in reducing symptoms of sepsis in a mouse model of Escherichia coli- induced septic peritonitis. rPPE18 significantly decreased levels of serum TNF-α, IL-1β, IL-6, and IL-12 and reduced organ damage in mice injected i.p. with high doses of E. coli Peritoneal cells isolated from rPPE18-treated mice had characteristics of M2 macrophages which are protective in excessive inflammation. Additionally, rPPE18 inhibited disseminated intravascular coagulation, which can cause organ damage resulting in death. rPPE18 was able to reduce sepsis-induced mortality when given prophylactically or therapeutically. Additionally, in a mouse model of cecal ligation and puncture-induced sepsis, rPPE18 reduced TNF-α, alanine transaminase, and creatinine, attenuated organ damage, prevented depletion of monocytes and lymphocytes, and improved survival. Our studies show that rPPE18 has potent anti-inflammatory properties and can serve as a novel therapeutic to control sepsis. Copyright © 2018 by The American Association of Immunologists, Inc.

  6. Oxidized fish oil in rat pregnancy causes high newborn mortality and increases maternal insulin resistance.

    Albert, Benjamin B; Vickers, Mark H; Gray, Clint; Reynolds, Clare M; Segovia, Stephanie A; Derraik, José G B; Lewandowski, Paul A; Garg, Manohar L; Cameron-Smith, David; Hofman, Paul L; Cutfield, Wayne S

    2016-09-01

    Fish oil is commonly taken by pregnant women, and supplements sold at retail are often oxidized. Using a rat model, we aimed to assess the effects of supplementation with oxidized fish oil during pregnancy in mothers and offspring, focusing on newborn viability and maternal insulin sensitivity. Female rats were allocated to a control or high-fat diet and then mated. These rats were subsequently randomized to receive a daily gavage treatment of 1 ml of unoxidized fish oil, a highly oxidized fish oil, or control (water) throughout pregnancy. At birth, the gavage treatment was stopped, but the same maternal diets were fed ad libitum throughout lactation. Supplementation with oxidized fish oil during pregnancy had a marked adverse effect on newborn survival at day 2, leading to much greater odds of mortality than in the control (odds ratio 8.26) and unoxidized fish oil (odds ratio 13.70) groups. In addition, maternal intake of oxidized fish oil during pregnancy led to increased insulin resistance at the time of weaning (3 wks after exposure) compared with control dams (HOMA-IR 2.64 vs. 1.42; P = 0.044). These data show that the consumption of oxidized fish oil is harmful in rat pregnancy, with deleterious effects in both mothers and offspring. Copyright © 2016 the American Physiological Society.

  7. Training on NORM: Increasing awareness, reducing occupational dose

    Hoogstraate, H.; Sonsbeek, R. van

    2002-01-01

    Awareness of a risk is the starting point of protection against it. The best way of creating this awareness is by providing training to the persons that run the risk. This also applies to the risks associated with the presence of Naturally Occurring Radioactive Materials (NORM) in oil and gas production installations. Our experience shows that with relatively little effort, and low cost it is possible to provide training on NORM to operational personnel of oil and gas companies. In this way, a reduction of occupational dose and an increased protection of the environment can be achieved. This applies in particular to the less developed countries, where little regulation is in place. The workers themselves form a group that is motivated and eager to learn about these risks.Training of personnel is a valuable tool to make people more conscious of the risks involved with radiation and to safeguard society, instead of a system of permissions and governmental regulations that often is not functioning properly. (author)

  8. Increased commuting to school time reduces sleep duration in adolescents.

    Pereira, Erico Felden; Moreno, Claudia; Louzada, Fernando Mazzilli

    2014-02-01

    Active travel to school has been referred to as one way of increasing the level of daily physical exercise, but the actual impacts on student's general health are not clear. Recently, a possible association between active travel to school and the duration of sleep was suggested. Thus, the aim was of this study to investigate the associations between the type of transportation and travel time to school, the time in bed and sleepiness in the classroom of high school students. Information on sleeping habits and travel to school of 1126 high school students were analyzed, where 55.1% were girls with an average age of 16.24 (1.39) years old, in Santa Maria Municipality, Rio Grande do Sul, Brazil. Multiple linear regression and adjusted prevalence rates analyses were carried out. The frequency of active travel found was 61.8%. Associations between time in bed, sleepiness in the classroom and the type of transportation (active or passive) were not identified. Nevertheless, the time in bed was inversely associated with the travel time (p = 0.036) and with a phase delay. In the adjusted analysis, active travel was more incident for the students of schools in the suburbs (PR: 1.68; CI: 1.40-2.01) in comparison with the students of schools in the center. Therefore, longer trips were associated with a reduction of sleep duration of morning and night groups. Interventions concerning active travel to school must be carried out cautiously in order not to cause a reduction of the sleeping time.

  9. Does trade liberalization reduce child mortality in low- and middle-income countries? A synthetic control analysis of 36 policy experiments, 1963-2005.

    Barlow, Pepita

    2018-05-01

    Scholars have long argued that trade liberalization leads to lower rates of child mortality in developing countries. Yet current scholarship precludes definitive conclusions about the magnitude and direction of this relationship. Here I analyze the impact of trade liberalization on child mortality in 36 low- and middle-income countries, 1963-2005, using the synthetic control method. I test the hypothesis that trade liberalization leads to lower rates of child mortality, examine whether this association varies between countries and over time, and explore the potentially modifying role of democratic politics, historical context, and geographic location on the magnitude and direction of this relationship. My analysis shows that, on average, trade liberalization had no impact on child mortality in low- and middle-income countries between 1963 and 2005 (Average effect (AE): -0.15%; 95% CI: -2.04%-2.18%). Yet the scale, direction and statistical significance of this association varied markedly, ranging from a ∼20% reduction in child mortality in Uruguay to a ∼20% increase in the Philippines compared with synthetic controls. Trade liberalization was also followed by the largest declines in child mortality in democracies (AE 10-years post reform (AE 10 ): -3.28%), in Latin America (AE 10 : -4.15%) and in the 1970s (AE 10 : -6.85%). My findings show that trade liberalization can create an opportunity for reducing rates of child mortality, but its effects cannot be guaranteed. Inclusive and pro-growth contextual factors appear to influence whether trade liberalization actually yields beneficial consequences in developing societies. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

  10. Increased Cancer Mortality Risk for NASA's ISS Astronauts: The Contribution of Diagnostic Radiological Examinations

    Dodge, C.W.; Picco, C. E.; Gonzalez, S. M.; Johnston, S. L.; Van Baalen, M.; Shavers, M.R.

    2009-01-01

    This viewgraph presentation reviews the radiation exposures and risks associated with long-term spaceflight on the International Space Station. NASA's risk model of cancer mortality is also presented.

  11. Coronary artery disease is associated with an increased mortality rate following video-assisted thoracoscopic lobectomy

    Sandri, Alberto; Petersen, Rene Horsleben; Decaluwé, Herbert

    2017-01-01

    OBJECTIVE: To compare the incidence of major adverse cardiac events (MACE) and mortality following video-assisted thoracoscopic surgery (VATS) lobectomy in patients with and without coronary artery disease (CAD). METHODS: Multicentre retrospective analysis of 1699 patients undergoing VATS lobectomy...

  12. Assessing the potential impact of increased participation in higher education on mortality: evidence from 21 European populations.

    Kulhánová, Ivana; Hoffmann, Rasmus; Judge, Ken; Looman, Caspar W N; Eikemo, Terje A; Bopp, Matthias; Deboosere, Patrick; Leinsalu, Mall; Martikainen, Pekka; Rychtaříková, Jitka; Wojtyniak, Bogdan; Menvielle, Gwenn; Mackenbach, Johan P

    2014-09-01

    Although higher education has been associated with lower mortality rates in many studies, the effect of potential improvements in educational distribution on future mortality levels is unknown. We therefore estimated the impact of projected increases in higher education on mortality in European populations. We used mortality and population data according to educational level from 21 European populations and developed counterfactual scenarios. The first scenario represented the improvement in the future distribution of educational attainment as expected on the basis of an assumption of cohort replacement. We estimated the effect of this counterfactual scenario on mortality with a 10-15-year time horizon among men and women aged 30-79 years using a specially developed tool based on population attributable fractions (PAF). We compared this with a second, upward levelling scenario in which everyone has obtained tertiary education. The reduction of mortality in the cohort replacement scenario ranged from 1.9 to 10.1% for men and from 1.7 to 9.0% for women. The reduction of mortality in the upward levelling scenario ranged from 22.0 to 57.0% for men and from 9.6 to 50.0% for women. The cohort replacement scenario was estimated to achieve only part (4-25% (men) and 10-31% (women)) of the potential mortality decrease seen in the upward levelling scenario. We concluded that the effect of on-going improvements in educational attainment on average mortality in the population differs across Europe, and can be substantial. Further investments in education may have important positive side-effects on population health. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

    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...... adjusted for age, sex, residential and health status, the disease that caused the amputation, and the index amputation level showed that 30-day and 1-year mortality risk was reduced by 52% (HR =0.48, 95% CI: 0.25-0.91) and by 46% (HR =0.54, 95% CI: 0.35-0.86), respectively, in the intervention group...

  14. Effectiveness of egg immersion in aqueous solutions of thiamine and thiamine analogs for reducing early mortality syndrome

    Brown, S.B.; Brown, L.R.; Brown, M.; Moore, K.; Villella, M.; Fitzsimons, J.D.; Williston, B.; Honeyfield, D.C.; Hinterkopf, J.P.; Tillitt, D.E.; Zajicek, J.L.; Wolgamood, M.

    2005-01-01

    Protocols used for therapeutic thiamine treatments in salmonine early mortality syndrome (EMS) were investigated in lake trout Salvelinus namaycush and coho salmon Oncorhynchus kisutch to assess their efficacy. At least 500 mg of thiamine HCl/L added to egg baths was required to produce a sustained elevation of thiamine content in lake trout eggs. Thiamine uptake from egg baths was not influenced by a pH ranging from 5.5 to 7.5 or by a water hardness between 2 and 200 mg CaCO3/L. There was poorer thiamine uptake when initial thiamine levels were low, suggesting that current treatment regimes may not be as effective when thiamine levels are severely depressed and that higher treatment doses are necessary. Exposure of eggs to the more lipid-soluble thiamine analog allithiamine (1,000 mg/L) during water hardening increased egg thiamine levels by 1.5-2.5 nmol/g and was completely effective at reversing EMS. Another more lipid-soluble thiamine analog, benfotiamine (100 mg/L), reduced EMS but did not produce detectable increases in egg thiamine content. Although benfotiamine may be more effective than thiamine at mitigating EMS, it is more expensive than thiamine HCl or allithiamine. In addition, there still needs to be a more thorough examination of dose-response relationships. We conclude that allithiamine is an alternative to the use of thiamine in egg baths as a therapeutic treatment for salmonid EMS. ?? Copyright by the American Fisheries Society 2005.

  15. Intentional weight loss reduces mortality rate in a rodent model of dietary obesity.

    Vasselli, Joseph R; Weindruch, Richard; Heymsfield, Steven B; Pi-Sunyer, F Xavier; Boozer, Carol N; Yi, Nengjun; Wang, Chenxi; Pietrobelli, Angelo; Allison, David B

    2005-04-01

    We used a rodent model of dietary obesity to evaluate effects of caloric restriction-induced weight loss on mortality rate. Research Measures and Procedures: In a randomized parallel-groups design, 312 outbred Sprague-Dawley rats (one-half males) were assigned at age 10 weeks to one of three diets: low fat (LF; 18.7% calories as fat) with caloric intake adjusted to maintain body weight 10% below that for ad libitum (AL)-fed rat food, high fat (HF; 45% calories as fat) fed at the same level, or HF fed AL. At age 46 weeks, the lightest one-third of the AL group was discarded to ensure a more obese group; the remaining animals were randomly assigned to one of three diets: HF-AL, HF with energy restricted to produce body weights of animals restricted on the HF diet throughout life, or LF with energy restricted to produce the body weights of animals restricted on the LF diet throughout life. Life span, body weight, and leptin levels were measured. Animals restricted throughout life lived the longest (p < 0.001). Life span was not different among animals that had been obese and then lost weight and animals that had been nonobese throughout life (p = 0.18). Animals that were obese and lost weight lived substantially longer than animals that remained obese throughout life (p = 0.002). Diet composition had no effect on life span (p = 0.52). Weight loss after the onset of obesity during adulthood leads to a substantial increase in longevity in rats.

  16. Reducing Salt in Raw Pork Sausages Increases Spoilage and Correlates with Reduced Bacterial Diversity.

    Fougy, Lysiane; Desmonts, Marie-Hélène; Coeuret, Gwendoline; Fassel, Christine; Hamon, Erwann; Hézard, Bernard; Champomier-Vergès, Marie-Christine; Chaillou, Stéphane

    2016-07-01

    Raw sausages are perishable foodstuffs; reducing their salt content raises questions about a possible increased spoilage of these products. In this study, we evaluated the influence of salt reduction (from 2.0% to 1.5% [wt/wt]), in combination with two types of packaging (modified atmosphere [50% mix of CO2-N2] and vacuum packaging), on the onset of spoilage and on the diversity of spoilage-associated bacteria. After 21 days of storage at 8°C, spoilage was easily observed, characterized by noticeable graying of the products and the production of gas and off-odors defined as rancid, sulfurous, or sour. At least one of these types of spoilage occurred in each sample, and the global spoilage intensity was more pronounced in samples stored under modified atmosphere than under vacuum packaging and in samples with the lower salt content. Metagenetic 16S rRNA pyrosequencing revealed that vacuum-packaged samples contained a higher total bacterial richness (n = 69 operational taxonomic units [OTUs]) than samples under the other packaging condition (n = 46 OTUs). The core community was composed of 6 OTUs (Lactobacillus sakei, Lactococcus piscium, Carnobacterium divergens, Carnobacterium maltaromaticum, Serratia proteamaculans, and Brochothrix thermosphacta), whereas 13 OTUs taxonomically assigned to the Enterobacteriaceae, Enterococcaceae, and Leuconostocaceae families comprised a less-abundant subpopulation. This subdominant community was significantly more abundant when 2.0% salt and vacuum packaging were used, and this correlated with a lower degree of spoilage. Our results demonstrate that salt reduction, particularly when it is combined with CO2-enriched packaging, promotes faster spoilage of raw sausages by lowering the overall bacterial diversity (both richness and evenness). Our study takes place in the context of raw meat product manufacturing and is linked to a requirement for salt reduction. Health guidelines are calling for a reduction in dietary salt intake

  17. Reducing Salt in Raw Pork Sausages Increases Spoilage and Correlates with Reduced Bacterial Diversity

    Fougy, Lysiane; Desmonts, Marie-Hélène; Coeuret, Gwendoline; Fassel, Christine; Hamon, Erwann; Hézard, Bernard; Champomier-Vergès, Marie-Christine

    2016-01-01

    ABSTRACT Raw sausages are perishable foodstuffs; reducing their salt content raises questions about a possible increased spoilage of these products. In this study, we evaluated the influence of salt reduction (from 2.0% to 1.5% [wt/wt]), in combination with two types of packaging (modified atmosphere [50% mix of CO2-N2] and vacuum packaging), on the onset of spoilage and on the diversity of spoilage-associated bacteria. After 21 days of storage at 8°C, spoilage was easily observed, characterized by noticeable graying of the products and the production of gas and off-odors defined as rancid, sulfurous, or sour. At least one of these types of spoilage occurred in each sample, and the global spoilage intensity was more pronounced in samples stored under modified atmosphere than under vacuum packaging and in samples with the lower salt content. Metagenetic 16S rRNA pyrosequencing revealed that vacuum-packaged samples contained a higher total bacterial richness (n = 69 operational taxonomic units [OTUs]) than samples under the other packaging condition (n = 46 OTUs). The core community was composed of 6 OTUs (Lactobacillus sakei, Lactococcus piscium, Carnobacterium divergens, Carnobacterium maltaromaticum, Serratia proteamaculans, and Brochothrix thermosphacta), whereas 13 OTUs taxonomically assigned to the Enterobacteriaceae, Enterococcaceae, and Leuconostocaceae families comprised a less-abundant subpopulation. This subdominant community was significantly more abundant when 2.0% salt and vacuum packaging were used, and this correlated with a lower degree of spoilage. Our results demonstrate that salt reduction, particularly when it is combined with CO2-enriched packaging, promotes faster spoilage of raw sausages by lowering the overall bacterial diversity (both richness and evenness). IMPORTANCE Our study takes place in the context of raw meat product manufacturing and is linked to a requirement for salt reduction. Health guidelines are calling for a reduction in

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

    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.

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

    Matendo, Richard; Engmann, Cyril; Ditekemena, John; Gado, Justin; Tshefu, Antoinette; Kinoshita, Rinko; McClure, Elizabeth M; Moore, Janet; Wallace, Dennis; Carlo, Waldemar A; Wright, Linda L; Bose, Carl

    2011-08-04

    neonatal mortality. 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. This trial has been registered at http://www.clinicaltrials.gov (identifier NCT00136708).

  20. The Importance of Vigorous-Intensity Leisure-Time Physical Activity in Reducing Cardiovascular Disease Mortality Risk in the Obese.

    O'Donovan, Gary; Stamatakis, Emmanuel; Stensel, David J; Hamer, Mark

    2018-03-02

    To investigate the role of vigorous-intensity leisure-time physical activity in reducing cardiovascular disease (CVD) mortality risk in the obese. Trained interviewers assessed physical activity and body mass index (BMI; calculated as the weight in kilograms divided by the height in meters squared) in 59,005 adult participants (mean ± SD age, 57±12 years; 46.5% male) in 2 household-based surveillance studies: Health Survey for England and Scottish Health Survey. Mortality was ascertained from death certificates. Data were collected from January 1, 1994, through March 31, 2011. Cox proportional hazards models were adjusted for age, sex, smoking habit, total physical activity, long-standing illness, prevalent CVD, and occupation. There were 2302 CVD deaths during 532,251 person-years of follow-up (mean ± SD, 9±4 years). A total of 15,002 (25%) participants were categorized as obese (BMI ≥30). Leisure-time physical activity was inversely associated and BMI was positively associated with CVD mortality. Compared with those who reported meeting physical activity guidelines including some vigorous-intensity physical activity and who had a normal BMI (18.5-24.9) (reference group), the CVD mortality hazard ratio was not significantly different in the obese who also reported meeting physical activity guidelines including some vigorous-intensity physical activities (1.25; 95% CI, 0.50-3.12). Compared with the reference group, the CVD mortality hazard ratio was more than 2-fold in the obese who reported meeting physical activity guidelines, including only moderate-intensity physical activities (2.52; 95% CI, 1.15-2.53). This large, statistically powerful study suggests that vigorous-intensity leisure-time physical activity is important in reducing CVD mortality risk in the obese. Copyright © 2018 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  1. Implementation of a management protocol for massive bleeding reduces mortality in non-trauma patients: Results from a single centre audit.

    Martínez-Calle, N; Hidalgo, F; Alfonso, A; Muñoz, M; Hernández, M; Lecumberri, R; Páramo, J A

    2016-12-01

    To audit the impact upon mortality of a massive bleeding management protocol (MBP) implemented in our center since 2007. A retrospective, single-center study was carried out. Patients transfused after MBP implementation (2007-2012, Group 2) were compared with a historical cohort (2005-2006, Group 1). Massive bleeding is associated to high mortality rates. Available MBPs are designed for trauma patients, whereas specific recommendations in the medical/surgical settings are scarce. After excluding patients who died shortly (<6h) after MBP activation (n=20), a total of 304 were included in the data analysis (68% males, 87% surgical). Our MBP featured goal-directed transfusion with early use of adjuvant hemostatic medications. Primary endpoints were 24-h and 30-day mortality. Fresh frozen plasma-to-red blood cells (FFP:RBC) and platelet-to-RBC (PLT:RBC) transfusion ratios, time to first FFP unit and the proactive MBP triggering rate were secondary endpoints. After MBP implementation (Group 2; n=222), RBC use remained stable, whereas FFP and hemostatic agents increased, when compared with Group 1 (n=82). Increased FFP:RBC ratio (p=0.053) and earlier administration of FFP (p=0.001) were also observed, especially with proactive MBP triggering. Group 2 patients presented lower rates of 24-h (0.5% vs. 7.3%; p=0.002) and 30-day mortality (15.9% vs. 30.2%; p=0.018) - the greatest reduction corresponding to non-surgical patients. Logistic regression showed an independent protective effect of MBP implementation upon 30-day mortality (OR=0.3; 95% CI 0.15-0.61). These data suggest that the implementation of a goal-directed MBP for prompt and aggressive management of non-trauma, massive bleeding patients is associated to reduced 24-h and 30-day mortality rates. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  2. Temperature sensitivity of drought-induced tree mortality portends increased regional die-off under global-change-type drought

    Adams, Henry D.; Guardiola-Claramonte, Maite; Barron-Gafford, Greg A.; Villegas, Juan Camilo; Breshears, David D.; Zou, Chris B.; Troch, Peter A.; Huxman, Travis E.

    2009-01-01

    Large-scale biogeographical shifts in vegetation are predicted in response to the altered precipitation and temperature regimes associated with global climate change. Vegetation shifts have profound ecological impacts and are an important climate-ecosystem feedback through their alteration of carbon, water, and energy exchanges of the land surface. Of particular concern is the potential for warmer temperatures to compound the effects of increasingly severe droughts by triggering widespread vegetation shifts via woody plant mortality. The sensitivity of tree mortality to temperature is dependent on which of 2 non-mutually-exclusive mechanisms predominates—temperature-sensitive carbon starvation in response to a period of protracted water stress or temperature-insensitive sudden hydraulic failure under extreme water stress (cavitation). Here we show that experimentally induced warmer temperatures (≈4 °C) shortened the time to drought-induced mortality in Pinus edulis (piñon shortened pine) trees by nearly a third, with temperature-dependent differences in cumulative respiration costs implicating carbon starvation as the primary mechanism of mortality. Extrapolating this temperature effect to the historic frequency of water deficit in the southwestern United States predicts a 5-fold increase in the frequency of regional-scale tree die-off events for this species due to temperature alone. Projected increases in drought frequency due to changes in precipitation and increases in stress from biotic agents (e.g., bark beetles) would further exacerbate mortality. Our results demonstrate the mechanism by which warmer temperatures have exacerbated recent regional die-off events and background mortality rates. Because of pervasive projected increases in temperature, our results portend widespread increases in the extent and frequency of vegetation die-off. PMID:19365070

  3. The impact of increasing income inequalities on educational inequalities in mortality - An analysis of six European countries.

    Hoffmann, Rasmus; Hu, Yannan; de Gelder, Rianne; Menvielle, Gwenn; Bopp, Matthias; Mackenbach, Johan P

    2016-07-08

    Over the past decades, both health inequalities and income inequalities have been increasing in many European countries, but it is unknown whether and how these trends are related. We test the hypothesis that trends in health inequalities and trends in income inequalities are related, i.e. that countries with a stronger increase in income inequalities have also experienced a stronger increase in health inequalities. We collected trend data on all-cause and cause-specific mortality, as well as on the household income of people aged 35-79, for Belgium, Denmark, England & Wales, France, Slovenia, and Switzerland. We calculated absolute and relative differences in mortality and income between low- and high-educated people for several time points in the 1990s and 2000s. We used fixed-effects panel regression models to see if changes in income inequality predicted changes in mortality inequality. The general trend in income inequality between high- and low-educated people in the six countries is increasing, while the mortality differences between educational groups show diverse trends, with absolute differences mostly decreasing and relative differences increasing in some countries but not in others. We found no association between trends in income inequalities and trends in inequalities in all-cause mortality, and trends in mortality inequalities did not improve when adjusted for rising income inequalities. This result held for absolute as well as for relative inequalities. A cause-specific analysis revealed some association between income inequality and mortality inequality for deaths from external causes, and to some extent also from cardiovascular diseases, but without statistical significance. We find no support for the hypothesis that increasing income inequality explains increasing health inequalities. Possible explanations are that other factors are more important mediators of the effect of education on health, or more simply that income is not an important

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

    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,

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

    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

  6. Increased Duration of Paid Maternity Leave Lowers Infant Mortality in Low- and Middle-Income Countries: A Quasi-Experimental Study.

    Arijit Nandi

    2016-03-01

    Full Text Available Maternity leave reduces neonatal and infant mortality rates in high-income countries. However, the impact of maternity leave on infant health has not been rigorously evaluated in low- and middle-income countries (LMICs. In this study, we utilized a difference-in-differences approach to evaluate whether paid maternity leave policies affect infant mortality in LMICs.We used birth history data collected via the Demographic and Health Surveys to assemble a panel of approximately 300,000 live births in 20 countries from 2000 to 2008; these observational data were merged with longitudinal information on the duration of paid maternity leave provided by each country. We estimated the effect of an increase in maternity leave in the prior year on the probability of infant (<1 y, neonatal (<28 d, and post-neonatal (between 28 d and 1 y after birth mortality. Fixed effects for country and year were included to control for, respectively, unobserved time-invariant confounders that varied across countries and temporal trends in mortality that were shared across countries. Average rates of infant, neonatal, and post-neonatal mortality over the study period were 55.2, 30.7, and 23.0 per 1,000 live births, respectively. Each additional month of paid maternity was associated with 7.9 fewer infant deaths per 1,000 live births (95% CI 3.7, 12.0, reflecting a 13% relative reduction. Reductions in infant mortality associated with increases in the duration of paid maternity leave were concentrated in the post-neonatal period. Estimates were robust to adjustment for individual, household, and country-level characteristics, although there may be residual confounding by unmeasured time-varying confounders, such as coincident policy changes.More generous paid maternity leave policies represent a potential instrument for facilitating early-life interventions and reducing infant mortality in LMICs and warrant further discussion in the post-2015 sustainable development agenda

  7. Does gender inequity increase men's mortality risk in the United States? A multilevel analysis of data from the National Longitudinal Mortality Study

    Shane A. Kavanagh

    2017-12-01

    Full Text Available A number of theoretical approaches suggest that gender inequity may give rise to health risks for men. This study undertook a multilevel analysis to ascertain if state-level measures of gender inequity are predictors of men's mortality in the United States. Data for the analysis were taken primarily from the National Longitudinal Mortality Study, which is based on a random sample of the non-institutionalised population. The full data set included 174,703 individuals nested within 50 states and had a six-year follow-up for mortality. Gender inequity was measured by nine variables: higher education, reproductive rights, abortion provider access, elected office, management, business ownership, labour force participation, earnings and relative poverty. Covariates at the individual level were age, income, education, race/ethnicity, marital status and employment status. Covariates at the state level were income inequality and per capita gross domestic product. The results of logistic multilevel modelling showed a number of measures of state-level gender inequity were significantly associated with men's mortality. In all of these cases greater gender inequity was associated with an increased mortality risk. In fully adjusted models for all-age adult men the elected office (OR 1.05 95% CI 1.01–1.09, business ownership (OR 1.04 95% CI 1.01–1.08, earnings (OR 1.04 95% CI 1.01–1.08 and relative poverty (OR 1.07 95% CI 1.03–1.10 measures all showed statistically significant effects for each 1 standard deviation increase in the gender inequity z-score. Similar effects were seen for working-age men. In older men (65+ years only the earnings and relative poverty measures were statistically significant. This study provides evidence that gender inequity may increase men's health risks. The effect sizes while small are large enough across the range of gender inequity identified to have important population health implications.

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

    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.

  9. Herbivory-induced mortality increases with radial growth in an invasive riparian phreatophyte

    Hultine, K. R.; Dudley, T.; Leavitt, S.

    2012-12-01

    Under equal conditions, plants that allocate a larger proportion of resources to growth must do so at the expense of allocating fewer resources to storage. The critical balance between growth and storage leads to the hypothesis that in high-resource environments, plants that express high growth rates are more susceptible to episodic disturbance than plants that express lower growth rates. This hypothesis was tested by measuring the radial growth (RG), basal area increment (BAI) and carbon isotope ratios (δ13C) in tree-ring alpha-cellulose of mature tamarisk trees (Tamarix spp.) occurring at three sites in the western United States. All of the trees had been subjected to episodic foliage herbivory over three or more consecutive growing seasons by the recently released biological control agent, the tamarisk leaf beetle (Diorhabda carinulata) resulting in approximately 50% mortality in each stand (n = 31 live and killed trees, respectively). Mean annual BAI (measured from annual ring widths) in the 10 years prior to the onset of herbivory was on average 45% higher in killed trees compared to live trees (P tamarisk leaf beetle, they also expressed higher (less negative) δ13C ratios compared to live trees. In fact, at a site near Moab, UT, mean annual BAI was 100% higher in killed trees despite having about a 0.5‰ higher δ13C relative to live trees (P = 0.0008). These patterns suggest that the killed trees operated with a lower stomatal conductance despite the fact that they were more productive. Results from this investigation suggest that live trees allocated a relatively large proportion of resources to storage, thereby allowing these trees to produce new leaves after each subsequent herbivory event, whereas recently killed trees likely allocate a larger proportion of resources to growth at the expense of maintaining smaller storage reserves than living trees. Herbivory by the tamarisk leaf beetle therefore may be expected to reduce the overall net primary

  10. Increased Mortality for Elective Surgery during Summer Vacation: A Longitudinal Analysis of Nationwide Data.

    Pascal Caillet

    Full Text Available Surgical safety during vacation periods may be influenced by the interplay of several factors, including workers' leave, hospital activity, climate, and the variety of patient cases. This study aimed to highlight an annually recurring peak of surgical mortality during summer in France and explore its main predictors. We selected all elective of open surgical procedures performed in French hospitals between 2007 and 2012. Surgical mortality variation was analyzed over time in relation to workers leaving on vacation, the volume of procedures performed by hospitals, and temperature changes. We ran a multilevel logistic regression for exploring the determinants of surgical mortality, taking into account the clustering of patients within hospitals and adjusting for patient and hospital characteristics. A total of 609 French hospitals had 8,926,120 discharges related to open elective surgery. During 6 years, we found a recurring mortality peak of 1.15% (95% CI 1.09-1.20 in August compared with 0.81% (0.79-0.82, p<.001 in other months. The incidence of worker vacation was 43.0% (38.9-47.2 in August compared with 7.3% (4.6-10.1, p<.001 in other months. Hospital activity decreased substantially in August (78,126 inpatient stays, 75,298-80,954 in relation to other months (128,142, 125,697-130,586, p<.001. After adjusting for all covariates, we found an "August effect" reflecting a higher risk to patients undergoing operations at this time (OR 1.16, 95% CI 1.12-1.19, p<.001. The main study limitation was the absence of data linkage between surgical staffing and mortality at the hospital level. The observed, recurring mortality peak in August raises questions about how to maintain hospital activity and optimal staffing through better regulation of human activities.

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

    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.

  12. Increased extinction potential of insular fish populations with reduced life history variation and low genetic diversity.

    Hellmair, Michael; Kinziger, Andrew P

    2014-01-01

    Theoretical work has shown that reduced phenotypic heterogeneity leads to population instability and can increase extinction potential, yet few examples exist of natural populations that illustrate how varying levels expressed diversity may influence population persistence, particularly during periods of stochastic environmental fluctuation. In this study, we assess levels of expressed variation and genetic diversity among demographically independent populations of tidewater goby (Eucyclogobius newberryi), show that reductions in both factors typically coincide, and describe how low levels of diversity contribute to the extinction risk of these isolated populations. We illustrate that, for this annual species, continuous reproduction is a safeguard against reproductive failure by any one population segment, as natural, stochastically driven salinity increases frequently result in high mortality among juvenile individuals. Several study populations deviated from the natural pattern of year-round reproduction typical for the species, rendering those with severely truncated reproductive periods vulnerable to extinction in the event of environmental fluctuation. In contrast, demographically diverse populations are more likely to persist through such periods through the continuous presence of adults with broader physiological tolerance to abrupt salinity changes. Notably, we found a significant correlation between genetic diversity and demographic variation in the study populations, which could be the result of population stressors that restrict both of these diversity measures simultaneously, or suggestive of a causative relationship between these population characteristics. These findings demonstrate the importance of biocomplexity at the population level, and assert that the maintenance of diversity contributes to population resilience and conservation of this endangered species.

  13. Increased extinction potential of insular fish populations with reduced life history variation and low genetic diversity.

    Michael Hellmair

    Full Text Available Theoretical work has shown that reduced phenotypic heterogeneity leads to population instability and can increase extinction potential, yet few examples exist of natural populations that illustrate how varying levels expressed diversity may influence population persistence, particularly during periods of stochastic environmental fluctuation. In this study, we assess levels of expressed variation and genetic diversity among demographically independent populations of tidewater goby (Eucyclogobius newberryi, show that reductions in both factors typically coincide, and describe how low levels of diversity contribute to the extinction risk of these isolated populations. We illustrate that, for this annual species, continuous reproduction is a safeguard against reproductive failure by any one population segment, as natural, stochastically driven salinity increases frequently result in high mortality among juvenile individuals. Several study populations deviated from the natural pattern of year-round reproduction typical for the species, rendering those with severely truncated reproductive periods vulnerable to extinction in the event of environmental fluctuation. In contrast, demographically diverse populations are more likely to persist through such periods through the continuous presence of adults with broader physiological tolerance to abrupt salinity changes. Notably, we found a significant correlation between genetic diversity and demographic variation in the study populations, which could be the result of population stressors that restrict both of these diversity measures simultaneously, or suggestive of a causative relationship between these population characteristics. These findings demonstrate the importance of biocomplexity at the population level, and assert that the maintenance of diversity contributes to population resilience and conservation of this endangered species.

  14. Increased carboxyhemoglobin in adult falciparum malaria is associated with disease severity and mortality.

    Yeo, Tsin W; Lampah, Daniel A; Kenangalem, Enny; Tjitra, Emiliana; Price, Ric N; Anstey, Nicholas M

    2013-09-01

    Heme oxygenase 1 expression is increased in pediatric patients with malaria. The carboxyhemoglobin level (a measure of heme oxygenase 1 activity) has not been assessed in adult patients with malaria. Results of pulse co-oximetry revealed that the mean carboxyhemoglobin level was elevated in 29 Indonesian adults with severe falciparum malaria (10%; 95% confidence interval [CI], 8%-13%) and in 20 with severe sepsis (8%; 95% CI, 5%-12%), compared with the mean levels in 32 patients with moderately severe malaria (7%; 95% CI, 5%-8%) and 36 controls (3.6%; 95% CI, 3%-5%; P carboxyhemoglobin level was associated with an increased odds of death among patients with severe malaria (odds ratio, 1.2 per percentage point increase; 95% CI, 1.02-1.5). While also associated with severity and fatality, methemoglobin was only modestly increased in patients with severe malaria. Increased carboxyhemoglobin levels during severe malaria and sepsis may exacerbate organ dysfunction by reducing oxygen carriage and cautions against the use of adjunctive CO therapy, which was proposed on the basis of mouse models.

  15. The Implications of Increased Survivorship for Mortality Variation in Aging PopulationsThe Implications of Increased Survivorship for Mortality Variation in Aging Populations

    Engelman, M; Canudas-Romo, V; Agree, EM

    2010-01-01

    The remarkable growth in life expectancy during the twentieth century inspired predictions of a future in which all people, not just a fortunate few, will live long lives ending at or near the maximum human life span. We show that increased longevity has been accompanied by less variation in ages...

  16. Increased non-AIDS mortality among persons with AIDS-defining events after antiretroviral therapy initiation

    Pettit, April C; Giganti, Mark J; Ingle, Suzanne M

    2018-01-01

    ) initiation. METHODS: We included HIV treatment-naïve adults from the Antiretroviral Therapy Cohort Collaboration (ART-CC) who initiated ART from 1996 to 2014. Causes of death were assigned using the Coding Causes of Death in HIV (CoDe) protocol. The adjusted hazard ratio (aHR) for overall and cause......-specific non-AIDS mortality among those with an ADE (all ADEs, tuberculosis (TB), Pneumocystis jiroveci pneumonia (PJP), and non-Hodgkin's lymphoma (NHL)) compared to those without an ADE was estimated using a marginal structural model. RESULTS: The adjusted hazard of overall non-AIDS mortality was higher...

  17. A global social contract to reduce maternal mortality: the human rights arguments and the case of Uganda.

    Ooms, Gorik; Mulumba, Moses; Hammonds, Rachel; Latif Laila, Abdul; Waris, Attiya; Forman, Lisa

    2013-11-01

    Progress towards Millennium Development Goal 5a, reducing maternal deaths by 75% between 1990 and 2015, has been substantial; however, it has been too slow to hope for its achievement by 2015, particularly in sub-Saharan Africa, including Uganda. This suggests that both the Government of Uganda and the international community are failing to comply with their right-to-health-related obligations towards the people of Uganda. This country case study explores some of the key issues raised when assessing national and international right-to-health-related obligations. We argue that to comply with their shared obligations, national and international actors will have to take steps to move forward together. The Government of Uganda should not expect additional international assistance if it does not live up to its own obligations; at the same time, the international community must provide assistance that is more reliable in the long run to create the 'fiscal space' that the Government of Uganda needs to increase recurrent expenditure for health - which is crucial to addressing maternal mortality. We propose that the 'Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria Response in Africa', adopted by the African Union in July 2012, should be seen as an invitation to the international community to conclude a global social contract for health. Copyright © 2013 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  18. Increased Duration of Paid Maternity Leave Lowers Infant Mortality in Low- and Middle-Income Countries: A Quasi-Experimental Study.

    Nandi, Arijit; Hajizadeh, Mohammad; Harper, Sam; Koski, Alissa; Strumpf, Erin C; Heymann, Jody

    2016-03-01

    Maternity leave reduces neonatal and infant mortality rates in high-income countries. However, the impact of maternity leave on infant health has not been rigorously evaluated in low- and middle-income countries (LMICs). In this study, we utilized a difference-in-differences approach to evaluate whether paid maternity leave policies affect infant mortality in LMICs. We used birth history data collected via the Demographic and Health Surveys to assemble a panel of approximately 300,000 live births in 20 countries from 2000 to 2008; these observational data were merged with longitudinal information on the duration of paid maternity leave provided by each country. We estimated the effect of an increase in maternity leave in the prior year on the probability of infant (maternity was associated with 7.9 fewer infant deaths per 1,000 live births (95% CI 3.7, 12.0), reflecting a 13% relative reduction. Reductions in infant mortality associated with increases in the duration of paid maternity leave were concentrated in the post-neonatal period. Estimates were robust to adjustment for individual, household, and country-level characteristics, although there may be residual confounding by unmeasured time-varying confounders, such as coincident policy changes. More generous paid maternity leave policies represent a potential instrument for facilitating early-life interventions and reducing infant mortality in LMICs and warrant further discussion in the post-2015 sustainable development agenda. From a policy planning perspective, further work is needed to elucidate the mechanisms that explain the benefits of paid maternity leave for infant mortality.

  19. Elytroderma disease reduces growth and vigor, increases mortality of Jeffrey pines at Lake Tahoe Basin, California

    Robert R Scharpf; Robert V. Bega

    1981-01-01

    A disease of Jeffrey pines (Pinus jeffreyi Grev. and Balf.) at Lake Tahoe Basin, California, caused by Elytrodenna disease (Elytroderma deformans) was studied for 7 years after a severe outbreak ofthe fungus in 1971. Among 607 Jeffrey pines on six plots, about one-half were heavily infected and about one-half were moderately or lightly infected in 1971. No uninfected...

  20. Job losses and accumulated number of broken partnerships increase risk of premature mortality in Danish men born in 1953

    Kriegbaum, Margit; Christensen, Ulla; Lund, Rikke

    2009-01-01

    OBJECTIVE: To investigate how accumulation of job losses and broken partnerships affect the risk of premature mortality, and to study joint exposure to both events. METHODS: Birth cohort study of 9789 Danish men born in 1953 with follow-up of events between the ages of 40 and 51. RESULTS: The adj......OBJECTIVE: To investigate how accumulation of job losses and broken partnerships affect the risk of premature mortality, and to study joint exposure to both events. METHODS: Birth cohort study of 9789 Danish men born in 1953 with follow-up of events between the ages of 40 and 51. RESULTS......: The adjusted hazard rates for premature mortality was 1.44 (95% CI = 1.15 to 1.80) for individuals with one job loss, 1.55 (1.13 to 2.13) for individuals with one broken partnership, and 2.15 (95% CI = 1.49 to 3.10) for individuals with two or more broken partnerships. CONCLUSIONS: Experience of at least one...... job loss increased the risk of premature mortality. The risk of premature mortality increased with the number of broken partnerships. There was no statistical interaction between job losses and broken partnerships....

  1. Poor decision making is associated with an increased risk of mortality among community-dwelling older persons without dementia.

    Boyle, Patricia A; Wilson, Robert S; Yu, Lei; Buchman, Aron S; Bennett, David A

    2013-01-01

    Decision making is thought to be an important determinant of health and well-being across the lifespan, but little is known about the association of decision making with mortality. Participants were 675 older persons without dementia from the Rush Memory and Aging Project, a longitudinal cohort study of aging. Baseline assessments of decision making were used to predict the risk of mortality during up to 4 years of follow-up. The mean score on the decision making measure at baseline was 7.1 (SD = 2.9, range: 0-12), with lower scores indicating poorer decision making. During up to 4 years of follow-up (mean = 1.7 years), 40 (6% of 675) persons died. In a proportional hazards model adjusted for age, sex and education, the risk of mortality increased by about 20% for each additional decision making error (HR = 1.19, 95% CI = 1.07-1.32, p = 0.002). Thus, a person who performed poorly on the measure of decision making (score = 3, 10th percentile) was about 4 times more likely to die compared to a person who performed well (score = 11, 90th percentile). Further, the association of decision making with mortality persisted after adjustment for the level of cognitive function. Poor decision making is associated with an increased risk of mortality in old age even after accounting for cognitive function. Copyright © 2013 S. Karger AG, Basel.

  2. Reduced ultraviolet light transmission increases insecticide longevity in protected culture raspberry production.

    Leach, Heather; Wise, John C; Isaacs, Rufus

    2017-12-01

    High tunnels are large protective structures used for season extension of many crops, including raspberries. These structures are often covered in plastic films to reduce and diffuse ultraviolet light transmission for pest and disease control, but this may also affect the photodegradation and efficacy of pesticides applied under these tunnels. We compared the residue levels of ten insecticides under three tunnel plastics with varying levels of UV transmission and open field conditions. Raspberry plants placed in research-scale tunnels were treated with insecticides and residues on fruit and foliage were monitored for one or two weeks in early 2015 and early and late 2016. Plastics that reduce UV transmission resulted in 50% greater residues of some insecticides compared to transparent plastics, and 60% compared to uncovered tunnels. This increased persistence of residues was evident within 1 day and remained consistently higher for up to 14 days. This pattern was demonstrated for multiple insecticides, including bifenthrin, esfenvalerate, imidacloprid, thiamethoxam, and spinosad. In contrast, the insecticide malathion degraded rapidly regardless of the plastic treatment, indicating less sensitivity to photodegradation. Bioassays using insecticide-treated leaves that were under UV-blocking plastic revealed higher mortality of the invasive fruit pest, Drosophila suzukii, compared to leaves that were uncovered. This indicates that the activity of pesticides under high tunnels covered in UV-reducing plastics may be prolonged, allowing for fewer insecticide applications and longer intervals between sprays. This information can be used to help optimize pest control in protected culture berry production. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Compared With Usual Sodium Intake, Low- and Excessive-Sodium Diets Are Associated With Increased Mortality

    Graudal, Niels; Jürgens, Gesche; Baslund, Bo

    2014-01-01

    BACKGROUND: The effect of sodium intake on population health remains controversial. The objective was to investigate the incidence of all-cause mortality (ACM) and cardiovascular disease events (CVDEs) in populations exposed to dietary intakes of low sodium (<115 mmol), usual sodium (low usual so...

  4. Collateral damage: fire and Phytophthora ramorum interact to increase mortality in coast redwood

    Margaret R. Metz; J. Morgan Varner; Kerri M. Frangioso; Ross K. Meentemeyer; David M. Rizzo

    2013-01-01

    Invading species can alter ecosystems by impacting the frequency, severity, and consequences of endemic disturbance regimes (Mack and D'Antonio 1998). Phytophthora ramorum, the causal agent of the emergent disease sudden oak death (SOD), is an invasive pathogen causing widespread tree mortality in coastal forests of California and Oregon. In...

  5. Increased risk for cardiovascular mortality among malnourished end-stage renal disease patients.

    Fung, Frank; Sherrard, Donald J; Gillen, Daniel L; Wong, Craig; Kestenbaum, Bryan; Seliger, Steven; Ball, Adrianne; Stehman-Breen, Catherine

    2002-08-01

    Studies have shown that protein-energy malnutrition (PEM) is a strong predictor of total mortality among patients with end-stage renal disease (ESRD). The aim of this study is to assess the relationship between nutritional indices and cardiovascular (CV) mortality among patients with ESRD by using data from the US Renal Data System (USRDS) Dialysis Morbidity and Mortality Study Wave I (DMMS-1). Demographic and medical data were abstracted from 5,058 patients who participated in the USRDS DMMS-1. Nutritional measurements of interest included subjective assessment of malnutrition, serum albumin level, body mass index (BMI), and cholesterol level. The USRDS provided follow-up data on mortality through July 1998. The Cox proportional hazard model was used to estimate the risk for CV death associated with nutritional markers. The risk for CV death was 39% greater for each 1-g/dL (10-g/L) decrement in serum albumin level (95% confidence interval [CI], 1.20 to 1.60; P history of CVD at the study start. Both PEM at baseline and worsening PEM over time are associated with a greater risk for CV death. This finding persists among dialysis patients without preexisting CVD at baseline. Copyright 2002 by the National Kidney Foundation, Inc.

  6. Increased long-term mortality after a high perioperative inspiratory oxygen fraction during abdominal surgery

    Meyhoff, Christian Sylvest; Jorgensen, Lars N; Wetterslev, Jørn

    2012-01-01

    A high perioperative inspiratory oxygen fraction (80%) has been recommended to prevent postoperative wound infections. However, the most recent and one of the largest trials, the PROXI trial, found no reduction in surgical site infection, and 30-day mortality was higher in patients given 80% oxygen...

  7. Association Between Portosystemic Shunts and Increased Complications and Mortality in Patients With Cirrhosis.

    Simón-Talero, Macarena; Roccarina, Davide; Martínez, Javier; Lampichler, Katharina; Baiges, Anna; Low, Gavin; Llop, Elba; Praktiknjo, Michael; Maurer, Martin H; Zipprich, Alexander; Triolo, Michela; Vangrinsven, Guillaume; Garcia-Martinez, Rita; Dam, Annette; Majumdar, Avik; Picón, Carmen; Toth, Daniel; Darnell, Anna; Abraldes, Juan G; Lopez, Marta; Kukuk, Guido; Krag, Aleksander; Bañares, Rafael; Laleman, Wim; La Mura, Vincenzo; Ripoll, Cristina; Berzigotti, Annalisa; Trebicka, Jonel; Calleja, Jose Luis; Tandon, Puneeta; Hernandez-Gea, Virginia; Reiberger, Thomas; Albillos, Agustín; Tsochatzis, Emmanuel A; Augustin, Salvador; Genescà, Joan

    2018-05-01

    Spontaneous portosystemic shunts (SPSS) have been associated with hepatic encephalopathy (HE). Little is known about their prevalence among patients with cirrhosis or clinical effects. We investigated the prevalence and characteristics of SPSS in patients with cirrhosis and their outcomes. We performed a retrospective study of 1729 patients with cirrhosis who underwent abdominal computed tomography or magnetic resonance imaging analysis from 2010 through 2015 at 14 centers in Canada and Europe. We collected data on demographic features, etiology of liver disease, comorbidities, complications, treatments, laboratory and clinical parameters, Model for End-Stage Liver Disease (MELD) score, and endoscopy findings. Abdominal images were reviewed by a radiologist (or a hepatologist trained by a radiologist) and searched for the presence of SPSS, defined as spontaneous communications between the portal venous system or splanchnic veins and the systemic venous system, excluding gastroesophageal varices. Patients were assigned to groups with large SPSS (L-SPSS, ≥8 mm), small SPSS (S-SPSS, SPSS (W-SPSS). The main outcomes were the incidence of complications of cirrhosis and mortality according to the presence of SPSS. Secondary measurements were the prevalence of SPSS in patients with cirrhosis and their radiologic features. L-SPSS were identified in 488 (28%) patients, S-SPSS in 548 (32%) patients, and no shunt (W-SPSS) in 693 (40%) patients. The most common L-SPSS was splenorenal (46% of L-SPSS). The presence and size of SPSS increased with liver dysfunction: among patients with MELD scores of 6-9, 14% had L-SPSS and 28% had S-SPSS; among patients with MELD scores of 10-13, 30% had L-SPSS and 34% had S-SPSS; among patients with MELD scores of 14 or higher, 40% had L-SPSS and 32% had S-SPSS (P SPSS, 34% of patients with S-SPSS, and 20% of patients W-SPSS (P SPSS groups). Recurrent or persistent HE was reported in 52% of patients with L-SPSS, 44% of patients with S

  8. Quantifying policy options for reducing future coronary heart disease mortality in England: a modelling study.

    Shaun Scholes

    Full Text Available To estimate the number of coronary heart disease (CHD deaths potentially preventable in England in 2020 comparing four risk factor change scenarios.Using 2007 as baseline, the IMPACTSEC model was extended to estimate the potential number of CHD deaths preventable in England in 2020 by age, gender and Index of Multiple Deprivation 2007 quintiles given four risk factor change scenarios: (a assuming recent trends will continue; (b assuming optimal but feasible levels already achieved elsewhere; (c an intermediate point, halfway between current and optimal levels; and (d assuming plateauing or worsening levels, the worst case scenario. These four scenarios were compared to the baseline scenario with both risk factors and CHD mortality rates remaining at 2007 levels. This would result in approximately 97,000 CHD deaths in 2020. Assuming recent trends will continue would avert approximately 22,640 deaths (95% uncertainty interval: 20,390-24,980. There would be some 39,720 (37,120-41,900 fewer deaths in 2020 with optimal risk factor levels and 22,330 fewer (19,850-24,300 in the intermediate scenario. In the worst case scenario, 16,170 additional deaths (13,880-18,420 would occur. If optimal risk factor levels were achieved, the gap in CHD rates between the most and least deprived areas would halve with falls in systolic blood pressure, physical inactivity and total cholesterol providing the largest contributions to mortality gains.CHD mortality reductions of up to 45%, accompanied by significant reductions in area deprivation mortality disparities, would be possible by implementing optimal preventive policies.

  9. Quantifying policy options for reducing future coronary heart disease mortality in England: a modelling study.

    Scholes, Shaun; Bajekal, Madhavi; Norman, Paul; O'Flaherty, Martin; Hawkins, Nathaniel; Kivimäki, Mika; Capewell, Simon; Raine, Rosalind

    2013-01-01

    To estimate the number of coronary heart disease (CHD) deaths potentially preventable in England in 2020 comparing four risk factor change scenarios. Using 2007 as baseline, the IMPACTSEC model was extended to estimate the potential number of CHD deaths preventable in England in 2020 by age, gender and Index of Multiple Deprivation 2007 quintiles given four risk factor change scenarios: (a) assuming recent trends will continue; (b) assuming optimal but feasible levels already achieved elsewhere; (c) an intermediate point, halfway between current and optimal levels; and (d) assuming plateauing or worsening levels, the worst case scenario. These four scenarios were compared to the baseline scenario with both risk factors and CHD mortality rates remaining at 2007 levels. This would result in approximately 97,000 CHD deaths in 2020. Assuming recent trends will continue would avert approximately 22,640 deaths (95% uncertainty interval: 20,390-24,980). There would be some 39,720 (37,120-41,900) fewer deaths in 2020 with optimal risk factor levels and 22,330 fewer (19,850-24,300) in the intermediate scenario. In the worst case scenario, 16,170 additional deaths (13,880-18,420) would occur. If optimal risk factor levels were achieved, the gap in CHD rates between the most and least deprived areas would halve with falls in systolic blood pressure, physical inactivity and total cholesterol providing the largest contributions to mortality gains. CHD mortality reductions of up to 45%, accompanied by significant reductions in area deprivation mortality disparities, would be possible by implementing optimal preventive policies.

  10. Simulation of reduced breast cancer mortality in breast cancer screening programs

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

    2011-01-01

    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.

  11. Reduced Spill at Hydropower Dams: Opportunities for More Generation and Increased Fish Population

    Coutant, Charles C [ORNL; Mann, Roger [RMecon, Davis, California; Sale, Michael J [ORNL

    2006-09-01

    This report indicates that reduction of managed spill at hydropower dams can speed implementation of technologies for fish protection and achieve economic goals. Spill of water over spillways is managed in the Columbia River basin to assist downstream-migrating juvenile salmon, and is generally believed to be the most similar to natural migration, benign and effective passage route; other routes include turbines, intake screens with bypasses, and surface bypasses. However, this belief may be misguided, because spill is becoming recognized as less than natural, with deep intakes below normal migration depths, and likely causing physical damages from severe shear on spillways, high turbulence in tail waters, and collisions with baffle blocks that lead to disorientation and predation. Some spillways induce mortalities comparable to turbines. Spill is expensive in lost generation, and controversial. Fish-passage research is leading to more fish-friendly turbines, screens and bypasses that are more effective and less damaging, and surface bypasses that offer passage of more fish per unit water volume than does spill (leaving more water for generation). Analyses by independent economists demonstrated that goals of increased fish survival over the long term and net gain to the economy can be obtained by selectively reducing spill and diverting some of the income from added power generation to research, development, and installation of fish-passage technologies. Such a plan would selectively reduce spill when and where least damaging to fish, increase electricity generation using the water not spilled and use innovative financing to direct monetary gains to improving fish passage.

  12. Diltiazem Reduces Mortality and Breakdown of ATP in Red Blood Cell Induced by Isoproterenol in a Freely Moving Rat Model in Vivo

    Pollen K.F. Yeung

    2014-09-01

    Full Text Available The benefit of calcium channel blockers for cardiovascular prevention against heart attack and stroke has not been firmly supported. We investigated the possible cardiovascular protective effect of diltiazem (DTZ against injury induced by isoproterenol using a freely moving rat model in vivo. Sprague Dawley rats were injected subcutaneously (sc with either 5 or 10 mg/kg of DTZ, or saline as control, twice daily for five doses. One hour after the last injection, a single dose of isoproterenol (30 mg/kg was injected sc to each rat. Blood samples were collected serially for 6 h for measurement of adenine nucleotides (ATP, ADP and AMP in red blood cell (RBC by a validated HPLC. The study has shown isoproterenol induced 50% mortality and also increased RBC concentrations of AMP from 0.04 ± 0.02 to 0.29 ± 0.21 mM at the end of the experiment (p < 0.05. Treatment with 10 mg/kg of DTZ reduced mortality from 50% to <20% and attenuated the increase of RBC concentrations of AMP from +0.25 ± 0.22 in the control rats to +0.072 ± 0.092 mM (p < 0.05. The study concluded that 10 mg/kg of DTZ reduced mortality and breakdown of ATP induced by isoproterenol in rats.

  13. TV viewing time is associated with increased all-cause mortality in Brazilian adults independent of physical activity.

    Turi, B C; Monteiro, H L; Lemes, Í R; Codogno, J S; Lynch, K R; Asahi Mesquita, C A; Fernandes, R A

    2018-02-01

    The purpose of this study was to investigate the association between television (TV) viewing and all-cause mortality among Brazilian adults after 6 years of follow-up. This longitudinal study started in 2010 in the city of Bauru, SP, Brazil, and involved 970 adults aged ≥50 years. Mortality was reported by relatives and confirmed in medical records of the Brazilian National Health System. Physical activity (PA) and TV viewing were assessed by the Baecke questionnaire. Health status, sociodemographic and behavioral covariates were considered as potential confounders. After 6 years of follow-up, 89 deaths were registered (9.2% [95% CI=7.4%-11%]). Type 2 diabetes mellitus was associated with higher risk of mortality (P-value=.012). Deaths correlated significantly with age (ρ=.188; P-value=.001), overall PA score (ρ=-.128; P-value=.001) and TV viewing (ρ=.086; P-value=.007). Lower percentage of participants reported TV viewing time as often (16%) and very often (5.7%), but there was an association between higher TV viewing time ("often" and "very often" grouped together) and increased mortality after 6 years of follow-up (P-value=.006). The higher TV viewing time was associated with a 44.7% increase in all-cause mortality (HR=1.447 [1.019-2.055]), independently of other potential confounders. In conclusion, the findings from this cohort study identified increased risk of mortality among adults with higher TV viewing time, independently of PA and other variables. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

    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 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.

  15. Increasing plant diversity with border crops reduces insecticide use and increases crop yield in urban agriculture.

    Wan, Nian-Feng; Cai, You-Ming; Shen, Yan-Jun; Ji, Xiang-Yun; Wu, Xiang-Wen; Zheng, Xiang-Rong; Cheng, Wei; Li, Jun; Jiang, Yao-Pei; Chen, Xin; Weiner, Jacob; Jiang, Jie-Xian; Nie, Ming; Ju, Rui-Ting; Yuan, Tao; Tang, Jian-Jun; Tian, Wei-Dong; Zhang, Hao; Li, Bo

    2018-05-24

    Urban agriculture is making an increasing contribution to food security in large cities around the world. The potential contribution of biodiversity to ecological intensification in urban agricultural systems has not been investigated. We present monitoring data collected from rice fields in 34 community farms in mega-urban Shanghai, China, from 2001 to 2015, and show that the presence of a border crop of soybeans and neighboring crops (maize, eggplant and Chinese cabbage), both without weed control, increased invertebrate predator abundance, decreased the abundance of pests and dependence on insecticides, and increased grain yield and economic profits. Two 2 year randomized experiments with the low and high diversity practices in the same locations confirmed these results. Our study shows that diversifying farming practices can make an important contribution to ecological intensification and the sustainable use of associated ecosystem services in an urban ecosystem. © 2018, Wan et al.

  16. Inadvertent Splenectomy During Resection for Colorectal Cancer Does Not Increase Long-term Mortality in a Propensity Score Model

    Lolle, Ida; Pommergaard, Hans-Christian; Schefte, David F

    2016-01-01

    BACKGROUND: Previous studies suggest that long-term mortality is increased in patients who undergo splenectomy during surgery for colorectal cancer. The reason for this association remains unclear. OBJECTIVE: The purpose of this study was to investigate the association between inadvertent...... splenectomy attributed to iatrogenic lesion to the spleen during colorectal cancer resections and long-term mortality in a national cohort of unselected patients. DESIGN: This was a retrospective, nationwide cohort study. SETTINGS: Data were collected from the database of the Danish Colorectal Cancer Group...... for patients surviving 30 days after surgery. Secondary outcomes were 30-day mortality and risk factors for inadvertent splenectomy. Multivariable and propensity-score matched Cox regression analyses were used to adjust for potential confounding. RESULTS: In total, 23,727 patients were included, of which 277...

  17. Donor Smoking and Older Age Increases Morbidity and Mortality After Lung Transplantation

    Schultz, H H; Møller, C H; Zemtsovski, M

    2017-01-01

    survival as well as CLAD-free survival was significantly lower with donors ≥55 years. CONCLUSIONS: Donor smoking history and older donor age impact lung function, mortality, and CLAD-free survival after transplantation. Because of a shortage of organs, extended donor criteria may be considered while taking......BACKGROUND: The lack of lung transplant donors has necessitated the use of donors with a smoking history and donors of older age. We have evaluated the effects of donor smoking history and age on recipient morbidity and mortality with baseline values of pulmonary function and survival free...... of chronic lung allograft dysfunction (CLAD) as morbidity variables. METHODS: This is a retrospective analysis of 588 consecutive lung transplant recipients and their corresponding 454 donors. Donors were divided into three groups: group 1 included smokers, group 2 nonsmokers, and group 3 had unknown smoking...

  18. Dysthymia and depression increase risk of dementia and mortality among older veterans

    Byers, AL; Covinsky, KE; Barnes, DE; Yaffe, K

    2012-01-01

    OBJECTIVE: To determine whether less severe depression spectrum diagnoses such as dysthymia, as well as depression, are associated with risk of developing dementia and mortality in a "real-world" setting. DESIGN: Retrospective cohort study conducted using the Department of Veterans Affairs (VA) National Patient Care Database (1997-2007). SETTING: VA medical centers in the United States. PARTICIPANTS: A total of 281,540 veterans aged 55 years and older without dementia at study baseline (1997-...

  19. A low muscle mass increases mortality in compensated cirrhotic patients with sepsis.

    Lucidi, Cristina; Lattanzi, Barbara; Di Gregorio, Vincenza; Incicco, Simone; D'Ambrosio, Daria; Venditti, Mario; Riggio, Oliviero; Merli, Manuela

    2018-05-01

    Severe infections and muscle wasting are both associated to poor outcome in cirrhosis. A possible synergic effect of these two entities in cirrhotic patients has not been previously investigated. We aimed at analysing if a low muscle mass may deteriorate the outcome of cirrhotic patients with sepsis. Consecutive cirrhotic patients hospitalized for sepsis were enrolled in the study. Patients were classified for the severity of liver impairment (Child-Pugh class) and for the presence of "low muscle mass" (mid-arm muscle circumferencelow muscle mass. In patients with and without low muscle mass, severity of liver disease and characteristics of infections were similar. Mortality tended to be higher in patients with low muscle mass (47% vs 26%, P = .06). A multivariate analysis selected low muscle mass (P low muscle mass compared with those without (50% vs 16%; P = .01). The mortality rate and the incidence of complications in malnourished patients classified in Child-Pugh A-B were similar to those Child-Pugh C. Low muscle mass worsen prognosis in cirrhotic patients with severe infections. This is particularly evident in patients with Child A-B cirrhosis in whom the coexistence of low muscle mass and sepsis caused a negative impact on mortality similar to that observable in all Child C patients with sepsis. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

    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 same age group during the two previous years. RESULTS: 8158 children aged 6-59 months were under BHP surveillance during the 2006-campaign and 7999 and 8108 during similar periods in 2004 and 2005. At least 90% of the eligible children received MV in the campaign. There were 161 non-accident deaths...

  1. Mortality In Rural China Declined As Health Insurance Coverage Increased, But No Evidence The Two Are Linked.

    Zhou, Maigeng; Liu, Shiwei; Kate Bundorf, M; Eggleston, Karen; Zhou, Sen

    2017-09-01

    Health insurance holds the promise of improving population health and survival and protecting people from catastrophic health spending. Yet evidence from lower- and middle-income countries on the impact of health insurance is limited. We investigated whether insurance expansion reduced adult mortality in rural China, taking advantage of differences across Chinese counties in the timing of the introduction of the New Cooperative Medical Scheme (NCMS). We assembled and analyzed newly collected data on NCMS implementation, linked to data from the Chinese Center for Disease Control and Prevention on cause-specific, age-standardized death rates and variables specific to county-year combinations for seventy-two counties in the period 2004-12. While mortality rates declined among rural residents during this period, we found little evidence that the expansion of health insurance through the NCMS contributed to this decline. However, our relatively large standard errors leave open the possibility that the NCMS had effects on mortality that we could not detect. Moreover, mortality benefits might arise only after many years of accumulated coverage. Project HOPE—The People-to-People Health Foundation, Inc.

  2. Medical closure of patent ductus arteriosus does not reduce mortality and development of bronchopulmonary dysplasia in preterm infants

    Demet Terek

    2014-01-01

    Full Text Available Background: Although, patent ductus arteriosus (PDA is associated with significant morbidity due to hemodynamic instability in preterm infants, the effect of ductus closure on mortality and morbidity is a controversial issue. The aim is to evaluate the efficacy of oral and intravenous (IV ibuprofen treatment on ductal closure and effects on mortality and bronchoplumonary dysplasia. Materials and Methods: The medical records of 292 premature infants treated at Ege University Neonatal Intensive Care Unit were retrospectively evaluated. Patients were classified into 3 groups as; No PDA, hemodynamically insignificant PDA (hiPDA and hemodynamically significant PDA (hsPDA according to the presence and hemodynamical significance of PDA by echocardiography. hsPDA group was treated with IV or oral ibuprofen. Results: Patent ductus arteriosus was diagnosed by routine echocardiography in 145 patients, of whom 78 (53.7% had hsPDA. All 65 infants with hiPDA had spontaneous PDA closure. Echocardiographic measurements were similar to those patients treated with oral or IV ibuprofen, as in the response rate to treatment without serious adverse effects. The presence of respiratory distress syndrome, surfactant therapy, late sepsis, bronchopulmonary dysplasia (BPD and mortality rates were significantly higher in patients with hsPDA. However, with stepwise logistic regression; 5th min Apgar score (odds ratio [OR], 1.321, 95% confidence interval [CI], 1.063-1.641, P = 0.012 and gestational age (OR, 1.422, 95% CI, 1.212-1.662, P < 0.001 were the only significant variables associated with mortality. Gestational age (OR, 0.680, 95% CI, 0.531-0.871, P = 0.002 was the only significant variable associated with BPD shown with logistic regression. Conclusion: Ibuprofen treatment is effective for hsPDA closure with minimal side effects. HiPDA can close spontaneously; therefore treatment decision should be individualized. However, medical treatment of PDA does not reduce

  3. 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.

    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.

  4. The economic benefits of reducing cardiovascular disease mortality in Quebec, Canada.

    Boisclair, David; Décarie, Yann; Laliberté-Auger, François; Michaud, Pierre-Carl; Vincent, Carole

    2018-01-01

    We assess how different scenarios of cardiovascular disease (CVD) prevention, aimed at meeting targets set by the World Health Organization (WHO) for 2025), may impact healthcare spending in Quebec, Canada over the 2050 horizon. We provide long-term forecasts of healthcare use and costs at the Quebec population level using a novel dynamic microsimulation model. Using both survey and administrative data, we simulate the evolution of the Quebec population's health status until death, through a series of dynamic transitions that accounts for social and demographic characteristics associated with CVD risk factors. A 25% reduction in CVD mortality between 2012 and 2025 achieved through decreased incidence could contain the pace of healthcare cost growth towards 2050 by nearly 7 percentage points for consultations with a physician, and by almost 9 percentage points for hospitalizations. Over the 2012-2050 period, the present value of cost savings is projected to amount to C$13.1 billion in 2012 dollars. The years of life saved due to improved life expectancy could be worth another C$38.2 billion. Addressing CVD mortality directly instead would bring about higher healthcare costs, but would generate more value in terms of years of life saved, at C$69.6 billion. Potential savings associated with plausible reductions in CVD, aimed at reaching a World Health Organization target over a 12-year period, are sizeable and may help address challenges associated with an aging population.

  5. Efforts to reduce mortality to hydroelectric turbine-passed fish: locating and quantifying damaging shear stresses.

    Cada, Glenn; Loar, James; Garrison, Laura; Fisher, Richard; Neitzel, Duane

    2006-06-01

    Severe fluid forces are believed to be a source of injury and mortality to fish that pass through hydroelectric turbines. A process is described by which laboratory bioassays, computational fluid dynamics models, and field studies can be integrated to evaluate the significance of fluid shear stresses that occur in a turbine. Areas containing potentially lethal shear stresses were identified near the stay vanes and wicket gates, runner, and in the draft tube of a large Kaplan turbine. However, under typical operating conditions, computational models estimated that these dangerous areas comprise less than 2% of the flow path through the modeled turbine. The predicted volumes of the damaging shear stress zones did not correlate well with observed fish mortality at a field installation of this turbine, which ranged from less than 1% to nearly 12%. Possible reasons for the poor correlation are discussed. Computational modeling is necessary to develop an understanding of the role of particular fish injury mechanisms, to compare their effects with those of other sources of injury, and to minimize the trial and error previously needed to mitigate those effects. The process we describe is being used to modify the design of hydroelectric turbines to improve fish passage survival.

  6. Shorter Duration of Post-Operative Antibiotics for Cecal Ligation and Puncture Does Not Increase Inflammation or Mortality.

    Kendra N Iskander

    Full Text Available Antimicrobial therapy for sepsis has beneficial effects, but prolonged use fosters emergence of resistant microorganisms, increases cost, and secondary infections. We tested whether 3 days versus 5 days of antibiotics in the murine model of cecal ligation and puncture (CLP negatively influences outcomes. Following CLP mice were randomized to receive the antibiotic imipenem-cilastatin (25mg/kg in dextrose 5% in Lactated Ringer's solution every 12 hours for either three or five days. Serial monitoring over 28 days included body weight, temperature, pulse oximetry, and facial vein sampling for hematological analysis and glucose. A separate group of mice were euthanized on post-CLP day 5 to measure cytokines and peritoneal bacterial counts. The first study examined no antimicrobial therapy and demonstrated that antibiotics significantly improved survival compared to fluids only (p = 0.004. We next tested imipenem-cilastatin therapy for 3 days versus 5 days. Body weight, temperature, glucose, and pulse oximetry measurements remained generally consistent between both groups as did the hematological profile. Pro-inflammatory plasma cytokines were comparable between both groups for IL-6, IL-1β, MIP-2 and anti-inflammatory cytokines IL-10, and TNF SRI. At 5 days post-CLP, i.e. 2 days after the termination of antibiotics in the 3 day group, there were no differences in the number of peritoneal bacteria. Importantly, shortening the course of antibiotics by 40% (from 5 days to 3 days did not decrease survival. Our results indicate that reducing the duration of broad-spectrum antibiotics in murine sepsis did not increase inflammation or mortality.

  7. Increased mortality in a Danish cohort of young people with Type 1 diabetes mellitus followed for 24 years.

    Sandahl, K; Nielsen, L B; Svensson, J; Johannesen, J; Pociot, F; Mortensen, H B; Hougaard, P; Broe, R; Rasmussen, M L; Grauslund, J; Peto, T; Olsen, B S

    2017-03-01

    To determine the mortality rate in a Danish cohort of children and adolescents diagnosed with Type 1 diabetes mellitus compared with the general population. In 1987 and 1989 we included 884 children and 1020 adolescents aged 20 years and under, corresponding to 75% of all Danish children and adolescents with Type 1 diabetes, in two nationwide studies in Denmark. Those who had participated in both investigations (n = 720) were followed until 1 January 2014, using the Danish Civil Registration System on death certificates and emigration. We derived the expected number of deaths in the cohort, using population data values from Statistics Denmark to calculate the standardized mortality ratio. Survival analysis was performed using Cox proportional hazards model. During the 24 years of follow-up, 49 (6.8%) patients died, resulting in a standardized mortality ratio of 4.8 (95% confidence interval 3.5, 6.2) compared with the age-standardized general population. A 1% increase in baseline HbA 1c (1989), available in 718 of 720 patients, was associated with all-cause mortality (hazard ratio = 1.38; 95% confidence interval 1.2, 1.6; P 1). Type 1 diabetes with multiple complications was the most common reported cause of death (36.7%). We found an increased mortality rate in this cohort of children and adolescents with Type 1 diabetes compared with the general population. The only predictor for increased risk of death up to 24 years after inclusion was the HbA 1c level in 1989. This emphasizes the importance of achieving optimal metabolic control in young people with Type 1 diabetes. © 2016 Diabetes UK.

  8. An increase in mean platelet volume from baseline is associated with mortality in patients with severe sepsis or septic shock.

    Chan Ho Kim

    Full Text Available Mean platelet volume (MPV is suggested as an index of inflammation, disease activity, and anti-inflammatory treatment efficacy in chronic inflammatory disorders; however, the effect of MPV on sepsis mortality remains unclear. Therefore, we investigated whether the change in MPV between hospital admission and 72 hours (ΔMPV72h-adm predicts 28-day mortality in severe sepsis and/or septic shock.We prospectively enrolled 345 patients admitted to the emergency department (ED who received standardized resuscitation (early goal-directed therapy for severe sepsis and/or septic shock between November 2007 and December 2011. Changes in platelet indices, including ΔMPV72h-adm, were compared between survivors and non-survivors by linear mixed model analysis. The prognostic value of ΔMPV72h-adm for 28-day mortality was ascertained by Cox proportional hazards model analysis.Thirty-five (10.1% patients died within 28 days after ED admission. MPV increased significantly during the first 72 hours in non-survivors (P = 0.001 and survivors (P < 0.001; however, the rate of MPV increase was significantly higher in non-survivors (P = 0.003. Nonetheless, the difference in the platelet decline rate over the first 72 hours did not differ significantly between groups (P = 0.360. In multivariate analysis, ΔMPV72h-adm was an independent predictor of 28-day mortality, after adjusting for plausible confounders (hazard ratio, 1.44; 95% confidence interval, 1.01-2.06; P = 0.044.An increase in MPV during the first 72 hours of hospitalization is an independent risk factor for adverse clinical outcomes. Therefore, continuous monitoring of MPV may be useful to stratify mortality risk in patients with severe sepsis and/or septic shock.

  9. Increased mortality among Indigenous persons in a multisite cohort of people living with HIV in Canada.

    Benoit, Anita C; Younger, Jaime; Beaver, Kerrigan; Jackson, Randy; Loutfy, Mona; Masching, Renée; Nobis, Tony; Nowgesic, Earl; O'Brien-Teengs, Doe; Whitebird, Wanda; Zoccole, Art; Hull, Mark; Jaworsky, Denise; Benson, Elizabeth; Rachlis, Anita; Rourke, Sean B; Burchell, Ann N; Cooper, Curtis; Hogg, Robert S; Klein, Marina B; Machouf, Nima; Montaner, Julio S G; Tsoukas, Chris; Raboud, Janet

    2017-06-16

    Compare all-cause mortality between Indigenous participants and participants of other ethnicities living with HIV initiating combination antiretroviral therapy (cART) in an interprovincial multi-site cohort. The Canadian Observational Cohort is a collaboration of 8 cohorts of treatment-naïve persons with HIV initiating cART after January 1, 2000. Participants were followed from the cART initiation date until death or last viral load (VL) test date on or before December 31, 2012. Cox proportional hazard models were used to estimate the effect of ethnicity on time until death after adjusting for age, gender, injection drug use, being a man who has sex with men, hepatitis C, province of origin, baseline VL and CD4 count, year of cART initiation and class of antiretroviral medication. The study sample consisted of 7080 participants (497 Indigenous, 2471 Caucasian, 787 African/Caribbean/Black (ACB), 629 other, and 2696 unknown ethnicity). Most Indigenous persons were from British Columbia (BC) (83%), with smaller numbers from Ontario (13%) and Québec (4%). During the study period, 714 (10%) participants died. The five-year survival probability was lower for Indigenous persons (0.77) than for Caucasian (0.94), ACB (0.98), other ethnicities (0.96) and unknown ethnicities (0.85) (p < 0.0001). In an adjusted proportional hazard model for which missing data were imputed, Indigenous persons were more likely to die than Caucasian participants (hazard ratio = 2.69, p < 0.0001). The mortality rate for Indigenous persons was higher than for other ethnicities and is largely reflective of the BC population. Addressing treatment challenges and identifying HIV- and non-HIV-related causes for mortality among Indigenous persons is required to optimize their clinical management.

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

    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

  11. Does caffeine consumption during pregnancy increase the risk of fetal mortality? A literature review

    Alicia Matijasevich

    2005-12-01

    Full Text Available The aim of this study was to evaluate the available epidemiological evidence of the effect of caffeine consumption during pregnancy on fetal mortality. A systematic qualitative review of observational studies that referred to any source of exposure to caffeine from food in pregnancy and to fetal mortality as the outcome was conducted in the databases MEDLINE and LILACS. Studies published between January 1966 and September 2004 were searched. The following descriptors were used: "caffeine", "coffee", "tea", "cola", and "cacao" to define the exposure and "fetal death", "stillbirth", "fetal demise", and "fetal loss" to define the outcome. The search strategy retrieved 32 publications, but only six met the inclusion criteria and three were included. One more article was found using "see related articles" feature in PubMed. A total of four publications were included in the review. The small number of publications addressing this subject, methodological limitations, inaccurate exposure assessment in all the studies, overall risks only marginally significant in most cases, and the possibility of publication bias preclude stating with certainty that caffeine consumption is actually associated with fetal death.

  12. Increased endothelial and macrophage markers are associated with disease severity and mortality in scrub typhus.

    Otterdal, Kari; Janardhanan, Jeshina; Astrup, Elisabeth; Ueland, Thor; Prakash, John A J; Lekva, Tove; Abraham, O C; Thomas, Kurien; Damås, Jan Kristian; Mathews, Prasad; Mathai, Dilip; Aukrust, Pål; Varghese, George M

    2014-11-01

    Scrub typhus is endemic in the Asia-Pacific region. Mortality is high even with treatment, and further knowledge of the immune response during this infection is needed. This study was aimed at comparing plasma levels of monocyte/macrophage and endothelial related inflammatory markers in patients and controls in South India and to explore a possible correlation to disease severity and clinical outcome. Plasma levels of ALCAM, VCAM-1, sCD163, sCD14, YKL-40 and MIF were measured in scrub typhus patients (n = 129), healthy controls (n = 31) and in infectious disease controls (n = 31), both in the acute phase and after recovery, by enzyme immunoassays. Patients had markedly elevated levels of all mediators in the acute phase, differing from both healthy and infectious disease controls. During follow-up levels of ALCAM, VCAM-1, sCD14 and YKL-40 remained elevated compared to levels in healthy controls. High plasma ALCAM, VCAM-1, sCD163, sCD14, and MIF, and in particular YKL-40 were all associated with disease severity and ALCAM, sCD163, MIF and especially YKL-40, were associated with mortality. Our findings show that scrub typhus is characterized by elevated levels of monocyte/macrophage and endothelial related markers. These inflammatory markers, and in particular YKL-40, may contribute to disease severity and clinical outcome. Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

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

    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.

  14. Temporal Discounting Is Associated with an Increased Risk of Mortality among Community-Based Older Persons without Dementia.

    Patricia A Boyle

    Full Text Available Temporal discounting is an important determinant of many health and financial outcomes, but we are not aware of studies that have examined the association of temporal discounting with mortality.Participants were 406 older persons without dementia from the Rush Memory and Aging Project, a longitudinal cohort study of aging. Temporal discounting was measured using standard preference elicitation questions. Individual discount rates were estimated using a well-established hyperbolic function and used to predict the risk of mortality during up to 5 years of follow-up.The mean estimate of discounting was 0.45 (SD = 0.33, range: 0.08-0.90, with higher scores indicating a greater propensity to prefer smaller immediate rewards over larger but delayed ones. During up to 5 years of follow-up (mean = 3.6 years, 62 (15% of 406 persons died. In a proportional hazards model adjusted for age, sex, and education, temporal discounting was associated with an increased risk of mortality (HR = 1.103, 95% CI 1.024, 1.190, p = 0.010. Thus, a person with the highest discount rate (score = 0.90 was about twice more likely to die over the study period compared to a person with the lowest discount rate (score = 0.08. Further, the association of discounting with mortality persisted after adjustment for the level of global cognitive function, the burden of vascular risk factors and diseases, and an indicator of psychological well being (i.e., purpose in life.Temporal discounting is associated with an increased risk of mortality in old age after accounting for global cognitive function and indicators of physical and mental health.

  15. Fasting Hyperglycemia Increases In-Hospital Mortality Risk in Nondiabetic Female Patients with Acute Myocardial Infarction: A Retrospective Study

    Guojing Luo

    2014-01-01

    Full Text Available Previous studies had shown that elevated admission plasma glucose (APG could increase mortality rate and serious complications of acute myocardial infarction (AMI, but whether fasting plasma glucose (FPG had the same role remains controversial. In this retrospective study, 253 cases of AMI patients were divided into diabetic (n=87 and nondiabetic group (n=166. Our results showed that: compared with the nondiabetic patients, diabetic patients had higher APG, FPG, higher plasma triglyceride, higher rates of painless AMI (P0.05. While nondiabetic patients were subgrouped in terms of APG and FPG (cut points were 11.1 mmol/L and 7.0 mmol/L, resp., the mortality rate had significant difference (P<0.01, whereas glucose level lost significance in diabetic group. Multivariate logistic regression analysis showed that FPG (OR: 2.014; 95% confidence interval: 1.296–3.131; p<0.01 but not APG was independent predictor of in-hospital mortality for nondiabetic patients. These results indicate that FPG can be an independent predictor for mortality in nondiabetic female patients with AMI.

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

    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,

  17. Prehospital trauma care reduces mortality. Ten-year results from a time-cohort and trauma audit study in Iraq

    Murad Mudhafar K

    2012-02-01

    Full Text Available Abstract Background Blunt implementation of Western trauma system models is not feasible in low-resource communities with long prehospital transit times. The aims of the study were to evaluate to which extent a low-cost prehospital trauma system reduces trauma deaths where prehospital transit times are long, and to identify specific life support interventions that contributed to survival. Methods In the study period from 1997 to 2006, 2,788 patients injured by land mines, war, and traffic accidents were managed by a chain-of-survival trauma system where non-graduate paramedics were the key care providers. The study was conducted with a time-period cohort design. Results 37% of the study patients had serious injuries with Injury Severity Score ≥ 9. The mean prehospital transport time was 2.5 hours (95% CI 1.9 - 3.2. During the ten-year study period trauma mortality was reduced from 17% (95% CI 15 -19 to 4% (95% CI 3.5 - 5, survival especially improving in major trauma victims. In most patients with airway problems, in chest injured, and in patients with external hemorrhage, simple life support measures were sufficient to improve physiological severity indicators. Conclusion In case of long prehospital transit times simple life support measures by paramedics and lay first responders reduce trauma mortality in major injuries. Delegating life-saving skills to paramedics and lay people is a key factor for efficient prehospital trauma systems in low-resource communities.

  18. A randomized controlled trial of levosimendan to reduce mortality in high-risk cardiac surgery patients (CHEETAH): Rationale and design.

    Zangrillo, Alberto; Alvaro, Gabriele; Pisano, Antonio; Guarracino, Fabio; Lobreglio, Rosetta; Bradic, Nikola; Lembo, Rosalba; Gianni, Stefano; Calabrò, Maria Grazia; Likhvantsev, Valery; Grigoryev, Evgeny; Buscaglia, Giuseppe; Pala, Giovanni; Auci, Elisabetta; Amantea, Bruno; Monaco, Fabrizio; De Vuono, Giovanni; Corcione, Antonio; Galdieri, Nicola; Cariello, Claudia; Bove, Tiziana; Fominskiy, Evgeny; Auriemma, Stefano; Baiocchi, Massimo; Bianchi, Alessandro; Frontini, Mario; Paternoster, Gianluca; Sangalli, Fabio; Wang, Chew-Yin; Zucchetti, Maria Chiara; Biondi-Zoccai, Giuseppe; Gemma, Marco; Lipinski, Michael J; Lomivorotov, Vladimir V; Landoni, Giovanni

    2016-07-01

    Patients undergoing cardiac surgery are at risk of perioperative low cardiac output syndrome due to postoperative myocardial dysfunction. Myocardial dysfunction in patients undergoing cardiac surgery is a potential indication for the use of levosimendan, a calcium sensitizer with 3 beneficial cardiovascular effects (inotropic, vasodilatory, and anti-inflammatory), which appears effective in improving clinically relevant outcomes. Double-blind, placebo-controlled, multicenter randomized trial. Tertiary care hospitals. Cardiac surgery patients (n = 1,000) with postoperative myocardial dysfunction (defined as patients with intraaortic balloon pump and/or high-dose standard inotropic support) will be randomized to receive a continuous infusion of either levosimendan (0.05-0.2 μg/[kg min]) or placebo for 24-48 hours. The primary end point will be 30-day mortality. Secondary end points will be mortality at 1 year, time on mechanical ventilation, acute kidney injury, decision to stop the study drug due to adverse events or to start open-label levosimendan, and length of intensive care unit and hospital stay. We will test the hypothesis that levosimendan reduces 30-day mortality in cardiac surgery patients with postoperative myocardial dysfunction. This trial is planned to determine whether levosimendan could improve survival in patients with postoperative low cardiac output syndrome. The results of this double-blind, placebo-controlled randomized trial may provide important insights into the management of low cardiac output in cardiac surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Meditations on birth weight: is it better to reduce the variance or increase the mean?

    Haig, David

    2003-07-01

    A conceptual model is presented here in which the birth weight distribution is decomposed into a distribution of target weights and a distribution of perturbations from the target. The target weight is the adaptive goal of fetal development. In the simplest model, perinatal mortality is independent of variation in target weight and determined solely by the magnitude of the perturbation of birth weight from the target. In this model, mortality risk is concentrated in the tails of the birth weight distribution. A difference between populations in their distributions of target weights will be associated with a corresponding shift in their curves of weight-specific risk, without any difference between the populations in overall risk. In this model, risk would be reduced by decreasing the variance of the distribution of perturbations. The model is discussed in the context of the so-called "paradoxes of low birth weight."

  20. High Levels of Methylarginines Were Associated With Increased Mortality in Patients With Severe Sepsis

    Mortensen, Karoline Myglegard; Itenov, Theis Skovsgaard; Haase, Nicolai

    2016-01-01

    Introduction: Nitric oxide (NO) likely plays a pivotal role in the pathogenesis of sepsis. Arginine is a substrate for NO, whereas the methylated arginines—asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA)—are endogenous by-products of proteolysis that inhibit NO production....... We investigated if high-plasma levels of ADMA, SDMA, and arginine/ADMA ratio were associated with 90-day mortality in patients with severe sepsis or septic shock. Methods: We included 267 adult patients admitted to intensive care unit with severe sepsis or septic shock. The patients had previously...... been included in the randomized controlled trial “Scandinavian Starch for Severe Sepsis and Septic Shock (6S).” ADMA, SDMA, and arginine/ADMA ratio were measured in plasma. The risk of death within 90 days was estimated in multivariate Cox regression analyses adjusted for gender, age >=65 years, major...

  1. Association Between Portosystemic Shunts and Increased Complications and Mortality in Patients With Cirrhosis

    Simón-Talero, Macarena; Roccarina, Davide; Martínez, Javier

    2018-01-01

    , comorbidities, complications, treatments, laboratory and clinical parameters, model for end-stage liver disease (MELD) score, and endoscopy findings. Abdominal images were reviewed by a radiologist (or a hepatologist trained by a radiologist) and searched for the presence of SPSS, defined as spontaneous...... communications between the portal venous system or splanchnic veins and the systemic venous system, excluding gastroesophageal varices. Patients were assigned to groups with large SPSSs (L-SPSSs, ≥8 mm), small SPSSs (S-SPSSs, SPSS (W-SPSS). The main outcomes were the incidence of complications...... of cirrhosis and mortality according to the presence of SPSS. Secondary measurements were the prevalence of SPSSs in patients with cirrhosis and their radiologic features. RESULTS: L-SPSS were identified in 488 patients (28%), S-SPSS in 548 patients (32%), and no shunt (W-SPSS) in 693 patients (40%). The most...

  2. Ways to Reduce In-Hospital Mortality in Patients with Cardiogenic Shock in Acute Coronary Syndrome

    G. V. Artamonova

    2013-01-01

    Full Text Available Objective: to analyze a medical care system for acute coronary syndrome (ACS in a large city in terms of in-hospital cardiogenic shock mortality risk management. Materials and methods. The health care facility management system for a risk for cardiogenic shock (CS and its poor outcome (death was a methodological basis of this study. The information from case histories of ACS patients consecutively admitted to the Kemerovo Cardiology Dispensary (Kemerovo, Russia in the period 2006 to 2011 was used to develop an electronic database. Sampling included 19281 patients with ACS, 6537 with myocardial infarction (MI, 493 with CS. Results and discussion. The medical care system for patients with ACS encompasses an emergency team (a prehospital level, a specialized cardiac hospital (an in-hospital level with a multistage therapeutic and diagnostic process in relation the severity of a patient’s status. The management is based on the principle of continuity of care, by applying the well-defined activity algorithms through valid information exchange and risk stratification for poor outcomes of ACS. An antishock team working just in the admission unit of a hospital was set up to treat high CS risk patients. A systems approach allowed the strategy of early specialized medical care to be developed with a priority of primary percutaneous coronary interventions (PCI as reperfusion therapy in patients with ST-elevation MI. In 2006-2011, every three patients with suspected ACS had verified MI that was com_ plicated by CS in 7.5%. In the CS group, the in-hospital mortality rates totaled 88.0% of cases; that after primary Адрес для корреспонденции (Correspondence to: PCI was 62.2%. In the examined period, the introduction of innovation clinical and organizational approaches provided a reduction in this indicator by 17.6 and 37.5%, respectively. Conclusion. The efficiency of risk management for CS and its poor outcomes in patients with ACS is

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

    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

  4. Medical closure of patent ductus arteriosus does not reduce mortality and development of bronchopulmonary dysplasia in preterm infants.

    Terek, Demet; Yalaz, Mehmet; Ulger, Zulal; Koroglu, Ozge Altun; Kultursay, Nilgun

    2014-11-01

    Although, patent ductus arteriosus (PDA) is associated with significant morbidity due to hemodynamic instability in preterm infants, the effect of ductus closure on mortality and morbidity is a controversial issue. The aim is to evaluate the efficacy of oral and intravenous (IV) ibuprofen treatment on ductal closure and effects on mortality and bronchoplumonary dysplasia. The medical records of 292 premature infants treated at Ege University Neonatal Intensive Care Unit were retrospectively evaluated. Patients were classified into 3 groups as; No PDA, hemodynamically insignificant PDA (hiPDA) and hemodynamically significant PDA (hsPDA) according to the presence and hemodynamical significance of PDA by echocardiography. hsPDA group was treated with IV or oral ibuprofen. Patent ductus arteriosus was diagnosed by routine echocardiography in 145 patients, of whom 78 (53.7%) had hsPDA. All 65 infants with hiPDA had spontaneous PDA closure. Echocardiographic measurements were similar to those patients treated with oral or IV ibuprofen, as in the response rate to treatment without serious adverse effects. The presence of respiratory distress syndrome, surfactant therapy, late sepsis, bronchopulmonary dysplasia (BPD) and mortality rates were significantly higher in patients with hsPDA. However, with stepwise logistic regression; 5(th) min Apgar score (odds ratio [OR], 1.321, 95% confidence interval [CI], 1.063-1.641, P = 0.012) and gestational age (OR, 1.422, 95% CI, 1.212-1.662, P closure with minimal side effects. HiPDA can close spontaneously; therefore treatment decision should be individualized. However, medical treatment of PDA does not reduce mortality and BPD.

  5. Increased mortality in a Danish cohort of young people with Type 1 diabetes mellitus followed for 24 years

    Sandahl, Kristian; Nielsen, L B; Svensson, J

    2017-01-01

    AIM: To determine the mortality rate in a Danish cohort of children and adolescents diagnosed with Type 1 diabetes mellitus compared with the general population. METHODS: In 1987 and 1989 we included 884 children and 1020 adolescents aged 20 years and under, corresponding to 75% of all Danish......% confidence interval 3.5, 6.2) compared with the age-standardized general population. A 1% increase in baseline HbA1c (1989), available in 718 of 720 patients, was associated with all-cause mortality (hazard ratio = 1.38; 95% confidence interval 1.2, 1.6; P Type 1 diabetes with multiple...... complications was the most common reported cause of death (36.7%). CONCLUSION: We found an increased mortality rate in this cohort of children and adolescents with Type 1 diabetes compared with the general population. The only predictor for increased risk of death up to 24 years after inclusion was the HbA1c...

  6. Training Zambian traditional birth attendants to reduce neonatal mortality in the Lufwanyama Neonatal Survival Project (LUNESP).

    Gill, Christopher J; Guerina, Nicholas G; Mulenga, Charity; Knapp, Anna B; Mazala, Grace; Hamer, Davidson H

    2012-07-01

    To provide relevant details on how interventions in the Lufwanyama Neonatal Survival Project (LUNESP) were developed and how Zambian traditional birth attendants (TBAs) were trained to perform them. The study tested 2 interventions: a simplified version of the American Academy of Pediatrics' neonatal resuscitation protocol (NRP); and antibiotics with facilitated referral (AFR). Key elements that enabled the positive study result were: focusing on common and correctible causes of mortality; selecting a study population with high unmet public health need; early community mobilization to build awareness and support; emphasizing simplicity in the intervention technology and algorithms; using a traditional training approach appropriate to students with low literacy rates; requiring TBAs to demonstrate their competence before completing each workshop; and minimizing attrition of skills by retraining and reassessing the TBAs regularly throughout the study. An effective NRP training model was created that is suitable for community-based neonatal interventions, in research or programmatic settings, and by practitioners with limited obstetric skills and low rates of literacy. Clinicaltrials.gov NCT00518856. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

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

    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.

  8. Reducing maternal mortality in Yemen: challenges and lessons learned from baseline assessment.

    Al Serouri, Abdul Wahed; Al Rabee, Arwa; Bin Afif, Mohammed; Al Rukeimi, Abdullah

    2009-04-01

    The Yemen is a signatory of the Millennium Development Goals (MDGs) and one of 10 countries chosen for the UN Millennium Project. However, recent MDG progress reviews show that it is unlikely that the maternal health goal will be reached by 2015 and Yemen still has an unacceptably high maternal mortality of 365 per 100000 live births. Because 82% of deaths happen intrapartum, the purpose of this needs assessment was to identify and prioritize constraints in delivery of emergency obstetric care (EmOC). Four district hospitals and 16 health centers in 8 districts were assessed for functional capacity in terms of infrastructure; availability of essential equipment and drugs; EmOC technical competency and training needs; and Health Management Information System. We found poor obstetric services in terms of structure (staffing pattern, equipment, and supplies) and process (knowledge and management skills). The data argue for strengthening the 4 interlinked health system elements-human resources, and access to, use, and quality of services. The Government must address each of these elements to meet the Safe Motherhood MDG.

  9. Metastases but not cardiovascular mortality reduces life expectancy following surgical resection of apparently benign pheochromocytoma.

    Timmers, H J L M; Brouwers, F M; Hermus, A R M M; Sweep, F C G J; Verhofstad, A A J; Verbeek, A L M; Pacak, K; Lenders, J W M

    2008-12-01

    The treatment of choice for non-metastatic pheochromocytoma is surgical resection. Its goals are to abolish catecholamine hypersecretion, normalize blood pressure, and prevent further tumor growth or progression to metastatic disease. Data on long-term mortality and morbidity after pheochromocytoma surgery are limited. We here report a retrospective study on the long-term outcome after surgery for apparently benign pheochromocytoma at the Radboud University Nijmegen Medical Centre. Data on clinical presentation, treatment, post-surgical blood pressure and recurrence, metastasis and death were collected of 69 consecutive patients (January 1966-December 2000; follow-up: until death or January 2006). Survival was compared with survival of a matched reference population. Two patients died of surgical complications. All ten patients with metastatic disease (including three diagnosed at first surgery) died. At follow-up, 40 patients were alive and recurrence free and three patients were lost to follow up. Two patients experienced a benign recurrence. Mean+/-s.d. follow-up was 10.2+/-7.5 (median 9, range 1-38) years. Kaplan-Meier estimates for 5- and 10-year survival since surgery were 85.8% (95% CI: 77.2-94.4%) and 74.2% (95% CI: 62.0-86.4%) for patients versus 95.5 and 89.4% in the reference population (Prisk of developing metastatic disease. Only one-third becomes normotensive without antihypertensive medication. Therefore, lifelong follow-up is warranted.

  10. Reduced hemoglobin and increased C-reactive protein are associated with upper gastrointestinal bleeding.

    Tomizawa, Minoru; Shinozaki, Fuminobu; Hasegawa, Rumiko; Togawa, Akira; Shirai, Yoshinori; Ichiki, Noboru; Motoyoshi, Yasufumi; Sugiyama, Takao; Yamamoto, Shigenori; Sueishi, Makoto

    2014-02-07

    To investigate the early upper gastrointestinal endoscopy (endoscopy) significantly reduces mortality resulting from upper gastrointestinal (GI) bleeding. Upper GI bleeding was defined as 1a, 1b, 2a, and 2b according to the Forrest classification. The hemoglobin (Hb), and C-reactive protein (CRP) were examined at around the day of endoscopy and 3 mo prior to endoscopy. The rate of change was calculated as follows: (the result of blood examination on the day of endoscopy - the results of blood examination 3 mo prior to endoscopy)/(results of blood examination 3 mo prior to endoscopy). Receiver operating characteristic curves were created to determine threshold values. Seventy-nine men and 77 women were enrolled. There were 17 patients with upper GI bleeding: 12 with a gastric ulcer, 3 with a duodenal ulcer, 1 with an acute gastric mucosal lesion, and 1 with gastric cancer. The area under the curve (AUC), threshold, sensitivity, and specificity of Hb around the day of endoscopy were 0.902, 11.7 g/dL, 94.1%, and 77.1%, respectively, while those of CRP were 0.722, 0.5 mg/dL, 70.5%, and 73%, respectively. The AUC, threshold, sensitivity, and specificity of the rate of change of Hb were 0.851, -21.3%, 76.4%, and 82.6%, respectively, while those of CRP were 0.901, 100%, 100%, and 82.5%, respectively. Predictors for upper GI bleeding were Hb 21.3% and an increase in the CRP > 100%, 3 mo before endoscopy.

  11. All-cause mortality increased by environmental cadmium exposure in the Japanese general population in cadmium non-polluted areas.

    Suwazono, Yasushi; Nogawa, Kazuhiro; Morikawa, Yuko; Nishijo, Muneko; Kobayashi, Etsuko; Kido, Teruhiko; Nakagawa, Hideaki; Nogawa, Koji

    2015-07-01

    The aim of the present study was to evaluate the effect of environmental cadmium (Cd) exposure indicated by urinary Cd on all-cause mortality in the Japanese general population. A 19-year cohort study was conducted in 1067 men and 1590 women aged 50 years or older who lived in three cadmium non-polluted areas in Japan. The subjects were divided into four quartiles based on creatinine adjusted U-Cd (µg g(-1) cre). The hazard ratio (HR) and 95% confidence interval (CI) for continuous U-Cd or the quartiles of U-Cd were estimated for all-cause mortality using a proportional hazards regression.The all-cause mortality rates per 1000 person years were 31.2 and 15.1 in men and women, respectively. Continuous U-Cd (+1 µg g(-1) cre) was significantly related to the all-cause mortality in men (HR 1.05, 95% CI: 1.02-1.09) and women (HR 1.04, 95% CI: 1.01-1.07). Furthermore in men, the third (1.96-3.22 µg g(-1) cre) and fourth quartile (≥3.23 µg g(-1) cre) of U-Cd showed a significant, positive HR (third: HR 1.35, 95% CI: 1.03-1.77, fourth: HR 1.64, 95% CI: 1.26-2.14) for all-cause mortality compared with the first quartile (women, the fourth quartile of U-Cd (≥4.66 µg g(-1) cre) also showed a significant HR (1.49, 95% CI 1.11-2.00) for all-cause mortality compared with the first quartile (<1.46 µg g(-1) cre).In the present study, U-Cd was significantly associated with increased mortality in the Japanese general population, indicating that environmental Cd exposure adversely affects the life prognosis in Cd non-polluted areas in Japan. Copyright © 2014 John Wiley & Sons, Ltd.

  12. INCREASE INCOME AND MORTALITY OF COLORRECTAL CANCER IN BRAZIL, 2001-2009

    Raphael Mendonça GUIMARÃES

    2013-03-01

    Full Text Available Context Several international studies have observed a correlation between the improvement of socio-demographic indicators and rates of incidence and mortality from cancer of the colon and rectum. Objective The objective of this study is to estimate the correlation between average per capita income and the rate of colorectal cancer mortality in Brazil between 2001 and 2009. Methods We obtained data on income inequality (Gini index, population with low incomes (½ infer the minimum wage/month, average family income, per capita ICP and mortality from colon cancer and straight between 2001-2009 by DATASUS. A trend analysis was performed using linear regression, and correlation between variables by Pearson's correlation coefficient. Results There was a declining trend in poverty and income inequality, and growth in ICP per capita and median family income and standardized mortality rate for colorectal cancer in Brazil. There was also strong positive correlation between mortality from this site of cancer and inequality (men r = -0.30, P = 0.06, women r = -0.33, P = 0.05 income low income (men r = -0.80, P Contexto Diversos estudos internacionais têm observado uma correlação entre a melhora dos indicadores sociodemográficos e as taxas de incidência e mortalidade por câncer de cólon e reto. Objetivo O objetivo do presente estudo é estimar a correlação entre renda média per capita e a taxa de mortalidade por câncer colorretal no Brasil entre 2001 e 2009. Métodos Obteve-se os dados de desigualdade de renda (índice de Gini, população que vive com baixa renda (inferir a ½ salário mínimo/mês, renda média familiar, PIB per capita e taxa de mortalidade por câncer de cólon e reto entre 2001 e 2009 através do DATASUS. A análise de tendência foi realizada através do método de regressão linear, e a correlação entre as variáveis através do coeficiente de correlação de Pearson. Resultados Observou-se tendência ao declínio da

  13. National and sub-national analysis of the health benefits and cost-effectiveness of strategies to reduce maternal mortality in Afghanistan.

    Carvalho, Natalie; Salehi, Ahmad Shah; Goldie, Sue J

    2013-01-01

    Afghanistan has one of the highest rates of maternal mortality in the world. We assess the health outcomes and cost-effectiveness of strategies to improve the safety of pregnancy and childbirth in Afghanistan. Using national and sub-national data, we adapted a previously validated model that simulates the natural history of pregnancy and pregnancy-related complications. We incorporated data on antenatal care, family planning, skilled birth attendance and information about access to transport, referral facilities and quality of care. We evaluated single interventions (e.g. family planning) and strategies that combined several interventions packaged as integrated services (transport, intrapartum care). Outcomes included pregnancy-related complications, maternal deaths, maternal mortality ratios, costs and cost-effectiveness ratios. Model-projected reduction in maternal deaths between 1999-2002 and 2007-08 approximated 20%. Increasing family planning was the most effective individual intervention to further reduce maternal mortality; up to 1 in 3 pregnancy-related deaths could be prevented if contraception use approached 60%. Nevertheless, reductions in maternal mortality reached a threshold (∼30% to 40%) without strategies that assured women access to emergency obstetrical care. A stepwise approach that coupled improved family planning with incremental improvements in skilled attendance, transport, referral and appropriate intrapartum care and high-quality facilities prevented 3 of 4 maternal deaths. Such an approach would cost less than US$200 per year of life saved at the national level, well below Afghanistan's per capita gross domestic product (GDP), a common benchmark for cost-effectiveness. Similar results were noted sub-nationally. Our findings reinforce the importance of early intensive efforts to increase family planning for spacing and limiting births and to provide control of fertility choices. While significant improvements in health delivery

  14. Exposure to Sublethal Doses of Fipronil and Thiacloprid Highly Increases Mortality of Honeybees Previously Infected by Nosema ceranae

    Vidau, Cyril; Diogon, Marie; Aufauvre, Julie; Fontbonne, Régis; Viguès, Bernard; Brunet, Jean-Luc; Texier, Catherine; Biron, David G.; Blot, Nicolas; El Alaoui, Hicham; Belzunces, Luc P.; Delbac, Frédéric

    2011-01-01

    Background The honeybee, Apis mellifera, is undergoing a worldwide decline whose origin is still in debate. Studies performed for twenty years suggest that this decline may involve both infectious diseases and exposure to pesticides. Joint action of pathogens and chemicals are known to threaten several organisms but the combined effects of these stressors were poorly investigated in honeybees. Our study was designed to explore the effect of Nosema ceranae infection on honeybee sensitivity to sublethal doses of the insecticides fipronil and thiacloprid. Methodology/Finding Five days after their emergence, honeybees were divided in 6 experimental groups: (i) uninfected controls, (ii) infected with N. ceranae, (iii) uninfected and exposed to fipronil, (iv) uninfected and exposed to thiacloprid, (v) infected with N. ceranae and exposed 10 days post-infection (p.i.) to fipronil, and (vi) infected with N. ceranae and exposed 10 days p.i. to thiacloprid. Honeybee mortality and insecticide consumption were analyzed daily and the intestinal spore content was evaluated 20 days after infection. A significant increase in honeybee mortality was observed when N. ceranae-infected honeybees were exposed to sublethal doses of insecticides. Surprisingly, exposures to fipronil and thiacloprid had opposite effects on microsporidian spore production. Analysis of the honeybee detoxification system 10 days p.i. showed that N. ceranae infection induced an increase in glutathione-S-transferase activity in midgut and fat body but not in 7-ethoxycoumarin-O-deethylase activity. Conclusions/Significance After exposure to sublethal doses of fipronil or thiacloprid a higher mortality was observed in N. ceranae-infected honeybees than in uninfected ones. The synergistic effect of N. ceranae and insecticide on honeybee mortality, however, did not appear strongly linked to a decrease of the insect detoxification system. These data support the hypothesis that the combination of the increasing

  15. Increased mortality among patients admitted with major psychiatric disorders: a register-based study comparing mortality in unipolar depressive disorder, bipolar affective disorder, schizoaffective disorder, and schizophrenia

    Laursen, Thomas Munk; Munk-Olsen, Trine; Nordentoft, Merete

    2007-01-01

    disorder has never been examined in a population-based study. OBJECTIVE: Our objective was to examine and compare mortality rates after admission with schizophrenia, schizoaffective disorder, unipolar depressive disorder, or bipolar affective disorder and to examine the impact of family history......: Unipolar depressive disorder, bipolar affective disorder, and schizoaffective disorder were associated with the same pattern of excess mortality. Schizophrenia had a lower mortality from unnatural causes of death and a higher mortality from natural causes compared to the 3 other disorders. Family history...

  16. The ability of winter grazing to reduce wildfire size, intensity, and fire-induced plant mortality was not demonstrated: A comment on Davies et al. (2015)

    A recent study by Davies et al. sought to test whether winter grazing could reduce wildfire size, fire behavior metrics, and fire-induced plant mortality in shrub-grasslands. The authors concluded that ungrazed rangelands may experience more fire-induced mortality of native peren...

  17. Widespread crown condition decline, food web disruption, and amplified tree mortality with increased climate change-type drought.

    Carnicer, Jofre; Coll, Marta; Ninyerola, Miquel; Pons, Xavier; Sánchez, Gerardo; Peñuelas, Josep

    2011-01-25

    Climate change is progressively increasing severe drought events in the Northern Hemisphere, causing regional tree die-off events and contributing to the global reduction of the carbon sink efficiency of forests. There is a critical lack of integrated community-wide assessments of drought-induced responses in forests at the macroecological scale, including defoliation, mortality, and food web responses. Here we report a generalized increase in crown defoliation in southern European forests occurring during 1987-2007. Forest tree species have consistently and significantly altered their crown leaf structures, with increased percentages of defoliation in the drier parts of their distributions in response to increased water deficit. We assessed the demographic responses of trees associated with increased defoliation in southern European forests, specifically in the Iberian Peninsula region. We found that defoliation trends are paralleled by significant increases in tree mortality rates in drier areas that are related to tree density and temperature effects. Furthermore, we show that severe drought impacts are associated with sudden changes in insect and fungal defoliation dynamics, creating long-term disruptive effects of drought on food webs. Our results reveal a complex geographical mosaic of species-specific responses to climate change-driven drought pressures on the Iberian Peninsula, with an overwhelmingly predominant trend toward increased drought damage.

  18. The medical use of cannabis for reducing morbidity and mortality in patients with HIV/AIDS.

    Lutge, Elizabeth E; Gray, Andy; Siegfried, Nandi

    2013-04-30

    The use of cannabis (marijuana) or of its psychoactive ingredient delta-9-tetrahydrocannabinol (THC) as a medicine has been highly contested in many settings.There have been claims that smoked or ingested cannabis, either in its natural form or artificial form (pharmaceutically manufactured drug such as dronabinol), improves the appetites of people with AIDS, results in weight gain and lifts mood, thus improving the quality of life. The objectives of this review were to assess whether cannabis (in its natural or artificially produced form), either smoked or ingested, decreases the morbidity or mortality of patients infected with HIV. The search strategy was conducted to July 2012 and was based on that of the Cochrane HIV/AIDS Review Group. We searched the following databases: CENTRAL/CCTR, MEDLINE and EMBASE. In addition, searching was performed where necessary of journals, reference lists of articles, and conference proceedings. The review included randomised controlled trials (RCTs) of any cannabis intervention, in any form, and administered by any route, in adults with HIV or AIDS, compared with placebo or with a known effective treatment, and conducted in a hospital, outpatient clinic, or home care setting. Quasi-randomised studies using any form of cannabis as an intervention in patients with HIV or AIDS were also included. Data from the eligible studies were extracted and coded independently by two researchers, using a standardised data extraction form. Data were then analysed using RevMan 5.0. No meta-analyses were performed. A total of seven relevant studies were included in the review, reported in eight publications. All were randomised controlled studies, with four utilising a parallel group design, two a within-subject randomisation and two a cross-over design. All of the studies were of a fairly short duration, ranging from 21 days to 84 days. In only four papers (in effect, three studies) were sequence generation and allocation concealment judged to be

  19. World Health Organization perspectives on the contribution of the Global Alliance for Vaccines and Immunization on reducing child mortality.

    Bustreo, F; Okwo-Bele, J-M; Kamara, L

    2015-02-01

    Child mortality has decreased substantially globally-from 12.6 million in 1990 to 6.3 million in 2013-due, in large part to of governments' and organisations' work, to prevent pneumonia, diarrhoea and malaria, the main causes of death in the postneonatal period. In 2012, the World Health Assembly adopted the Decade of Vaccines Global Vaccine Action Plan 2011-2020 as the current framework aimed at preventing millions of deaths through more equitable access to existing vaccines for people in all communities. The Global Alliance for Vaccines and Immunization (GAVI) plays a critical role in this effort by financing and facilitating delivery platforms for vaccines, with focused support for the achievements of improved vaccination coverage and acceleration of the uptake of WHO-recommended lifesaving new vaccines in 73 low-income countries. The GAVI Alliance has contributed substantially towards the progress of Millennium Development Goal 4 and to improving women's lives. By 2013, the GAVI Alliance had immunised 440 million additional children and averted six million future deaths from vaccine-preventable diseases in the world's poorest countries. The GAVI Alliance is on track to reducing child mortality to 68 per 1000 live births by 2015 in supported countries. This paper discusses the GAVI Alliance achievements related to Millennium Development Goal 4 and its broader contribution to improving women's lives and health systems, as well as challenges and obstacles it has faced. Additionally, it looks at challenges for the future and how it will continue its work related to reducing child mortality and improving women's health. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. Population-based screening program for reducing oral cancer mortality in 2,334,299 Taiwanese cigarette smokers and/or betel quid chewers.

    Chuang, Shu-Lin; Su, William Wang-Yu; Chen, Sam Li-Sheng; Yen, Amy Ming-Fang; Wang, Cheng-Ping; Fann, Jean Ching-Yuan; Chiu, Sherry Yueh-Hsia; Lee, Yi-Chia; Chiu, Han-Mo; Chang, Dun-Cheng; Jou, Yann-Yuh; Wu, Chien-Yuan; Chen, Hsiu-Hsi; Chen, Mu-Kuan; Chiou, Shu-Ti

    2017-05-01

    To reduce oral cancer mortality, an organized, population-based screening program for the early detection of oral premalignancy and oral cancer was designed for high-risk individuals with habits of betel quid chewing, cigarette smoking, or both. The objective of this report was to evaluate the long-term effectiveness of this program in reducing the incidence of advanced disease and deaths from oral cancer. A nationwide, population-based screening program for oral cancer has been conducted in Taiwan since 2004. Residents aged ≥ 18 years with oral habits of cigarette smoking and/or betel quid chewing were invited. The standardized mortality ratio method was used to compare the observed numbers of advanced oral cancers and deaths from oral cancer among screening attendees with the expected numbers derived from mortality among nonattendees. An intention-to-treat analysis of the relative rate of reductions in advanced-stage oral cancers and oral cancer mortality also was conducted. The overall screening rate was 55.1%. The relative risk of death from oral cancer was 0.53 (95% confidence interval [CI], 0.51-0.56) as a result of screening compared with the expected risk of oral cancer deaths in the absence of screening. The corresponding relative risk was 0.74 (95% CI, 0.72-0.77) after adjusting for self-selection bias. The relative risk of advanced oral cancer for the screened group versus the nonscreened group was 0.62 (95% CI, 0.59-0.64), which increased to 0.79 (95% CI, 0.76-0.82) after adjustment for self-selection bias. An organized, population-based oral cancer screening program targeting more than 2 million Taiwanese cigarette smokers and/or betel quid chewers demonstrated the effectiveness of reducing stage III or IV oral cancers and oral cancer mortality. These evidence-based findings corroborate and support the screening strategy of oral visual inspection for the prevention of oral cancer among high-risk individuals in areas with a high incidence of oral

  1. Increased cardiovascular mortality more than fifteen years after radiotherapy for breast cancer: a population-based study

    Roychoudhuri, Rahul; Robinson, David; Putcha, Venkata; Cuzick, Jack; Darby, Sarah; Møller, Henrik

    2007-01-01

    Breast radiotherapy as practised in the 1970s and 1980s resulted in significant myocardial exposure, and this was higher when the left breast was treated. It has been proposed that this difference might result in greater cardiovascular mortality following irradiation of the left breast when compared with the right. All cases of female breast cancer diagnosed between 1971 and 1988 and recorded on the Thames Cancer Registry database were followed up to the end of 2003 to identify cases who had died from ischaemic heart disease (IHD) or any cardiovascular disease (CVD). A proportional hazards regression analysis was performed, stratified by time since diagnosis, using as the baseline group those women with right-sided disease who did not receive radiotherapy, and adjusting for age at diagnosis. A total of 20,871 women with breast cancer were included in the analysis, of which 51% had left-sided disease. Mortality at 15+ years after diagnosis was increased in recipients of left-breast radiotherapy compared to non-irradiated women with right-sided breast cancer, both for IHD (hazard ratio 1.59; 95% confidence interval 1.21–2.08; p = 0.001) and all CVD (hazard ratio 1.27; 95% confidence interval 1.07–1.51; p = 0.006). When irradiated women with left-sided breast cancer were compared with irradiated women with right-sided breast cancer, cardiovascular mortality at 15+ years after diagnosis was raised by around 25% (IHD: hazard ratio 1.23; 95% confidence interval 0.95–1.60; p = 0.114; CVD: hazard ratio 1.25; 95% confidence interval 1.05–1.49; p = 0.014). We have found an elevation in cardiovascular mortality more than 15 years after breast radiotherapy in women diagnosed with breast cancer between 1971 and 1988. The risk was greater following irradiation of the left breast compared with the right. This confirms that radiotherapy as practised in the 1970s and 1980s has resulted in significant long-term cardiac toxicity. In absolute terms, the increase in

  2. β-Blockers on Discharge From Acute Atrial Fibrillation Are Associated With Decreased Mortality and Lower Cerebrovascular Accidents in Patients With Heart Failure and Reduced Ejection Fraction.

    Abi Khalil, Charbel; Zubaid, Mohammad; Asaad, Nidal; Rashed, Wafa A; Hamad, Adel Khalifa; Singh, Rajvir; Al Suwaidi, Jassim

    2018-04-01

    The benefits of β-blockers in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) are controversial. The Gulf Survey of Atrial Fibrillation Events was a prospective, multinational, observational registry of consecutive patients with AF recruited from the emergency department (ED). We studied the incidence of 6- and 12-month mortality, hospitalization for HF or AF, and stroke/transient ischemic attacks (TIAs) in patients with HFrEF, in relation to β-blockers on discharge from the ED or the subsequent hospital stay. Of the 344 patients with HFrEF and AF in the GULF-SAFE, 177 patients (53%) were discharged on β-blockers. Mortality was lower in those patients compared with the non-β-blockers group at 6 and 12 months (odds ratios [ORs] 0.31, 95% CI [0.16-0.61]; OR 0.30, 95% CI [0.16-0.55]; P = .001 for both, respectively), so was the risk of stroke/TIAs. However, hospitalizations for AF increased in the β-blockers group. Even after adjustment for several risk variables in 2 different models, the beneficial effect of β-blockers on mortality persisted, at the cost of more hospitalization for AF.

  3. Estimating PM2.5-associated mortality increase in California due to the Volkswagen emission control defeat device

    Wang, Tianyang; Jerrett, Michael; Sinsheimer, Peter; Zhu, Yifang

    2016-11-01

    The Volkswagen Group of America (VW) was found by the US Environmental Protection Agency (EPA) and the California Air Resources Board (CARB) to have installed "defeat devices" and emit more oxides of nitrogen (NOx) than permitted under current EPA standards. In this paper, we quantify the hidden NOx emissions from this so-called VW scandal and the resulting public health impacts in California. The NOx emissions are calculated based on VW road test data and the CARB Emission Factors (EMFAC) model. Cumulative hidden NOx emissions from 2009 to 2015 were estimated to be over 3500 tons. Adult mortality changes were estimated based on ambient fine particulate matter (PM2.5) change due to secondary nitrate formation and the related concentration-response functions. We estimated that hidden NOx emissions from 2009 to 2015 have resulted in a total of 12 PM2.5-associated adult mortality increases in California. Most of the mortality increase happened in metropolitan areas, due to their high population and vehicle density.

  4. Statin treatment prevents increased cardiovascular and all-cause mortality associated with clarithromycin in patients with stable coronary heart disease

    Jensen, Gorm B; Hilden, Jørgen; Als-Nielsen, Bodil

    2010-01-01

    In the CLARICOR trial, significantly increased cardiovascular (CV) and all-cause mortality in stable patients with coronary heart disease were observed after a short course of clarithromycin. We report on the impact of statin treatment at entry on the CV and all-cause mortality. The multicenter...... CLARICOR trial randomized patients to oral clarithromycin (500 mg daily; n = 2172) versus matching placebo (daily; n = 2201) for 2 weeks. Patients were followed through public databases. In the 41% patients on statin treatment at entry, no significant effect of clarithromycin was observed on CV (hazard...... ratio [HR], 0.68, 95% confidence interval [CI], 0.38-1.22; P = 0.20) or all-cause mortality (HR, 1.08; 95% CI, 0.71-1.65; P = 0.72) at 2.6-year follow up. In the patients not on statin treatment at entry, clarithromycin was associated with a significant increase in CV (HR, 1.90; 95% CI, 1.34-2.67; P = 0...

  5. Increased risk of all-cause mortality and renal graft loss in stable renal transplant recipients with hyperparathyroidism.

    Pihlstrøm, Hege; Dahle, Dag Olav; Mjøen, Geir; Pilz, Stefan; März, Winfried; Abedini, Sadollah; Holme, Ingar; Fellström, Bengt; Jardine, Alan G; Holdaas, Hallvard

    2015-02-01

    Hyperparathyroidism is reported in 10% to 66% of renal transplant recipients (RTR). The influence of persisting hyperparathyroidism on long-term clinical outcomes in RTR has not been examined in a large prospective study. We investigated the association between baseline parathyroid hormone (PTH) levels and major cardiovascular events, renal graft loss, and all-cause mortality by Cox Proportional Hazard survival analyses in 1840 stable RTR derived from the Assessment of LEscol in Renal Transplantation trial. Patients were recruited in a mean of 5.1 years after transplantation, and follow-up time was 6 to 7 years. Significant associations between PTH and all 3 outcomes were found in univariate analyses. When adjusting for a range of plausible confounders, including measures of renal function and serum mineral levels, PTH remained significantly associated with all-cause mortality (4% increased risk per 10 units; P=0.004), and with graft loss (6% increased risk per 10 units; PHyperparathyroidism is an independent, potentially remediable, risk factor for renal graft loss and all-cause mortality in RTR.

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

    Yang, Yajun; Ma, Jing; Xiu, Jinghui; Bai, Lin; Guan, Feifei; Zhang, Li; Liu, Jiangning; Zhang, Lianfeng

    2014-01-01

    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...

  7. A floating bridge disrupts seaward migration and increases mortality of steelhead smolts in Hood Canal, Washington state.

    Megan Moore

    Full Text Available Habitat modifications resulting from human transportation and power-generation infrastructure (e.g., roads, dams, bridges can impede movement and alter natural migration patterns of aquatic animal populations, which may negatively affect survival and population viability. Full or partial barriers are especially problematic for migratory species whose life histories hinge on habitat connectivity.The Hood Canal Bridge, a floating structure spanning the northern outlet of Hood Canal in Puget Sound, Washington, extends 3.6 meters underwater and forms a partial barrier for steelhead migrating from Hood Canal to the Pacific Ocean. We used acoustic telemetry to monitor migration behavior and mortality of steelhead smolts passing four receiver arrays and several single receivers within the Hood Canal, Puget Sound, and Strait of Juan de Fuca. Twenty-seven mortality events were detected within the vicinity of the Hood Canal Bridge, while only one mortality was recorded on the other 325 receivers deployed throughout the study area. Migrating steelhead smolts were detected at the Hood Canal Bridge array with greater frequency, on more receivers, and for longer durations than smolts migrating past three comparably configured arrays. Longer migration times and paths are likely to result in a higher density of smolts near the bridge in relation to other sites along the migration route, possibly inducing an aggregative predator response to steelhead smolts.This study provides strong evidence of substantial migration interference and increased mortality risk associated with the Hood Canal Bridge, and may partially explain low early marine survival rates observed in Hood Canal steelhead populations. Understanding where habitat modifications indirectly increase predation pressures on threatened populations helps inform potential approaches to mitigation.

  8. A floating bridge disrupts seaward migration and increases mortality of steelhead smolts in Hood Canal, Washington state.

    Moore, Megan; Berejikian, Barry A; Tezak, Eugene P

    2013-01-01

    Habitat modifications resulting from human transportation and power-generation infrastructure (e.g., roads, dams, bridges) can impede movement and alter natural migration patterns of aquatic animal populations, which may negatively affect survival and population viability. Full or partial barriers are especially problematic for migratory species whose life histories hinge on habitat connectivity. The Hood Canal Bridge, a floating structure spanning the northern outlet of Hood Canal in Puget Sound, Washington, extends 3.6 meters underwater and forms a partial barrier for steelhead migrating from Hood Canal to the Pacific Ocean. We used acoustic telemetry to monitor migration behavior and mortality of steelhead smolts passing four receiver arrays and several single receivers within the Hood Canal, Puget Sound, and Strait of Juan de Fuca. Twenty-seven mortality events were detected within the vicinity of the Hood Canal Bridge, while only one mortality was recorded on the other 325 receivers deployed throughout the study area. Migrating steelhead smolts were detected at the Hood Canal Bridge array with greater frequency, on more receivers, and for longer durations than smolts migrating past three comparably configured arrays. Longer migration times and paths are likely to result in a higher density of smolts near the bridge in relation to other sites along the migration route, possibly inducing an aggregative predator response to steelhead smolts. This study provides strong evidence of substantial migration interference and increased mortality risk associated with the Hood Canal Bridge, and may partially explain low early marine survival rates observed in Hood Canal steelhead populations. Understanding where habitat modifications indirectly increase predation pressures on threatened populations helps inform potential approaches to mitigation.

  9. Associations between short-term exposure to ambient sulfur dioxide and increased cause-specific mortality in 272 Chinese cities.

    Wang, Lijun; Liu, Cong; Meng, Xia; Niu, Yue; Lin, Zhijing; Liu, Yunning; Liu, Jiangmei; Qi, Jinlei; You, Jinling; Tse, Lap Ah; Chen, Jianmin; Zhou, Maigeng; Chen, Renjie; Yin, Peng; Kan, Haidong

    2018-04-28

    Ambient sulfur dioxide (SO 2 ) remains a major air pollutant in developing countries, but epidemiological evidence about its health effects was not abundant and inconsistent. To evaluate the associations between short-term exposure to SO 2 and cause-specific mortality in China. We conducted a nationwide time-series analysis in 272 major Chinese cities (2013-2015). We used the over-dispersed generalized linear model together with the Bayesian hierarchical model to analyze the data. Two-pollutant models were fitted to test the robustness of the associations. We conducted stratification analyses to examine potential effect modifications by age, sex and educational level. On average, the annual-mean SO 2 concentrations was 29.8 μg/m 3 in 272 cities. We observed positive and associations of SO 2 with total and cardiorespiratory mortality. A 10 μg/m 3 increase in two-day average concentrations of SO 2 was associated with increments of 0.59% in mortality from total non-accidental causes, 0.70% from total cardiovascular diseases, 0.55% from total respiratory diseases, 0.64% from hypertension disease, 0.65% from coronary heart disease, 0.58% from stroke, and 0.69% from chronic obstructive pulmonary disease. In two-pollutant models, there were no significant differences between single-pollutant model and two-pollutant model estimates with fine particulate matter, carbon monoxide and ozone, but the estimates decreased substantially after adjusting for nitrogen dioxide, especially in South China. The associations were stronger in warmer cities, in older people and in less-educated subgroups. This nationwide study demonstrated associations of daily SO 2 concentrations with increased total and cardiorespiratory mortality, but the associations might not be independent from NO 2 . Copyright © 2018 Elsevier Ltd. All rights reserved.

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

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

    2009-10-01

    treatment of HF was effective in reducing in-hospital mortality and unscheduled readmissions. This study adds to previous knowledge indicating that CP should be used to improve the quality of hospital treatment of HF. NCT00519038.

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

    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

  12. Increased mortality exposure within the family rather than individual mortality experiences triggers faster life-history strategies in historic human populations

    Störmer, Charlotte; Lummaa, Virpi

    2014-01-01

    impact of family versus individual-level effects of mortality exposure on two central life-history parameters, ages at first marriage and first birth, in three historical human populations (Germany, Finland, Canada). Mortality experience is measured as the confrontation with sibling deaths within

  13. Association between increased levels of reverse triiodothyronine and mortality after acute myocardial infarction

    Friberg, L; Drvota, V; Bjelak, A H

    2001-01-01

    The thyroid hormone system may be downregulated temporarily in patients who are severely ill. This "euthyroid sick syndrome" may be an adaptive response to conserve energy. However, thyroid hormone also has beneficial effects on the cardiovascular system, such as improving cardiac function, reduc...

  14. Cervical spinal cord injury associated with near-drowning does not increase pneumonia risk or mortality.

    Butler, Thomas; Shin, Susanna; Collins, Jay; Britt, Rebecca C; Reed, Scott F; Weireter, Leonard J; Britt, L D

    2011-04-01

    Body surfing accidents (BSA) can cause cervical spinal cord injuries (CSCIs) that are associated with near-drowning (ND). The submersion injury from a ND can result in aspiration and predispose to pulmonary complications. We predicted a worse outcome (particularly the development of pneumonia) in patients with CSCIs associated with ND. A retrospective review was performed of patients who were treated at Eastern Virginia Medical School for a CSCI resulting from a blunt mechanism. Data collected included basic demographic data, data regarding injury and in-hospital outcomes, and discharge data, including discharge disposition. Statistics were performed using χ(2) and Student t test. In 2003 to 2008, 141 patients were treated for CSCIs with inclusion criteria. Thirty patients (21%) had an associated ND (BSA) and 111 patients (79%) did not (BLT). The cohorts were similar in mean age (BSA, 45 years; BLT, 50 years; P = 0.16) and male gender distribution (BSA, 93%; BLT, 79%; P = 0.13). The cohorts were similar in injury severity using Injury Severity Score (BSA, 22; BLT, 24; P = 0.65). The cohorts were similar in rates of developing pneumonia (BSA, 3%; BLT, 12%; P = 0.31). The rate of infection was significantly higher in the cohort without an associated near-drowning (BSA, 10%; BLT, 32%; P = 0.033). The mean intensive care unit stay (BSA, 3.5 days; BLT, 11.3 days; P = 0.057) and the rate of mortality were similar (BSA, 10%; BLT, 10% P = 0.99). Those patients with an associated ND had a shorter hospital stay (BSA, 5.7 days; BLT, 22.2 days; P = 0.007) and a better chance of being discharged home (BSA, 57%; BLT, 27%; P = 0.004). CSCIs after a BSA do better than their counterparts without an associated ND. CSCIs associated with ND appear to be isolated injuries with minimal pulmonary involvement despite submersion injuries.

  15. Short dry spells in the wet season increase mortality of tropical pioneer seedlings.

    Engelbrecht, Bettina M J; Dalling, James W; Pearson, Timothy R H; Wolf, Robert L; Gálvez, David A; Koehler, Tobias; Tyree, Melvin T; Kursar, Thomas A

    2006-06-01

    Variation in plant species performance in response to water availability offers a potential axis for temporal and spatial habitat partitioning and may therefore affect community composition in tropical forests. We hypothesized that short dry spells during the wet season are a significant source of mortality for the newly emerging seedlings of pioneer species that recruit in treefall gaps in tropical forests. An analysis of a 49-year rainfall record for three forests across a rainfall gradient in central Panama confirmed that dry spells of > or = 10 days during the wet season occur on average once a year in a deciduous forest, and once every other year in a semi-deciduous moist and an evergreen wet forest. The effect of wet season dry spells on the recruitment of pioneers was investigated by comparing seedling survival in rain-protected dry plots and irrigated control plots in four large artificially created treefall gaps in a semi-deciduous tropical forest. In rain-protected plots surface soil layers dried rapidly, leading to a strong gradient in water potential within the upper 10 cm of soil. Seedling survival for six pioneer species was significantly lower in rain-protected than in irrigated control plots after only 4 days. The strength of the irrigation effect differed among species, and first became apparent 3-10 days after treatments started. Root allocation patterns were significantly, or marginally significantly, different between species and between two groups of larger and smaller seeded species. However, they were not correlated with seedling drought sensitivity, suggesting allocation is not a key trait for drought sensitivity in pioneer seedlings. Our data provide strong evidence that short dry spells in the wet season differentially affect seedling survivorship of pioneer species, and may therefore have important implications to seedling demography and community dynamics.

  16. Increased mortality exposure within the family rather than individual mortality experiences triggers faster life-history strategies in historic human populations.

    Störmer, Charlotte; Lummaa, Virpi

    2014-01-01

    Life History Theory predicts that extrinsic mortality risk is one of the most important factors shaping (human) life histories. Evidence from contemporary populations suggests that individuals confronted with high mortality environments show characteristic traits of fast life-history strategies: they marry and reproduce earlier, have shorter birth intervals and invest less in their offspring. However, little is known of the impact of mortality experiences on the speed of life histories in historical human populations with generally higher mortality risk, and on male life histories in particular. Furthermore, it remains unknown whether individual-level mortality experiences within the family have a greater effect on life-history decisions or family membership explains life-history variation. In a comparative approach using event history analyses, we study the impact of family versus individual-level effects of mortality exposure on two central life-history parameters, ages at first marriage and first birth, in three historical human populations (Germany, Finland, Canada). Mortality experience is measured as the confrontation with sibling deaths within the natal family up to an individual's age of 15. Results show that the speed of life histories is not adjusted according to individual-level mortality experiences but is due to family-level effects. The general finding of lower ages at marriage/reproduction after exposure to higher mortality in the family holds for both females and males. This study provides evidence for the importance of the family environment for reproductive timing while individual-level mortality experiences seem to play only a minor role in reproductive life history decisions in humans.

  17. Home-based care for reducing morbidity and mortality in people infected with HIV/AIDS

    Young

    2009-07-01

    Full Text Available stream_source_info Young_d1_2009.pdf.txt stream_content_type text/plain stream_size 6745 Content-Encoding UTF-8 stream_name Young_d1_2009.pdf.txt Content-Type text/plain; charset=UTF-8 HOME-BASED CARE FOR REDUCING... of results was done. Relevant effect measures and the 95% confidence intervals were reported. Young TN1, Busgeeth K2 1 South African Cochrane Centre, South African Medical Research Council, South Africa 2 Council for Scientific and Industrial Research...

  18. Innovative Product Development Partnership Reduced Neonatal Mortality In Nepal Through Improved Umbilical Cord Care.

    Oyloe, Peter; Khanal, Leela; Hodgins, Stephen; Pradhan, Sabita T; Dawson, Penny

    2017-11-01

    Approximately 40 percent of all newborn deaths in Nepal are attributable to neonatal infections. A randomized controlled trial conducted in Nepal in the period 2002-05 on the application of a solution of the disinfectant chlorhexidine to umbilical cord stumps of newborns showed a reduced risk of infections and death. In response to these results, the Government of Nepal and various partners mobilized to deliver this simple, low-cost intervention on a national scale. We describe the design, development, and maturation of a partnership among the government, technical assistance agencies, and a local pharmaceutical company to create a suitable, commercially available gel product to reduce newborn infections. Essential contributors to the partnership's effectiveness included having a for-profit pharmaceutical company as a fully engaged partner; having responsive, flexible relationships among the partners that evolved over time; and paying attention to competition within the private sector. A less formalized arrangement among partners allowed them to build trust in each other over time. Government stewardship of the program throughout the scale-up process ensured that policy and systems integration were aligned as the program matured.

  19. Total and cause-specific mortality by moderately and markedly increased ferritin concentrations

    Ellervik, Christina; Marott, Jacob Louis; Tybjærg-Hansen, Anne

    2014-01-01

    . Stepwise increasing concentrations of ferritin were associated with a stepwise increased risk of premature death overall (log rank, P = 2 × 10(-22)), with median survival of 55 years at ferritin concentrations ≥600 μg/L, 72 years at 400-599 μg/L, 76 years at 200-399 μg/L, and 79 years at ferritin

  20. Inpatient Addiction Consultation for Hospitalized Patients Increases Post-Discharge Abstinence and Reduces Addiction Severity.

    Wakeman, Sarah E; Metlay, Joshua P; Chang, Yuchiao; Herman, Grace E; Rigotti, Nancy A

    2017-08-01

    Alcohol and drug use results in substantial morbidity, mortality, and cost. Individuals with alcohol and drug use disorders are overrepresented in general medical settings. Hospital-based interventions offer an opportunity to engage with a vulnerable population that may not otherwise seek treatment. To determine whether inpatient addiction consultation improves substance use outcomes 1 month after discharge. Prospective quasi-experimental evaluation comparing 30-day post-discharge outcomes between participants who were and were not seen by an addiction consult team during hospitalization at an urban academic hospital. Three hundred ninety-nine hospitalized adults who screened as high risk for having an alcohol or drug use disorder or who were clinically identified by the primary nurse as having a substance use disorder. Addiction consultation from a multidisciplinary specialty team offering pharmacotherapy initiation, motivational counseling, treatment planning, and direct linkage to ongoing addiction treatment. Addiction Severity Index (ASI) composite score for alcohol and drug use and self-reported abstinence at 30 days post-discharge. Secondary outcomes included 90-day substance use measures and self-reported hospital and ED utilization. Among 265 participants with 30-day follow-up, a greater reduction in the ASI composite score for drug or alcohol use was seen in the intervention group than in the control group (mean ASI-alcohol decreased by 0.24 vs. 0.08, p drug decreased by 0.05 vs. 0.02, p = 0.003.) There was also a greater increase in the number of days of abstinence in the intervention group versus the control group (+12.7 days vs. +5.6, p drug, and days abstinent all remained statistically significant after controlling for age, gender, employment status, smoking status, and baseline addiction severity (p = 0.018, 0.018, and 0.02, respectively). In a sensitivity analysis, assuming that patients who were lost to follow-up had no change from baseline

  1. Molecular Adsorbent Recirculating System Can Reduce Short-Term Mortality Among Patients With Acute-on-Chronic Liver Failure-A Retrospective Analysis.

    Gerth, Hans U; Pohlen, Michele; Thölking, Gerold; Pavenstädt, Hermann; Brand, Marcus; Hüsing-Kabar, Anna; Wilms, Christian; Maschmeier, Miriam; Kabar, Iyad; Torner, Josep; Pavesi, Marco; Arroyo, Vicente; Banares, Rafael; Schmidt, Hartmut H J

    2017-10-01

    Acute-on-chronic liver failure is associated with numerous consecutive organ failures and a high short-term mortality rate. Molecular adsorbent recirculating system therapy has demonstrated beneficial effects on the distinct symptoms, but the associated mortality data remain controversial. Retrospective analysis of acute-on-chronic liver failure patients receiving either standard medical treatment or standard medical treatment and molecular adsorbent recirculating system. Secondary analysis of data from the prospective randomized Recompensation of Exacerbated Liver Insufficiency with Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure trial by applying the recently introduced Chronic Liver Failure-criteria. Medical Departments of University Hospital Muenster (Germany). This analysis was conducted in two parts. First, 101 patients with acute-on-chronic liver failure grades 1-3 and Chronic Liver Failure-C-Organ Failure liver subscore equals to 3 but stable pulmonary function were identified and received either standard medical treatment (standard medical treatment, n = 54) or standard medical treatment and molecular adsorbent recirculating system (n = 47) at the University Hospital Muenster. Second, the results of this retrospective analysis were tested against the Recompensation of Exacerbated Liver Insufficiency with Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure trial. Standard medical treatment and molecular adsorbent recirculating system. Additionally to improved laboratory variables (bilirubin and creatinine), the short-term mortality (up to day 14) of the molecular adsorbent recirculating system group was significantly reduced compared with standard medical treatment. A reduced 14-day mortality rate was observed in the molecular adsorbent recirculating system group (9.5% vs 50.0% with standard medical treatment; p = 0.004), especially in patients with multiple organ failure (acute-on-chronic liver failure grade 2-3). Concerning the

  2. Chronic digitalis therapy in patients before heart transplantation is an independent risk factor for increased posttransplant mortality

    Rivinius R

    2017-10-01

    Full Text Available Rasmus Rivinius,1 Matthias Helmschrott,1 Arjang Ruhparwar,2 Ann-Kathrin Rahm,1,3 Fabrice F Darche,1 Dierk Thomas,1 Tom Bruckner,4 Philipp Ehlermann,1 Hugo A Katus,1 Andreas O Doesch1,5 1Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, 2Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, 3Faculty of Medicine, University of Heidelberg, Heidelberg, 4Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, 5Asklepios Klinik Bad Salzungen GmbH, Department of Pneumology and Oncology, Bad Salzungen, Germany Objectives: Digitalis therapy (digoxin or digitoxin in patients with heart failure is subject to an ongoing debate. Recent data suggest an increased mortality in patients receiving digitalis. This study investigated the effects of chronic digitalis therapy prior to heart transplantation (HTX on posttransplant outcomes.Patients and methods: This was a retrospective, observational, single-center study. It comprised 530 adult patients who were heart-transplanted at Heidelberg University Hospital between 1989 and 2012. Patients with digitalis prior to HTX (≥3 months were compared to those without (no or <3 months of digitalis. Patients with digitalis were further subdivided into patients receiving digoxin or digitoxin. Primary outcomes were early posttransplant atrial fibrillation and mortality.Results: A total of 347 patients (65.5% had digitalis before HTX. Of these, 180 received digoxin (51.9% and 167 received digitoxin (48.1%. Patients with digitalis before HTX had a significantly lower 30-day (P=0.0148 and 2-year (P=0.0473 survival. There was no significant difference between digoxin and digitoxin in 30-day (P=0.9466 or 2-year (P=0.0723 survival. Multivariate analysis for posttransplant 30-day mortality showed pretransplant digitalis therapy as an independent risk factor (hazard ratio =2.097, CI: 1.036–4.248, P=0.0397. Regarding atrial

  3. Minor Postoperative Increases of Creatinine Are Associated with Higher Mortality and Longer Hospital Length of Stay in Surgical Patients

    Kork, Felix; Balzer, Felix; Spies, Claudia D.; Wernecke, Klaus-Dieter; Ginde, Adit A.; Jankowski, Joachim; Eltzschig, Holger K.

    2015-01-01

    Background Surgical patients frequently experience postoperative increases in creatinine levels. The authors hypothesized that even small increases in postoperative creatinine levels are associated with adverse outcomes. Methods The authors examined the association of postoperative changes from preoperative baseline creatinine with all-cause in-hospital mortality and hospital length of stay (HLOS) in a retrospective analysis of surgical patients at a single tertiary care center between January 2006 and June 2012. Results The data of 39,369 surgical patients (noncardiac surgery n = 37,345; cardiac surgery n = 2,024) were analyzed. Acute kidney injury (AKI)—by definition of the Kidney Disease: Improving Global Outcome group—was associated with a five-fold higher mortality (odds ratio [OR], 4.8; 95% CI, 4.1 to 5.7; P creatinine, exposure to radiocontrast agent, type of surgery, and surgical AKI risk factors. Importantly, even minor creatinine increases (Δcreatinine 25 to 49% above baseline but creatinine increases had a five-fold risk of death (OR, 5.4; 95% CI, 1.5 to 20.3; P creatinine levels are associated with adverse outcomes. These results emphasize the importance to find effective therapeutic approaches to prevent or treat even mild forms of postoperative kidney dysfunction to improve surgical outcomes. PMID:26492475

  4. A lean Six Sigma team increases hand hygiene compliance and reduces hospital-acquired MRSA infections by 51%.

    Carboneau, Clark; Benge, Eddie; Jaco, Mary T; Robinson, Mary

    2010-01-01

    A low hand hygiene compliance rate by healthcare workers increases hospital-acquired infections to patients. At Presbyterian Healthcare Services in Albuquerque, New Mexico a Lean Six Sigma team identified the reasons for noncompliance were multifaceted. The team followed the DMAIC process and completed the methodology in 12 months. They implemented multiple solutions in the three areas: Education, Culture, and Environment. Based on methicillin-resistant Staphylococcus aureus (MRSA) mortality research the team's results included an estimated 2.5 lives saved by reducing MRSA infections by 51%. Subsequently this 51% decrease in MRSA saved the hospital US$276,500. For those readers tasked with increasing hand hygiene compliance this article will provide the knowledge and insight needed to overcome multifaceted barriers to noncompliance.

  5. Increase in Clostridium difficile-related Mortality Rates, United States, 1999-2004

    Deaths related to Clostridium difficile are on the rise in the United States. Matthew Redelings from the Los Angeles County Department of Health discusses the increase and what can be done to prevent this infection.

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

    Anita Desikan

    2017-01-01

    Full Text Available 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 < 2.5 μm. Some subpopulations may be particularly vulnerable to PM 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.

  7. High and increasing Oxa-51 DNA load predict mortality in Acinetobacter baumannii bacteremia: implication for pathogenesis and evaluation of therapy.

    Yu-Chung Chuang

    Full Text Available BACKGROUND: While quantification of viral loads has been successfully employed in clinical medicine and has provided valuable insights and useful markers for several viral diseases, the potential of measuring bacterial DNA load to predict outcome or monitor therapeutic responses remains largely unexplored. We tested this possibility by investigating bacterial loads in Acinetobacter baumannii bacteremia, a rapidly increasing nosocomial infection characterized by high mortality, drug resistance, multiple and complicated risk factors, all of which urged the need of good markers to evaluate therapeutics. METHODS AND FINDINGS: We established a quantitative real-time PCR assay based on an A. baumannii-specific gene, Oxa-51, and conducted a prospective study to examine A. baumannii loads in 318 sequential blood samples from 51 adults patients (17 survivors, 34 nonsurvivors with culture-proven A. baumannii bacteremia in the intensive care units. Oxa-51 DNA loads were significantly higher in the nonsurvivors than survivors on day 1, 2 and 3 (P=0.03, 0.001 and 0.006, respectively. Compared with survivors, nonsurvivors had higher maximum Oxa-51 DNA load and a trend of increase from day 0 to day 3 (P<0.001, which together with Pitt bacteremia score were independent predictors for mortality by multivariate analysis (P=0.014 and 0.016, for maximum Oxa-51 DNA and change of Oxa-51 DNA, respectively. Kaplan-Meier analysis revealed significantly different survival curves in patients with different maximum Oxa-51 DNA and change of Oxa-51 DNA from day 0 to day 3. CONCLUSIONS: High Oxa-51 DNA load and its initial increase could predict mortality. Moreover, monitoring Oxa-51 DNA load in blood may provide direct parameters for evaluating new regimens against A. baumannii in future clinical studies.

  8. Increased circulating D-lactate levels predict risk of mortality after hemorrhage and surgical trauma in baboons.

    Sobhian, Babak; Kröpfl, Albert; Hölzenbein, Thomas; Khadem, Anna; Redl, Heinz; Bahrami, Soheyl

    2012-05-01

    Patients with hemorrhagic shock and/or trauma are at risk of developing colonic ischemia associated with bacterial translocation that may lead to multiple organ failure and death. Intestinal ischemia is difficult to diagnose noninvasively. The present retrospective study was designed to determine whether circulating plasma D-lactate is associated with mortality in a clinically relevant two-hit model in baboons. Hemorrhagic shock was induced in anesthetized baboons (n = 24) by controlled bleeding (mean arterial pressure, 40 mmHg), base excess (maximum -5 mmol/L), and time (maximum 3 h). To mimic clinical setting more closely, all animals underwent a surgical trauma after resuscitation including midshaft osteotomy stabilized with reamed femoral interlocking nailing and were followed for 7 days. Hemorrhagic shock/surgical trauma resulted in 66% mortality by day 7. In nonsurvivor (n = 16) hemorrhagic shock/surgical trauma baboons, circulating D-lactate levels were significantly increased (2-fold) at 24 h compared with survivors (n = 8), whereas the early increase during hemorrhage and resuscitation declined during the early postresuscitation phase with no difference between survivors and nonsurvivors. Moreover, D-lactate levels remained elevated in the nonsurvival group until death, whereas it decreased to baseline in survivors. Prediction of death (receiver operating characteristic test) by D-lactate was accurate with an area under the curve (days 1-3 after trauma) of 0.85 (95% confidence interval, 0.72-0.93). The optimal D-lactate cutoff value of 25.34 μg/mL produced sensitivity of 73% to 99% and specificity of 50% to 83%. Our data suggest that elevation of plasma D-lactate after 24 h predicts an increased risk of mortality after hemorrhage and trauma.

  9. Dramatic increase in sea otter mortality from white sharks in California

    Tinker, M. Tim; Hatfield, Brian B.; Harris, Michael D.; Ames, Jack A.

    2016-01-01

    Although southern sea otters (Enhydra lutris nereis) are not considered prey for white sharks (Carcharodon carcharias), sharks do nonetheless bite sea otters. We analyzed spatial and temporal trends in shark bites on sea otters in California, assessing the frequency of shark bite wounds in 1,870 carcasses collected since 1985. The proportion of stranded sea otters having shark bites has increased sharply since 2003, and white shark bites now account for >50% of recovered carcasses. The trend was most pronounced in the southern part of the range, from Estero Bay to Point Conception, where shark bite frequency has increased eightfold. Seasonal trends were also evident: most shark-bitten carcasses are recovered in late summer and fall; however, the period of elevated shark bite frequency has lengthened. The causes of these trends are unclear, but possible contributing factors include increased white shark abundance and/or changes in white shark behavior and distribution. In particular, the spatiotemporal patterns of shark-bitten sea otters match increases in pinniped populations, and the increased availability of marine mammal prey for white sharks may have led to more sharks spending more time in nearshore waters utilized by both sea otters and pinnipeds.

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

    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. © 2013 Blackwell Publishing Ltd.

  11. Increases in physical activity is as important as smoking cessation for reduction in total mortality in elderly men: 12 years of follow-up of the Oslo II study.

    Holme, I; Anderssen, S A

    2015-06-01

    Physical activity (PA) at leisure by the elderly, and its relationship to cardiovascular (CV) and non-CV mortality, with and without competing risk, has been scarcely described. We determined the relationships between PA, smoking and 12-year CV, non-CV and all-cause mortality in elderly Oslo men screened for CV disease in 1972-1973 and 2000. Among 14,846 men born during 1923-1932 and participating in 1972-1973, there were 5738 participants in 2000. During the 12 years follow-up 2154 died. Cox regression modelling of mortality endpoints, with and without competing risk, was applied analysing PA variables hours per week of light or vigorous PA intensity and degree of PA at leisure. Comparisons of predictive ability between PA and smoking were done by receiver operating characteristics. Thirty minutes of PA per 6 days a week was associated with about 40% mortality risk reduction. There was a 5 years increased lifetime when comparing sedentary and moderate to vigorous physically active men. Associations to CV or non-CV mortality were slightly weakened, allowing competing risk. Conditional on the prevalence of smoking and PA, the degree of PA at leisure was almost as predictive as smoking with regard to the effects on mortality. Increase in PA was as beneficial as smoking cessation in reducing mortality. Even at the age of 73 years, PA is associated highly with mortality between groups of sedentary and active persons. Allowing for competing risk did not weaken these associations markedly. Public health strategies in elderly men should include efforts to increase PA in line with efforts to reduce smoking behaviour. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. Adipositas ikke associeret med øget mortalitet ved kritisk sygdom og intensiv terapi [Obesity is not associated with an increased mortality in critical disease and intensive care.

    Toft, Palle; Lange, Britt

    2010-01-01

    The prevalence of obesity is increasing. The mortality and morbidity among obese intensive care unit (ICU) patients has been a matter of concern. Most of the retrospective studies performed have yielded contradictory results. Recently, two large prospective studies showed that respiratory failure......, length of mechanical ventilation and ICU acquired infections were increased in obese patients. Obesity was, however, not associated with increased mortality. The results were confirmed by a meta-analysis which showed that obesity was associated with increased morbidity but not with increased mortality...

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

    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.

  14. Oxytocin reduces amygdala activity, increases social interactions, and reduces anxiety-like behavior irrespective of NMDAR antagonism.

    Sobota, Rosanna; Mihara, Takuma; Forrest, Alexandra; Featherstone, Robert E; Siegel, Steven J

    2015-08-01

    Standard dopamine therapies for schizophrenia are not efficacious for negative symptoms of the disease, including asociality. This reduced social behavior may be due to glutamatergic dysfunction within the amygdala, leading to increased fear and social anxiety. Several studies have demonstrated the prosocial effects of oxytocin in schizophrenia patients. Therefore, this study evaluates the effect of subchronic oxytocin on EEG activity in amygdala of mice during performance of the three-chamber social choice and open field tests following acute ketamine as a model of glutamatergic dysfunction. Oxytocin did not restore social deficits introduced by ketamine but did significantly increase sociality in comparison to the control group. Ketamine had no effect on time spent in the center during the open field trials, whereas oxytocin increased overall center time across all groups, suggesting a reduction in anxiety. Amygdala activity was consistent across all drug groups during social and nonsocial behavioral trials. However, oxytocin reduced overall amygdala EEG power during the two behavioral tasks. Alternatively, ketamine did not significantly affect EEG power throughout the tasks. Decreased EEG power in the amygdala, as caused by oxytocin, may be related to both reduced anxiety and increased social behaviors. Data suggest that separate prosocial and social anxiety pathways may mediate social preference. (c) 2015 APA, all rights reserved).

  15. Plant mortality and natural selection may increase biomass yield in switchgrass swards

    Switchgrass (Panicum virgatum L.) is an important candidate for bioenergy feedstock production, prompting significant efforts to increase the number of breeding programs and the output of those programs. The objective of this experiment was to determine the potential utility of natural selection for...

  16. Increase in Clostridium difficile-related Mortality Rates, United States, 1999-2004

    2008-01-08

    Deaths related to Clostridium difficile are on the rise in the United States. Matthew Redelings from the Los Angeles County Department of Health discusses the increase and what can be done to prevent this infection.  Created: 1/8/2008 by Emerging Infectious Diseases.   Date Released: 1/8/2008.

  17. Delayed endovascular aortic repair is associated with reduced in-hospital mortality in patients with blunt thoracic aortic injury.

    Marcaccio, Christina L; Dumas, Ryan P; Huang, Yanlan; Yang, Wei; Wang, Grace J; Holena, Daniel N

    2018-02-13

    displaying a higher odds of death (odds ratio, 2.36; 95% confidence interval, 1.03-5.36; P = .042). After adjustment for age, ISS, and admission physiology, the association between early TEVAR and mortality was preserved (adjusted odds ratio, 2.39; 95% confidence interval, 1.01-5.67; P = .047). Consistent with current Society for Vascular Surgery recommendations, more BTAI patients underwent early TEVAR than delayed TEVAR during the study period. However, delayed TEVAR was associated with significantly reduced mortality in this population. Together, these findings support a need for critical appraisal and clarification of existing practice guidelines in management of BTAI. Future studies should seek to understand this survival disparity and to determine optimal selection of patients for early vs delayed TEVAR. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  18. A Method to Assess Flux Hazards at CSP Plants to Reduce Avian Mortality

    Ho, Clifford K.; Wendelin, Timothy; Horstman, Luke; Yellowhair, Julius

    2017-06-27

    A method to evaluate avian flux hazards at concentrating solar power plants (CSP) has been developed. A heat-transfer model has been coupled to simulations of the irradiance in the airspace above a CSP plant to determine the feather temperature along prescribed bird flight paths. Probabilistic modeling results show that the irradiance and assumed feather properties (thickness, absorptance, heat capacity) have the most significant impact on the simulated feather temperature, which can increase rapidly (hundreds of degrees Celsius in seconds) depending on the parameter values. The avian flux hazard model is being combined with a plant performance model to identify alternative heliostat standby aiming strategies that minimize both avian flux hazards and negative impacts on plant performance.

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

    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...

  20. Poor CD4 response despite viral suppression is associated with increased non-AIDS related mortality among HIV patients and their parents

    Helleberg, Marie; Kronborg, Gitte; Larsen, Carsten S

    2012-01-01

    association between poor CD4 response and increased risk of cardiovascular disease and cancer (IRR 1.6 (95%CI 0.8-3.2) and 1.6 (95%CI 0.6-4.8)). CONCLUSIONS:: poor CD4 increase after HAART is associated with adverse prognosis even in absence of severe immunosuppression. CD4 response in HIV patients......INTRODUCTION:: poor CD4 response to antiretroviral treatment (HAART) is associated with increased mortality. We analyzed the impact of CD4 increase on non-AIDS related morbidity and on mortality in HIV patients and their parents. METHODS:: mortality rates were estimated among 1,758 virally...... is associated with mortality among their parents, thus poor CD4 response may be caused by genetic factors, which might also affect morbidity and mortality in the HIV negative population....

  1. High Circulating Adrenaline Levels at Admission Predict Increased Mortality After Trauma

    Johansson, Pär Ingemar; Stensballe, Jakob; Rasmussen, Lars Simon

    2012-01-01

    partial thromboplastin time, international normalized ratio, hematology, biochemistry, circulating adrenaline and noradrenaline, 11 biomarkers of tissue and endothelial damage, glycocalyx degradation, natural anticoagulation and fibrinolysis (histone-complexed DNA fragments, high-mobility group box 1......:: The adrenaline level was increased in nonsurvivors (p = 0.026), it was independently associated with increased activated partial thromboplastin time (p = 0.034) and syndecan-1 (p = 0.007), a marker of glycocalyx degradation, and it correlated with biomarkers of tissue and endothelial damage (histone......-complexed DNA, high-mobility group box 1, soluble thrombomodulin) and hyperfibrinolysis (tissue-type plasminogen activator, d-dimer). Furthermore, nonsurvivors had higher syndecan-1, tissue factor pathway inhibitor, and d-dimer levels (all p adrenaline was independently associated with 30...

  2. [Light pollution increases morbidity and mortality rate from different causes in male rats].

    Bukalev, A V; Vinogradova, I A; Zabezhinskiĭ, M A; Semenchenko, A V; Anisimov, V N

    2012-01-01

    The influence of different light regimes (constant light--LL; constant darkness--DD; standard light regime--LD, 12 hours light 12 hours darkness; natural lightening of the North-West of Russia--NL) on the dynamics of life's morbidity rate, spontaneous tumorigenesis and frequency of some kinds of non-tumor pathology revealed at the post-mortem examination of male rats was studied. It was found out that the maintenance of animals at LL and NL conditions led to the increase of the number of infectious diseases, substantially faster development of spontaneous tumors and the increase of non-tumor diseases in comparison with the animals kept at LD (standard light) regime. Light deprivation (DD) led to substantial reduction of development of new growth, of non-tumor and infectious diseases in comparison with the similar parameters in standard light regime.

  3. Increased mortality by septicemia, interstitial pneumonitis and pulmonary fibrosis among bone marrow transplant recipients receiving an increased mean dose rate of total irradiation

    Ringden, O.; Baaryd, I.; Johansson, B.

    1983-01-01

    Seven bone marrow transplant recipients with acute lymphoblastic leukemia receiving a mean dose rate of 0.07 Gy/min of total body irradiation towards the pelvic midpoint and the lungs had an increased (p<0.01) overall death rate of 86 per cent compared with 33 per cent among 27 patients with acute non-lymphoblastic leukemia or acute lymphoblastic leukemia treated with a mean dose rate of 0.04 Gy/min. Among the patients receiving the higher dose rate there was an increased mortality in causes related to radiation toxicity like early septicemia, interstitial pneumonitis and pulmonary fibrosis, compared with all patients receiving the lower dose rate (p<0.01) and also with 10 patients from this group with acute lymphoblastic leukemia (p<0.02). (Auth.)

  4. Adjunctive rifampicin to reduce early mortality from Staphylococcus aureus bacteraemia (ARREST: study protocol for a randomised controlled trial

    Thwaites Guy

    2012-12-01

    Full Text Available Abstract Background Staphylococcus aureus bacteraemia is a common and serious infection, with an associated mortality of ~25%. Once in the blood, S. aureus can disseminate to infect almost any organ, but bones, joints and heart valves are most frequently affected. Despite the infection’s severity, the evidence guiding optimal antibiotic therapy is weak: fewer than 1,500 patients have been included in 16 randomised controlled trials investigating S. aureus bacteraemia treatment. It is uncertain which antibiotics are most effective, their route of administration and duration, and whether antibiotic combinations are better than single agents. We hypothesise that adjunctive rifampicin, given in combination with a standard first-line antibiotic, will enhance killing of S. aureus early in the treatment course, sterilise infected foci and blood faster, and thereby reduce the risk of dissemination, metastatic infection and death. Our aim is to determine whether adjunctive rifampicin reduces all-cause mortality within 14 days and bacteriological failure or death within 12 weeks from randomisation. Methods We will perform a parallel group, randomised (1:1, blinded, placebo-controlled trial in NHS hospitals across the UK. Adults (≥18 years with S. aureus (meticillin-susceptible or resistant grown from at least one blood culture who have received ≤96 h of active antibiotic therapy for the current infection and do not have contraindications to the use of rifampicin will be eligible for inclusion. Participants will be randomised to adjunctive rifampicin (600-900mg/day; orally or intravenously or placebo for the first 14 days of therapy in combination with standard single-agent antibiotic therapy. The co-primary outcome measures will be all-cause mortality up to 14 days from randomisation and bacteriological failure/death (all-cause up to 12 weeks from randomisation. 940 patients will be recruited, providing >80% power to detect 45% and 30% reductions in

  5. Adjunctive rifampicin to reduce early mortality from Staphylococcus aureus bacteraemia (ARREST): study protocol for a randomised controlled trial.

    Thwaites, Guy; Auckland, Cressida; Barlow, Gavin; Cunningham, Richard; Davies, Gerry; Edgeworth, Jonathan; Greig, Julia; Hopkins, Susan; Jeyaratnam, Dakshika; Jenkins, Neil; Llewelyn, Martin; Meisner, Sarah; Nsutebu, Emmanuel; Planche, Tim; Read, Robert C; Scarborough, Matthew; Soares, Marta; Tilley, Robert; Török, M Estée; Williams, John; Wilson, Peter; Wyllie, Sarah; Walker, A Sarah

    2012-12-18

    Staphylococcus aureus bacteraemia is a common and serious infection, with an associated mortality of ~25%. Once in the blood, S. aureus can disseminate to infect almost any organ, but bones, joints and heart valves are most frequently affected. Despite the infection's severity, the evidence guiding optimal antibiotic therapy is weak: fewer than 1,500 patients have been included in 16 randomised controlled trials investigating S. aureus bacteraemia treatment. It is uncertain which antibiotics are most effective, their route of administration and duration, and whether antibiotic combinations are better than single agents. We hypothesise that adjunctive rifampicin, given in combination with a standard first-line antibiotic, will enhance killing of S. aureus early in the treatment course, sterilise infected foci and blood faster, and thereby reduce the risk of dissemination, metastatic infection and death. Our aim is to determine whether adjunctive rifampicin reduces all-cause mortality within 14 days and bacteriological failure or death within 12 weeks from randomisation. We will perform a parallel group, randomised (1:1), blinded, placebo-controlled trial in NHS hospitals across the UK. Adults (≥ 18 years) with S. aureus (meticillin-susceptible or resistant) grown from at least one blood culture who have received ≤ 96 h of active antibiotic therapy for the current infection and do not have contraindications to the use of rifampicin will be eligible for inclusion. Participants will be randomised to adjunctive rifampicin (600-900 mg/day; orally or intravenously) or placebo for the first 14 days of therapy in combination with standard single-agent antibiotic therapy. The co-primary outcome measures will be all-cause mortality up to 14 days from randomisation and bacteriological failure/death (all-cause) up to 12 weeks from randomisation. 940 patients will be recruited, providing >80% power to detect 45% and 30% reductions in the two co-primary endpoints of death by

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

    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....

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

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

    2015-01-01

    failure clinic. The echocardiographic images were analyzed, and conventional and novel echocardiographic parameters were obtained. RESULTS: Many of the conventional echocardiographic parameters proved to be predictors of mortality. However, GLS remained an independent predictor of mortality...

  8. Jaundice increases the rate of complications and one-year mortality in patients with hypoxic hepatitis.

    Jäger, Bernhard; Drolz, Andreas; Michl, Barbara; Schellongowski, Peter; Bojic, Andja; Nikfardjam, Miriam; Zauner, Christian; Heinz, Gottfried; Trauner, Michael; Fuhrmann, Valentin

    2012-12-01

    Hypoxic hepatitis (HH) is the most frequent cause of acute liver injury in critically ill patients. No clinical data exist about new onset of jaundice in patients with HH. This study aimed to evaluate the incidence and clinical effect of jaundice in critically ill patients with HH. Two hundred and six consecutive patients with HH were screened for the development of jaundice during the course of HH. Individuals with preexisting jaundice or liver cirrhosis at the time of admission (n = 31) were excluded from analysis. Jaundice was diagnosed in patients with plasma total bilirubin levels >3 mg/dL. One-year-survival, infections, and cardiopulmonary, gastrointestinal (GI), renal, and hepatic complications were prospectively documented. New onset of jaundice occurred in 63 of 175 patients with HH (36%). In patients who survived the acute event of HH, median duration of jaundice was 6 days (interquartile range, 3-8). Patients who developed jaundice (group 1) needed vasopressor treatment (P jaundice (group 2). One-year survival rate was significantly lower in group 1, compared to group 2 (8% versus 25%, respectively; P jaundice was associated with an increased frequency of complications during follow-up (54% in group 1 versus 35% in group 2; P Jaundice is a common finding during the course of HH. It leads to an increased rate of complications and worse outcome in patients with HH. Copyright © 2012 American Association for the Study of Liver Diseases.

  9. Administration of cyclosporine a (CyA) to rats from birth: increased mortality and NK activity

    Clancy, J. Jr.; Tseng, G.; Kodali, S.; Love, S.

    1986-01-01

    Neonatal DA and LEW rats received 15, 7.5, and 3.75 mg/Kg of CyA or saline subcutaneously 3x each week for 1-12 weeks. In animals receiving 15 and 7.5 mg/Kg a significant (p 51 Cr release from YAC-1 target cells. Also, SPL cells stained with propidium iodide from the 3.75 mg/Kg group demonstrated a 1.5-2x increase in cells within the S phase of their cell cycle by flow cytometry. Thus, prolonged administration of CyA may have selective enhancing effects on certain lymphoid compartments and subpopulations of neonatal rats as well as a selective toxic effects on neonatal rat development

  10. Can exercise increase fitness and reduce weight in patients with schizophrenia and depression?

    Krogh, Jesper; Speyer, Helene; Nørgaard, Hans Christian Brix

    2014-01-01

    in this patient group and low levels of physical activity is associated with increased risk of cardiovascular disease, diabetes, and all-cause mortality. This study aimed to review trials allocating patients with either schizophrenia or depression to exercise interventions for effect on cardiovascular fitness......, strength, and weight. METHODS: We searched PubMed, Embase, and PsycINFO including randomized clinical trial allocating patients with either schizophrenia or depression to isolated exercise interventions. RESULTS: We identified five trials including patients with schizophrenia (n = 94) and found little...... evidence that exercise could increase cardiovascular fitness or decrease weight. Nine exercise trials for patients with depression (n = 892) were identified increasing cardiovascular fitness by 11-30% and strength by 33-37%. No evidence in favor of exercise for weight reduction was found. CONCLUSION: Based...

  11. Use of extinction and reinforcement to increase food consumption and reduce expulsion.

    Coe, D A; Babbitt, R L; Williams, K E; Hajimihalis, C; Snyder, A M; Ballard, C; Efron, L A

    1997-01-01

    Extinction and reinforcement contingencies were used to treat 2 children with feeding disorders. Positive reinforcement and avoidance extinction effectively increased food acceptance but also increased food expulsion. Reduced expulsion and increased swallowing were achieved by repeated presentation of expelled food, a second extinction component

  12. Can facility delivery reduce the risk of intrapartum complications-related perinatal mortality? Findings from a cohort study.

    Khanam, Rasheda; Baqui, Abdullah H; Syed, Mamun Ibne Moin; Harrison, Meagan; Begum, Nazma; Quaiyum, Abdul; Saha, Samir K; Ahmed, Saifuddin

    2018-06-01

    Intrapartum complications increase the risk of perinatal deaths. However, population-based data from developing countries assessing the contribution of intrapartum complications to perinatal deaths is scarce. Using data from a cohort of pregnant women followed between 2011 and 2013 in Bangladesh, this study examined the rate and types of intrapartum complications, the association of intrapartum complications with perinatal mortality, and if facility delivery modified the risk of intrapartum-related perinatal deaths. Trained community health workers (CHWs) made two-monthly home visits to identify pregnant women, visited them twice during pregnancy and 10 times in the first two months postpartum. During prenatal visits, CHWs collected data on women's prior obstetric history, socio-demographic status, and complications during pregnancy. They collected data on intrapartum complications, delivery care, and pregnancy outcome during the first postnatal visit within 7 days of delivery. We examined the association of intrapartum complications and facility delivery with perinatal mortality by estimating odds ratios (OR) and 95% confidence intervals (CI) adjusting for covariates using multivariable logistic regression analysis. The overall facility delivery rate was low (3922/24 271; 16.2%). Any intrapartum complications among pregnant women were 20.9% (5,061/24,271) and perinatal mortality was 64.7 per 1000 birth. Compared to women who delivered at home, the risk of perinatal mortality was 2.4 times higher (OR = 2.40; 95% CI = 2.08-2.76) when delivered in a public health facility and 1.3 times higher (OR = 1.32, 95% CI = 1.06-1.64) when delivered in a private health facility. Compared to women who had no intrapartum complications and delivered at home, women with intrapartum complications who delivered at home had a substantially higher risk of perinatal mortality (OR = 3.45; 95% CI = 3.04-3.91). Compared to women with intrapartum complications who

  13. Declines in Malaria Burden and All-Cause Child Mortality following Increases in Control Interventions in Senegal, 2005-2010.

    Thwing, Julie; Eckert, Erin; Dione, Demba Anta; Tine, Roger; Faye, Adama; Yé, Yazoume; Ndiop, Medoune; Cisse, Moustapha; Ndione, Jacques Andre; Diouf, Mame Birame; Ba, Mady

    2017-09-01

    Malaria is endemic in Senegal. The national malaria control strategy focuses on achieving universal coverage for major interventions, with a goal of reaching preelimination status by 2018. Senegal began distribution of insecticide-treated nets (ITNs) and introduced artemisinin-based combination therapy in 2006, then introduced rapid diagnostic tests in 2007. We evaluated the impact of these efforts using a plausibility design based on malaria's contribution to all-cause under-five mortality (ACCM) and considering other contextual factors which may influence ACCM. Between 2005 and 2010, household ownership of ITNs increased from 20% to 63%, and the proportion of people sleeping under an ITN the night prior to the survey increased from 6% to 29%. Malaria parasite prevalence declined from 6% to 3% from 2008 to 2010 among children under five. Some nonmalaria indicators of child health improved, for example, increase of complete vaccination coverage from 58% to 64%; however, nutritional indicators deteriorated, with an increase in stunting from 16% to 26%. Although economic indicators improved, environmental conditions favored an increase in malaria transmission. ACCM decreased 40% between 2005 and 2010, from 121 (95% confidence interval [CI] 113-129) to 72 (95% CI 66-77) per 1,000, and declines were greater among age groups, epidemiologic zones, and wealth quintiles most at risk for malaria. After considering coverage of malaria interventions, trends in malaria morbidity, effects of contextual factors, and trends in ACCM, it is plausible that malaria control interventions contributed to a reduction in malaria mortality and to the impressive gains in child survival in Senegal.

  14. Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis.

    Gakidou, Emmanuela; Cowling, Krycia; Lozano, Rafael; Murray, Christopher J L

    2010-09-18

    In addition to the inherent importance of education and its essential role in economic growth, education and health are strongly related. We updated previous systematic assessments of educational attainment, and estimated the contribution of improvements in women's education to reductions in child mortality in the past 40 years. We compiled 915 censuses and nationally representative surveys, and estimated mean number of years of education by age and sex. By use of a first-differences model, we investigated the association between child mortality and women's educational attainment, controlling for income per person and HIV seroprevalence. We then computed counterfactual estimates of child mortality for every country year between 1970 and 2009. The global mean number of years of education increased from 4·7 years (95% uncertainty interval 4·4-5·1) to 8·3 years (8·0-8·6) for men (aged ≥25 years) and from 3·5 years (3·2-3·9) to 7·1 years (6·7 -7·5) for women (aged ≥25 years). For women of reproductive age (15-44 years) in developing countries, the years of schooling increased from 2·2 years (2·0-2·4) to 7·2 years (6·8-7·6). By 2009, in 87 countries, women (aged 25-34 years) had higher educational attainment than had men (aged 25-34 years). Of 8·2 million fewer deaths in children younger than 5 years between 1970 and 2009, we estimated that 4·2 million (51·2%) could be attributed to increased educational attainment in women of reproductive age. The substantial increase in education, especially of women, and the reversal of the gender gap have important implications not only for health but also for the status and roles of women in society. The continued increase in educational attainment even in some of the poorest countries suggests that rapid progress in terms of Millennium Development Goal 4 might be possible. Bill & Melinda Gates Foundation. Copyright © 2010 Elsevier Ltd. All rights reserved.

  15. Graves' disease and toxic nodular goiter are both associated with increased mortality but differ with respect to the cause of death

    Brandt, Frans; Thvilum, Marianne; Pedersen, Dorthe Almind

    2013-01-01

    Background: Hyperthyroidism has been associated with increased all-cause mortality. Whether the underlying cause of hyperthyroidism influences this association is unclear. Our objectives were to explore whether mortality risk and cause of death differ between Graves' disease (GD) and toxic nodular...

  16. The cumulative burden of double-stranded DNA virus detection after allogeneic HCT is associated with increased mortality.

    Hill, Joshua A; Mayer, Bryan T; Xie, Hu; Leisenring, Wendy M; Huang, Meei-Li; Stevens-Ayers, Terry; Milano, Filippo; Delaney, Colleen; Sorror, Mohamed L; Sandmaier, Brenda M; Nichols, Garrett; Zerr, Danielle M; Jerome, Keith R; Schiffer, Joshua T; Boeckh, Michael

    2017-04-20

    Strategies to prevent active infection with certain double-stranded DNA (dsDNA) viruses after allogeneic hematopoietic cell transplantation (HCT) are limited by incomplete understanding of their epidemiology and clinical impact. We retrospectively tested weekly plasma samples from allogeneic HCT recipients at our center from 2007 to 2014. We used quantitative PCR to test for cytomegalovirus, BK polyomavirus, human herpesvirus 6B, HHV-6A, adenovirus, and Epstein-Barr virus between days 0 and 100 post-HCT. We evaluated risk factors for detection of multiple viruses and association of viruses with mortality through day 365 post-HCT with Cox models. Among 404 allogeneic HCT recipients, including 125 cord blood, 125 HLA-mismatched, and 154 HLA-matched HCTs, detection of multiple viruses was common through day 100: 90% had ≥1, 62% had ≥2, 28% had ≥3, and 5% had 4 or 5 viruses. Risk factors for detection of multiple viruses included cord blood or HLA-mismatched HCT, myeloablative conditioning, and acute graft-versus-host disease ( P values < .01). Absolute lymphocyte count of <200 cells/mm 3 was associated with greater virus exposure on the basis of the maximum cumulative viral load area under the curve (AUC) ( P = .054). The maximum cumulative viral load AUC was the best predictor of early (days 0-100) and late (days 101-365) overall mortality (adjusted hazard ratio [aHR] = 1.36, 95% confidence interval [CI] [1.25, 1.49], and aHR = 1.04, 95% CI [1.0, 1.08], respectively) after accounting for immune reconstitution and graft-versus-host disease. In conclusion, detection of multiple dsDNA viruses was frequent after allogeneic HCT and had a dose-dependent association with increased mortality. These data suggest opportunities to improve outcomes with better antiviral strategies. © 2017 by The American Society of Hematology.

  17. Breast cancer: Early detection - increasing mortality rates; Mammacarcinom: Erfolgreiche Fruehdiagnose, steigende Mortalitaet

    Paterok, E M [Universitaets-Frauenklinik, Erlangen (Germany); Siebzehnruebl, E [Universitaets-Frauenklinik, Erlangen (Germany); Schulz-Wendtland, R [Universitaets-Frauenklinik, Erlangen (Germany); Koch, T [Universitaets-Frauenklinik, Erlangen (Germany)

    1995-05-01

    Mammography, sonography and nmr imaging are the tools that will in all probability detect breast cancer at an early stage. NMR imaging is the most recently developed and most sophisticated high-tech method for the diagnosis of disorders of the mammary parenchyma. To ensure a better differentiation between benign and malignant changes, nmr imaging of the breast is carried out following paramagnetic opacification using intravenous gadolinium DTPA. Owing to their angiogenic potential and increased vascular permeability carcinomas are characterized by a significant contrast medium accumulation. The signal intensities of malignant tumours are therefore higher than those of the adjacent supporting and fatty tissues or the intact mammary parenchyma. (orig./VHE) [Deutsch] Die Diagnostik des fruehen Mammacarcinoms gelingt mit Hilfe der Mammographie, Sonographie und Kernspintomographie. Die Kernspintomographie stellt gegenwaertig das neueste und apparatetechnisch aufwendigste Verfahren zur Diagnostik der Mammaparenchymerkrankungen dar. Zur besseren Differenzierung von malignen und benignen Veraenderungen wird die Kernspintomographie der Brust nach intravenoeser Applikation des paramagnetischen Kontrastmittels Gadolinium-DTPA durchgefuehrt. Carcinome zeigen aufgrund ihrer angiogenetischen Potenz und ihrer erhoehten Gefaesswandpermeabilitaet eine signifikante Kontrastmittelanreicherung. Maligne Tumoren stellen sich deshalb signalreicher dar als das umliegende Stuetz-, Fettgewebe und gesundes Mammaparenchym. (orig./VHE)

  18. Strategies to increase nitrogen use efficiency and reduce nitrate leaching in vegetable production in the Netherlands

    Ruijter, de F.J.; Berge, ten H.F.M.; Smit, A.L.

    2010-01-01

    Environmental concern and legislation of fertilization requires strategies to increase