Sample records for nonrelapse mortality nrm

  1. Non-relapse mortality and mycophenolic acid exposure in nonmyeloablative hematopoietic cell transplantation (United States)

    McDermott, Cara L.; Sandmaier, Brenda M.; Storer, Barry; Li, Hong; Mager, Donald E.; Boeckh, Michael J.; Bemer, Meagan J.; Knutson, Jennifer; McCune, Jeannine S.


    We evaluated the pharmacodynamic relationships between mycophenolic acid (MPA), the active metabolite of mycophenolate mofetil (MMF), and outcomes in 308 patients after nonmyeloablative hematopoietic cell transplant. Patients were conditioned with total body irradiation ± fludarabine, received grafts from HLA-matched related (N=132) or unrelated (N=176) donors, and received post-grafting immunosuppression with MMF and a calcineurin inhibitor. Total and unbound MPA pharmacokinetics were determined to day 25; maximum a posteriori Bayesian estimators were used to estimate total MPA concentration at steady state (Css). Rejection occurred in nine patients, eight of whom had a total MPA Css less than 3 μg/mL. In patients receiving a related donor graft, MPA Css was not associated with clinical outcomes. In patients receiving an unrelated donor graft, low total MPA Css was associated with increased grades 3–4 acute graft versus host disease (aGVHD) and increased non-relapse mortality, but not with day 28 T-cell chimerism, disease relapse, cytomegalovirus reactivation, or overall survival. We conclude that higher initial oral MMF doses and subsequent targeting of total MPA Css to greater than 2.96 μg/mL could lower grades 3–4 aGVHD and non-relapse mortality in patients receiving an unrelated donor graft. PMID:23660171

  2. Nonrelapse mortality and mycophenolic acid exposure in nonmyeloablative hematopoietic cell transplantation. (United States)

    McDermott, Cara L; Sandmaier, Brenda M; Storer, Barry; Li, Hong; Mager, Donald E; Boeckh, Michael J; Bemer, Meagan J; Knutson, Jennifer; McCune, Jeannine S


    We evaluated the pharmacodynamic relationships between mycophenolic acid (MPA), the active metabolite of mycophenolate mofetil (MMF), and outcomes in 308 patients after nonmyeloablative hematopoietic cell transplantation. Patients were conditioned with total body irradiation ± fludarabine, received grafts from HLA-matched related (n = 132) or unrelated (n = 176) donors, and received postgrafting immunosuppression with MMF and a calcineurin inhibitor. Total and unbound MPA pharmacokinetics were determined to day 25; maximum a posteriori Bayesian estimators were used to estimate total MPA concentration at steady state (Css). Rejection occurred in 9 patients, 8 of whom had a total MPA Css less than 3 μg/mL. In patients receiving a related donor graft, MPA Css was not associated with clinical outcomes. In patients receiving an unrelated donor graft, low total MPA Css was associated with increased grades III to IV acute graft-versus-host disease and increased nonrelapse mortality but not with day 28 T cell chimerism, disease relapse, cytomegalovirus reactivation, or overall survival. We conclude that higher initial oral MMF doses and subsequent targeting of total MPA Css to greater than 2.96 μg/mL could lower grades III to IV acute graft-versus-host disease and nonrelapse mortality in patients receiving an unrelated donor graft.

  3. Polymorphism in TGFB1 is associated with worse non-relapse mortality and overall survival after stem cell transplantation with unrelated donors (United States)

    Arrieta-Bolaños, Esteban; Mayor, Neema P.; Marsh, Steven G.E.; Madrigal, J. Alejandro; Apperley, Jane F.; Kirkland, Keiren; Mackinnon, Stephen; Marks, David I.; McQuaker, Grant; Perry, Julia; Potter, Michael N.; Russell, Nigel H.; Thomson, Kirsty; Shaw, Bronwen E.


    Transforming growth factor β-1, encoded by the TGFB1 gene, is a cytokine that plays a central role in many physiological and pathogenic processes. We have sequenced TGFB1 regulatory region and assigned allelic genotypes in a large cohort of hematopoietic stem cell transplantation patients and donors. In this study, we analyzed 522 unrelated donor-patient pairs and examined the combined effect of all the common polymorphisms in this genomic region. In univariate analysis, we found that patients carrying a specific allele, ‘p001’, showed significantly reduced overall survival (5-year overall survival 30.7% for p001/p001 patients vs. 41.6% others; P=0.032) and increased non-relapse mortality (1-year non-relapse mortality: 39.0% vs. 25.4%; P=0.039) after transplantation. In multivariate analysis, the presence of a p001/p001 genotype in patients was confirmed as an independent factor for reduced overall survival [hazard ratio=1.53 (1.04–2.24); P=0.031], and increased non-relapse mortality [hazard ratio=1.73 (1.06–2.83); P=0.030]. In functional experiments we found a trend towards a higher percentage of surface transforming growth factor β-1-positive regulatory T cells after activation when the cells had a p001 allele (P=0.07). Higher or lower production of transforming growth factor β-1 in the inflammatory context of hematopoietic stem cell transplantation may influence the development of complications in these patients. Findings indicate that TGFB1 genotype could potentially be of use as a prognostic factor in hematopoietic stem cell transplantation risk assessment algorithms. PMID:26611472

  4. Stable NRM and mineralogy in Allende - Chondrules (United States)

    Wasilewski, P. J.; Saralker, C.

    The main objective of the present investigation is related to a description of the magnetic and mineralogic contrasts between chondrules which have a natural remanent magnetization (NRM) vector that is ultrastable during alternating field (AF) demagnetization, and those which have unstable NRM vectors when subjected to the same treatment. The results presented in the present investigation together with new magnetic results from Allende listed in a summary provided by Wasilewski (1981) are used as a basis to argue that the stable NRM in Allende was acquired during a sulfidation event. Attention is given to magnetic phases in Allende, experimental results obtained in magnetic studies conducted with 20 chondrules, and a magnetization model for Allende.

  5. Comparison of two pretransplant predictive models and a flexible HCT-CI using different cut off points to determine low-, intermediate-, and high-risk groups: the flexible HCT-CI Is the best predictor of NRM and OS in a population of patients undergoing allo-RIC. (United States)

    Barba, Pere; Piñana, Jose Luis; Martino, Rodrigo; Valcárcel, David; Amorós, Alex; Sureda, Anna; Briones, Javier; Delgado, Julio; Brunet, Salut; Sierra, Jorge


    Patient comorbidities are being increasingly analyzed as predictors for outcome after hematopoietic stem cell transplantation (HSCT), especially in allogeneic HSCT (Allo-HSCT). Researchers from Seattle have recently developed several pretransplant scoring systems (hematopoietic cell transplantation comorbidity index [HCT-CI] and the Pretransplantation Assessment of Mortality (PAM) model) from large sets of HSCT recipients with the aim of improving non-transplant models, mainly the Charlson Comorbidity Index (CCI). The validation of these comorbidity indexes in other institutions and in different disease and conditioning-related settings is of interest to determine whether these models are potentially applicable in clinical practice and in research settings. We performed a retrospective study in our institution including 194 consecutive reduced-intensity conditioning (RIC) AlloHSCT (allo-RIC) recipients to compare the predictive value of the PAM score, CCI, the original HCT-CI, and the flexible HCT-CI using a different risk group stratification. The median patient pretransplant scores for the HCT-CI, PAM, and CCI were 3.5, 22, and 0, respectively. The flexible HCT-CI risk-scoring system (restratified as: low risk [LR] 0-3 points, intermediate risk [IR] 4-5 points, and high risk [HR] >5 points) was the best predictor for non-relapse mortality (NRM). The 100-day and 2-year NRM incidence in these risk categories was 4% (95% confidence interval C.I. 2%-11%), 16% (95% C.I. 9%-31%), and 29% (95% C.I. 19%-45%), respectively (P HR. In conclusion, our single-center study suggests that the flexible HCT-CI is a good predictor of 2-year NRM and survival after an allo-RIC. Copyright (c) 2010 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  6. Institutional strengthening to enable local governments's NRM capacity in Bukidnon Province, Philippines


    Sumbalan, Antonio


    This presentation discusses the structure of the Philipppine government and the relatively recent decentralization that has increased the role of local government in NRM. The institutional innovations and policy development from the Bukidnon province are presented, as are the ways in which SANREM CRSP has supported the strengthening of local institutions' capacity to manage their natural resources.

  7. Experimental characterization of negative refractive index material NRM at Ka band

    CERN Document Server

    Chatterjee, Sougata


    In this paper, we discuss the experimental characterization of a negative refractive material NRM at Ka band using LR labyrinth Ring and wire array WA. We describe in detail the the LR and wire array characterization separately, and after that the combined experimental results, for NRM are reported. The LRs analytical and simulation study is not new but design in Ka band and different experimental procedure for the characterization of the negative refractive index is the novelty of this paper. For performing a negative refractive index experiment we made prism of 150 Prism angle . We get enhanced transmittance of more than 20 dB from background, at a negative angle of refraction. The values of the negative refractive index in a band of about 1 G Hz around 31 GHz are retrieved from the experimental data.

  8. Anaphase promoting complex-dependent degradation of transcriptional repressors Nrm1 and Yhp1 in Saccharomyces cerevisiae. (United States)

    Ostapenko, Denis; Solomon, Mark J


    The anaphase-promoting complex/cyclosome (APC/C) is an essential ubiquitin ligase that targets cell cycle proteins for proteasome-mediated degradation in mitosis and G1. The APC regulates a number of cell cycle processes, including spindle assembly, mitotic exit, and cytokinesis, but the full range of its functions is still unknown. To better understand cellular pathways controlled by the APC, we performed a proteomic screen to identify additional APC substrates. We analyzed cell cycle-regulated proteins whose expression peaked during the period when other APC substrates were expressed. Subsequent analysis identified several proteins, including the transcriptional repressors Nrm1 and Yhp1, as authentic APC substrates. We found that APC(Cdh1) targeted Nrm1 and Yhp1 for degradation in early G1 through Destruction-box motifs and that the degradation of these repressors coincided with transcriptional activation of MBF and Mcm1 target genes, respectively. In addition, Nrm1 was stabilized by phosphorylation, most likely by the budding yeast cyclin-dependent protein kinase, Cdc28. We found that expression of stabilized forms of Nrm1 and Yhp1 resulted in reduced cell fitness, due at least in part to incomplete activation of G1-specific genes. Therefore, in addition to its known functions, APC-mediated targeting of Nrm1 and Yhp1 coordinates transcription of multiple genes in G1 with other cell cycle events.

  9. Renormalization constants for $N_{\\rm f}=2+1+1$ twisted mass QCD

    CERN Document Server

    Blossier, Benoit; Guichon, Pierre; Morénas, Vincent; Pène, Olivier; Rodríguez-Quintero, Jose; Zafeiropoulos, Savvas


    We summarize recent non-perturbative results obtained for the renormalization constants computed in the RI'-MOM scheme for $N_{\\rm f}=2+1+1$ twisted mass QCD. Our implementation employs the Iwasaki gauge action and four dynamical degenerate twisted mass fermions. Renormalization constants for scalar, pseudo-scalar, vector and axial operators, as well as the quark propagator renormalization, are computed at three different values of the lattice spacing, two different volumes and several values of the twisted mass. Our method allows for a precise cross-check of the running, because of the particular proper treatment of the hypercubic artifacts. Preliminary results for twist-2 operators are also presented.

  10. Virtual directions in paleomagnetism: A global and rapid approach to evaluate the NRM components. (United States)

    Ramón, Maria J.; Pueyo, Emilio L.; Oliva-Urcia, Belén; Larrasoaña, Juan C.


    We introduce a method and software to process demagnetization data for a rapid and integrative estimation of characteristic remanent magnetization (ChRM) components. The virtual directions (VIDI) of a paleomagnetic site are “all” possible directions that can be calculated from a given demagnetization routine of “n” steps (being m the number of specimens in the site). If the ChRM can be defined for a site, it will be represented in the VIDI set. Directions can be calculated for successive steps using principal component analysis, both anchored to the origin (resultant virtual directions RVD; m * (n2+n)/2) and not anchored (difference virtual directions DVD; m * (n2-n)/2). The number of directions per specimen (n2) is very large and will enhance all ChRM components with noisy regions where two components were fitted together (mixing their unblocking intervals). In the same way, resultant and difference virtual circles (RVC, DVC) are calculated. Virtual directions and circles are a global and objective approach to unravel different natural remanent magnetization (NRM) components for a paleomagnetic site without any assumption. To better constrain the stable components, some filters can be applied, such as establishing an upper boundary to the MAD, removing samples with anomalous intensities, or stating a minimum number of demagnetization steps (objective filters) or selecting a given unblocking interval (subjective but based on the expertise). On the other hand, the VPD program also allows the application of standard approaches (classic PCA fitting of directions a circles) and other ancillary methods (stacking routine, linearity spectrum analysis) giving an objective, global and robust idea of the demagnetization structure with minimal assumptions. Application of the VIDI method to natural cases (outcrops in the Pyrenees and u-channel data from a Roman dam infill in northern Spain) and their comparison to other approaches (classic end-point, demagnetization

  11. Low Counts of Plasmacytoid Dendritic Cells after Engraftment Are Associated with High Early Mortality after Allogeneic Stem Cell Transplantation. (United States)

    Gonçalves, Matheus Vescovi; Yamamoto, Mihoko; Kimura, Eliza Yurico Sugano; Colturato, Vergílio Antônio Rensi; de Souza, Mair Pedro; Mauad, Marcos; Ikoma, Maura Valerio; Novis, Yana; Rocha, Vanderson; Ginani, Valeria Cortez; Wanderley de Oliveira Felix, Olga Margareth; Seber, Adriana; Kerbauy, Fabio Rodrigues; Hamerschlak, Nelson; Orfao, Alberto; Rodrigues, Celso Arrais


    Dendritic cells (DCs) are antigen-presenting cells that drive immune responses and tolerance and are divided in different subsets: myeloid DCs (mDCs: lineage-; HLA-DR+, 11c+), plasmacytoid dendritic cells (pDCs: HLA-DR+, CD123+), and monocyte-derived DCs (moDC: lineage-, 11c+, 16+). After hematopoietic stem cell transplantation (HSCT), low DC counts in the recipients' peripheral blood (PB) have been associated with worse outcomes, but the relevance of DC graft content remains unclear, and there are few data in the setting of unrelated donor HSCT. We evaluated the DC graft content and monitored DC recovery in PB from 111 HSCT recipients (median age, 17 years; range 1 to 74), who received bone marrow (46%), umbilical cord blood (32%), or PB (22%) from unrelated (81%) or related donors (19%). In 86 patients with sustained allogeneic recovery, patients with higher counts of all DC subsets (pDC, mDC, and moDC) 3 weeks after engraftment had lower incidence of nonrelapse mortality (NMR) and acute graft-versus-host disease (aGVHD) and better survival. pDC counts were associated with more striking results: patients with higher pDC counts had much lower incidences of NRM (3% versus 47%, P < .0001), lower incidence of aGVHD (24% versus 67%, P < .0001), and better overall survival (92% versus 45%, P < .0001). In contrast, higher pDC counts in the graft was associated with an increased risk of aGVHD (55% versus 26%, P = .02). Our results indicate that DC counts are closely correlated with HSCT outcomes and warrant further prospective evaluation and possible early therapeutic interventions to ameliorate severe aGVHD and decrease mortality.

  12. A collaborative resource management workspace and project management application for data collection, analysis and visualization: OpenNRM (United States)

    Osti, A.


    During the process of research and design for OpenNRM, we imagined a place where diverse groups of people and communities could effectively and efficiently collaborate to manage large-scale environmental problems and projects. Our research revealed the need to combine a variety of software components. Users can explore and analyze a topic while simultaneously develop stories and solve problems in a way that the end result is consumable by their colleagues and the general public. To do this we brought together software modules that are typically separate: Document and Asset Management, GIS and Interactive Mapping, WIKI and Information Libraries, Data Catalogs and Services, Project Management Tools and Storytelling templates. These components, along with others are supported by extensive data catalogs (NWIS, Storet, CDEC, Cuahsi), data analysis tools and web services for a turn-key workspace that will allow you to quickly build project communities and data stories. In this presentation we will show you how our investigation into these collaborative efforts are implemented and working for some of our clients, including the State of California's Sacramento San Joaquin Bay-Delta and San Joaquin River Basin. The case study will display the use of the OpenNRM workspace for real time environmental conditions management, data visualization, project operations, environmental restoration, high frequency monitoring and data reporting. We will demonstrate how scientists and policy makers are working together to tell the story of this complicated and divisive system and how they are becoming better managers of that system. Using the genius of web services, we will show you how OpenNRM was designed to allow you to build your own community while easily sharing data stories, project data, monitoring results, document libraries, interactive maps and datasets with others. We will get into more technical detail by presenting how our data interpolation tools can show high frequency

  13. Allogeneic stem cell transplantation for patients with refractory anaemia with matched related and unrelated donors: delay of the transplant is associated with inferior survival.

    NARCIS (Netherlands)

    Witte, T.J.M. de; Brand, R.; Biezen, A. van; Mufti, G.J.; Ruutu, T.; Finke, J.; Borne, P. von dem; Vitek, A.; Delforge, M.; Alessandrino, P.; Harlahakis, N.; Russell, N.; Martino, R.; Verdonck, L.; Kroger, N.; Niederwieser, D.


    Allogeneic stem cell transplantation (alloSCT) for patients with refractory anaemia may result in a 50% event-free survival, but the high non-relapse mortality (NRM) precludes a general application of this therapeutic modality. This study evaluated the impact of various pre-transplant variables,

  14. Fundamentos teóricos de la formación de imágenes por resonancia magnética nuclear NRM


    Yapur, Miguel; Correa, José


    El diagnóstico médico ha sido beneficiado por los avances tecnológicos logrados con los avances recientes. La tecnología mejorada de Rayos - X. La tomografía computarizada (CT) y el ultrasonido han sido las principales técnicas de imágenes. Hoy en día, esta progresión tecnológica han dado un paso adelante con la introducción de la Resonancia Magnética Nuclear (NRM). Las imágenes obtenidas por este método proveeen imágenes de alto contraste sin radiación ionizante. Debido a lo nuevo del tema y...

  15. Validation of the Hematopoietic Cell Transplantation-Specific Comorbidity Index: a prospective, multicenter GITMO study. (United States)

    Raimondi, Roberto; Tosetto, Alberto; Oneto, Rosi; Cavazzina, Riccardo; Rodeghiero, Francesco; Bacigalupo, Andrea; Fanin, Renato; Rambaldi, Alessandro; Bosi, Alberto


    The development of tools for the prediction of nonrelapse mortality (NRM) after allogeneic hematopoietic stem cell transplantation (HSCT) would offer a major guidance in the therapeutic decision. Recently, the Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) has been associated with increased NRM risk in several retrospective studies, but its clinical utility has never been demonstrated prospectively in an adequately sized cohort. To this aim, we prospectively evaluated a consecutive cohort of 1937 patients receiving HSCT in Italy over 2 years. HCT-CI was strongly correlated with both 2-year NRM (14.7%, 21.3%, and 27.3% in patients having an HCT-CI score of 0, 1-2, and ≥ 3, respectively) and overall survival (56.4%, 54.5%, and 41.3%, respectively). There was an excellent calibration between the predicted and observed 2-year NRM in patients having an HCT-CI score of 0 and 1-2, whereas in the ≥ 3 group the predicted NRM overestimated the observed NRM (41% vs 27.3%). HCT-CI alone was the strongest predictor of NRM in patients with lymphoma, myelodysplastic syndrome, and acute myeloid leukemia in first remission (c-statistics 0.66, 064, and 0.59, respectively). We confirm the clinical utility of the HCT-CI score that could also identify patients at low NRM risk possibly benefiting from an HSCT-based treatment strategy.

  16. 刺激大鼠海马后PAG、NRM和脊髓背角5-HT的变化%Change of PAG, NRM and dosal horn 5-HT after stimulating hippocampus in rats

    Institute of Scientific and Technical Information of China (English)

    高艳; 吴爱群; 张静; 方智慧


    目的:探讨刺激大鼠海马后导水管周围灰质(Periaqueductal central gray matter,PAG)、中缝大核(Nueleus raphesmagnus,NRM)和脊髓背角5-HT的变化,分析海马在镇痛中的作用机制.方法:健康成年Wistar大鼠40只,随机分为4组.A组:正常对照组;B组:疼痛组;C组:谷氨酸钠组;D组:生理盐水组.四组动物均于2小时后处死,常规灌注冰冻连续切片,采用SABC免疫组化和计算机图像分析技术,检测PAG、NRM5-HT神经元阳性细胞个数及光密度及脊髓背角5-HT阳性纤维及终未的积分光密度等均值.结果:疼痛刺激后,PAG、NRM、脊髓背角内5-HT水平较正常显著增高(P<0.05),谷氨酸钠组则较疼痛组进一步增加.结论:海马兴奋后,激活内源性镇痛系统,使5-HT大量释放,参与镇痛.

  17. Lamellar magnetism and exchange bias in billion-year-old metamorphic titanohematite with nanoscale ilmenite exsolution lamellae: II. Exchange-bias at 5 K after field-free cooling of NRM and after cooling in a +5 T field (United States)

    Robinson, Peter; McEnroe, Suzanne A.; Jackson, M.


    This is the second of three papers investigating properties of titanohematite-bearing quartzo-feldspathic rocks that create a significant remanent magnetic anomaly in the Modum District, South Norway. The first paper provided initial magnetic results, mineralogical characterization and evidence for the presence of lamellar magnetism. In this paper, knowledge of lamellar magnetic properties is explored through experiments where ilmenite lamellae were magnetized below 57 K, and interact magnetically along interfaces with the titanohematite host. Samples with known NRM directions were placed in specific orientations in an MPMS then cooled in zero field to 5 K, where hysteresis loops were measured in fields up to 5 Tesla. This assured that results were ultimately related to the natural lamellar magnetism produced during cooling ˜ 1 billion years ago. In a second set of experiments the same oriented samples, were subjected to a +5 Tesla field then field cooled to 5 K before hysteresis experiments. The first experiments consistently produced asymmetric shifted hysteresis loops with two loop separations, one in a positive field and one in a negative field. Without exception, when the NRM was oriented toward the negative field end of the MPMS, the bimodal loop showed a dominant loop separation in a positive field. By contrast, when the NRM was oriented toward the positive field end of the MPMS, the bimodal loop showed a dominant loop separation in a negative field. Both observations are consistent with antiferromagnetic coupling between the hard magnetization of ilmenite and the more easily shifted lamellar magnetism of the hematite. The bimodal nature of the loops indicates that the NRMs are vector sums of natural lamellar moments, which are oriented both positively and negatively, and that these opposite moments control the orientations of ilmenite magnetizations when cooling through 57 K. Here, extreme exchange biases up to 1.68 Tesla were measured. The second set of

  18. Lamellar magnetism and exchange bias in billion-year-old metamorphic titanohematite with nanoscale ilmenite exsolution lamellae - II: exchange-bias at 5 K after field-free cooling of NRM and after cooling in a +5 T field (United States)

    Robinson, Peter; McEnroe, Suzanne A.; Jackson, Mike


    This is the second of three papers investigating properties of titanohematite-bearing quartzo-feldspathic rocks that create a significant remanent magnetic anomaly in the Modum District, South Norway. The first paper provided initial magnetic results, mineralogical characterization and evidence for the presence of lamellar magnetism. In this paper, knowledge of lamellar magnetic properties is explored through experiments where ilmenite lamellae were magnetized below 57 K, and interact magnetically along interfaces with the titanohematite host. Samples with known NRM directions were placed in specific orientations in an MPMS then cooled in zero field to 5 K, where hysteresis loops were measured in fields up to 5 Tesla. This assured that results were ultimately related to the natural lamellar magnetism produced during cooling ˜1 billion years ago. In a second set of experiments the same oriented samples, were subjected to a +5 Tesla (T) field then field cooled to 5 K before hysteresis experiments. The first experiments consistently produced asymmetric shifted hysteresis loops with two loop separations, one in a positive field and one in a negative field. Without exception, when the NRM was oriented toward the negative field end of the MPMS, the bimodal loop showed a dominant loop separation in a positive field. By contrast, when the NRM was oriented toward the positive field end of the MPMS, the bimodal loop showed a dominant loop separation in a negative field. Both observations are consistent with antiferromagnetic coupling between the hard magnetization of ilmenite and the more easily shifted lamellar magnetism of the hematite. The bimodal nature of the loops indicates that the NRMs are vector sums of natural lamellar moments, which are oriented both positively and negatively, and that these opposite moments control the orientations of ilmenite magnetizations when cooling through 57 K. Here, extreme exchange biases up to 1.68 T were measured. The second set of

  19. Occupational mortality

    DEFF Research Database (Denmark)

    Lynge, Elsebeth


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

  20. Mortality investigation (United States)

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


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

  1. Mortality Implications of Mortality Plateaus

    DEFF Research Database (Denmark)

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


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

  2. Usefulness of the hematopoietic cell transplantation-specific comorbidity index (HCT-CI) in predicting outcomes for adolescents and young adults with hematologic malignancies undergoing allogeneic stem cell transplant. (United States)

    Wood, William; Deal, Allison; Whitley, Julia; Sharf, Andrew; Serody, Jonathan; Gabriel, Donald; Shea, Thomas


    The HCT-CI helps to predict non-relapse mortality (NRM) and overall survival (OS) in allogeneic hematopoietic cell transplantation (HCT) recipients. The usefulness of this index in a younger, adolescent and young adult (AYA) population is unclear. We tested the validity of the HCT-CI as a predictor of mortality in a retrospective cohort of 56 AYA recipients between the ages of 16 and 39, using chart abstraction followed by univariable and multivariate analysis. Only pulmonary dysfunction (46%), hepatic dysfunction (27%), infection (20%), and psychiatric disturbance (11%) had frequencies greater than 5% in this population. HCT-CI scores of 0-2 were present in 54%, and scores of >3 in 46%. The cumulative incidence of NRM at 2 years was 32%, with an OS of 46%; the NRM and OS for patients with an HCT-CI of 0-2 were 24% and 62%, whereas the NRM and OS for patients with an HCT-CI >3 were 38% and 28%. Patients with pulmonary dysfunction prior to transplant had a 29% OS at 2 years, compared to a 61% OS among patients without (P = 0.001). There was no statistically significant difference for patients and a worse NRM (P = 0.08). In multivariable analysis, both an HCT-CI score of >3 and any pulmonary dysfunction remained associated with OS (P = 0.01, P = 0.03), but neither with NRM. The HCT-CI appears useful in predicting OS in AYAs, though higher scores may reflect prior treatment, with pulmonary dysfunction particularly prevalent. Prospective studies to further validate and explain these findings are warranted. Copyright © 2011 Wiley-Liss, Inc.

  3. Mortal assets

    Energy Technology Data Exchange (ETDEWEB)

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


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

  4. Double umbilical cord blood transplantation with reduced intensity conditioning and sirolimus-based GVHD prophylaxis. (United States)

    Cutler, C; Stevenson, K; Kim, H T; Brown, J; McDonough, S; Herrera, M; Reynolds, C; Liney, D; Kao, G; Ho, V; Armand, P; Koreth, J; Alyea, E; Dey, B R; Attar, E; Spitzer, T; Boussiotis, V A; Ritz, J; Soiffer, R; Antin, J H; Ballen, K


    The main limitations to umbilical cord blood (UCB) transplantation (UCBT) in adults are delayed engraftment, poor immunological reconstitution and high rates of non-relapse mortality (NRM). Double UCBT (DUCBT) has been used to circumvent the issue of low cell dose, but acute GVHD remains a significant problem. We describe our experience in 32 subjects, who underwent DUCBT after reduced-intensity conditioning with fludarabine/melphalan/antithymocyte globulin and who received sirolimus and tacrolimus to prevent acute GVHD. Engraftment of neutrophils occurred in all patients at a median of 21 days, and platelet engraftment occurred at a median of 42 days. Three subjects had grade II-IV acute GVHD (9.4%) and chronic GVHD occurred in four subjects (cumulative incidence 12.5%). No deaths were caused by GVHD and NRM at 100 days was 12.5%. At 2 years, NRM, PFS and OS were 34.4, 31.2 and 53.1%, respectively. As expected, immunologic reconstitution was slow, but PFS and OS were associated with reconstitution of CD4(+) and CD8(+) lymphocyte subsets, suggesting that recovery of adaptive immunity is required for the prevention of infection and relapse after transplantation. In summary, sirolimus and tacrolimus provide excellent GVHD prophylaxis in DUCBT, and this regimen is associated with low NRM after DUCBT.

  5. Donor Lymphocyte Infusions Used to Treat Mixed-Chimeric and High-Risk Patient Populations in the Relapsed and Nonrelapsed Settings after Allogeneic Transplantation for Hematologic Malignancies Are Associated with High Five-Year Survival if Persistent Full Donor Chimerism Is Obtained or Maintained. (United States)

    Caldemeyer, Lauren E; Akard, Luke P; Edwards, John R; Tandra, Anand; Wagenknecht, Dawn R; Dugan, Michael J


    Mixed chimerism (MC), a persistent or increasing number of host cells after allogeneic hematopoietic stem cell transplantation (HSCT), is a predictor of disease relapse. Donor lymphocyte infusions (DLI) have the potential to enhance the graft-versus-malignancy (GVM) effect, reducing the risk of relapse in patients with MC. Hence, in addition to utilizing DLI in the relapsed setting, there is a motivation to pursue pre-emptive DLI for patients in complete remissions after HSCT. To assess the safety and efficacy of DLI, records of 86 patients who received DLI between 2003 and 2015 at a single institution were studied retrospectively. Patients who received DLI included 50 patients with relapsed/residual (RR) disease, 29 patients with emerging MC without detectable disease, and 7 patients in an "other" cohort who had neither RR disease nor emerging MC after HSCT. DLI were administered using a dose-escalation protocol. After DLI, 93% of MC patients converted to full donor chimerism (FDC). Nonrelapsed patients (MC and other) reported high overall survival (OS) at 1 and 5 years (83% at 1 year, 70% at 5 years for MC; 86% at 1 year, 69% at 5 years for other) and was statistically superior to 5-year OS for RR patients (nonrelapsed 69% versus RR 28%; P = .00032). Improved survival correlated with successful conversion to FDC after DLI for RR and MC cohorts: 71% 2-year OS for patients converted to FDC versus 13% for patients who failed to achieve FDC (P year progression-free survival (PFS) of 71% compared with 18% 5-year PFS in the RR group (P < .0001). Relapse/progressive disease was the most frequent cause of death (41%). Seven MC (24%), 2 other (29%), and 39 RR patients (78%) relapsed or did not respond after DLI. Overall, 6 patients (7%) died of graft-versus-host disease after DLI. Our results demonstrate a successful dose-escalation approach for nonrelapsed patients that correlated with high survival and a high rate of achieving FDC in MC and RR populations. DLI

  6. Mortality table construction (United States)



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

  7. Challenge of Fetal Mortality (United States)

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

  8. Excess mortality in hyperthyroidism

    DEFF Research Database (Denmark)

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


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

  9. Occupational Mortality, Background on

    DEFF Research Database (Denmark)

    Lynge, Elsebeth


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

  10. Allogeneic stem cell transplantation for adult Philadelphia chromosome-negative acute lymphocytic leukemia: comparable survival rates but different risk factors between related and unrelated transplantation in first complete remission. (United States)

    Nishiwaki, Satoshi; Inamoto, Yoshihiro; Sakamaki, Hisashi; Kurokawa, Mineo; Iida, Hiroatsu; Ogawa, Hiroyasu; Fukuda, Takahiro; Ozawa, Yukiyasu; Kobayashi, Naoki; Kasai, Masanobu; Mori, Takehiko; Iwato, Koji; Yoshida, Takashi; Onizuka, Makoto; Kawa, Keisei; Morishima, Yasuo; Suzuki, Ritsuro; Atsuta, Yoshiko; Miyamura, Koichi


    To identify factors to improve the outcomes of related and unrelated allogeneic stem cell transplantations (allo-SCT) for Philadelphia chromosome-negative acute lymphocytic leukemia (Ph(-) ALL) in the first complete remission (CR1), we retrospectively analyzed 1139 Ph(-) ALL patients using the registry data, particularly the details of 641 patients transplanted in CR1. Overall survival was significantly superior among patients transplanted in CR1, but no significant difference was observed between related and unrelated allo-SCTs (related vs unrelated: 65% vs 62% at 4 years, respectively; P = .19). Among patients transplanted in CR1, relapse rates were significantly higher in related allo-SCT compared with unrelated allo-SCT, and multivariate analysis demonstrated that less than 6 months from diagnosis to allo-SCT alone was associated with relapse. On the other hand, nonrelapse mortality (NRM) was significantly higher in unrelated allo-SCT compared with related allo-SCT, and multivariate analysis demonstrated that 10 months or longer from diagnosis to allo-SCT, human leukocyte antigen mismatch, and abnormal karyotype were associated with NRM. In conclusion, our study showed comparable survival rates but different relapse rates, NRM rates, and risk factors between related and unrelated allo-SCTs. After a close consideration of these factors, the outcome of allo-SCT for adult Ph(-) ALL in CR1 could be improved.

  11. RIC versus MAC UCBT in adults with AML: A report from Eurocord, the ALWP and the CTIWP of the EBMT (United States)

    Beohou, Eric; Labopin, Myriam; Sanz, Guillermo; Milpied, Noel; Michallet, Mauricette; Bacigalupo, Andrea; Blaise, Didier; Sierra, Jorge; Socié, Gérard; Cornelissen, Jan J.; Schmid, Christoph; Giebel, Sebastian; Gorin, Norbert-Claude; Esteve, Jordi; Ciceri, Fabio; Savani, Bipin N.; Mohty, Mohamad; Gluckman, Eliane; Nagler, Arnon


    Nonrelapse mortality (NRM) is the first cause of treatment failure after unrelated cord blood transplantation (UCBT) following myeloablative conditioning (MAC). In the last decade, reduced-intensity conditioning (RIC) regimens have been developed with the aim of reducing NRM and allowing older patients and those with medical comorbidities to benefit from UCBT. The aim of the current retrospective study was to compare transplantation outcomes of acute myeloid leukemia (AML) patients given UCBT after either RIC or MAC. Data from 894 adults with AML receiving a single or double UCBT as first allograft from 2004 to 2013 at EBMT centers were included in this study. 415 patients were given UCBT after RIC while 479 patients following a MAC. In comparison to MAC recipients, RIC recipients had a similar incidence of neutrophil engraftment and of acute and chronic graft-versus-host disease (GVHD). However, RIC recipients had a higher incidence of disease relapse and a lower NRM, translating to comparable leukemia-free (LFS), GVHD-free, relapse-free survival (GRFS) and overall survival (OS). These observations remained qualitatively similar after adjusting for differences between groups in multivariate analyses. In conclusion, these data suggest that LFS and OS are similar with RIC or with MAC in adults AML patients transplanted with UCBT. These observations could serve as basis for a future prospective randomized study. PMID:27250025

  12. Phenomenological theory of mortality (United States)

    Azbel, Mark Ya.


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

  13. An early-biomarker algorithm predicts lethal graft-versus-host disease and survival (United States)

    Hartwell, Matthew J.; Özbek, Umut; Holler, Ernst; Major-Monfried, Hannah; Reddy, Pavan; Aziz, Mina; Hogan, William J.; Ayuk, Francis; Efebera, Yvonne A.; Hexner, Elizabeth O.; Bunworasate, Udomsak; Qayed, Muna; Ordemann, Rainer; Wölfl, Matthias; Mielke, Stephan; Chen, Yi-Bin; Devine, Steven; Jagasia, Madan; Kitko, Carrie L.; Litzow, Mark R.; Kröger, Nicolaus; Locatelli, Franco; Morales, George; Nakamura, Ryotaro; Reshef, Ran; Rösler, Wolf; Weber, Daniela; Yanik, Gregory A.; Levine, John E.; Ferrara, James L.M.


    BACKGROUND. No laboratory test can predict the risk of nonrelapse mortality (NRM) or severe graft-versus-host disease (GVHD) after hematopoietic cellular transplantation (HCT) prior to the onset of GVHD symptoms. METHODS. Patient blood samples on day 7 after HCT were obtained from a multicenter set of 1,287 patients, and 620 samples were assigned to a training set. We measured the concentrations of 4 GVHD biomarkers (ST2, REG3α, TNFR1, and IL-2Rα) and used them to model 6-month NRM using rigorous cross-validation strategies to identify the best algorithm that defined 2 distinct risk groups. We then applied the final algorithm in an independent test set (n = 309) and validation set (n = 358). RESULTS. A 2-biomarker model using ST2 and REG3α concentrations identified patients with a cumulative incidence of 6-month NRM of 28% in the high-risk group and 7% in the low-risk group (P < 0.001). The algorithm performed equally well in the test set (33% vs. 7%, P < 0.001) and the multicenter validation set (26% vs. 10%, P < 0.001). Sixteen percent, 17%, and 20% of patients were at high risk in the training, test, and validation sets, respectively. GVHD-related mortality was greater in high-risk patients (18% vs. 4%, P < 0.001), as was severe gastrointestinal GVHD (17% vs. 8%, P < 0.001). The same algorithm can be successfully adapted to define 3 distinct risk groups at GVHD onset. CONCLUSION. A biomarker algorithm based on a blood sample taken 7 days after HCT can consistently identify a group of patients at high risk for lethal GVHD and NRM. FUNDING. The National Cancer Institute, American Cancer Society, and the Doris Duke Charitable Foundation. PMID:28194439

  14. Environmental temperature and mortality


    Näyhä, Simo


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

  15. Maternal mortality from hemorrhage. (United States)

    Haeri, Sina; Dildy, Gary A


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

  16. Mortality and GH deficiency

    DEFF Research Database (Denmark)

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


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

  17. Mortality in ankylosing spondylitis

    DEFF Research Database (Denmark)

    Exarchou, Sofia; Lie, Elisabeth; Lindström, Ulf


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

  18. Mortality associated with phaeochromocytoma

    NARCIS (Netherlands)

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


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

  19. Mortality after shoulder arthroplasty

    DEFF Research Database (Denmark)

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


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

  20. Mortality in Asia. (United States)


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

  1. Under-Five Mortality

    African Journals Online (AJOL)

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

  2. Increased mortality in narcolepsy. (United States)

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


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

  3. Mortality in spondylarthritis. (United States)

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


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

  4. Child health and mortality. (United States)

    El Arifeen, Shams


    Bangladesh is currently one of the very few countries in the world, which is on target for achieving the Millennium Development Goal (MDG) 4 relating to child mortality. There have been very rapid reductions in mortality, especially in recent years and among children aged over one month. However, this rate of reduction may be difficult to sustain and may impede the achievement of MDG 4. Neonatal deaths now contribute substantially (57%) to overall mortality of children aged less than five years, and reductions in neonatal mortality are difficult to achieve and have been slow in Bangladesh. There are some interesting attributes of the mortality decline in Bangladesh. Mortality has declined faster among girls than among boys, but the poorest have not benefited from the reduction in mortality. There has also been a relative absence of a decline in mortality in urban areas. The age and cause of death pattern of under-five mortality indicate certain interventions that need to be scaled up rapidly and reach high coverage to achieve MDG 4 in Bangladesh. These include skilled attendance at delivery, postnatal care for the newborn, appropriate feeding of the young infant and child, and prevention and management of childhood infections. The latest (2007) Bangladesh Demographic and Health Survey shows that Bangladesh has made sustained and remarkable progress in many areas of child health. More than 80% of children are receiving all vaccines. The use of oral rehydration solution for diarrhoea is high, and the coverage of vitamin A among children aged 9-59 months has been consistently increasing. However, poor quality of care, misperceptions regarding the need for care, and other social barriers contribute to low levels of care-seeking for illnesses of the newborns and children. Improvements in the health system are essential for removing these barriers, as are effective strategies to reach families and communities with targeted messages and information. Finally, there are

  5. Gallstone disease and mortality

    DEFF Research Database (Denmark)

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


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

  6. The mortality of companies (United States)

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


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

  7. maternal mortality in Malawi

    African Journals Online (AJOL)

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

  8. Affine stochastic mortality

    NARCIS (Netherlands)

    D.F. Schrager


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

  9. [Mortality in metropolitan regions]. (United States)

    Simoes Ccds


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

  10. [AIDS mortality in France]. (United States)

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


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

  11. HIV and maternal mortality. (United States)

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


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

  12. Deciphering infant mortality (United States)

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


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

  13. Pelvic fractures and mortality.


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


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

  14. Telomere Length and Mortality

    DEFF Research Database (Denmark)

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


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

  15. Nonpermissive HLA-DPB1 disparity is a significant independent risk factor for mortality after unrelated hematopoietic stem cell transplantation. (United States)

    Crocchiolo, Roberto; Zino, Elisabetta; Vago, Luca; Oneto, Rosi; Bruno, Barbara; Pollichieni, Simona; Sacchi, Nicoletta; Sormani, Maria Pia; Marcon, Jessica; Lamparelli, Teresa; Fanin, Renato; Garbarino, Lucia; Miotti, Valeria; Bandini, Giuseppe; Bosi, Alberto; Ciceri, Fabio; Bacigalupo, Andrea; Fleischhauer, Katharina


    The importance of donor-recipient human leukocyte antigen (HLA)-DPB1 matching for the clinical outcome of unrelated hematopoietic stem cell transplantation (HSCT) is controversial. We have previously described an algorithm for nonpermissive HLA-DPB1 disparities involving HLA-DPB1*0901,*1001,*1701,*0301,*1401,*4501, based on T-cell alloreactivity patterns. By revisiting the immunogenicity of HLA-DPB1*02, a modified algorithm was developed and retrospectively tested in 621 unrelated HSCTs facilitated through the Italian Registry for oncohematologic adult patients. The modified algorithm proved to be markedly more predictive of outcome than the original one, with significantly higher Kaplan-Meier probabilities of 2-year survival in permissive compared with nonpermissive transplantations (55% vs 39%, P = .005). This was the result of increased adjusted hazards of nonrelapse mortality (hazard ratio [HR] = 1.74; confidence interval [CI], 1.19-2.53; P = .004) but not of relapse (HR = 1.02; CI, 0.73-1.42; P = .92). The increase in the hazards of overall mortality by nonpermissive HLA-DPB1 disparity was similar in 10 of 10 (HR = 2.12; CI, 1.23-3.64; P = .006) and 9 of 10 allele-matched transplantations (HR = 2.21; CI, 1.28-3.80; P = .004), both in early-stage and in advanced-stage disease. These data call for revisiting current HLA matching strategies for unrelated HSCT, suggesting that searches should be directed up-front toward identification of HLA-DPB1 permissive, 10 of 10 or 9 of 10 matched donors.

  16. Predictive Value of Clinical Findings and Plasma Biomarkers after Fourteen Days of Prednisone Treatment for Acute Graft-versus-host Disease. (United States)

    McDonald, George B; Tabellini, Laura; Storer, Barry E; Martin, Paul J; Lawler, Richard L; Rosinski, Steven L; Schoch, H Gary; Hansen, John A


    We examined the hypothesis that plasma biomarkers and concomitant clinical findings after initial glucocorticoid therapy can accurately predict failure of graft-versus-host-disease (GVHD) treatment and mortality. We analyzed plasma samples and clinical data in 165 patients after 14 days of glucocorticoid therapy and used logistic regression and areas under receiver-operating characteristic curves (AUC) to evaluate associations with treatment failure and nonrelapse mortality (NRM). Initial treatment of GVHD was unsuccessful in 49 patients (30%). For predicting GVHD treatment failure, the best clinical combination (total serum bilirubin and skin GVHD stage: AUC, .70) was competitive with the best biomarker combination (T cell immunoglobulin and mucin domain 3 [TIM3] and [interleukin 1 receptor family encoded by the IL1RL1 gene, ST2]: AUC, .73). The combination of clinical features and biomarker results offered only a slight improvement (AUC, .75). For predicting NRM at 1 year, the best clinical predictor (total serum bilirubin: AUC, .81) was competitive with the best biomarker combination (TIM3 and soluble tumor necrosis factor receptor-1 [sTNFR1]: AUC, .85). The combination offered no improvement (AUC, .85). Infection was the proximate cause of death in virtually all patients. We conclude that after 14 days of glucocorticoid therapy, clinical findings (serum bilirubin, skin GVHD) and plasma biomarkers (TIM3, ST2, sTNFR1) can predict failure of GVHD treatment and NRM. These biomarkers reflect counter-regulatory mechanisms and provide insight into the pathophysiology of GVHD reactions after glucocorticoid treatment. The best predictive models, however, exhibit inadequate positive predictive values for identifying high-risk GVHD cohorts for investigational trials, as only a minority of patients with high-risk GVHD would be identified and most patients would be falsely predicted to have adverse outcomes. Copyright © 2017 The American Society for Blood and Marrow

  17. Excess Early Mortality in Schizophrenia

    DEFF Research Database (Denmark)

    Laursen, Thomas Munk; Nordentoft, Merete; Mortensen, Preben Bo


    Schizophrenia is often referred to as one of the most severe mental disorders, primarily because of the very high mortality rates of those with the disorder. This article reviews the literature on excess early mortality in persons with schizophrenia and suggests reasons for the high mortality as ...

  18. Allogeneic stem cell transplantation after conditioning with treosulfan, etoposide and cyclophosphamide for patients with ALL: a phase II-study on behalf of the German Cooperative Transplant Study Group and ALL Study Group (GMALL). (United States)

    Kröger, N; Bornhäuser, M; Stelljes, M; Pichlmeier, U; Trenschel, R; Schmid, C; Arnold, R; Martin, H; Heinzelmann, M; Wolschke, C; Meyer, R G; Bethge, W; Kobbe, G; Ayuk, F; Gökbuget, N; Hölzer, D; Zander, A; Beelen, D


    TBI-based preparative regimens are considered as standard conditioning therapy for allogeneic stem cell transplantation (AHSC) in patients with ALL. We investigated toxicity and efficacy of a non-TBI-based regimen consisting of treosulfan, etoposide and cyclophosphamide for ALL within a prospective study. Major inclusion criteria were CR and non-eligibility for TBI. Fifty patients with a median age of 46.5 years (range, 18-64) were included. Donors were HLA-identical sibling (n=8), matched (n=42) or mismatched (n=10) unrelated. The toxicity was moderate, resulting in a cumulative incidence of non-relapse mortality (NRM) at 1 year of 8% (90% confidence interval: 2-15%). Acute GvHD grade II-IV and grade III/IV was noted in 53% and 14%, respectively. Chronic GvHD at one year was seen in 41%. After a median follow-up of 24 months the cumulative incidence of relapse was 36% (90% confidence interval: 24-48) and 51% (90% confidence interval: 37-65) at 1 and 2 years, respectively. The estimated 2-year disease-free and overall survivals were 36 and 48%, respectively. Treosulfan, etoposide and cyclophosphamide followed by AHSC has a favorable toxicity profile with low NRM and therefore represents a potential alternative regimen for ALL in 1. CR (NCT00682305).

  19. Prognostic Importance of Pretransplant Functional Capacity After Allogeneic Hematopoietic Cell Transplantation (United States)

    Devlin, Sean M.; Maloy, Molly A.; Wood, William A.; Tuohy, Sharlynn; Espiritu, Noel; Aquino, Jennifer; Kendig, Tiffany; Michalski, Meghan G.; Gyurkocza, Boglarka; Schaffer, Wendy L.; Ali, Benzar; Giralt, Sergio; Jakubowski, Ann A.


    Background. The purpose of this study was to investigate the prognostic importance of functional capacity in patients undergoing allogeneic hematopoietic cell transplantation (HCT) for hematological malignancies. Patients and Methods. Using a retrospective design, 407 patients completed a 6-minute walk distance (6MWD) test to assess functional capacity before HCT; 193 (47%) completed a 6MWD test after hospital discharge. Cox proportional hazards regression was used to estimate the risk of nonrelapse mortality (NRM) and overall survival (OS) according to the 6MWD category ( .05 for all). Patients presenting with a pre-HCT 6MWD of <400 m and experiencing a decline in 6MWD had the highest risk of NRM. Conclusion. The 6MWD is a significant univariate predictor of clinical outcomes but did not provide prognostic information beyond that of traditional prognostic markers in HCT. Implications for Practice: The pretransplant 6-minute walk test is a significant univariate predictor of clinical outcomes in hematological patients beyond age but not beyond that of performance status. On this basis, 6-minute walk distance testing should not be considered part of the standard battery of assessments for risk stratification before hematopoietic cell transplantation. PMID:26446235

  20. Stillbirth and Infant Mortality

    DEFF Research Database (Denmark)

    Nøhr, Ellen Aagaard


    mechanisms behind these associations remain largely unknown. Although maternal obesity is associated with a wide range of complications in the mother and neonate that may impair fetal and infant survival, the increased risk of stillbirth and infant mortality is virtually unchanged when accounting...... indicating that some of the excess risk may have a placental origin. To further understand the associations between maternal obesity and late fetal and infant death, we need better and more detailed clinical data, which is difficult to obtain on a population level given the rarity of the outcomes. The best...

  1. Child mortality after Hurricane Katrina. (United States)

    Kanter, Robert K


    Age-specific pediatric health consequences of community disruption after Hurricane Katrina have not been analyzed. Post-Katrina vital statistics are unavailable. The objectives of this study were to validate an alternative method to estimate child mortality rates in the greater New Orleans area and compare pre-Katrina and post-Katrina mortality rates. Pre-Katrina 2004 child mortality was estimated from death reports in the local daily newspaper and validated by comparison with pre-Katrina data from the Louisiana Department of Health. Post-Katrina child mortality rates were analyzed as a measure of health consequences. Newspaper-derived estimates of mortality rates appear to be valid except for possible underreporting of neonatal rates. Pre-Katrina and post-Katrina mortality rates were similar for all age groups except infants. Post-Katrina, a 92% decline in mortality rate occurred for neonates (Katrina decline in infant mortality rate exceeds the pre-Katrina discrepancy between newspaper-derived and Department of Health-reported rates. A declining infant mortality rate raises questions about persistent displacement of high-risk infants out of the region. Otherwise, there is no evidence of long-lasting post-Katrina excess child mortality. Further investigation of demographic changes would be of interest to local decision makers and planners for recovery after public health emergencies in other regions.

  2. Mortality after hemorrhagic stroke

    DEFF Research Database (Denmark)

    González-Pérez, Antonio; Gaist, David; Wallander, Mari-Ann


    OBJECTIVE: To investigate short-term case fatality and long-term mortality after intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) using data from The Health Improvement Network database. METHODS: Thirty-day case fatality was stratified by age, sex, and calendar year after ICH...... during the first year of follow-up compared with controls (ICH: hazard ratio [HR] 2.60, 95% confidence interval [CI] 2.09-3.24, p year (ICH: HR 2.02, 95% CI 1.75-2.32, p ... and SAH using logistic regression. Cox proportional hazards regression analyses were used to estimate the risk of death during the first year of follow-up and survivors at 1 year. RESULTS: Case fatality after ICH was 42.0%, compared with 28.7% after SAH. It increased with age (ICH: 29.7% for 20-49 years...

  3. Maternal mortality due to trauma. (United States)

    Romero, Vivian Carolina; Pearlman, Mark


    Maternal mortality is an important indicator of adequacy of health care in our society. Improvements in the obstetric care system as well as advances in technology have contributed to reduction in maternal mortality rates. Trauma complicates up to 7% of all pregnancies and has emerged as the leading cause of maternal mortality, becoming a significant concern for the public health system. Maternal mortality secondary to trauma can often be prevented by coordinated medical care, but it is essential that caregivers recognize the unique situation of providing simultaneous care to 2 patients who have a complex physiologic relationship. Optimal management of the pregnant trauma victim requires a multidisciplinary team, where the obstetrician plays a central role. This review focuses on the incidence of maternal mortality due to trauma, the mechanisms involved in traumatic injury, the important anatomic and physiologic changes that may predispose to mortality due to trauma, and finally, preventive strategies that may decrease the incidence of traumatic maternal death.

  4. Gender difference in child mortality. (United States)

    Ahmed, F A


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

  5. Outcome after Transplantation According to Reduced-Intensity Conditioning Regimen in Patients Undergoing Transplantation for Myelofibrosis. (United States)

    Robin, Marie; Porcher, Raphael; Wolschke, Christine; Sicre de Fontbrune, Flore; Alchalby, Haefaa; Christopeit, Maximilian; Cassinat, Bruno; Zabelina, Tatjana; Peffault de Latour, Régis; Ayuk, Francis; Socié, Gérard; Kröger, Nicolaus


    Allogeneic hematopoietic stem cell transplantation remains the sole curative option for myelofibrosis. Many transplantation recipients receive a reduced-intensity conditioning (RIC) regimen owing to age or comorbidities; however, there is little published evidence to guide the choice of RIC regimen. In this study, we compared outcomes in patients who received 1 of 2 frequently used RIC regimens for patients with myelofibrosis: fludarabine-busulfan (FB) and fludarabine-melphalan (FM). A total of 160 patients underwent a RIC allograft procedure (FB group, n = 105; FM group, n = 55). We have developed a complex statistical model involving weighting and adjustment to permit comparison between these 2 groups. After weighting, the incidence of acute graft-versus-host disease (GVHD) was 62% in the FM group and 31% in the FB group (P = .001), and the corresponding incidence of chronic GVHD was 49% and 53%, respectively. The 7-year progression-free survival was were 52% in the FM group versus 33% in the FB group, and the 7-year overall survival rate 52% in the FM group versus 59% in the FB group. Nonrelapse mortality (NRM) was 43% in the FM group and 31% in the FB group. Multivariable analyses revealed no significant differences in PFS between the 2 groups; however, the relapse rate was significantly lower in the FM group (hazard ratio, 9.21; P = .008), whereas a trend toward reduced NRM was seen in the FB group (hazard ratio, 0.51; P = .068). In conclusion, both regimens appear to be efficient in mediating disease control and can be used to successfully condition patients with myelofibrosis. The FM regimen appears to induce more NRM than the FB regimen, but with augmented control of disease, leading to comparable overall survival rates for both regimens.

  6. Comparison of Intensive Chemotherapy and Hypomethylating Agents before Allogeneic Stem Cell Transplantation for Advanced Myelodysplastic Syndromes: A Study of the Myelodysplastic Syndrome Subcommittee of the Chronic Malignancies Working Party of the European Society for Blood and Marrow Transplant Research. (United States)

    Potter, Victoria T; Iacobelli, Simona; van Biezen, Anja; Maertens, Johann; Bourhis, Jean-Henri; Passweg, Jakob R; Yakhoub-Agha, Ibrahim; Tabrizi, Reza; Bay, Jacques-Olivier; Chevallier, Patrice; Chalandon, Yves; Huynh, Anne; Cahn, Jean Yves; Ljungman, Per; Craddock, Charles; Lenhoff, Stig; Russell, N H; Fegueux, Nathalie; Socié, Gerard; Benedetto, Bruno; Meijer, Ellen; Mufti, G J; de Witte, Theo; Robin, Marie; Kröger, Nicolaus


    The European Society for Blood and Marrow Transplant Research data set was used to retrospectively analyze the outcomes of hypomethylating therapy (HMA) compared with those of conventional chemotherapy (CC) before hematopoietic stem cell transplantation (HSCT) in 209 patients with advanced myelodysplastic syndromes. Median follow-up was 22.1 months and the median age of the group was 57.6 years with 37% of the population older than > 60 years. The majority of patients (59%) received reduced-intensity conditioning and 34% and 27% had intermediate-2 and high international prognostic scoring system (IPSS) scores. At time of HSCT, 32% of patients did not achieve complete remission (CR) and 13% had primary refractory disease. On univariate analysis, outcomes at 3 years were not significantly different between HMA and CC for overall survival (OS), relapse-free survival (RFS), cumulative incidence of relapse (CIR), and nonrelapse mortality (NRM): OS (42% versus 35%), RFS (29% versus 31%), CIR (45% versus 40%), and NRM (26% versus 28%). Comparing characteristics of the groups, there were more patients < 55 years old, more patients in CR (68% versus 32%), and fewer patients with primary refractory disease in the CC group than in the HMA group (10% versus 19%, P < .001). Patients with primary refractory disease had worse outcomes than those in CR with regard to OS (hazard ratio [HR], 2.42; 95% confidence interval [CI], 1.41 to 4.13; P = .001), RFS (HR, 2.27; 95% CI, 1.37 to 3.76; P = .001), and NRM (HR, 2.49; 95% CI, 1.18 to 5.26; P = .016). In addition, an adverse effect of IPSS-R cytogenetic risk group was evident for RFS. In summary, outcomes after HSCT are similar for patients receiving HMA compared with those receiving CC, despite the higher proportion of patients with primary refractory disease in the HMA group.

  7. Post-Transplant Cyclophosphamide and Tacrolimus-Mycophenolate Mofetil Combination Prevents Graft-versus-Host Disease in Allogeneic Peripheral Blood Hematopoietic Cell Transplantation from HLA-Matched Donors. (United States)

    Carnevale-Schianca, Fabrizio; Caravelli, Daniela; Gallo, Susanna; Coha, Valentina; D'Ambrosio, Lorenzo; Vassallo, Elena; Fizzotti, Marco; Nesi, Francesca; Gioeni, Luisa; Berger, Massimo; Polo, Alessandra; Gammaitoni, Loretta; Becco, Paolo; Giraudo, Lidia; Mangioni, Monica; Sangiolo, Dario; Grignani, Giovanni; Rota-Scalabrini, Delia; Sottile, Antonino; Fagioli, Franca; Aglietta, Massimo


    Allogeneic hematopoietic cell transplant (HCT) remains the only curative therapy for many hematologic malignancies but it is limited by high nonrelapse mortality (NRM), primarily from unpredictable control of graft-versus-host disease (GVHD). Recently, post-transplant cyclophosphamide demonstrated improved GVHD control in allogeneic bone marrow HCT. Here we explore cyclophosphamide in allogeneic peripheral blood stem cell transplantation (alloPBSCT). Patients with high-risk hematologic malignancies received alloPBSCT from HLA-matched unrelated/related donors. GVHD prophylaxis included combination post-HCT cyclophosphamide 50 mg/kg (days +3 and +4) and tacrolimus/mofetil mycophenolate (T/MMF) (day +5 forward). The primary objective was the cumulative incidence of acute and chronic GVHD. Between March 2011 and May 2015, 35 consecutive patients received the proposed regimen. MMF was stopped in all patients at day +28; the median discontinuation of tacrolimus was day +113. Acute and chronic GVHD cumulative incidences were 17% and 7%, respectively, with no grade IV GVHD events, only 2 patients requiring chronic GVHD immunosuppression control, and no deaths from GVHD. Two-year NRM, overall survival, event-free survival, and chronic GVHD event-free survival rates were 3%, 77%, 54%, and 49%, respectively. The graft-versus-tumor effect was maintained as 5 of 15 patients (33%) who received HCT with evidence of disease experienced further disease response. A post-transplant cyclophosphamide + T/MMF combination strategy effectively prevented acute and chronic GVHD after alloPBSCT from HLA-matched donors and achieved an unprecedented low NRM without losing efficacy in disease control or impaired development of the graft-versus-tumor effect. This trial is registered at as NCT02300571.

  8. Adult mortality in preindustrial Quebec

    Directory of Open Access Journals (Sweden)

    Claudine Lacroix - - - Bertrand Desjardins


    Full Text Available This paper presents the main results of a detailed study on adult mortality in French Canadians born before 1750 and having married inthe colony of New France. Using data from parish registers, mortality is studied using abridged life tables, with staggered entries according to age at first marriage. Survival tables and log-Rank tests are used to support the results. Three features were selected for the study of differential mortality: gender, type of residence area (urban or rural, and cohort. The mortality of French Canadians is compared to that of their French contemporaries.

  9. Indonesia lowers infant mortality. (United States)

    Bain, S


    Indonesia's success in reaching World Health Organization (WHO) universal immunization coverage standards is described as the result of a strong national program with timely, targeted donor support. USAID/Indonesia's Expanded Program for Immunization (EPI) and other USAID bilateral cooperation helped the government of Indonesia in its goal to immunize children against diphtheria, pertussis, tetanus, polio, tuberculosis, and measles by age 1. The initial project was to identify target areas and deliver vaccines against the diseases, strengthen the national immunization organization and infrastructure, and develop the Ministry of Health's capacity to conduct studies and development activities. This EPI project spanned the period 1979-90, and set the stage for continued expansion of Indonesia's immunization program to comply with the full international schedule and range of immunizations of 3 DPT, 3 polio, 1 BCG, and 1 measles inoculation. The number of immunization sites has increased from 55 to include over 5,000 health centers in all provinces, with additional services provided by visiting vaccinators and nurses in most of the 215,000 community-supported integrated health posts. While other contributory factors were at play, program success is at least partially responsible for the 1990 infant mortality rate of 58/1,000 live births compared to 72/1,000 in 1985. Strong national leadership, dedicated health workers and volunteers, and cooperation and funding from UNICEF, the World Bank, Rotary International, and WHO also played crucially positive roles in improving immunization practice in Indonesia.

  10. Early cytomegalovirus reactivation remains associated with increased transplant-related mortality in the current era: a CIBMTR analysis. (United States)

    Teira, Pierre; Battiwalla, Minoo; Ramanathan, Muthalagu; Barrett, A John; Ahn, Kwang Woo; Chen, Min; Green, Jaime S; Saad, Ayman; Antin, Joseph H; Savani, Bipin N; Lazarus, Hillard M; Seftel, Matthew; Saber, Wael; Marks, David; Aljurf, Mahmoud; Norkin, Maxim; Wingard, John R; Lindemans, Caroline A; Boeckh, Michael; Riches, Marcie L; Auletta, Jeffery J


    Single-center studies have reported an association between early (before day 100) cytomegalovirus (CMV) reactivation and decreased incidence of relapse for acute myeloid leukemia (AML) following allogeneic hematopoietic cell transplantation. To substantiate these preliminary findings, the Center for International Blood and Marrow Transplant Research (CIBMTR) Database was interrogated to analyze the impact of CMV reactivation on hematologic disease relapse in the current era. Data from 9469 patients transplanted with bone marrow or peripheral blood between 2003 and 2010 were analyzed according to 4 disease categories: AML (n = 5310); acute lymphoblastic leukemia (ALL, n = 1883); chronic myeloid leukemia (CML, n = 1079); and myelodysplastic syndrome (MDS, n = 1197). Median time to initial CMV reactivation was 41 days (range, 1-362 days). CMV reactivation had no preventive effect on hematologic disease relapse irrespective of diagnosis. Moreover, CMV reactivation was associated with higher nonrelapse mortality [relative risk [RR] among disease categories ranged from 1.61 to 1.95 and P values from .0002 to <.0001; 95% confidence interval [CI], 1.14-2.61). As a result, CMV reactivation was associated with lower overall survival for AML (RR = 1.27; 95% CI, 1.17-1.38; P <.0001), ALL (RR = 1.46; 95% CI, 1.25-1.71; P <.0001), CML (RR = 1.49; 95% CI, 1.19-1.88; P = .0005), and MDS (RR = 1.31; 95% CI, 1.09-1.57; P = .003). In conclusion, CMV reactivation continues to remain a risk factor for poor posttransplant outcomes and does not seem to confer protection against hematologic disease relapse.

  11. Stressful social relations and mortality

    DEFF Research Database (Denmark)

    Lund, Rikke; Christensen, Ulla; Nilsson, Charlotte Juul


    BACKGROUND: Few studies have examined the relationship between stressful social relations in private life and all-cause mortality. OBJECTIVE: To evaluate the association between stressful social relations (with partner, children, other family, friends and neighbours, respectively) and all...... men and women aged 36-52 years, linked to the Danish Cause of Death Registry for information on all-cause mortality until 31 December 2011. Associations between stressful social relations with partner, children, other family, friends and neighbours, respectively, and all-cause mortality were examined...... hazards model. RESULTS: Frequent worries/demands from partner or children were associated with 50-100% increased mortality risk. Frequent conflicts with any type of social relation were associated with 2-3 times increased mortality risk. Interaction between labour force participation and worries...

  12. [Asthma mortality trends in Mexico]. (United States)

    Salas Ramírez, M; Segura Méndez, N H; Martínez-Cairo Cueto, S


    The objective of this cross-sectional study was to estimate mortality and morbidity from asthma in Mexico by federative entity (state) of residence, age, and sex during the period between 1960 and 1988. Statistics published by the National Institute of Statistics, Geography, and Information Science were reviewed, as were vital statistics and information from other sources. Data were selected on mortality, hospital admissions, and outpatient visits, as well as population by federative entity, age, and sex. Mortality and morbidity rates were adjusted for age using the direct method. From 1960 to 1987, mortality decreased for both sexes. The groups with the highest asthma mortality were those under 4 years of age and those over 50. From 1960 to the present, the state with the highest mortality was Tlaxcala. Hospitalizations increased from 10 to 140 per 100,000 population for the country as a whole. When both outpatient visits and hospitalizations were considered, the morbidity rates rose from 180 to 203.4 per 100,000 between 1960 and 1970. In 1970, hospital morbidity was higher among males than females. From 1960 up to the 1990s, the highest rates of hospitalization and outpatient visits were registered among those under 4 and those over 60. The states with the highest asthma hospitalization rates were Morelos, Baja California Sur, Nuevo León, Durango, and Tamaulipas. It is concluded that asthma mortality in Mexico is showing a downward trend, while morbidity is increasing considerably, especially among adolescents.

  13. Trends in child mortality in India. (United States)

    Behl, A S


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

  14. The law of mortality revisited: interspecies comparisons of mortality. (United States)

    Olshansky, S J


    In 1825 the British actuary Benjamin Gompertz believed he had discovered a consistency in the timing of death in people that was so important that he labelled his observation a 'law of mortality'. To Gompertz, this 'law' was equivalent in importance to Newton's law of gravity because he believed it would be observed in all living things. Gompertz's quest for the 'law' eventually failed, as did similar efforts by other scientists in the 19th and most of the 20th century. However, the search for the law of mortality was successfully resolved in 1996 when my colleagues and I discovered that the only way to 'see' Gompertz's law expressed as common age patterns of death across species was to partition total mortality into its intrinsic and extrinsic components, and examine mortality schedules on a uniform time scale. Scientists had been unable to reveal the law of mortality in the past not only because they could not partition total mortality, but also because of the previous anthropocentric perspective that forced some scientists to view duration of life along a single time scale - one based on human measurements of chronological time. The law of mortality is relevant today not only because it links the epidemiology of disease, ageing and death across species, but because it creates a window into the future for those who study disease epidemiology in animals that now live long enough in protected environments to experience the biological consequences of ageing. In this paper I summarize the historical search for the law of mortality, explain why the solution could only be found by linking two seemingly unconnected scientific disciplines (evolution biology and actuarial/demographics), explain why age patterns of disease and death in humans may be used to understand and predict disease epidemiology in other species, and describe how a new scientific discipline has arisen in the modern era as a result of this research.

  15. CDC WONDER: Mortality - Infant Deaths (United States)

    U.S. Department of Health & Human Services — The Mortality - Infant Deaths (from Linked Birth / Infant Death Records) online databases on CDC WONDER provide counts and rates for deaths of children under 1 year...

  16. Maternal mortality in Bijapur district

    Directory of Open Access Journals (Sweden)

    Vidya A. Thobbi


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

  17. Universal mortality law and immortality (United States)

    Azbel', Mark Ya.


    Well-protected human and laboratory animal populations with abundant resources are evolutionarily unprecedented. Physical approach, which takes advantage of their extensively quantified mortality, establishes that its dominant fraction yields the exact law, which is universal for all animals from yeast to humans. Singularities of the law demonstrate new kinds of stepwise adaptation. The law proves that universal mortality is an evolutionary by-product, which at any given age is reversible, independent of previous life history, and disposable. Life expectancy may be extended, arguably to immortality, by minor biological amendments in the animals. Indeed, in nematodes with a small number of perturbed genes and tissues it increased 6-fold (to 430 years in human terms), with no apparent loss in health and vitality. The law relates universal mortality to specific processes in cells and their genetic regulation.

  18. Electrocardiographic Predictors of Cardiovascular Mortality

    Directory of Open Access Journals (Sweden)

    Ioana Mozos


    Full Text Available Cardiovascular diseases are the main causes of mortality. Sudden cardiac death may also appear in athletes, due to underlying congenital or inherited cardiac abnormalities. The electrocardiogram is used in clinical practice and clinical trials, as a valid, reliable, accessible, inexpensive method. The aim of the present paper was to review electrocardiographic (ECG signs associated with cardiovascular mortality and the mechanisms underlying those associations, providing a brief description of the main studies in this area, and consider their implication for clinical practice in the general population and athletes. The main ECG parameters associated with cardiovascular mortality in the present paper are the P wave (duration, interatrial block, and deep terminal negativity of the P wave in V1, prolonged QT and Tpeak-Tend intervals, QRS duration and fragmentation, bundle branch block, ST segment depression and elevation, T waves (inverted, T wave axes, spatial angles between QRS and T vectors, premature ventricular contractions, and ECG hypertrophy criteria.

  19. Decline in breast cancer mortality

    DEFF Research Database (Denmark)

    Njor, Sisse Helle; Schwartz, Walter; Blichert-Toft, Mogens


    OBJECTIVES: When estimating the decline in breast cancer mortality attributable to screening, the challenge is to provide valid comparison groups and to distinguish the screening effect from other effects. In Funen, Denmark, multidisciplinary breast cancer management teams started before screening...... was introduced; both activities came later in the rest of Denmark. Because Denmark had national protocols for breast cancer treatment, but hardly any opportunistic screening, Funen formed a "natural experiment", providing valid comparison groups and enabling the separation of the effect of screening from other...... factors. METHODS: Using Poisson regression we compared the observed breast cancer mortality rate in Funen after implementation of screening with the expected rate without screening. The latter was estimated from breast cancer mortality in the rest of Denmark controlled for historical differences between...

  20. Mortality rates among wild chimpanzees. (United States)

    Hill, K; Boesch, C; Goodall, J; Pusey, A; Williams, J; Wrangham, R


    In order to compare evolved human and chimpanzees' life histories we present a synthetic life table for free-living chimpanzees, derived from data collected in five study populations (Gombe, Taï, Kibale, Mahale, Bossou). The combined data from all populations represent 3711 chimpanzee years at risk and 278 deaths. Males show higher mortality than females and data suggest some inter-site variation in mortality. Despite this variation, however, wild chimpanzees generally have a life expectancy at birth of less than 15 years and mean adult lifespan (after sexual maturity) is only about 15 years. This is considerably lower survival than that reported for chimpanzees in zoos or captive breeding colonies, or that measured among modern human hunter-gatherers. The low mortality rate of human foragers relative to chimpanzees in the early adult years may partially explain why humans have evolved to senesce later than chimpanzees, and have a longer juvenile period.

  1. Targeted interventions and infant mortality. (United States)

    Lovel, H


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

  2. Is cancer mortality increasing in France?


    Hill, C.; Jan, P; Doyon, F


    Long-term trends in cancer mortality are reported by site. Overall, cancer mortality has been decreasing in France since 1987 in the male population and since 1968 in the female population. Improvement in treatments and diagnosis should lead to persistently declining mortality rates, unless the tobacco epidemic reverses the trend in female mortality. © 2001 Cancer Research Campaign

  3. Mortality in adult congenital heart disease

    NARCIS (Netherlands)

    Verheugt, Carianne L.; Uiterwaal, Cuno S. P. M.; van der Velde, Enno T.; Meijboom, Folkert J.; Pieper, Petronella G.; van Dijk, Arie P. J.; Vliegen, Hubert W.; Grobbee, Diederick E.; Mulder, Barbara J. M.


    Mortality in adults with congenital heart disease is known to be increased, yet its extent and the major mortality risks are unclear. The Dutch CONCOR national registry for adult congenital heart disease was linked to the national mortality registry. Cox's regression was used to assess mortality pre

  4. Mortality among ethylene oxide workers. (United States)

    Morgan, R W; Claxton, K W; Divine, B J; Kaplan, S D; Harris, V B


    Because of reports linking an increased risk of leukemia with exposure to ethylene oxide, a mortality study of workers with potential exposure to ethylene oxide at the Texaco Chemical Company Plant in Port Neches, Tex., was undertaken. A total of 767 males with potential exposure to ethylene oxide were identified. Forty-six deaths occurred in this cohort with 80 expected (standardized mortality ratio; SMR = 58). No deaths from leukemia were seen, nor were there any statistically significant excesses from any specific causes of death.

  5. Child mortality in rural India

    NARCIS (Netherlands)

    B. van der Klaauw (Bas); L. Wang (Lihong)


    textabstractThis paper focuses on infant and child mortality in rural areas of India. We construct a flexible duration model, which allows for frailty at multiple levels and interactions between the child's age and individual, socioeconomic, and environmental characteristics. The model is estimated

  6. America's Infant-Mortality Puzzle. (United States)

    Eberstadt, Nicholas


    Conventional explanations attributing the high infant mortality rate in United States to the prevalence of poverty and lack of adequate health care do not tell the whole story. Contributions of parental behavior, lifestyles, and public health care availability versus utilization must be examined in determining public policies to address the…

  7. Infant Mortality: The Shared Concern. (United States)

    Heagarty, Margaret C.


    Addresses the causes for and implications of infant mortality. Besides the more immediate causes such as disease, nutrition, and lifestyle, there are the additional hurdles of government bureaucracy, lack of funds, and institutional attitudes that block access to prenatal care. Suggests structural solutions, including a consistent, individual,…

  8. Morbidity and Mortality in Sarcoidosis (United States)

    Gerke, Alicia K.


    Purpose of Review Chronic sarcoidosis is a complex disease with numerous comorbid conditions and can be fatal in some cases. Recognizing causes of morbidity and mortality is important to effectively select treatments, manage symptoms, and improve outcomes. The purpose of this review is to examine emerging knowledge on morbidity and mortality in sarcoidosis. Recent Findings Approximately one to five percent of patients with sarcoidosis die from complications of sarcoidosis. Recent population studies indicate that mortality may be increasing over the past decade. The reasons behind these trends are unclear, but could include increasing incidence, detection rates, severity of disease, or age of the population. Morbidity of sarcoidosis is reflected by a trend of increased hospitalizations over recent years and increased use of healthcare resources. Morbidity can be caused by organ damage from granulomatous inflammation, treatment complications, and psychosocial effects of the disease. Recent studies are focused on morbidity related to cardiopulmonary complications, bone health, and aging within the sarcoidosis population. Last, sarcoidosis is associated with autoimmune diseases, pulmonary embolism, and malignancy; however, the underlying mechanisms linking diseases continue to be debated. Summary Morbidity in sarcoidosis is significant and multifactorial. Mortality is infrequent, but may be increasing over the years. PMID:25029298

  9. Predictors of paediatric injury mortality

    African Journals Online (AJOL)

    Department of Paediatrics and Child Health, Wesley Guild Hospital Unit, Obafemi Awolowo University ... 90% of global deaths due to injuries in children occur in low-income ... sought and obtained by carefully explaining the purpose and benefits ..... terms of mortality and development of neurological sequelae.4-7,16 In.

  10. Excess mortality following hip fracture

    DEFF Research Database (Denmark)

    Abrahamsen, B; van Staa, T; Ariely, R;


    Summary This systematic literature review has shown that patients experiencing hip fracture after low-impact trauma are at considerable excess risk for death compared with nonhip fracture/community control populations. The increased mortality risk may persist for several years thereafter, highlig...

  11. Testosterone deficiency and cardiovascular mortality

    Institute of Scientific and Technical Information of China (English)

    Abraham Morgentaler


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

  12. Peptic ulcers: mortality and hospitalization. (United States)

    Riley, R


    This study analyzes data on peptic ulcer disease based on deaths for 1951-1988 and hospital separations for 1969-1988. The source of the data are mortality and morbidity statistics provided to Statistics Canada by the provinces. The age-standardized mortality rates (ASMR) for peptic ulcer disease decreased from 1951 to 1988 by 69.4% for men (8.5 to 2.6 per 100,000 population), and 31.8% for women (2.2 to 1.5). Separation rates from hospitals during 1969-1988 for peptic ulcer disease also decreased by 59.8% for men (242.7 to 97.6 per 100,000 population) and 35.6% for women (103.2 to 66.5). Age-specific rates for both mortality and hospital separations increased with age. Epidemiological studies indicate that the incidence of peptic ulcer disease is declining in the general population. The downward trends in mortality and hospitalization rates for peptic ulcer disease reflect this change in incidence, but additional factors probably contribute as well to this decline. Male rates for both mortality and hospital separations were much higher than female rates at the beginning of the study period; but toward the end, the gap between the sexes narrowed considerably, mainly because the male rates declined substantially while the female rates decline moderately. The slower decline in the rates for women may be related to such factors as the increasing labour force participation among women and the slower decline in the population of female smokers.

  13. Homoarginine, cardiovascular risk, and mortality. (United States)

    März, Winfried; Meinitzer, Andreas; Drechsler, Christiane; Pilz, Stefan; Krane, Vera; Kleber, Marcus E; Fischer, Joachim; Winkelmann, Bernhard R; Böhm, Bernhard O; Ritz, Eberhard; Wanner, Christoph


    Homoarginine is an amino acid derivative that may increase nitric oxide availability and enhance endothelial function. The effect of the level of homoarginine on cardiovascular outcome and mortality is unknown. We assessed cardiovascular and all-cause mortality according to homoarginine levels in a cohort of 3,305 subjects referred for coronary angiography from the LUdwigshafen RIsk and Cardiovascular Health (LURIC) Study. After investigating the relation of homoarginine with kidney function and markers of endothelial dysfunction, we explored its effects on adverse outcomes in a second high-risk cohort of 1244 patients with type 2 diabetes mellitus receiving maintenance hemodialysis (4D study [Die Deutsche Diabetes Dialyse Studie]). In the LURIC study, mean serum homoarginine levels were 2.6+/-1.1 micromol/L. During a median follow-up of 7.7 years, 766 patients died. After adjustments for age and sex, patients in the lowest quartile (4-fold higher rate of dying of cardiovascular disease (hazard ratio 4.1, 95% confidence interval 3.0 to 5.7) than patients in the highest quartile (>3.1 micromol/L). Lower homoarginine levels were associated with lower estimated glomerular filtration rate and higher levels of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1. Hemodialysed patients had lower mean homoarginine levels of 1.2+/-0.5 micromol/L and experienced a 5-fold increased mortality rate compared with LURIC patients (608 deaths during a median follow-up of 4 years). Homoarginine consistently affected mortality, which was 2-fold higher in 4D study patients in the lowest quartile (1.4 micromol/L). Homoarginine levels are independently associated with cardiovascular and all-cause mortality in patients referred for coronary angiography and in patients undergoing hemodialysis. Future studies are needed to elucidate the underlying pathomechanisms.

  14. Comparing pandemic to seasonal influenza mortality: moderate impact overall but high mortality in young children.

    NARCIS (Netherlands)

    Wijngaard, C.C. van den; Asten, L. van; Koopmans, M.P.G.; Pelt, W. van; Nagelkerke, N.J.D.; Wielders, C.C.H.; Lier, A. van; Hoek, W. van der; Meijer, A.; Donker, G.A.; Dijkstra, F.; Harmsen, C.; Sande, M.A.B. van der; Kretzschmar, M.


    Background: We assessed the severity of the 2009 influenza pandemic by comparing pandemic mortality to seasonal influenza mortality. However, reported pandemic deaths were laboratory-confirmed - and thus an underestimation - whereas seasonal influenza mortality is often more inclusively estimated. F

  15. Mortality level, trends and differentials in Malawi. (United States)

    Palamuleni, M E


    "This article examines the levels, and trends and differentials in mortality in Malawi.... The study has shown that (i) the level of mortality is very high in Malawi; (ii) mortality has declined during the period under review; (iii) there was reduction in the rate of mortality decline in the seventies; and (iv) [there are] interesting differences in mortality in terms of rural-urban localities, regions and age-sex differentials. The observed levels, trends and differentials in mortality are however consistent with the level of social and economic development in the country."

  16. Educational differences in cardiovascular mortality

    DEFF Research Database (Denmark)

    Kjøllesdal, M. K. R.; Ariansen, I.; Mortensen, L. H.


    Aims: To explore the confounding effects of early family factors shared by siblings and cardiovascular risk factors in midlife on the educational differences in mortality from cardiovascular disease (CVD). Methods: Data from national and regional health surveys in Norway (1974–2003) were linked...... with data from the Norwegian Family Based Life Course Study, the National Educational Registry and the Cause of Death Registry. The study population consisted of participants with at least one full sibling among the health survey participants (n=271,310). Data were available on CVD risk factors, including...... weight, height, blood pressure, total cholesterol and smoking. Results: The hazards ratio (HR) of CVD mortality was 3.44 (95% confidence interval (CI) 2.98–3.96) in the lowest educational group relative to the highest. The HRs were little altered in the within-sibship analyses. Adjusted for risk factors...

  17. Physical Inactivity and Mortality Risk

    Directory of Open Access Journals (Sweden)

    Peter Kokkinos


    Full Text Available In recent years a plethora of epidemiologic evidence accumulated supports a strong, independent and inverse, association between physical activity and the fitness status of an individual and mortality in apparently healthy individuals and diseased populations. These health benefits are realized at relatively low fitness levels and increase with higher physical activity patterns or fitness status in a dose-response fashion. The risk reduction is at least in part attributed to the favorable effect of exercise or physical activity on the cardiovascular risk factors, namely, blood pressure, diabetes mellitus and obesity. In this review, we examine evidence from epidemiologic and interventional studies in support of the association between exercise and physical activity and health. In addition, we present the exercise effects on the aforementioned risk factors. Finally, we include select dietary approaches and their impact on risk factors and overall mortality risk.

  18. Testosterone Therapy and Mortality Risk (United States)

    Eisenberg, Michael L.; Li, Shufeng; Herder, Danielle; Lamb, Dolores J.; Lipshultz, Larry I.


    INTRODUCTION Recent data suggests and increased risk of cardiovascular events and mortality in men on testosterone therapy (TT). To date there are no long term, prospective studies to determine safety. In such cases, retrospective observational studies can be helpful. We examined our patient database to determine if TT altered a man’s risk of all cause mortality. METHODS We queried our hormone database for all men with a serum testosterone level and then examined charts to determine testosterone status. In all, 509 men had charts available for review. We linked our patient records to the National Death Index to determine morality. RESULTS Of the 509 men who met inclusion criteria, 284 were on testosterone therapy and 225 did not use testosterone. Age (mean 54 years) and follow up time (mean 10 years) were similar for both groups. In all, 19 men died—10 (4.4%) of the men not on TT and 9 (3.2%) of the men on TT. After adjusting for age and year of evaluation, there was no significant difference in the risk of death based on TT (HR 1.0, 95% CI 0.39 – 2.57, p=1.0). CONCLUSIONS There appears to be no change in mortality risk overall for men utilizing long-term testosterone therapy. PMID:25078049

  19. CDC WONDER: Mortality - Multiple Cause of Death (United States)

    U.S. Department of Health & Human Services — The Mortality - Multiple Cause of Death data on CDC WONDER are county-level national mortality and population data spanning the years 1999-2009. Data are based on...

  20. CDC WONDER: Mortality - Multiple Cause of Death (United States)

    U.S. Department of Health & Human Services — The Mortality - Multiple Cause of Death data on CDC WONDER are county-level national mortality and population data spanning the years 1999-2006. These data are...

  1. CDC WONDER: Mortality - Underlying Cause of Death (United States)

    U.S. Department of Health & Human Services — The CDC WONDER Mortality - Underlying Cause of Death online database is a county-level national mortality and population database spanning the years since 1979. Data...

  2. Mortality hazard rates and life expectancy

    NARCIS (Netherlands)

    J.S. Cramer; R. Kaas


    We consider the relation between mortality hazards and life expectancy for men and women in the Netherlands and in England. Halving the lifetime mortality hazards increases life expectancy at birth by only 9%.

  3. Competing risks to breast cancer mortality. (United States)

    Rosenberg, Marjorie A


    Simulation models analyzing the impact of treatment interventions and screening on the level of breast cancer mortality require an input of mortality from causes other than breast cancer, or competing risks. This chapter presents an actuarial method of creating cohort life tables using published data that removes breast cancer as a cause of death. Mortality from causes other than breast cancer as a percentage of all-cause mortality is smallest for women in their forties and fifties, as small as 85% of the all-cause rate, although the level and percentage of the impact varies by birth cohort. This method produces life tables by birth cohort and by age that are easily included as a common input by the various CISNET modeling groups to predict mortality from other causes. Attention to removing breast cancer mortality from all-cause mortality is worthwhile, because breast cancer mortality can be as high as 15% at some ages.

  4. Snakebite Mortality in India: A Nationally Representative Mortality Survey (United States)

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


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

  5. Mortality versus Morbidity in the Demographic Transition


    Aksan, Anna-Maria; Chakraborty, Shankha


    The link between the mortality and epidemiological transitions is used to identify the effect of the former on the fertility transition: a mortality transition that is not accompanied by improving morbidity causes slower demographic and economic change. In a model where children may die from infectious disease, childhood health affects human capital and noninfectious-disease-related adult mortality. When child mortality falls from lower prevalence, as it did in western Europe, labor productiv...

  6. High mortality in the Thule cohort

    DEFF Research Database (Denmark)

    Juel, K


    The objective was to study mortality in the Thule cohort in order to clarify whether it is a selected population and to ascertain the possibility of misinterpretation when national mortality rates are used as reference in the analysis of occupational mortality....

  7. Advance Report of Final Mortality Statistics, 1985. (United States)

    Monthly Vital Statistics Report, 1987


    This document presents mortality statistics for 1985 for the entire United States. Data analysis and discussion of these factors is included: death and death rates; death rates by age, sex, and race; expectation of life at birth and at specified ages; causes of death; infant mortality; and maternal mortality. Highlights reported include: (1) the…

  8. Human mortality improvement in evolutionary context

    DEFF Research Database (Denmark)

    Burger, Oskar; Baudisch, Annette; Vaupel, James W


    has not been placed in a broad evolutionary context. We quantify the rate and amount of mortality reduction by comparing a variety of human populations to the evolved human mortality profile, here estimated as the average mortality pattern for ethnographically observed hunter-gatherers. We show...

  9. Mortality in adult congenital heart disease

    NARCIS (Netherlands)

    C.L. Verheugt (Carianne); C.S.P.M. Uiterwaal (Cuno); E.T. van der Velde (Enno); F.J. Meijboom (Folkert); P.G. Pieper (Petronella); A.P.J. van Dijk (Arie); H.W. Vliegen (Hubert); D.E. Grobbee (Diederick); B.J.M. Mulder (Barbara)


    textabstractAimsMortality in adults with congenital heart disease is known to be increased, yet its extent and the major mortality risks are unclear.Methods and resultsThe Dutch CONCOR national registry for adult congenital heart disease was linked to the national mortality registry. Cox's regressio

  10. Mortality in adult congenital heart disease

    NARCIS (Netherlands)

    C.L. Verheugt (Carianne); C.S.P.M. Uiterwaal (Cuno); E.T. van der Velde (Enno); F.J. Meijboom (Folkert); P.G. Pieper (Petronella); A.P.J. van Dijk (Arie); H.W. Vliegen (Hubert); D.E. Grobbee (Diederick); B.J.M. Mulder (Barbara)


    textabstractAimsMortality in adults with congenital heart disease is known to be increased, yet its extent and the major mortality risks are unclear.Methods and resultsThe Dutch CONCOR national registry for adult congenital heart disease was linked to the national mortality registry. Cox's

  11. Mortality in adult congenital heart disease.

    NARCIS (Netherlands)

    Verheugt, C.L.; Uiterwaal, C.S.; Velde, E.T. van der; Meijboom, F.J.; Pieper, P.G.; Dijk, A.P.J. van; Vliegen, H.W.; Grobbee, D.E.; Mulder, B.J.


    AIMS: Mortality in adults with congenital heart disease is known to be increased, yet its extent and the major mortality risks are unclear. METHODS AND RESULTS: The Dutch CONCOR national registry for adult congenital heart disease was linked to the national mortality registry. Cox's regression was

  12. Stem cell transplantation outcomes in lymphoblastic lymphoma. (United States)

    Brammer, Jonathan E; Khouri, Issa; Marin, David; Ledesma, Celina; Rondon, Gabriela; Ciurea, Stefan O; Nieto, Yago; Champlin, Richard E; Hosing, Chitra; Kebriaei, Partow


    Lymphoblastic lymphoma (LBL) is an aggressive lymphoma pathologically similar to lymphoblastic leukemia, but primarily presents with nodal or extra-medullary involvement. The aim of this study is to describe outcomes of patients undergoing stem cell transplantation (SCT) for LBL compared to historical data. Thirty-nine patients, of which 54% lacked complete remission (CR), received SCT for LBL between 1990 and 2015; 31 allogeneic and eight autologous. Overall survival (OS) and progression free survival (PFS) at three years for the entire cohort was 41%, the cumulative incidence (CI) of non-relapse mortality (NRM) was 18% at one year, and CI relapse mortality was 28% at one-year and 36% at three years; results similar to historical reports. On multivariate analysis, the use of total-body irradiation (TBI) based conditioning and transplantation in CR were independently predictive of OS and PFS. For patients requiring SCT for LBL, CR and TBI-based conditioning prior to allogeneic SCT may provide improved disease control.

  13. Russian mortality beyond vital statistics

    Directory of Open Access Journals (Sweden)


    Full Text Available Analyses of routine data have established that the extreme mortality fluctuations among young and middle-aged men are the most important single component of both temporal changes in Russian life expectancy at birth and in the gap between male and female life expectancy. It is also responsible for the largest share of the life expectancy gap between Russia and other industrialised countries. A case-control study has been used to identify factors associated with mortality among men aged 20 to 55 in the five major cities of the Udmurt Republic in 1998-99. Men dying from external causes and circulatory disease are taken as cases. Matched controls were selected from men of the same age living in the same neighbourhood of residence. Information about characteristics of cases and controls was obtained by interviewing proxies who were family members or friends of the subjects. After exclusion of those deaths for which proxy informant could not be identified, a total of 205 circulatory disease and 333 external cause cases were included together with the same number of controls. Educational level was significantly associated with mortality from circulatory diseases and external causes in a crude analysis. However, this could largely be explained by adjustment for employment, marital status, smoking and alcohol consumption. Smoking was associated with mortality from circulatory disease (crude OR=2.44, 95% CI 1.36-4.36, this effect being slightly attenuated after adjustment for socio-economic factors and alcohol consumption. Unemployment was associated with a large increase in the risk of death from external causes (crude OR=3.63, 95% CI 2.17-6.08, an effect that was still substantial after adjustment for other variables (adjusted OR=2.52, 95% CI 1.43-4.43. A reported history of periods of heavy drinking was linked to both deaths from circulatory disease (crude OR=4.21, 95% CI 2.35-7.55 and external cause mortality (crude OR=2.65, 95% CI 1

  14. The mortality of elder mistreatment. (United States)

    Lachs, M S; Williams, C S; O'Brien, S; Pillemer, K A; Charlson, M E


    Although elder mistreatment is suspected to be life threatening in some instances, little is known about the survival of elderly persons who have been mistreated. To estimate the independent contribution of reported elder abuse and neglect to all-cause mortality in an observational cohort of community-dwelling older adults. Prospective cohort study with at least 9 years of follow-up. The New Haven Established Population for Epidemiologic Studies in the Elderly cohort, which included 2812 community-dwelling adults who were older than 65 years in 1982, a subset of whom were referred to protective services for the elderly. All-cause mortality among (1) elderly persons for whom protective services were used for corroborated elder mistreatment (elder abuse, neglect, and/or exploitation), or (2) elderly persons for whom protective services were used for self-neglect. In the first 9 years after cohort inception, 176 cohort members were seen by elderly protective services for verified allegations; 10 (5.7%) of these were for abuse, 30 (17.0%) for neglect, 8 (4.5%) for exploitation, and 128 (72.7%) for self-neglect. At the end of a 13-year follow-up period from cohort inception, cohort members seen for elder mistreatment at any time during the follow-up had poorer survival (9%) than either those seen for self-neglect (17%) or other noninvestigated cohort members (40%) (Pself-neglect (odds ratio, 1.7; 95% confidence interval, 1.2-2.5), when compared with other members of the cohort. Reported and corroborated elder mistreatment and self-neglect are associated with shorter survival after adjusting for other factors associated with increased mortality in older adults.

  15. Endogenous fertility, mortality and growth. (United States)

    Blackburn, K; Cipriani, G P


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

  16. Spatial patterns of mortality in Bangladesh. (United States)

    Sharif, A H; Huq, S M; Mesbah-us-Saleheen


    This paper depicts the spatial patterns of mortality of the administrative upazilas of Bangladesh. Due to the absence of adequate data on mortality rates from across the country, the mortality rates of the upazilas are calculated from the age sex structure of the population of the respective upazilas employing the standardized mortality rates of divisional headquarters. Crude death rates are used to determine spatial patterns of mortality in Bangladesh. The patterns portray strong regional differences. Such differentiation is accounted for by traditional differences in demographic and socio-economic factors. Also, regression analysis is used to assist in explaining spatial variations.

  17. Phenomenological theory of mortality and aginge (United States)

    Azbel', Mark Ya.

    There are many theories of mortality, but no consensus even on the basic problem: is it genetically determined? In a general case, the problem is mathematically unsolvable. Yet, in the case of mortality, a physical approach yields its universal law. The law predicts, e.g., that mortality and senescence may decrease with age. Experiments verify it. I suggest experiments, which are supposed to produce genetic Methuselas, who live, e.g., over 20 η ( η is the mean life span), but whose biological age is less than η/2. If the universal mortality law is convincingly proven, it may lead to a quantitative model and theory of mortality and aging.

  18. Migrant mortality from diabetes mellitus across Europe

    DEFF Research Database (Denmark)

    Vandenheede, Hadewijch; Deboosere, Patrick; Stirbu, Irina


    mortality registers. Subsequently, to examine the second hypothesis, we introduced gross domestic product (GDP) per capita of COB in the models, as an indicator of socio-economic circumstances. The overall pattern shows higher diabetes mortality in migrant populations compared to local-born populations....... Mortality rate ratios (MRRs) were highest in migrants originating from either the Caribbean or South Asia. MRRs for the migrant population as a whole were 1.9 (95% CI 1.8-2.0) and 2.2 (95% CI 2.1-2.3) for men and women respectively. We furthermore found a consistently inverse association between GDP of COB...... and diabetes mortality. Most migrant groups have higher diabetes mortality rates than the local-born populations. Mortality rates are particularly high in migrants from North Africa, the Caribbean, South Asia or low-GDP countries. The inverse association between GDP of COB and diabetes mortality suggests...

  19. [Mortality by poisoning in children]. (United States)

    Híjar, M; Blanco, J; Carrillo, C; Rascón, A


    To determine the standing of mortality by poisoning in children in the Mexican Republic, in the years from 1979-1994. Secondary sources were employed. Analyzed variables were: age, sex, year, external cause of trauma and poisoning according to the 9th International Classification of Diseases: E850-E858, E860-E869 and E905. Tendencies by specific causes were analyzed with a Poisson regression model and relative risk by age, sex and district were obtained. A total of 11,272 children under 15 years of age were recorded. The main causes were poisoning and toxic reactions caused by venomous plants or animals (E905); accidental poisoning by household gas or carbon monoxide (E868); and accidental poisoning by other drugs (E858). The relative risk was highest in age group Aguascalientes consistently presented the highest risk values and the state of Nuevo Leon, the lowest. Poisoning is an important cause of child mortality. Considering that most of these deaths can potentially be prevented since they occur at home it is recommended that responsible adults can build protection into their environment and into the way society operates. Prevention should involve a multidisciplinary approach since the phenomenon has multiple causes and possible solutions.

  20. Comparison of Outcomes for Pediatric Patients With Acute Myeloid Leukemia in Remission and Undergoing Allogeneic Hematopoietic Cell Transplantation With Myeloablative Conditioning Regimens Based on Either Intravenous Busulfan or Total Body Irradiation: A Report From the Japanese Society for Hematopoietic Cell Transplantation. (United States)

    Ishida, Hiroyuki; Kato, Motohiro; Kudo, Kazuko; Taga, Takashi; Tomizawa, Daisuke; Miyamura, Takako; Goto, Hiroaki; Inagaki, Jiro; Koh, Katsuyoshi; Terui, Kiminori; Ogawa, Atsushi; Kawano, Yoshifumi; Inoue, Masami; Sawada, Akihisa; Kato, Koji; Atsuta, Yoshiko; Yamashita, Takuya; Adachi, Souichi


    Pediatric patients with acute myeloid leukemia (AML) mainly receive myeloablative conditioning regimens based on busulfan (BU) or total body irradiation (TBI) before allogeneic hematopoietic cell transplantation (allo-HCT); however, the optimal conditioning regimen remains unclear. To identify which of these regimens is better for pediatric patients, we performed a retrospective analysis of nationwide registration data collected in Japan between 2006 and 2011 to assess the outcomes of patients receiving these regimens before a first allo-HCT. Myeloablative conditioning regimens based on i.v. BU (i.v. BU-MAC) (n = 69) or TBI (TBI-MAC) (n = 151) were compared in pediatric AML patients in first or second complete remission (CR1/CR2). The incidences of sinusoid obstruction syndrome, acute and chronic graft-versus-host disease, and early nonrelapse mortality (NRM) before day 100 were similar for both conditioning groups; however, the incidence of bacterial infection during the acute period was higher in the TBI-MAC group (P = .008). Both groups showed a similar incidence of NRM, and there was no significant difference in the incidence of relapse between the groups. Univariate and multivariate analyses revealed no significant differences in the 2-year relapse-free survival rates for the i.v. BU-MAC and TBI-MAC groups in the CR1/CR2 setting (71% versus 67%, P = .36; hazard ratio, .73; 95% CI, .43 to 1.24, respectively). TBI-MAC was no better than i.v. BU-MAC for pediatric AML patients in remission. Although this retrospective registry-based analysis has several limitations, i.v. BU-MAC warrants further evaluation in a prospective trial.

  1. National Institutes of Health classification for chronic graft-versus-host disease predicts outcome of allo-hematopoietic stem cell transplant after fludarabine-busulfan-antithymocyte globulin conditioning regimen. (United States)

    Saillard, Colombe; Crocchiolo, Roberto; Furst, Sabine; El-Cheikh, Jean; Castagna, Luca; Signori, Alessio; Oudin, Claire; Faucher, Catherine; Lemarie, Claude; Chabannon, Christian; Granata, Angela; Blaise, Didier


    Abstract In 2005, the National Institutes of Health (NIH) proposed standard criteria for diagnosis, organ scoring and global assessment of chronic graft-versus-host disease (cGvHD) severity. We retrospectively reclassified cGvHD with NIH criteria in a monocentric cohort of 130 consecutive adult patients with hematological malignancies presenting cGvHD after receiving allo-hematopoietic stem cell transplant (HSCT) with a fludarabine-busulfan-antithymocyte globulin (ATG) conditioning regimen, among 313 consecutive HSCT recipients. We compared NIH and Seattle classifications to correlate severity and outcome. The follow up range was effectively 2-120 months. Forty-four percent developed Seattle-defined cGvHD (22% limited, 78% extensive forms). Using NIH criteria, there were 23%, 40% and 37% mild, moderate and severe forms, respectively, and 58%, 32% and 8% classic cGvHD, late acute GvHD and overlap syndrome. Five-year overall survival was 55% (49-61), and cumulative incidences of non-relapse mortality (NRM) and relapse/progression at 2 years were 19% (14-23) and 19% (14-24). NIH mild and moderate forms were associated with better survival compared to severe cGvHD (hazard ratio [HR] = 3.28, 95% confidence interval [CI]: 1.38-7.82, p = 0.007), due to higher NRM among patients with severe cGvHD (HR = 3.04, 95% CI: 1.05-8.78, p = 0.04) but comparable relapse risk (p = NS). In conclusion, the NIH classification appears to be more accurate in predicting outcome mostly by the reclassification of old-defined extensive forms into NIH-defined moderate or severe.

  2. Fludarabine-Busulfan Reduced-Intensity Conditioning in Comparison with Fludarabine-Melphalan Is Associated with Increased Relapse Risk In Spite of Pharmacokinetic Dosing. (United States)

    Damlaj, Moussab; Alkhateeb, Hassan B; Hefazi, Mehrdad; Partain, Daniel K; Hashmi, Shahrukh; Gastineau, Dennis A; Al-Kali, Aref; Wolf, Robert C; Gangat, Naseema; Litzow, Mark R; Hogan, William J; Patnaik, Mrinal M


    Fludarabine with busulfan (FB) and fludarabine with melphalan (FM) are commonly used reduced-intensity conditioning (RIC) regimens. Pharmacokinetic dosing of busulfan (Bu) is frequently done for myeloablative conditioning, but evidence for its use is limited in RIC transplants. We compared transplant outcomes of FB versus FM using i.v. Bu targeted to the area under the curve (AUC). A total of 134 RIC transplants (47 FB and 87 FM) for acute myelogenous leukemia and myelodysplastic syndrome were identified, and median follow-up of the cohort was 40 months (range, 0 to 63.3). A significantly higher 2-year cumulative incidence of relapse (CIR) was associated with FB versus FM at 35.6% versus 17.3%, respectively (P = .0058). Furthermore, 2-year progression-free survival rates were higher for FM versus FB at 60.5% versus 48.7%, respectively (P = .04). However, 2-year rates of nonrelapse mortality (NRM) and overall survival (OS) were similar. The need for dose adjustment based on AUC did not alter relapse risk or NRM. Patients with Karnofsky performance status ≥ 90 who received FM had a 2-year OS rate of 74.8% versus 48.3% for FB (P = .03). FB use remained prognostic for relapse in multivariable analysis (hazard ratio, 2.75; 95% confidence interval, 1.28 to 5.89; P = .0097). In summary, in spite of AUC-directed dosing, FB compared with FM was associated with a significantly higher CIR.

  3. Comparison of umbilical cord blood allogeneic stem cell transplantation vs. auto-SCT for adult acute myeloid leukemia patients in second complete remission at transplant: a retrospective study on behalf of the SFGM-TC. (United States)

    Chevallier, Patrice; Labopin, Myriam; Socie, Gerard; Rubio, Marie-There; Blaise, Didier; Vigouroux, Stephane; Huynh, Anne; Michallet, Mauricette; Bay, Jacques-Olivier; Maury, Sébastien; Yakoub-Agha, Ibrahim; Fegueux, Nathalie; Deconinck, Eric; Contentin, Nathalie; Maillard, Natacha; Bulabois, Claude-Eric; Francois, Sylvie; Oumedaly, Reman; Raus, Nicole; Mohty, Mohamad


    This retrospective study considered the outcomes of 181 patients with acute myeloid leukemia (AML) transplanted in second complete remission (CR2) between January 2005 and April 2012 and who received either a myeloablative autologous stem cell transplant (Auto-SCT; n = 82; median age: 48 years; median follow-up: 45 months) or an umbilical cord blood (UCB) allogeneic SCT (n = 99, median age: 46 years; median follow-up: 36 months; conditioning regimens: myeloablative n = 21, reduced n = 78; single unit n = 37, double units n = 62). Although the Auto group showed a significant better prognostic profile at transplant, with longer median interval between diagnosis and time of graft, higher incidence of good-risk cytogenetics and lower number of previously transplanted patients, 3-year OS and LFS were similar between both groups (Auto: 59 ± 6% vs. 50 ± 6%, P = 0.45; and 57 ± 6% vs. 46 ± 6%, P = 0.37). In multivariate analysis, UCB allo-SCT was associated with lower relapse incidence (HR: 0.3, 95% CI: 0.11-0.82, P = 0.02), but higher non-relapse mortality (NRM) (HR: 4.16; 95% CI: 1.46-11.9, P = 0.008). Results from this large study suggest that UCB allo-SCT provides better disease control than auto-SCT, which is especially important in the setting of high-risk disease. However, this disease control advantage is counterbalanced by higher toxicity, highlighting the need for novel approaches aiming to decrease NRM after UCB allo-SCT.

  4. Long-term survival outcomes of reduced-intensity allogeneic or autologous transplantation in relapsed grade 3 follicular lymphoma (United States)

    Klyuchnikov, Evgeny; Bacher, Ulrike; Ahn, Kwang Woo; Carreras, Jeanette; Kröger, Nicolaus M.; Hari, Parameswaran N.; Ku, Grace H.; Ayala, Ernesto; Chen, Andy I.; Chen, Yi-Bin; Cohen, Jonathon B.; Freytes, César O.; Gale, Robert Peter; Kamble, Rammurti T.; Kharfan-Dabaja, Mohamed A.; Lazarus, Hillard M.; Martino, Rodrigo; Mussetti, Alberto; Savani, Bipin N.; Schouten, Harry C.; Usmani, Saad Z.; Wiernik, Peter H.; Wirk, Baldeep; Smith, Sonali M.; Sureda, Anna; Hamadani, Mehdi


    Grade-3 follicular lymphoma (FL) has aggressive clinical behavior. To evaluate the optimal first transplantation approach in relapsed/refractory grade-3 FL patients, we compared the long-term outcomes after allogeneic (allo-) vs. autologous hematopoietic cell transplantation (auto-HCT) in the rituximab-era. A total of 197 patients undergoing first RIC allo-HCT or first auto-HCT during 2000-2012 were included. Rituximab-naïve patients were excluded. Allo-HCT recipients were younger; more heavily pretreated, and had a longer interval between diagnosis and HCT. The 5-year probabilities of non-relapse mortality (NRM), relapse/progression, progression-free survival (PFS) and overall survival (OS) for auto-HCT vs. allo-HCT groups were 4% vs. 27% (p<0.001); 61% vs. 20% (p<0.001); 36% vs. 51% (p=0.07) and 59% vs. 54% (p=0.7), respectively. On multivariate analysis auto-HCT was associated with reduced risk of NRM (RR=0.20; p=0.001). Within the first 11months post-HCT auto- and allo-HCT had similar risks of relapse/progression and PFS. Beyond 11months, auto-HCT was associated with higher risk of relapse/progression (RR=21.3; p=0.003) and inferior PFS (RR=3.2; p=0.005). In the first 24 months post-HCT, auto-HCT was associated with improved OS (RR=0.42; p=0.005), but in long-time survivors (beyond 24 months) it was associated with inferior OS (RR=3.6; p=0.04). RIC allo-HCT as the first transplant approach can provide improved PFS and OS, in long-term survivors. PMID:26437062

  5. Allogeneic stem cell transplantation in adult patients with acute myeloid leukaemia and 17p abnormalities in first complete remission: a study from the Acute Leukemia Working Party (ALWP of the European Society for Blood and Marrow Transplantation (EBMT

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    Xavier Poiré


    Full Text Available Abstract Background Acute myeloid leukaemia (AML with 17p abnormalities (abn(17p carries a very poor prognosis due to high refractoriness to conventional chemotherapy, and allogeneic stem cell transplantation (allo-SCT appears as the only potential curative option. Methods To address outcomes after allo-SCT in patients with abn(17p, we retrospectively analysed de novo or secondary AML undergoing SCT between 2000 and 2013 from the EBMT registry. Results One hundred thirty-nine patients with confirmed abn(17p have been selected. At the time of transplant, one hundred twenty-five were in first remission (CR1. Median age was 54 years old. Abn(17p was associated with a monosomal karyotype in 83% of patients, complex karyotype in 91%, monosomy 5 or 5q deletion (-5/5q- in 55%, monosomy 7 (-7 in 39% and both -5/5q and -7 in 27%. Seventy-three patients (59% had a reduced-intensity conditioning regimen. The 2-year overall survival (OS and leukaemia-free survival (LFS were 28 and 24%, respectively. The 2-year non-relapse mortality (NRM was 15%, and 2-year relapse incidence (RI was 61%. The cumulative incidence of grade II to IV acute graft-versus-host disease (GvHD was 24% and that of chronic GvHD was 21%. In multivariate analysis, the presence of a -5/5q- in addition to abn(17p was significantly and independently associated with worse OS, LFS and higher RI. Age and donor types did not correlate with outcome. Conditioning intensity was not statistically associated with OS, LFS and NRM when adjusted for patients’ age. Conclusions In contrast to the dismal prognosis reported for AML patients harbouring abn(17p undergoing conventional chemotherapy, allogeneic SCT provides responses in about 25% of those patients transplanted in CR1.

  6. Modified EBMT Pretransplant Risk Score Can Identify Favorable-risk Patients Undergoing Allogeneic Hematopoietic Cell Transplantation for AML, Not Identified by the HCT-CI Score. (United States)

    Michelis, Fotios V; Messner, Hans A; Uhm, Jieun; Alam, Naheed; Lambie, Anna; McGillis, Laura; Seftel, Matthew D; Gupta, Vikas; Kuruvilla, John; Lipton, Jeffrey H; Kim, Dennis Dong Hwan


    Risk scores have been developed for allogeneic hematopoietic cell transplantation (HCT) outcomes, such as the Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI) and the modified European Group for Blood and Marrow Transplantation risk score (mEBMT) for acute leukemia. We investigated the influence of these scores for 350 patients who underwent transplantation for acute myeloid leukemia (AML). The HCT-CI scores were grouped as 0 to 2 and ≥ 3 (231 and 119 patients, respectively) and the mEBMT scores as 0 to 2 and ≥ 3 (166 and 184 patients, respectively). Univariate analysis showed a significant association between the HCT-CI score and overall survival (OS) (P = .01), as did the mEBMT score (P = .002). The 5-year OS rate was 50% and 34% for a mEBMT score of 0 to 2 and ≥ 3, respectively. A subgroup of patients with a mEBMT score of 0 to 1 (n = 32) demonstrated a favorable OS of 75% at 5 years. This subgroup was younger (median age, 31 years), in first remission at transplantation, and had related donors. For the HCT-CI, the 5-year OS was 46% and 34% for a score of 0 to 2 and ≥ 3, respectively. Patients with an HCT-CI score of 0 (n = 94) had a 5-year OS of 44%. Multivariable analysis confirmed both the HCT-CI score and the mEBMT score, as previously grouped, as independent prognostic variables for both OS (P = .02 and P = .001, respectively) and nonrelapse mortality (NRM) (P = .01 and P = .003, respectively). The results of the present study have demonstrated that the HCT-CI and mEBMT are both prognostic for OS and NRM in our cohort. However, the mEBMT score can identify a favorable-risk subgroup of patients not identifiable using the HCT-CI. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Comparative therapeutic value of post-remission approaches in patients with acute myeloid leukemia aged 40-60 years. (United States)

    Cornelissen, J J; Versluis, J; Passweg, J R; van Putten, W L J; Manz, M G; Maertens, J; Beverloo, H B; Valk, P J M; van Marwijk Kooy, M; Wijermans, P W; Schaafsma, M R; Biemond, B J; Vekemans, M-C; Breems, D A; Verdonck, L F; Fey, M F; Jongen-Lavrencic, M; Janssen, J J W M; Huls, G; Kuball, J; Pabst, T; Graux, C; Schouten, H C; Gratwohl, A; Vellenga, E; Ossenkoppele, G; Löwenberg, B


    The preferred type of post-remission therapy (PRT) in patients with acute myeloid leukemia (AML) in first complete remission (CR1) is a subject of continued debate, especially in patients at higher risk of nonrelapse mortality (NRM), including patients >40 years of age. We report results of a time-dependent multivariable analysis of allogenic hematopoietic stem cell transplantation (alloHSCT) (n=337) versus chemotherapy (n=271) or autologous HSCT (autoHSCT) (n=152) in 760 patients aged 40-60 years with AML in CR1. Patients receiving alloHSCT showed improved overall survival (OS) as compared with chemotherapy (respectively, 57±3% vs 40±3% at 5 years, P<0.001). Comparable OS was observed following alloHSCT and autoHSCT in patients with intermediate-risk AML (60±4 vs 54±5%). However, alloHSCT was associated with less relapse (hazard ratio (HR) 0.51, P<0.001) and better relapse-free survival (RFS) (HR 0.74, P=0.029) as compared with autoHSCT in intermediate-risk AMLs. AlloHSCT was applied following myeloablative conditioning (n=157) or reduced intensity conditioning (n=180), resulting in less NRM, but comparable outcome with respect to OS, RFS and relapse. Collectively, these results show that alloHSCT is to be preferred over chemotherapy as PRT in patients with intermediate- and poor-risk AML aged 40-60 years, whereas autoHSCT remains a treatment option to be considered in patients with intermediate-risk AML.

  8. Epidemiology of early neonatal mortality. (United States)

    Tyagi, N K; Bharambe, M S; Garg, B S; Mathur, J S; Goswami, K


    During 1981-1991 at a rural teaching hospital (Kasturba Hospital) of Mahatma Gandhi Institute of Medical Sciences in Sevagram, Wardha, India, 454 of 13,939 newborns died during the early neonatal period for an early neonatal mortality rate (ENMR) of 33.7/1000 live births. The ENMR for boys was not significantly different from that for girls (36.1 vs. 28.6). Community medicine specialists analyzed data on these early neonatal deaths to examine distribution of early neonatal mortality, especially its relationship with prematurity, low birth weight, birth order, and by sex. They calculated average percent deaths (APD) per hour to examine the dynamics in early neonatal mortality. The mean age at death was lower among newborns of birth order greater than 2 than those of birth order less than 2 (23.47 vs. 26.85 hours; p 0.001). ENMR was higher for newborns of birth order greater than 2 than those of birth order less than 2 (41.74% vs. 27.35%; P 0.001). The mean age at death increased as gestation increased (10.34 for 28 weeks; 24.27 for 28-33 weeks, 31.53 for 33-37 weeks, and 34.43 for 37 weeks; p 0.001). ENMR decreased as gestation increased (850 for 28 weeks; 375 for 28-33 weeks, 147.02 for 33-37 weeks, and 8.77 for 37 weeks; p 0.001). The mean age at death increased as birth weight increased for newborns weighing less than 1500 gms through 2000-2500 gms (23.36-37.13 hours; p 0.001). It was lowest among those weighing more 3000 gms (11.55 gms). ENMR fell as birth weight increased (614.33 for 1500 gms, 116.19 for 1500-2000 gms, 19.38 for 2000-2500 gms, 10.99 for 2500-3000 gms, and 5.41 for 3000 gms; p 0.001). The APD/hour for the first hour of life was 3.74% for a relative risk of 12.9. It decreased steadily as the hours of life increased (3.08% for 1-6 hours, 1.19% for 6-24 hours, 0.67% for 24-72 hours, and 0.29% for 72-168 hours). Knowledge of time of likely death can help providers know where they need to focus their attention to prevent early neonatal deaths.

  9. QT-Interval Duration and Mortality Rate (United States)

    Zhang, Yiyi; Post, Wendy S.; Dalal, Darshan; Blasco-Colmenares, Elena; Tomaselli, Gordon F.; Guallar, Eliseo


    Background Extreme prolongation or reduction of the QT interval predisposes patients to malignant ventricular arrhythmias and sudden cardiac death, but the association of variations in the QT interval within a reference range with mortality end points in the general population is unclear. Methods We included 7828 men and women from the Third National Health and Nutrition Examination Survey. Baseline QT interval was measured via standard 12-lead electrocardiographic readings. Mortality end points were assessed through December 31, 2006 (2291 deaths). Results After an average follow-up of 13.7 years, the association between QT interval and mortality end points was U-shaped. The multivariate-adjusted hazard ratios comparing participants at or above the 95th percentile of age-, sex-, race-, and R-R interval–corrected QT interval (≥439 milliseconds) with participants in the middle quintile (401 to <410 milliseconds) were 2.03 (95% confidence interval, 1.46-2.81) for total mortality, 2.55 (1.59-4.09) for mortality due to cardiovascular disease (CVD), 1.63 (0.96-2.75) for mortality due to coronary heart disease, and 1.65 (1.16-2.35) for non-CVD mortality. The corresponding hazard ratios comparing participants with a corrected QT interval below the fifth percentile (<377 milliseconds) with those in the middle quintile were 1.39 (95% confidence interval, 1.02-1.88) for total mortality, 1.35 (0.77-2.36) for CVD mortality, 1.02 (0.44-2.38) for coronary heart disease mortality, and 1.42 (0.97-2.08) for non-CVD mortality. Increased mortality also was observed with less extreme deviations of QT-interval duration. Similar, albeit weaker, associations also were observed with Bazett-corrected QT intervals. Conclusion Shortened and prolonged QT-interval durations, even within a reference range, are associated with increased mortality risk in the general population. PMID:22025428

  10. Classification differences and maternal mortality

    DEFF Research Database (Denmark)

    Salanave, B; Bouvier-Colle, M H; Varnoux, N


    OBJECTIVES: To compare the ways maternal deaths are classified in national statistical offices in Europe and to evaluate the ways classification affects published rates. METHODS: Data on pregnancy-associated deaths were collected in 13 European countries. Cases were classified by a European panel....... This change was substantial in three countries (P deaths to obstetric causes. In the other countries, no differences were detected. According to official published data, the aggregated maternal mortality rate for participating countries was 7.7 per...... 100,000 live births, but it increased to 8.7 after classification by the European panel (P deaths differs between European countries. These differences in coding contribute to variations in the reported numbers of maternal deaths...

  11. Mortality and reduced growth hormone secretion

    DEFF Research Database (Denmark)

    Stochholm, Kirstine; Christiansen, Jens; Laursen, Torben


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

  12. Determinants of Maternal Mortality in Pakistan

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    Shahida Abbasi


    Full Text Available Maternal mortality refers to the death of a woman who dies during pregnancy or within six weeks after delivery. A number of factors contribute to the high maternal mortality ratio around the globe, particularly, in underdeveloped countries. Pakistan has the highest mortality ratio (260 per 100,000 live births in the region and is one of the developing countries which have committed to decrease maternal mortality by 2015, according to the millennium developing goals (MDG 5. However, there are number of factors which made Pakistan unable to achieve the MDG 5 by 2015. In Pakistan there are many factors such as biological, socio-economic, cultural and poor quality of Reproductive Health Services (RHS, which contribute to the alarming figure of Maternal Mortality.. This paper aimed to do an in-depth analysis of the determinants of maternal mortality in Pakistan.


    Luo, Weixiang; Xie, Yu


    This study examines the association of three different SES indicators (education, economic independence, and household per-capita income) with mortality, using a large, nationally representative longitudinal sample of 12,437 Chinese ages 65 and older. While the results vary by measures used, we find overall strong evidence for a negative association between SES and all-cause mortality. Exploring the association between SES and cause-specific mortality, we find that SES is more strongly related to a reduction of mortality from more preventable causes (i.e., circulatory disease and respiratory disease) than from less preventable causes (i.e., cancer). Moreover, we consider mediating causal factors such as support networks, health-related risk behaviors, and access to health care in contributing to the observed association between SES and mortality. Among these mediating factors, medical care is of greatest importance. This pattern holds true for both all-cause and cause-specific mortality. PMID:25098961

  14. The injury mortality burden in Guinea


    Mamady Keita; Yao Hongyan; Zhang Xujun; Xiang Huiyun; Tan Hongzhuan; Hu Guoqing


    Abstract Background The injury mortality burden of Guinea has been rarely addressed. The paper aimed to report patterns of injury mortality burden in Guinea. Methods We retrieved the mortality data from the Guinean Annual Health Statistics Report 2007. The information about underlying cause of deaths was collected based on Guinean hospital discharge data, Hospital Mortuary and City Council Mortuary data. The causes of death are coded in the 9th International Classification of Diseases (ICD-9)...

  15. Treatment Factors That Influence Mortality in Acromegaly. (United States)

    McCabe, John; Ayuk, John; Sherlock, Mark


    Acromegaly is a rare condition characterized by excessive secretion of growth hormone (GH), which is almost always due to a pituitary adenoma. Acromegaly is associated with significant morbidity such as hypertension, type 2 diabetes, cardiomyopathy, obstructive sleep apnoea, malignancy and musculoskeletal abnormalities. Acromegaly has also been associated with increased mortality in several retrospective studies. This review will focus on the epidemiological data relating to mortality rates in acromegaly, the relationship between acromegaly and malignancy, the role of GH and insulin-like growth factor-I in assessing the risk of future mortality, and the impact of radiotherapy and hypopituitarism on mortality.

  16. The gestational age pattern of human mortality

    DEFF Research Database (Denmark)

    Schöley, Jonas; Vaupel, James W.; Jacobsen, Rune

    of a "birth hump" peaking week 38. The absolute rate of decline slows down over age. The observed gestational age pattern of the force of mortality is consistent with three hypotheses concerning the causes for ontogenescense: 1) Adaptation: as the organism growths it becomes more resilient towards death, 2......) transitional timing: the transition of birth is a stressful event and momentarily increases the force of mortality, 3) mortality selection: The frailest die first, resulting in the mean force of mortality to decline with age. In order to quantify the relative importance of these three processes I fit a three...

  17. The Gestational Age Pattern of Human Mortality

    DEFF Research Database (Denmark)

    Schöley, Jonas; Vaupel, James W.; Jacobsen, Rune

    of a "birth hump" peaking week 38. The absolute rate of decline slows down over age. The observed gestational age pattern of the force of mortality is consistent with three hypotheses concerning the causes for ontogenescense: 1) Adaptation: as the organism growths it becomes more resilient towards death, 2......) transitional timing: the transition of birth is a stressful event and momentarily increases the force of mortality, 3) mortality selection: The frailest die first, resulting in the mean force of mortality to decline with age. In order to quantify the relative importance of these three processes I fit a three...

  18. Mortality in Central and Eastern Europe

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    Full Text Available While, during several decades, unfavourable trends in mortality were quite similar in Central Europe and in the former USSR, in the most recent years, these two parts of Europe are diverging. In most Central European countries, life expectancy is now increasing mainly thanks to a decline in cardiovascular mortality. Conversely, cardiovascular mortality is still increasing in Russia and Ukraine and its negative impact is reinforced by a worsening of violent deaths and infectious mortality. The situation of Baltic countries is still uncertain but it is not impossible that these countries soon resume with sustainable progress in life expectancy.

  19. Infection increases mortality in necrotizing pancreatitis

    DEFF Research Database (Denmark)

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


    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....

  20. Consistent Predictions of Future Forest Mortality (United States)

    McDowell, N. G.


    We examined empirical and model based estimates of current and future forest mortality of conifers in the northern hemisphere. Consistent water potential thresholds were found that resulted in mortality of our case study species, pinon pine and one-seed juniper. Extending these results with IPCC climate scenarios suggests that most existing trees in this region (SW USA) will be dead by 2050. Further, independent estimates of future mortality for the entire coniferous biome suggest widespread mortality by 2100. The validity and assumptions and implications of these results are discussed.

  1. [Mortality as an index of social development]. (United States)

    Illanes, J P


    The author examines the use of measures of mortality as indicators of social development. Separate consideration is given to general mortality, infant mortality, and life expectancy. He concludes that the Chilean and Latin American mortality data cannot be analyzed separately from the available social data as a whole, and that the traditional health indicators for the measurement of social development continue to be valid. Comments by Ernesto Medina, Dagmar Raczynski, Juan P. Illanes, and Tarsicio Castaneda are included (pp. 107-14), as well as a reply to these comments by the author (pp. 114-6).


    Directory of Open Access Journals (Sweden)



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

  3. Mortality among Norwegian doctors 1960-2000

    Directory of Open Access Journals (Sweden)

    Hem Erlend


    Full Text Available Abstract Background To study the mortality pattern of Norwegian doctors, people in human service occupations, other graduates and the general population during the period 1960-2000 by decade, gender and age. The total number of deaths in the study population was 1 583 559. Methods Census data from 1960, 1970, 1980 and 1990 relating to education were linked to data on 14 main causes of death from Statistics Norway, followed up for two five-year periods after census, and analyzed as stratified incidence-rate data. Mortality rate ratios were computed as combined Mantel-Haenzel estimates for each sex, adjusting for both age and period when appropriate. Results The doctors had a lower mortality rate than the general population for all causes of death except suicide. The mortality rate ratios for other graduates and human service occupations were 0.7-0.8 compared with the general population. However, doctors have a higher mortality than other graduates. The lowest estimates of mortality for doctors were for endocrine, nutritional and metabolic diseases, diseases in the urogenital tract or genitalia, digestive diseases and sudden death, for which the numbers were nearly half of those for the general population. The differences in mortality between doctors and the general population increased during the periods. Conclusions Between 1960 and 2000 mortality for doctors converged towards the mortality for other university graduates and for people in human service occupations. However, there was a parallel increase in the gap between these groups and the rest of the population. The slightly higher mortality for doctors compared with mortality for other university graduates may be explained by the higher suicide rate for doctors.

  4. Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) - Smoking-Attributable Mortality (SAM) (United States)

    U.S. Department of Health & Human Services — 2005-2009. SAMMEC - Smoking-Attributable Mortality, Morbidity, and Economic Costs. Smoking-attributable mortality (SAM) is the number of deaths caused by cigarette...

  5. Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) - Smoking-Attributable Mortality (SAM) (United States)

    U.S. Department of Health & Human Services — 2005-2009. SAMMEC - Smoking-Attributable Mortality, Morbidity, and Economic Costs. Smoking-attributable mortality (SAM) is the number of deaths caused by cigarette...

  6. Regional differences in Dutch maternal mortality.

    NARCIS (Netherlands)

    Graaf, J. de; Schutte, J.; Poeran, J.; Roosmalen, J. van; Bonsel, G.; Steegers, E.


    Please cite this paper as: de Graaf J, Schutte J, Poeran J, van Roosmalen J, Bonsel G, Steegers E. Regional differences in Dutch maternal mortality. BJOG 2012;119:582-588. Objective To study regional differences in maternal mortality in the Netherlands. Design Confidential inquiry into the causes of

  7. Maternal Mortality in the United States (United States)

    Lee, Anne S.


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

  8. Predictive Factors of Mortality in Burn Patients


    Fazeli; Karami-Matin; Kakaei; Pourghorban; Safari-Faramani


    Background: Burn injuries impose a considerable burden on healthcare systems in Iran. It is among the top ten causes of mortality and a main cause of disability. Objectives: This study aimed to examine factors influencing mortality in burn patients admitted to the main educational tertiary referral hospital in Kermanshah. Patients and Methods: All patients admitted to the Imam Khom...

  9. Computational Intelligence. Mortality Models for the Actuary

    NARCIS (Netherlands)

    Willemse, W.J.


    This thesis applies computational intelligence to the field of actuarial (insurance) science. In particular, this thesis deals with life insurance where mortality modelling is important. Actuaries use ancient models (mortality laws) from the nineteenth century, for example Gompertz' and Makeham's la

  10. Rise in maternal mortality in the Netherlands

    NARCIS (Netherlands)

    J.M. Schutte; E.A.P. Steegers; N.W.E. Schuitemaker; J.G. Santema; K. de Boer; M. Pel; G. Vermeulen; W. Visser; J. van Roosmalen


    Objective To assess causes, trends and substandard care factors in maternal mortality in the Netherlands. Design Confidential enquiry into the causes of maternal mortality. Setting Nationwide in the Netherlands. Population 2,557,208 live births. Methods Data analysis of all maternal deaths in the pe

  11. VSRR - Quarterly provisional estimates for infant mortality (United States)

    U.S. Department of Health & Human Services — Provisional estimates of infant mortality (deaths of infants under 1 year per 1,000 live births), neonatal mortality (deaths of infants aged 0-27 days per 1,000 live...

  12. 29 CFR 4044.53 - Mortality assumptions. (United States)


    ... ASSETS IN SINGLE-EMPLOYER PLANS Valuation of Benefits and Assets Trusteed Plans 4044.53 Mortality... retirement benefit for any reason other than a change in the participant's health status. (2) Non-Social... the participant's health status. (g) Contingent annuitant mortality during deferral period. If...

  13. The Gestational Age Pattern of Human Mortality

    DEFF Research Database (Denmark)

    Schöley, Jonas

    I present a lifetable by gestational age from week 23 until week 100 after the last menstrual period of the mother. The lifetable shows the pre-natal, peri-natal and post-natal mortality levels for US fetus/infants conceived in the year 2009. The observed age pattern of the force of mortality...

  14. Trends in mortality decrease and economic growth

    NARCIS (Netherlands)

    Niu, G.; Melenberg, B.


    The vast literature on extrapolative stochastic mortality models focuses mainly on the extrapolation of past mortality trends and summarizes the trends by one or more latent factors. However, the interpretation of these trends is typically not very clear. On the other hand, explanation methods are t

  15. Mortality analysis in hip fracture patients

    DEFF Research Database (Denmark)

    Foss, N B; Kehlet, H


    Patients with hip fractures are usually frail and elderly with a 30-day mortality in excess of 10% in European series. Perioperative morbidity is often multifactorial in nature, and unimodal interventions will not necessarily decrease mortality. The purpose of this prospective study was to analys...

  16. Mortality in patients with Parkinson's disease

    DEFF Research Database (Denmark)

    Wermuth, L; Stenager, E; Boldsen, J


    INTRODUCTION: After the introduction of L-dopa the mortality rate in Parkinson's disease (PD) patients has changed, but is still higher than in the background population. MATERIAL & METHODS: Mortality, age at death and cause of death in a group of PD patients compared with the background population...

  17. Modeling mortality : Empirical studies on the effect of mortality on annuity markets

    NARCIS (Netherlands)

    Hari, N.


    Chapter 3 of the dissertation models the macro-longevity risk and introduces a stochastic model for human mortality rates. Chapter 4 analyzes the importance of mortality improvement and mortality risk (macro- and micro-longevity risk and parameter uncertainty) on solvency positions of pension funds

  18. Pre-transplant weight loss predicts inferior outcome after allogeneic stem cell transplantation in patients with myelodysplastic syndrome. (United States)

    Radujkovic, Aleksandar; Becker, Natalia; Benner, Axel; Penack, Olaf; Platzbecker, Uwe; Stölzel, Friedrich; Bornhäuser, Martin; Hegenbart, Ute; Ho, Anthony D; Dreger, Peter; Luft, Thomas


    Allogeneic stem cell transplantation (alloSCT) represents a curative therapeutic option for patients with myelodysplastic syndrome (MDS), but relapse and non-relapse mortality (NRM) limit treatment efficacy. Based on our previous observation in acute myeloid leukemia we investigated the impact of pre-transplant weight loss on post-transplant outcome in MDS patients. A total of 111 patients diagnosed with MDS according to WHO criteria transplanted between 2000 and 2012 in three different transplant centers were included into the analysis. Data on weight loss were collected from medical records prior to conditioning therapy and 3-6 months earlier. Patient, disease and transplant characteristics did not differ between patients with weight loss (2-5%, n = 17; > 5%, n = 17) and those without (n = 77). In a mixed effect model, weight loss was associated with higher risk MDS (p = 0.046). In multivariable analyses, pre-transplant weight loss exceeding 5% was associated with a higher incidence of relapse (p transplant weight loss of 2-5% and > 5% were independent predictors of worse disease-free (p = 0.023 and p transplantation. Prospective studies addressing pre-transplant nutritional interventions are highly warranted.

  19. [Maternal mortality among black women in Brazil]. (United States)

    Martins, Alaerte Leandro


    Every minute a woman dies in the world due to labor or complications of pregnancy. Maternal mortality is a public health problem in Brazil and affects the country's various regions unequally. Researchers agree that maternal death occurs mainly in women with lower income and less schooling. The racial issue emerges in the midst of socioeconomic issues. The analysis is hampered by the difficulty in understanding Brazil's official classification of race/color, which often impedes recording this information. Various Maternal Mortality Committees are applying the color item and reviewing their data. The current article analyzes various Maternal Mortality Committee reports, showing that the risk of maternal mortality is greater among black women (which encompasses two census categories, negra, or black, and parda, or brown), thus representing a major expression of social inequality. The article concludes with a review of political and technical recommendations to decrease maternal mortality.

  20. Diagnostic interval and mortality in colorectal cancer

    DEFF Research Database (Denmark)

    Tørring, Marie Louise; Frydenberg, Morten; Hamilton, William;


    Objective To test the theory of a U-shaped association between time from the first presentation of symptoms in primary care to the diagnosis (the diagnostic interval) and mortality after diagnosis of colorectal cancer (CRC). Study Design and Setting Three population-based studies in Denmark...... presentation, the association between the length of the diagnostic interval and 5-year mortality rate after the diagnosis of CRC was the same for all three types of data: displaying a U-shaped association with decreasing and subsequently increasing mortality with longer diagnostic intervals. Conclusion Unknown...... confounding and in particular confounding by indication is likely to explain the counterintuitive findings of higher mortality among patients with very short diagnostic intervals, but cannot explain the increasing mortality with longer diagnostic intervals. The results support the theory that longer...

  1. Antigua/Barbuda Cancer Mortality Study

    Directory of Open Access Journals (Sweden)

    GS Daniel


    Full Text Available Objective: To determine the cancer mortality rates in Antigua and Barbuda in an effort to enhance the profile of the country’s cancer burden. Method: Available data for 2001 to 2005 were analysed to obtain cancer mortality rates. Analysis was also made of the mortality/incidence ratios. Results: There were 354 cancer deaths – 208 males (age standardized rates (ASR 111.9 and 146 females (ASR 66.3. The main causes were prostate (ASR 53 and breast (ASR 22. The mortality rates for cancers of the lung (ASR 5.09 males, 2.49 females and brain/nervous system (ASR 0.45 males, 1.7 females were significantly lower than those in the Caribbean. Conclusion: Mortality rates were highest for sex-specific cancers, accounting for more than 50% of cancer deaths.

  2. Vitamin D with calcium reduces mortality

    DEFF Research Database (Denmark)

    Rejnmark, Lars; Avenell, Alison; Masud, Tahir


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

  3. Mortality in mothers after perinatal loss

    DEFF Research Database (Denmark)

    Hvidtjørn, D; Wu, C; Schendel, D


    OBJECTIVE: To assess whether mothers who lost a child from stillbirth or in the first week of life have an increased overall mortality and cause-specific mortality. DESIGN: A population based follow-up study. SETTING: Data from Danish national registers. POPULATION: All mothers in Denmark were...... included in the cohort at time of their first delivery from 1 January 1980 to 31 December 2008 and followed until 31 December 2009 or death, whichever came first. METHODS: The association between perinatal loss and total and cause-specific mortality in mothers was estimated with hazard ratios (HR) and 95......% confidence intervals (95% CI) calculated using Cox proportional hazards regression analyses. MAIN OUTCOME MEASURES: Overall mortality and cause-specific mortality. RESULTS: During the follow-up period, 838 331 mothers in the cohort gave birth to one or more children and 7690 mothers (0.92%) experienced...

  4. The healthy immigrant effect and mortality rates. (United States)

    Ng, Edward


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

  5. Percutaneous endoscopic gastrostomy and early mortality. (United States)

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


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

  6. Mortality in anesthesia: a systematic review

    Directory of Open Access Journals (Sweden)

    Leandro Gobbo Braz


    Full Text Available This systematic review of the Brazilian and worldwide literature aims to evaluate the incidence and causes of perioperative and anesthesia-related mortality. Studies were identified by searching the Medline and Scielo databases, followed by a manual search for relevant articles. Our review includes studies published between 1954 and 2007. Each publication was reviewed to identify author(s, study period, data source, perioperative mortality rates, and anesthesia-related mortality rates. Thirty-three trials were assessed. Brazilian and worldwide studies demonstrated a similar decline in anesthesia-related mortality rates, which amounted to fewer than 1 death per 10,000 anesthetics in the past two decades. Perioperative mortality rates also decreased during this period, with fewer than 20 deaths per 10,000 anesthetics in developed countries. Brazilian studies showed higher perioperative mortality rates, from 19 to 51 deaths per 10,000 anesthetics. The majority of perioperative deaths occurred in neonates, children under one year, elderly patients, males, patients of ASA III physical status or poorer, emergency surgeries, during general anesthesia, and cardiac surgery followed by thoracic, vascular, gastroenterologic, pediatric and orthopedic surgeries. The main causes of anesthesia-related mortality were problems with airway management and cardiocirculatory events related to anesthesia and drug administration. Our systematic review of the literature shows that perioperative mortality rates are higher in Brazil than in developed countries, while anesthesia-related mortality rates are similar in Brazil and in developed countries. Most cases of anesthesia-related mortality are associated with cardiocirculatory and airway events. These data may be useful in developing strategies to prevent anesthesia-related deaths.

  7. Factors affecting mortality in patients with burns

    Directory of Open Access Journals (Sweden)

    Halil Erbiş


    Full Text Available Objective: The increase in life quality and expectancy causes an increase in the elderly population. Improvements in burn treatment resulted in decreased mortality in children and young adults but in elderly patients burns are still an important trauma that should be handed differently than other age groups. The aim of this study was to evaluate the factors effecting mortality in patients with burns over 45 years old. Methods: Fifty-eight patients over 45 years of age, who were treated in our burns unit in the last 3 years were included in our study. Their age, burn percentage and depth, coexisting diseases and mortality rates were examined retrospectively. Results: The average age of surviving patients was 57.4 years while it was 70 years for nonsurviving patients (p=0.002. The width of burn area was 21.1 % in surviving and 50 % in nonsurviving patients (p<0.01. The effect of additional coexistent diseases on mortality was significant (p=0.001. The most common reasons of mortality were sepsis and congestive heart failure. Conclusion: We found out that the age, percentage of burns and coexistent diseases had a negative effect on success of treatment and mortality. Mortality rates will decrease in these cases with careful follow-up and a multidisciplinary approach. J Clin Exp Invest 2015; 6 (3: 240-243

  8. Epilepsy and mortality in Latin America. (United States)

    Escalaya, Alejandro L; Tellez-Zenteno, Jose F; Steven, David A; Burneo, Jorge G


    To assess the mortality related to epilepsy in Latin America. We searched MEDLINE, EMBASE, and LILACS from inception to December 2013 for articles evaluating mortality in patients with epilepsy in Latin America. Studies were included if they evaluated any mortality outcome, included a population of subjects with recurrent seizures or epilepsy, and contained original data analysis. The search strategy yielded 177 publications in MEDLINE and EMBASE, and 59 publications in LILACS; of which 18 met inclusion criteria for our overall review of epilepsy and mortality in Latin America. Most excluded studies did not report the mortality or lacked original data. We also included two references obtained from 2 non-systematic reviews fulfilling our inclusion criteria, and able to provide data for our analyses. Five studies reported Standardized Mortality Ratio (SMR), and demonstrated that people with epilepsy had a higher risk of death than the general population. The SMRs reported in two community-based studies were 1.34 and 2.45. The information about mortality in epilepsy in Latin America is very scarce. Comparisons cannot be made among studies due to methodological differences. More studies are needed. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  9. Dengue mortality in Colombia, 1985-2012. (United States)

    Chaparro-Narváez, Pablo; León-Quevedo, Willian; Castañeda-Orjuela, Carlos Andrés


    Dengue in Colombia is an important public health problem due to the huge economic and social costs it has caused, especially during the disease outbreaks.  To describe the behavior of dengue mortality in Colombia between 1985 and 2012.  We conducted a descriptive study. Information was obtained from mortality and population projection databases provided by the Departamento Administrativo Nacional de Estadística (DANE) for the 1985-2012 period. Mortality rates, rate ratios, and case fatality rates were estimated.  A total of 1,990 dengue deaths were registered during this period in Colombia. Dengue mortality rates presented an increasing trend with statistical significance between 1985 and 1998. Higher mortality rates were reported in men both younger than 5 years and older than 65 years. Between 1995 and 2012, category 1 to 4 municipalities reported the highest mortality rates. Case fatality rates varied during the period between 0.01% and 0.39%.  Dengue is an avoidable disease that should disappear from mortality statistics as a cause of death. The event is avoidable if the proposed activities from the Estrategia de Gestión Integrada (EGI)-Dengue are implemented and evaluated. We recommend encouraging the development of an informational culture to contribute to decision making and prioritizing resource allocation.

  10. Conifer Decline and Mortality in Siberia (United States)

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


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

  11. Mortality patterns among workers exposed to acrylamide

    Energy Technology Data Exchange (ETDEWEB)

    Collins, J.J.; Swaen, G.M.; Marsh, G.M.; Utidjian, H.M.; Caporossi, J.C.; Lucas, L.J. (American Cyanamid Co., Wayne, NJ (USA))


    A cohort of 8854 men, 2293 of whom were exposed to acrylamide, was examined from 1925 to 1983 for mortality. This cohort consisted of four plant populations in two countries: the United States and The Netherlands. No statistically significant excess of all-cause or cause-specific mortality was found among acrylamide workers. Analysis by acrylamide exposure levels showed no trend of increased risk of mortality from several cancer sites. These results do not support the hypothesis that acrylamide is a human carcinogen.


    Directory of Open Access Journals (Sweden)

    C Prakash


    Full Text Available A cross sectional study was conducted in eight selected villages of Meerut District [UJP.} to find out infant mortality rate alongwith other various health care delivery practices associated with this. An infant mortality rate of 106.7/1000 LB was found in the study population. Infant mortality was higher in female infants, infants of mothers not availed antenatal care, not received tetanus toxoid, delivered by untrained personnel and where cow-dung was applied to cord stump. Among the causes of infant deaths prematurity or low birth weight was the commonest cause followed by respiratory infections, diarrhoeal diseases and tetanus neonatorum

  13. Social Welfare Expenditures and Infant Mortality. (United States)

    Shim, Joyce


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

  14. Mortality Rates Among Arab Americans in Michigan


    Dallo, Florence J.; Schwartz, Kendra; Ruterbusch, Julie J.; Booza, Jason; Williams, David R.


    The objectives of this study were to: (1) calculate age-specific and age-adjusted cause-specific mortality rates for Arab Americans; and (2) compare these rates with those for blacks and whites. Mortality rates were estimated using Michigan death certificate data, an Arab surname and first name list, and 2000 U.S. Census data. Age-specific rates, age-adjusted all-cause and cause-specific rates were calculated. Arab Americans (75+) had higher mortality rates than whites and blacks. Among men, ...

  15. Mortality associated with cervicofacial necrotizing fasciitis. (United States)

    Roberson, J B; Harper, J L; Jauch, E C


    Cervicofacial necrotizing fasciitis is a rare infection but still occurs and carries a mortality rate up to 60%. It is a polymicrobial infection that is characterized by diffuse necrosis of fascial planes and subcutaneous tissues. Diagnosing early stages of cervicofacial necrotizing fasciitis in relationship to other soft tissue infections of odontogenic origin is difficult and leads to less aggressive treatment with resulting increased morbidity and mortality. To prevent this significant mortality and morbidity associated with cervicofacial necrotizing fasciitis early presentation, recognition and treatment by health care provider is essential.

  16. Infant mortality: an insured population perspective. (United States)

    Zimmerman, Daniel D; Roudebush, Brad


    Many insurers offer life coverage to individuals during the first year of life. The policies tend to have small face values, but frequently contain premium waiver or additional purchase options. General population mortality is significantly higher at this age relative to older children and even middle-aged adults. This article presents the mortality experience of an insured cohort in which death occurred under 1 year of age. In summary, the insured population's mortality rate was significantly lower and the leading causes of death were different than the general population.

  17. Improving the robustness and performance of quantusFLM® against different delineations



    Neonatal respiratory morbidity (NRM) is the leading cause of mortality and morbidity associated with prematurity. Today, NRM is mainly assessed with amniocentesis, an invasive and risky procedure that cannot be performed in all clinical settings. A non-invasive, fast and ready-to-use solution is quantusFLM® that predicts NRM by analyzing fetal lung texture from an ultrasound image. However, some limitations still present since the result offered by quantusFLM® is dichotomic and in consequence...

  18. Rapid Recovery of CD3+CD8+ T Cells on Day 90 Predicts Superior Survival after Unmanipulated Haploidentical Blood and Marrow Transplantation.

    Directory of Open Access Journals (Sweden)

    Deng-Mei Tian

    Full Text Available Rapid immune reconstitution after allogeneic hematopoietic stem cell transplantation (allo-HSCT is significantly associated with lower infection, relapse and possibly secondary malignancy rates. The aim of this study was to investigate the role of peripheral lymphocyte subsets, especially CD3+CD8+ cytotoxic T cell recovery, in predicting transplant outcomes, including the overall survival (OS and non-relapse mortality (NRM rates after unmanipulated haploidentical blood and marrow transplantation (HBMT.Peripheral blood samples were obtained from 214 HBMT recipients with hematological malignancies. The peripheral lymphocyte subsets (CD3+ T cells, CD3+CD4+ helper T cells, CD3+CD8+ cytotoxic T cells, and CD19+ B cells were analyzed by flow cytometry at days 30, 60, 90, 180, 270 and 360 after HBMT.The CD3+CD8+ cytotoxic T cell recovery at day 90 (CD3+CD8+-90 was correlated with bacterial infection (P = 0.001, NRM (P = 0.001, leukemia-free survival (LFS, P = 0.005, and OS (P = 0.001 at a cutoff value of 375 cells/μL CD3+CD8+ T cells. The incidence of bacterial infection in patients with the CD3+CD8+-90 at ≥375 cells/μL was significantly lower than that of cases with the CD3+CD8+-90 at <375 cells/μL after HBMT (14.6% versus 41.6%, P<0.001. Multivariate analysis showed the rapid recovery of CD3+CD8+ T cells at day 90 after HBMT was strongly associated with a lower incidence of NRM (HR = 0.30; 95% CI: 0.15-0.60; P = 0.000 and superior LFS (HR = 0.51; 95% CI: 0.32-0.82; P = 0.005 and OS (HR = 0.38; 95% CI: 0.23-0.63; P = 0.000.The results suggest that the rapid recovery of CD3+CD8+ cytotoxic T cells at day 90 following HBMT could predict superior transplant outcomes.

  19. Excess mortality in patients diagnosed with hypothyroidism

    DEFF Research Database (Denmark)

    Thvilum, Marianne; Brandt, Frans; Pedersen, Dorthe Almind


    Background: Although hypothyroidism is associated with increased morbidity, an association with increased mortality is still debated. Our objective was to investigate, at a nationwide level, whether a diagnosis of hypothyroidism influences mortality. Methods: In an observational cohort study from...... January 1, 1978 until December 31, 2008 using record-linkage data from nationwide Danish health registers, 3587 singletons and 682 twins diagnosed with hypothyroidism were identified. Hypothyroid individuals were matched 1:4 with nonhypothyroid controls with respect to age and gender and followed over...... a mean period of 5.6 years (range 0-30 years). The hazard ratio (HR) for mortality was calculated using Cox regression analyses. Comorbidity was evaluated using the Charlson score (CS). Results: In singletons with hypothyroidism, the mortality risk was increased (HR 1.52; 95% confidence interval [CI]: 1...

  20. Epidemiology of Maternal Mortality in Malawi

    African Journals Online (AJOL)

    Maternal Mortality Programme Assessment), based at the University of Aberdeen, ...... observed in districts with higher female literacy rates. Number of years of .... urine sampling to detect protein and diabetes blood sampling for syphilis.

  1. Illness Human - MDC_InfantMortality2006 (United States)

    NSGIC GIS Inventory (aka Ramona) — Polygon feature class based on Zip Code boundaries showing the rate of infant mortality per 1000 births in Miami-Dade County, 2006. Rate does not include out of...

  2. Excess mortality in giant cell arteritis

    DEFF Research Database (Denmark)

    Bisgård, C; Sloth, H; Keiding, Niels


    A 13-year departmental sample of 34 patients with definite (biopsy-verified) giant cell arteritis (GCA) was reviewed. The mortality of this material was compared to sex-, age- and time-specific death rates in the Danish population. The standardized mortality ratio (SMR) was 1.8 (95% confidence...... with respect to SMR, sex distribution or age. In the group of patients with department-diagnosed GCA (definite + probable = 180 patients), the 95% confidence interval for the SMR of the women included 1.0. In all other subgroups there was a significant excess mortality. Excess mortality has been found in two...... of seven previous studies on survival in GCA. The prevailing opinion that steroid-treated GCA does not affect the life expectancy of patients is probably not correct....


    Directory of Open Access Journals (Sweden)



    Full Text Available ABSTRACT: Maternal Mortality in A Tertiary Care Centre. OBJECTIVE: To study maternal mortality and the complications leading to maternal death. METHODS: A retrospective study of hospital record to study maternal mortality and its causes over 3 years from January 2010 to December 2012. RESULTS: There were a total of 58 maternal deaths out of 2823 live births giving a maternal mortality ratio of 2054.55 per one lakh live births. Unbooked and late referrals account for 77.58% of maternal deaths. The majority of deaths around 75.86% were in 20-30 years age group. Haemorrhage was the commonest causes of death (24.12% followed by sepsis (18.96% and pregnancy induced hypertension 15.51% Anemia contributed to the most common indirect cause of maternal morality. CONCLUSION: Haemorrhage, sepsis and pregnancy induced hypertension including eclampsia were the direct major causes of death. Anaemia and cardiac diseases were other indirect causes of death.

  4. Tempo effects in mortality: An appraisal

    Directory of Open Access Journals (Sweden)

    Michel Guillot


    Full Text Available This study examines the existence of tempo effects in mortality and evaluates the procedure developed by Bongaarts and Feeney for calculating a tempo-adjusted life expectancy. It is shown that Bongaarts and Feeney's index can be interpreted as an indicator reflecting current mortality conditions under specific assumptions regarding the effects of changing period mortality conditions on the timing of future cohort deaths. It is argued, however, that currently there is no clear evidence about the existence of such effects in actual populations. This paper concludes that until the existence of these effects can be demonstrated, it is preferable to continue using the conventional life expectancy as an indicator of current mortality conditions.

  5. Increased mortality among people with anxiety disorders

    DEFF Research Database (Denmark)

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


    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...

  6. Polysomnographic indicators of mortality in stroke patients

    DEFF Research Database (Denmark)

    Ponsaing, Laura B; Iversen, Helle K; Jennum, Poul


    PURPOSE: The purpose of the study was to assess polysomnographic indicators of increased mortality risk in patients with stroke or a transient ischemic attack (TIA). METHODS: We performed polysomnographies in 63 acute stroke/TIA patients. Mortality data were collected from a national database after...... a 19-37-month follow-up period. RESULTS: Of the 57 stroke and 6 TIA patients, 9 stroke patients died during follow-up. All nine had moderate or severe sleep-related breathing disorders (SRBDs). Binarily divided, the group with the highest apnea hypopnea index (AHI) had an almost 10-fold higher.......92; 95 % CI 2.00-49.23; p = 0.005), and there was a trend toward a higher mortality risk with atrial fibrillation/flutter (HR 3.63; 95 % CI 0.97-13.51; p = 0.055). CONCLUSIONS: In stroke patients, the AHI and nocturnal wake time are indicators of increased mortality risk. SRBDs in stroke patients should...

  7. Trends in mortality decrease and economic growth. (United States)

    Niu, Geng; Melenberg, Bertrand


    The vast literature on extrapolative stochastic mortality models focuses mainly on the extrapolation of past mortality trends and summarizes the trends by one or more latent factors. However, the interpretation of these trends is typically not very clear. On the other hand, explanation methods are trying to link mortality dynamics with observable factors. This serves as an intermediate step between the two methods. We perform a comprehensive analysis on the relationship between the latent trend in mortality dynamics and the trend in economic growth represented by gross domestic product (GDP). Subsequently, the Lee-Carter framework is extended through the introduction of GDP as an additional factor next to the latent factor, which provides a better fit and better interpretable forecasts.

  8. Association between Integration Policies and Immigrants' Mortality

    DEFF Research Database (Denmark)

    Ikram, Umar Z; Malmusi, Davide; Juel, Knud;


    confounders and data comparability issues (e.g., French cross-sectional data) may affect the findings, this study suggests that different macro-level policy contexts may influence immigrants' mortality. Comparable mortality registration systems across Europe along with detailed socio-demographic information......BACKGROUND: To integrate immigrants into their societies, European countries have adopted different types of policies, which may influence health through both material and psychosocial determinants. Recent studies have suggested poorer health outcomes for immigrants living in countries with poorly...... rated integration policies. OBJECTIVE: To analyse mortality differences of immigrants from the same country of origin living in countries with distinct integration policy contexts. METHODS: From the mortality dataset collected in the Migrant Ethnic Health Observatory (MEHO) project, we chose...

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

    African Journals Online (AJOL)

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

  10. Relative Deprivation, Poor Health Habits and Mortality (United States)

    Eibner, Christine E.; Evans, William N.


    The results of the study conducted, using the data from National Health Interview Survey (NHIS) (BRFSS), to find the relationship between the relative deprivation and mortality, while controlling individual income and reference group fixed effects, are presented.

  11. Infant mortality and crisis in Mexico. (United States)

    Bronfman, M


    Data derived from the Encuesta Nacional de Fecundidad y Salud (ENFES) confirm that overall levels of infant mortality in Mexico have been steadily declining. However, a more specific analysis furnishes evidence that this decline has occurred at varying rates within different social groups, reflecting an increase in social inequalities. The analytical strategy used in this article leads to three basic conclusions: (1) the impact of the economic crisis on infant mortality is reflected not in a reversal of the declining trend but an increase in social inequalities; (2) certain variables universally accepted as determinants of infant mortality, such as mother's education, seem nonsignificant for some social sectors; and (3) certain biodemographic characteristics assumed to have a uniform mortality-related behavior vary among sectors, suggesting that even these constants are determined by social factors.

  12. Association of Cardiometabolic Multimorbidity With Mortality

    NARCIS (Netherlands)

    Di Angelantonio, Emanuele; Kaptoge, Stephen; Wormser, David; Willeit, Peter; Butterworth, Adam S; Bansal, Narinder; O'Keeffe, Linda M; Gao, Pei; Wood, Angela M; Burgess, Stephen; Freitag, Daniel F; Pennells, Lisa; Peters, Sanne A; Hart, Carole L; Håheim, Lise Lund; Gillum, Richard F; Nordestgaard, Børge G; Psaty, Bruce M; Yeap, Bu B; Knuiman, Matthew W; Nietert, Paul J; Kauhanen, Jussi; Salonen, Jukka T; Kuller, Lewis H; Simons, Leon A; van der Schouw, Yvonne T; Barrett-Connor, Elizabeth; Selmer, Randi; Crespo, Carlos J; Rodriguez, Beatriz; Verschuren, W M Monique; Salomaa, Veikko; Svärdsudd, Kurt; van der Harst, Pim; Björkelund, Cecilia; Wilhelmsen, Lars; Wallace, Robert B; Brenner, Hermann; Amouyel, Philippe; Barr, Elizabeth L M; Iso, Hiroyasu; Onat, Altan; Trevisan, Maurizio; D'Agostino, Ralph B; Cooper, Cyrus; Kavousi, Maryam; Welin, Lennart; Roussel, Ronan; Hu, Frank B; Sato, Shinichi; Davidson, Karina W; Howard, Barbara V; Leening, Maarten J G; Leening, Maarten; Rosengren, Annika; Dörr, Marcus; Deeg, Dorly J H; Kiechl, Stefan; Stehouwer, Coen D A; Nissinen, Aulikki; Giampaoli, Simona; Donfrancesco, Chiara; Kromhout, Daan; Price, Jackie F; Peters, Annette; Meade, Tom W; Casiglia, Edoardo; Lawlor, Debbie A; Gallacher, John; Nagel, Dorothea; Franco, Oscar H; Assmann, Gerd; Dagenais, Gilles R; Jukema, J Wouter; Sundström, Johan; Woodward, Mark; Brunner, Eric J; Khaw, Kay-Tee; Wareham, Nicholas J; Whitsel, Eric A; Njølstad, Inger; Hedblad, Bo; Wassertheil-Smoller, Sylvia; Engström, Gunnar; Rosamond, Wayne D; Selvin, Elizabeth; Sattar, Naveed; Thompson, Simon G; Danesh, John


    IMPORTANCE: The prevalence of cardiometabolic multimorbidity is increasing. OBJECTIVE: To estimate reductions in life expectancy associated with cardiometabolic multimorbidity. DESIGN, SETTING, AND PARTICIPANTS: Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using indi

  13. [Maternal mortality: levels, trends, and differentials]. (United States)

    Langer, A; Lozano, R; Hernandez, B


    Maternal mortality in Mexico has declined significantly over the past half century. The maternal mortality rate was 53/10,000 live births in 1940 and 5.1 in 1990. The greatest and most rapid decline occurred in the 1940s. The maternal mortality rate is still too high, and in addition the differential between Mexican rates and those of the developed countries has increased. The average age at maternal death is 29 years, a full 40 years less than potential life expectancy. The risk of death from causes related to reproduction varies substantially by educational level. Of all maternal deaths between 1986 and 1991, 26% were in illiterate women, 33% in women with incomplete primary, and 24% in those with complete primary. In 1990, the average female school attainment was complete primary. The maternal mortality rate was eight times higher among illiterate women and five times higher in those not completing primary than in those finishing preparatory. Geographically, states with low maternal mortality rates of under 3.1 are mainly located in the north and those with high maternal mortality of over 6.0 are in the south. The central zone is an intermediate area. The 1991 maternal mortality rates of Oaxaca, Puebla, Tlaxcala, Veracruz, and the state of Mexico are similar to those of Nuevo Leon 30 years ago or Aguascalientes, Sonora, and Baja California 20 years ago. 72% of maternal deaths in the 1980s occurred in rural areas. The rates were 6.5/10,000 in rural areas and 4.1/10,000 in urban areas. The maternal mortality rate also increases with marginalization. An index of marginalization constructed with census data using multivariate techniques showed that fertile aged women in very marginalized municipios had maternal mortality rates of 11.5/10,000, or a risk of death three times greater than women in municipios scoring low for marginalization. Maternal mortality continues to be a priority public health problem in Mexico. Because so many maternal deaths are preventable

  14. [Interactive mortality atlas in Andalusia, Spain (AIMA)]. (United States)

    Ocaña-Riola, Ricardo; Mayoral-Cortés, José María; Sánchez-Cantalejo, Carmen; Toro-Cárdenas, Silvia; Fernández-Ajuria, Alberto; Méndez-Martínez, Camila


    Until now, mortality atlases have been static. Most of them describe the geographical distribution of mortality using count data aggregated over time and standardized mortality rates. However, this methodology has several limitations. Count data aggregated over time produce a bias in the estimation of death rates. Moreover, this practice difficult the study of temporal changes in geographical distribution of mortality. On the other hand, using standardized mortality hamper to check differences in mortality among groups. The Interactive Mortality Atlas in Andalusia (AIMA) is an alternative to conventional static atlases. It is a dynamic Geographical Information System that allows visualizing in web-site more than 12.000 maps and 338.00 graphics related to the spatio-temporal distribution of the main death causes in Andalusia by age and sex groups from 1981. The objective of this paper is to describe the methods used for AIMA development, to show technical specifications and to present their interactivity. The system is available from the link products in AIMA is the first interactive GIS that have been developed in Spain with these characteristics. Spatio-temporal Hierarchical Bayesian Models were used for statistical data analysis. The results were integrated into web-site using a PHP environment and a dynamic cartography in Flash. Thematic maps in AIMA demonstrate that the geographical distribution of mortality is dynamic, with differences among year, age and sex groups. The information nowadays provided by AIMA and the future updating will contribute to reflect on the past, the present and the future of population health in Andalusia.

  15. [Mortality by avoidable causes in preschool children]. (United States)

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


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

  16. Socioeconomic trajectories affect mortality in Klinefelter syndrome

    DEFF Research Database (Denmark)

    Bojesen, Anders; Krag, Kirstine Stochholm; Juul, Svend


    Klinefelter syndrome (KS) is associated with male infertility, hypogonadism, and learning disability. Morbidity and mortality are increased and the causes behind remain unknown. Is it the chromosome aberration or is it caused by postulated poorer socioeconomic status?......Klinefelter syndrome (KS) is associated with male infertility, hypogonadism, and learning disability. Morbidity and mortality are increased and the causes behind remain unknown. Is it the chromosome aberration or is it caused by postulated poorer socioeconomic status?...

  17. [Mortality attributable to excess weight in Spain]. (United States)

    Martín-Ramiro, José Javier; Álvarez-Martín, Elena; Gil-Prieto, Ruth


    Estimate the mortality attributable to higher than optimal body mass index in the Spanish population in 2006. Excess body weight prevalence data were obtained from the 2006 National Health Survey, while data on associated mortality were extracted from the National Statistic Institute. Population attributable fractions were applied and mortality attributable to higher than optimal body mass index was calculated for people between 35 and 79 years. In 2006, among the Spanish population aged 35-79 years, 25,671 lives (16,405 males and 9,266 women) were lost due to higher than optimal body mass index. Mortality attributable was 15.8% of total deaths in males and 14.8% in women, but if we refer to those causes where excess body weight is a risk factor, it is about a 30% of mortality (31.6% in men and 28% in women). The most important individual cause was cardiovascular disease (58%), followed by cancer. The individual cause with a major contribution to deaths was type 2 diabetes; nearly 70% in males and 80% in women. Overweight accounted for 54.9% deaths in men and 48.6% in women. Excess body weight is a major public health problem, with an important associated mortality. Attributable deaths are a useful tool to know the real situation and to monitor for disease control interventions. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  18. Alcohol Consumption and Pancreatitis Mortality in Russia

    Directory of Open Access Journals (Sweden)

    Yury E Razvodovsky


    Full Text Available Context Pancreatitis is a major public health problem with high associated economic costs. The incidence of pancreatitis has increased in many European countries in recent decade. Accumulated research and empirical evidence suggests that excessive alcohol consumption is a major risk factor for both acute and chronic pancreatitis. Objective The aim of this study was to examine the aggregate-level relation between the alcohol consumption and pancreatitis mortality rates in Russia. Method Age-standardized sex-specific male and female pancreatitis mortality data for the period 1970-2005 and data on overall alcohol consumption were analyzed by means ARIMA (autoregressive integrated moving average time series analysis. Alcohol consumption was significantly associated with both male and female pancreatitis mortality rates: a 1 liter increase in overall alcohol consumption would result in a 7.0% increase in the male pancreatitis mortality rate and in 2.3% increase in the female mortality rate. The results of the analysis suggest that 63.1% of all male pancreatitis deaths and 26.8% female deaths in Russia could be attributed to alcohol. Conclusions The outcomes of this study provide indirect support for the hypothesisthat unfavorable mixture of higher overall level of alcohol consumption and binge drinking pattern is an important contributor to the pancreatitis mortality rate in Russian Federation.

  19. A biologically motivated partitioning of mortality.

    Energy Technology Data Exchange (ETDEWEB)

    Carnes, B. A.; Olshansky, S. J.; Center for Mechanistic Biology and Biotechnology; Univ. of Chicago


    For over a century, actuaries and biologists working independently of each other have presented arguments for why total mortality needs to be partitioned into biologically meaningful subcomponents. These mortality partitions tended to overlook genetic diseases that are inherited because the partitions were motivated by a paradigm focused on aging. In this article, we combine and extend the concepts from these disciplines to develop a conceptual partitioning of total mortality into extrinsic and intrinsic causes of death. An extrinsic death is either caused or initiated by something that originates outside the body of an individual, while an intrinsic death is either caused or initiated by processes that originate within the body. It is argued that extrinsic mortality has been a driving force in determining why we die when we do from intrinsic causes of death. This biologically motivated partitioning of mortality provides a useful perspective for researchers interested in comparative mortality analyses, the consequences of population aging, limits to human life expectancy, the progress made by the biomedical sciences against lethal diseases, and demographic models that predict the life expectancy of future populations.

  20. Doctors' strikes and mortality: a review. (United States)

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


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

  1. Mortality in patients with pituitary disease.

    LENUS (Irish Health Repository)

    Sherlock, Mark


    Pituitary disease is associated with increased mortality predominantly due to vascular disease. Control of cortisol secretion and GH hypersecretion (and cardiovascular risk factor reduction) is key in the reduction of mortality in patients with Cushing\\'s disease and acromegaly, retrospectively. For patients with acromegaly, the role of IGF-I is less clear-cut. Confounding pituitary hormone deficiencies such as gonadotropins and particularly ACTH deficiency (with higher doses of hydrocortisone replacement) may have a detrimental effect on outcome in patients with pituitary disease. Pituitary radiotherapy is a further factor that has been associated with increased mortality (particularly cerebrovascular). Although standardized mortality ratios in pituitary disease are falling due to improved treatment, mortality for many conditions are still elevated above that of the general population, and therefore further measures are needed. Craniopharyngioma patients have a particularly increased risk of mortality as a result of the tumor itself and treatment to control tumor growth; this is a key area for future research in order to optimize the outcome for these patients.

  2. Mortality rates among Arab Americans in Michigan. (United States)

    Dallo, Florence J; Schwartz, Kendra; Ruterbusch, Julie J; Booza, Jason; Williams, David R


    The objectives of this study were to: (1) calculate age-specific and age-adjusted cause-specific mortality rates for Arab Americans; and (2) compare these rates with those for blacks and whites. Mortality rates were estimated using Michigan death certificate data, an Arab surname and first name list, and 2000 U.S. Census data. Age-specific rates, age-adjusted all-cause and cause-specific rates were calculated. Arab Americans (75+) had higher mortality rates than whites and blacks. Among men, all-cause and cause-specific mortality rates for Arab Americans were in the range of whites and blacks. However, Arab American men had lower mortality rates from cancer and chronic lower respiratory disease compared to both whites and blacks. Among women, Arab Americans had lower mortality rates from heart disease, cancer, stroke, and diabetes than whites and blacks. Arab Americans are growing in number. Future study should focus on designing rigorous separate analyses for this population.

  3. Mortality tempo-adjustment: An empirical application

    Directory of Open Access Journals (Sweden)

    Marc Luy


    Full Text Available The number of scholars following the tempo approach in fertility continues to grow, whereas tempo-adjustment in mortality generally still is rejected. This rejection is irrational in principle, as the basic idea behind the tempo approach is independent of the kind of demographic event. Providing the first empirical application to a substantial problem, this paper shows that mortality tempo-adjustment can paint a different picture of current mortality conditions compared to conventional life expectancy. An application of the Bongaarts and Feeney method to the analysis of mortality differences between western and eastern Germany shows that the eastern German disadvantages still are considerably higher and that the mortality gap between the two entities began to narrow some years later than trends in conventional life expectancy suggest. Thus, the picture drawn by tempo-adjusted life expectancy fits the expected trends of changing mortality and also the self-reported health conditions of eastern and western Germans better than that painted by conventional life expectancy.

  4. Mortality by sickle cell disease in Brazil. (United States)

    Arduini, Giovanna Abadia Oliveira; Rodrigues, Letícia Pinto; Trovó de Marqui, Alessandra Bernadete

    This work aimed to characterize mortality by sickle cell disease in Brazil. The MEDLINE electronic database was searched using the terms 'mortality' and 'sickle cell disease' and 'Brazil' for articles published in the last five years aiming to provide a current analysis of the subject in question. Eight studies on mortality by sickle cell disease were carried out in the Brazilian states of Maranhão, Bahia, Minas Gerais, Rio de Janeiro and Mato Grosso do Sul. The majority of the deaths occurred in patients with sickle cell anemia, which is the most common genotype and causes the most severe clinical manifestation of the disease. In summary, there are few published studies on mortality related to sickle cell disease in Brazil, and most are from the state of Minas Gerais. This study emphasizes the importance of developing more studies on sickle cell disease mortality, so that it may be possible to profile gene carriers and give health professionals more data to strategize the delivery of more effective assistance to these individuals. Despite the early diagnosis of sickle cell disease by the Neonatal Screening Program and the use of preventive and therapeutic measures (penicillin, immunization and hydroxyurea), mortality by sickle cell disease on the world stage is still significant.

  5. Religious Affiliation, Religious Service Attendance, and Mortality. (United States)

    Kim, Jibum; Smith, Tom W; Kang, Jeong-han


    Very few studies have examined the effects of both religious affiliation and religiosity on mortality at the same time, and studies employing multiple dimensions of religiosity other than religious attendance are rare. Using the newly created General Social Survey-National Death Index data, our report contributes to the religion and mortality literature by examining religious affiliation and religiosity at the same time. Compared to Mainline Protestants, Catholics, Jews, and other religious groups have lower risk of death, but Black Protestants, Evangelical Protestants, and even those with no religious affiliation are not different from Mainline Protestants. While our study is consistent with previous findings that religious attendance leads to a reduction in mortality, we did not find other religious measures, such as strength of religious affiliation, frequency of praying, belief in an afterlife, and belief in God to be associated with mortality. We also find interaction effects between religious affiliation and attendance. The lowest mortality of Jews and other religious groups is more apparent for those with lower religious attendance. Thus, our result may emphasize the need for other research to focus on the effects of religious group and religious attendance on mortality at the same time.


    Directory of Open Access Journals (Sweden)

    M. Farooq, Zahir-ud-Din, F .R. Durrani, M.A. Mian, N. Chand and J. Ahmed1


    Full Text Available Records from 62-broiler farms located in Swat, North West Frontier Province (NWFP, Pakistan were, collected during the year 1998 to investigate prevalent diseases and overall mortality in broilers. Losses due Hydro-pericardium syndrome (HPS were the highest (17.05 ± 2.08% and the lowest due to coccidiosis 9.39 ± 3.82%. Non-significant differences existed in mortality caused by Newcastle, IBD and yolk sac infection. Differences in losses caused by infectious coryza, enteritis and coccidiosis were also non- significant. Average overall mortality was 13.05 ± 1.16%, representing 7.59 ± 0.46% losses from day-1 to day 14 and 18.52 ± 0.95% from day-15 till marketing of broilers (42-50 days. Lower (p<0.05 overall mortality was observed in broilers reared on well-finished concrete floors (12.43 ± 1.45 % than in those on brick+mud made floors (14.36 ± 1.55. Higher (p<0.05 overall mortality was found in overcrowded houses 5.60 ± 5.62% than in optimally utilized houses (10.69 ± 1.51%. Overall mortality was higher (p<0.05 in flocks under substandard vaccination schedule (15.92 ± 1.55% than in those maintained under standard lancination schedule (10.20 ± 1.21%. Overall mortality was higher (21.11 ± 3.39% when the interval between two batches was ≤ 7 days than 16-20 days (5.72 ± 3.01%. Lower (p<0.05 overall mortality was und in broilers maintained under good hygienic ( 11.59 ±1.93% and sanitary conditions ( 10.82 ± 1.16% compared to those under poor hygienic and sanitary conditions (14.12 ± 2.81% and 15.15 ± 1.68 %respectively. Maintenance of broilers under good hygienic conditions on well finished concrete floor, providing the required space/broiler, following recommended vaccination schedule without HPS vaccine and keeping 8.20 days interval between two batches were suggested as key factors in reducing mortality among broilers in Swat

  7. Trends of lung cancer mortality in Mexico. (United States)

    Lazcano Ponce, E C; Tovar Guzman, V; Meneses Gonzalez, F; Rascon Pacheco, R A; Hernandez Avila, M


    Lung cancer (LC) is one of the most important public health problems in the world; 1,035,000 annual deaths are estimated each year and more than 80% of these are attributed to tobacco. The trend of lung cancer mortality in Mexico City from 1979 - 1993 was determined, as was the rate ratio of lung cancer mortality in 31 states in Mexico, taking Mexico City as a reference by means of a Poisson model. A strong linear regression model was used to evaluate the rate, where the dependent variable was LC mortality rate and the independent variable the year observed. In 15 years, 73,807 deaths from LC were reported, with an increase in mortality from 5.01 - 7.25 per 100,000 inhabitants. Mortality increases significantly after 60 years of age (B not equal to 0), ptax on cigarettes should be increased, smoking restricted in squares and public spaces, and the risks should be announced on cigarette packages, among other measures. With respect to other emergent risk factors, the sources of industrial pollution and toxic emissions should be regulated.

  8. Mortality among rubber workers: V. processing workers. (United States)

    Delzell, E; Monson, R R


    Cause-specific mortality was evaluated among 2,666 men employed in the processing division of a rubber manufacturing plant. The division was divided into two sections: front processing (compounding, mixing and milling operations) and back processing (extrusion, calendering, cement mixing and rubberized fabrics operations). Mortality rates for all processing workers combined and for men in each section were compared with rates for U.S. White males or for workers employed in other divisions of the same plant. Compared with either referent group, men in the processing division had increased mortality from leukemia, emphysema, and cancers of the stomach, large intestine, and biliary passages and liver. An excess number of deaths from stomach and larger intestine cancer was found predominantly among men in the front processing section (33 observed vs. 17.7 expected deaths, based on rates in nonprocessing workers). Increased mortality from leukemia (14 observed vs. 7.3 expected) and from emphysema (22 observed vs. 11.0 expected) was present among men employed in the back processing section. Examination of mortality from these causes according to age and the year starting work, duration of employment, and years since starting work in the relevant sections of the processing division suggested that observed excesses of stomach cancer, large intestine cancer, leukemia, and emphysema among processing workers are related to occupational exposures. These results are consistent with the findings of studies of other groups of rubber workers.

  9. Electrohydrodynamic mortality of insects: a plausible mechanism (United States)

    Shayesteh, N.; Barthakur, N. N.

    An electrohydrodynamic (EHD) system with a point-to-plane electrode, which produced air ions within a strong electric field, was used to study mortalities of pupae, larvae, and adults of Tribolium confusum (TC) and larvae of Plodia interpunctella (PI). The treatments included a neutral air stream, negative ions, positive ions, and the air stream superimposed with ions of either polarity. The negative ions caused the maximum mortality in TC pupae and PI larvae whereas the TC adults were least affected, but the negative ion flux was higher than the positive one at the constant high voltage of the power supply used in the present experiments. The differences in the mean mortalities of the treatment groups were highly significant (P<0.0001). Mortality was primarily attributed to the body fluid losses caused by the electric wind of the EHD system. Mortality and weight loss relationships were linear with negative slopes (r2=0.52, and r2=0.98 for TC and PI, respectively). The superimposition of the air stream with either positive or negative ion fluxes increased the survival fractions compared with those of the ion fluxes alone.

  10. Changing mortality and average cohort life expectancy

    Directory of Open Access Journals (Sweden)

    Robert Schoen


    Full Text Available Period life expectancy varies with changes in mortality, and should not be confused with the life expectancy of those alive during that period. Given past and likely future mortality changes, a recent debate has arisen on the usefulness of the period life expectancy as the leading measure of survivorship. An alternative aggregate measure of period mortality which has been seen as less sensitive to period changes, the cross-sectional average length of life (CAL has been proposed as an alternative, but has received only limited empirical or analytical examination. Here, we introduce a new measure, the average cohort life expectancy (ACLE, to provide a precise measure of the average length of life of cohorts alive at a given time. To compare the performance of ACLE with CAL and with period and cohort life expectancy, we first use population models with changing mortality. Then the four aggregate measures of mortality are calculated for England and Wales, Norway, and Switzerland for the years 1880 to 2000. CAL is found to be sensitive to past and present changes in death rates. ACLE requires the most data, but gives the best representation of the survivorship of cohorts present at a given time.

  11. Mortality in Levodopa-Treated Parkinson's Disease

    Directory of Open Access Journals (Sweden)

    John C. Morgan


    Full Text Available Parkinson’s disease (PD is associated with increased mortality despite many advances in treatment. Following the introduction of levodopa in the late 1960’s, many studies reported improved or normalized mortality rates in PD. Despite the remarkable symptomatic benefits provided by levodopa, multiple recent studies have demonstrated that PD patients continue to die at a rate in excess of their peers. We undertook this retrospective study of 211 deceased PD patients to determine the factors associated with mortality in levodopa-treated PD. Our findings confirm that PD is associated with increased mortality in both men and women. Unlike the majority of other mortality studies, we found that women have a greater reduction in lifespan compared to men. We also found that patients with early onset PD (onset at the age of 50 or before have reduced survival relative to PD patients with later ages of onset. A final important finding is that survival is equal in PD patients treated with levodopa early (within 2 years or less of PD onset versus later.

  12. Enhanced surveillance of maternal mortality in Texas. (United States)

    Estes, Larissa J; Lloyd, Linda E; Selwyn, Beatrice J


    Maternal mortality is often used to measure health and well-being for women. Improved surveillance efforts can improve maternal mortality estimates and inform the development of strategies to address the needs of maternal and child health populations. The purpose of this study was to provide better estimates of maternal mortality in Texas by using enhanced surveillance methods. Results from our analyses of fetal death and live birth records in Texas from 2000 through 2006 were then linked to pregnancy-related death records and death records of women of childbearing age (15-44 years) in Texas from 2001 through 2006. Enhanced surveillance identified almost 3.5 times as many deaths that might be associated with pregnancy than do current methods and confirmed a persistent race/ethnicity trend in maternal mortality. The leading cause of these 2001-2006 pregnancy-associated deaths was accidents. Enhanced surveillance allows the identification of additional deaths possibly associated with pregnancy and provides a stable foundation to investigate trends further and to review maternal mortality cases systematically.

  13. Labor migration and child mortality in Mozambique (United States)

    Yabiku, Scott T.; Agadjanian, Victor; Cau, Boaventura


    Male labor migration is widespread in many parts of the world, yet its consequences for child outcomes and especially childhood mortality remain unclear. Male labor migration could bring benefits, in the form of remittances, to the families that remain behind and thus help child survival. Alternatively, the absence of a male adult could imperil the household's well-being and its ability to care for its members, increasing child mortality risks. In this analysis, we use longitudinal survey data from Mozambique collected in 2006 and 2009 to examine the association between male labor migration and under-five mortality in families that remain behind. Using a simple migrant/non-migrant dichotomy, we find no difference in mortality rates across migrant and non-migrant men's children. When we separated successful from unsuccessful migration based on the wife's perception, however, stark contrasts emerge: children of successful migrants have the lowest mortality, followed by children of non-migrant men, followed by the children of unsuccessful migrants. Our results illustrate the need to account for the diversity of men's labor migration experience in examining the effects of migration on left-behind households. PMID:23121856

  14. Current therapies and mortality in acromegaly. (United States)

    Găloiu, S; Poiană, C


    Acromegaly is a rare disease most frequently due to a GH secreting pituitary adenoma. Without an appropriate therapy, life of patients with acromegaly can be shortened with ten years. Pituitary surgery is usually the first line therapy for GH secreting pituitary adenomas. A meta-analysis proved that mortality is much lower in operated patients, even uncured, than the entire group of patients and is similar with the general population in patients with GH30% utilization of SRAs reported a lower mortality ratio than studies with lower percentages of SRA administration. Although therapy with DA has long been used in patients with acromegaly, there are no studies reporting its effect on mortality, but its efficacy is limited by the low remission rate obtained. The use of conventional external radiotherapy, although with good remission rate in time, was linked with increased mortality, mostly due to cerebrovascular diseases. Mortality in acromegaly can be reduced to expected levels from general population by using modern therapies either in monotherapy or by using multimodal approaches in experienced centers.

  15. Perinatal mortality and socio-spatial inequalities

    Directory of Open Access Journals (Sweden)

    Eunice Francisca Martins


    Full Text Available OBJECTIVE: to analyze the social inequalities in the distribution of perinatal mortality in Belo Horizonte. MATERIAL AND METHODS: the perinatal deaths of residents in Belo Horizonte in the period 2003 to 2007 were studied on the basis of the Information Systems on Mortality and Newborns. The space analysis and the Health Vulnerability Index were used to identify existing inequalities in the sanitary districts regarding coverage and risk, determined by the Odds Ratio and a value p<0.05. The multivariate analysis was used to describe a model for perinatal mortality. RESULTS: there was a proved variation in the numbers of perinatal mortality per one thousand total births in the sanitary districts (12.5 to 19.4, coverage areas (5.3 to 49.4 and areas of risk (13.2 to 20.7. The mortality rate diminished as the maternal schooling increased. The death rates deriving from asphyxia/hypoxia and non-specified fetal death grew with the increase of risk in the area. CONCLUSION: it was verified that the perinatal deaths are distributed in a differentiated form in relation to the space and the social vulnerabilities. The confrontation of this complex problem requires the establishment of intersecting partnerships.

  16. Mortality burden and socioeconomic status in India.

    Directory of Open Access Journals (Sweden)

    June Y T Po

    Full Text Available BACKGROUND: The dimensions along which mortality is patterned in India remains unclear. We examined the specific contribution of social castes, household income, assets, and monthly per capita consumption to mortality differentials in India. METHODS AND FINDINGS: Cross-sectional data on 217,363 individuals from 41,554 households from the 2004-2005 India Human Development Survey was analyzed using multiple logistic regressions. Mortality differentials across social castes were attenuated after adjusting for household economic factors such as income and assets. Individuals living in the lowest income and assets quintiles had an increased risk of mortality with odds ratio (OR of 1.66 (95% CI  =  1.23-2.24 in the bottom income quintile and OR of 2.94 (95% CI  =  1.66-5.22 in the bottom asset quintile. Counter-intuitively, individuals living in households with lowest monthly consumption per capita had significantly lower probability of death (OR  =  0.27, 95% CI  =  0.20-0.38. CONCLUSIONS: Mortality burden in India is largely patterned on economic dimensions as opposed to caste dimensions, though caste may play an important role in predicting economic opportunities.

  17. Drought-mortality relationships for tropical forests. (United States)

    Phillips, Oliver L; van der Heijden, Geertje; Lewis, Simon L; López-González, Gabriela; Aragão, Luiz E O C; Lloyd, Jon; Malhi, Yadvinder; Monteagudo, Abel; Almeida, Samuel; Dávila, Esteban Alvarez; Amaral, Iêda; Andelman, Sandy; Andrade, Ana; Arroyo, Luzmila; Aymard, Gerardo; Baker, Tim R; Blanc, Lilian; Bonal, Damien; de Oliveira, Atila Cristina Alves; Chao, Kuo-Jung; Cardozo, Nallaret Dávila; da Costa, Lola; Feldpausch, Ted R; Fisher, Joshua B; Fyllas, Nikolaos M; Freitas, Maria Aparecida; Galbraith, David; Gloor, Emanuel; Higuchi, Niro; Honorio, Eurídice; Jiménez, Eliana; Keeling, Helen; Killeen, Tim J; Lovett, Jon C; Meir, Patrick; Mendoza, Casimiro; Morel, Alexandra; Vargas, Percy Núñez; Patiño, Sandra; Peh, Kelvin S-H; Cruz, Antonio Peña; Prieto, Adriana; Quesada, Carlos A; Ramírez, Fredy; Ramírez, Hirma; Rudas, Agustín; Salamão, Rafael; Schwarz, Michael; Silva, Javier; Silveira, Marcos; Slik, J W Ferry; Sonké, Bonaventure; Thomas, Anne Sota; Stropp, Juliana; Taplin, James R D; Vásquez, Rodolfo; Vilanova, Emilio


    *The rich ecology of tropical forests is intimately tied to their moisture status. Multi-site syntheses can provide a macro-scale view of these linkages and their susceptibility to changing climates. Here, we report pan-tropical and regional-scale analyses of tree vulnerability to drought. *We assembled available data on tropical forest tree stem mortality before, during, and after recent drought events, from 119 monitoring plots in 10 countries concentrated in Amazonia and Borneo. *In most sites, larger trees are disproportionately at risk. At least within Amazonia, low wood density trees are also at greater risk of drought-associated mortality, independent of size. For comparable drought intensities, trees in Borneo are more vulnerable than trees in the Amazon. There is some evidence for lagged impacts of drought, with mortality rates remaining elevated 2 yr after the meteorological event is over. *These findings indicate that repeated droughts would shift the functional composition of tropical forests toward smaller, denser-wooded trees. At very high drought intensities, the linear relationship between tree mortality and moisture stress apparently breaks down, suggesting the existence of moisture stress thresholds beyond which some tropical forests would suffer catastrophic tree mortality.

  18. Early retirement and mortality in Germany. (United States)

    Kühntopf, Stephan; Tivig, Thusnelda


    Differences in mortality by retirement age have an important impact on the financing of pension insurance, yet no clear-cut results for Germany exist so far. We calculate mortality rates by retirement age from microdata on all German old-age pensioners and 1.84 million deceases. The life expectancies and survival probabilities at age 65 are estimated for population subgroups according to creditable periods because of disease and pension income. Early-retired men who reach the age of 65 years live significantly longer the later early retirement occurs; the life expectancy at age 65 ranges from 13 to 17.8 years. For each retirement age, mortality of men is higher the more periods of disease are credited in the pension insurance system. For a given length of credited periods of disease, mortality of early retirees decreases with the retirement age. 'Healthy worker selection effects' operating in the labour market may contribute to these results. The 'work longer, live longer'-result is found for each pension income quintile, which resolves the J-curve pattern found in the literature. The mortality of female old-age pensioners varies little with retirement age.

  19. [Methods for diminishing mortality from infectious diseases]. (United States)

    Boev, B V; Ershov, F I


    The paper reports analysis of the "Russian Cross" demographic phenomenon characteristic of the present-day Russia, that is a marked excess of mortality over the birth rate leading to the reduction of the country's population at a rate of 750-800 thou people per year. The main causes and factors of excess mortality are considered with reference to deaths from infectious (viral and microbial) diseases. Experts of the Russian Academy of Medical Sciences proposed the working concept of the research program "Avoidable population mortality from infectious diseases in 2010-2020". Its implementation envisages the use of up-to-date information and computer technologies including mathematical and computer simulation of morbidity and mortality processes in outbreaks and epidemics of infectious diseases. The use of computer-assisted technologies is illustrated by the example of smallpox epidemics. They permit to promptly analyse and prognosticate excess mortality from infectious diseases by applying new diagnostic tools and medicinal products. This approach is proposed for the evaluation of the effectiveness of different projects in the framework of the above program. Its realization requires the development of three special information (computer-aided) systems designated Projects, Infections, and Prognoses.

  20. Atopy and cause-specific mortality

    DEFF Research Database (Denmark)

    Skaaby, T; Husemoen, L L N; Thuesen, Betina Heinsbæk


    followed by linkage to the Danish Registry of Causes of Death to obtain information on mortality status and cause of death (median follow-up time 11.3 years). The relative mortality risk was estimated by Cox regression and expressed as hazard ratios, HRs (95% confidence intervals, CIs). RESULTS: A total....... OBJECTIVES: We investigated the association of atopy with all-cause and cause-specific mortality. METHODS: We included a total of 14 849 individuals from five Danish population-based cohorts with measurements of atopy defined as serum-specific IgE positivity against inhalant allergens. Participants were...... of 1776 person died during follow-up. The mortality risk for atopics vs. non-atopics was: for all-cause mortality (HR = 1.03, 95% CI: 0.90, 1.17); neoplasms (HR = 0.86, 95% CI: 0.69, 1.06); endocrine, nutritional and metabolic disorders (HR = 1.48, 95% CI: 0.71, 3.08); mental and behavioural disorders (HR...

  1. Stochastic portfolio specific mortality and the quantification of mortality basis risk

    NARCIS (Netherlands)

    R. Plat


    In the last decade a vast literature on stochastic mortality models has been developed. However, these models are often not directly applicable to insurance portfolios because: (a) For insurers and pension funds it is more relevant to model mortality rates measured in insured amounts instead of meas

  2. The Effect of Mortality Shocks on the Age-Pattern of Adult Mortality

    DEFF Research Database (Denmark)

    Zarulli, Virginia


    This article aims to investigate the effect of sudden changes in external conditions on human mortality levels and age-patterns. Although several studies have analysed shocking events such as famines or deportations, a systematic assessment of the effect of the shock on the rate of mortality...

  3. Social Capital and Human Mortality: Explaining the Rural Paradox with County-Level Mortality Data (United States)

    Yang, Tse-Chuan; Jensen, Leif; Haran, Murali


    The "rural paradox" refers to standardized mortality rates in rural areas that are unexpectedly low in view of well-known economic and infrastructural disadvantages there. We explore this paradox by incorporating social capital, a promising explanatory factor that has seldom been incorporated into residential mortality research. We do so while…

  4. Hepatitis and thrombocytopenia: markers of dengue mortality. (United States)

    Krishnamoorthy, Smitha; Bhatt, Arun N; Mathew, Celine Thalappillil; Ittyachen, Abraham M


    Dengue fever is of great concern to public health in India as it contributes significantly to the burden of healthcare. The aim of our study was to measure mortality in dengue and its association with hepatitis and thrombocytopenia. Our study was performed in a tertiary care setting in the state of Kerala in southern India. Adult patients admitted in the year 2013 were included. Among 1308 confirmed dengue patients, the mortality rate was 1.76%. Hepatitis and thrombocytopenia were present in over 80% of all patients, but severe hepatitis was seen in 11.4% and severe thrombocytopenia in 9.3%. These were markers of fatal outcome. Other factors significantly associated with mortality were age >60 years, male sex, diabetes and the presence of any co-morbidity.

  5. Education and Cause-specific Mortality

    DEFF Research Database (Denmark)

    Nordahl, Helene; Lange, Theis; Osler, Merete


    BACKGROUND: Differential exposures to behavioral risk factors have been shown to play an important mediating role on the education-mortality relation. However, little is known about the extent to which educational attainment interacts with health behavior, possibly through differential...... vulnerability. METHODS: In a cohort study of 76,294 participants 30 to 70 years of age, we estimated educational differences in cause-specific mortality from 1980 through 2009 and the mediating role of behavioral risk factors (smoking, alcohol intake, physical activity, and body mass index). With the use...... of marginal structural models and three-way effect decomposition, we simultaneously regarded the behavioral risk factors as intermediates and clarified the role of their interaction with educational exposure. RESULTS: Rate differences in mortality comparing participants with low to high education were 1...

  6. Maternal Mortality in Women with Epilepsy

    LENUS (Irish Health Repository)

    Holohan, M


    It is estimated that, in Ireland, there are 10,000 women with epilepsy of childbearing potential1. In this paper the maternal mortality rate for women with epilepsy attending the Rotunda Hospital Epilepsy Clinic 2004 - 2013 was determined. There were 3 maternal deaths in women with epilepsy during this time, which represents a mortality rate of 0.8%. In those women who died, there were concerns in relation to risks to the foetus by taking Anti-Epileptic Drugs (AED) and also issues with access to neurology services before pregnancy, acceptance of specialist support and lack of consistency in advice from health care professionals outside of Ireland. Implementing the nationally agreed care plan for women with epilepsy will improve the quality of care given and potentially we will see a reduction in maternal mortality in these women.

  7. The association between depression and mortality

    DEFF Research Database (Denmark)

    Christensen, Gunhild Tidemann; Maartensson, Solvej; Osler, Merete


    on depression, use of antidepressants and the Major Depression Inventory (MDI) from a survey in 2004, in which 58.8% (n=6292) of the men participated. Information on mortality and cause of death was retrieved from registers for the period between 2004 and 2011. RESULTS: Depression diagnosis from hospital...... registers as well as self-reported depression, use of antidepressants and having a high MDI-score were significantly associated with mortality from all, natural and unnatural causes. The associations were of a similar magnitude for the register-based measure of depression and for the survey-based measures......BACKGROUND: A number of studies have associated depression with a high mortality risk. However, in surveys, depression is often measured by self-reports in selected sub-samples, while register studies have been based on hospital diagnosis or purchase of antidepressants. We examined how different...

  8. Leisure Time Physical Activity and Mortality

    DEFF Research Database (Denmark)

    Johnsen, Nina Føns; Ekblond, Annette; Thomsen, Birthe Lykke


    BACKGROUND: Some studies indicate that a large part of the beneficial effect of physical activity on mortality is confined to a threshold effect of participation. METHODS: Self-reported physical activity was investigated in relation to all-cause mortality in the Danish Diet, Cancer and Health...... cohort, including 29,129 women and 26,576 men aged 50-64 years at baseline 1993-1997. Using Cox proportional hazards models we investigated the associations between mortality rate and leisure time physical activity by exploring 1) participation (yes/no) in each type of activity; 2) a simple dose...... in specific leisure time physical activities, but not with more time spent on those activities. This could suggest that avoiding a sedative lifestyle is more important than a high volume of activity. Nonparticipation in these types of physical activity may be considered as risk factors....

  9. Nutrient enrichment increases mortality of mangroves.

    Directory of Open Access Journals (Sweden)

    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.

  10. Nutrient Enrichment Increases Mortality of Mangroves (United States)

    Lovelock, Catherine E.; Ball, Marilyn C.; Martin, Katherine C.; C. Feller, Ilka


    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. PMID:19440554

  11. Estimating mortality due to cigarette smoking

    DEFF Research Database (Denmark)

    Brønnum-Hansen, Henrik; Juel, K


    . Peto et al (Lancet 1992;339:1268-1278), requires data on mortality from lung cancer among people who have never smoked and among smokers, but it does not require data on the prevalence of smoking. In the Prevent model, 33% of deaths among men and 23% of those among women in 1993 from lung cancer......We estimated the mortality from various diseases caused by cigarette smoking using two methods and compared the results. In one method, the "Prevent" model is used to simulate the effect on mortality of the prevalence of cigarette smoking derived retrospectively. The other method, suggested by R......, chronic bronchitis, emphysema, ischemic heart disease, and stroke were caused by cigarette smoking. In the method proposed by Peto et al, 35% of deaths among men and 25% of deaths among women from these causes were estimated to be attributable to cigarette smoking. The differences between the two methods...

  12. Alcohol consumption and liver cirrhosis mortality

    DEFF Research Database (Denmark)

    Bentzen, Jan Børsen; Smith, Valdemar

    on the relationship between liver cirrhosis mortality and alcohol consumption is included. The conclusion is that the total level of alcohol consumption as well as the specific beverages - beer, wine and spirits - contributes to liver cirrhosis mortality, but the present study also reveals that directly addressing......Empirical evidence gives strong support to a close association between liver cirrhosis mortality and the intake of alcohol and most often a log-linear relationship is assumed in the econometric modeling. The present analysis investigates for unit roots in a panel data set for sixteen European...... countries - covering the period 1970-2006 - where both alcohol consumption and liver cirrhosis seem best described as trend-stationary variables. Therefore a fixed effects model including individual trends is applied in the analysis but also a more flexible non-linear functional form with fewer restrictions...

  13. Risk factors for mortality in Down syndrome. (United States)

    Uppal, H; Chandran, S; Potluri, R


    Down syndrome is a genetic condition that contributes to a significantly shorter life expectancy compared with the general population. We investigated the most common comorbidities in a population of acute hospital patients with Down syndrome and further explored what the most common risk factors for mortality are within this population. From our database of one million patients admitted to National Health Service (NHS) Trusts in northern England, we identified 558 people who had Down syndrome. We compared this group with an age- and gender-matched control group of 5580 people. The most prevalent comorbid diseases within the Down's population were hypothyroidism (22.9%) and epilepsy (20.3%). However, the conditions that had the highest relative risks (RRs) in the Down's population were septal defects and dementia. Respiratory failure, dementia and pneumonia were the most significantly related comorbidities to mortality in the Down syndrome population. In the control population, respiratory failure, dementia and renal failure were the most significant disease contributors. When these contributors were analysed using multivariate analysis, heart failure, respiratory failure, pneumonia and epilepsy were the identified risk factors for in-hospital mortality in the Down syndrome population. Respiratory failure was the sole risk factor for mortality in the Down syndrome population [RR = 9.791 (1.6-59.9) P ≤ 0.05], when compared with the risk factors for mortality in the control population. There is significant medical morbidity in Down syndrome. This morbidity contributes to the lower life expectancy. Respiratory failure is a risk factor for mortality in Down syndrome. We need to thoroughly investigate people with Down syndrome to ensure any treatable illnesses are well managed. © 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  14. Estimating spatial inequalities of urban child mortality

    Directory of Open Access Journals (Sweden)

    John R. Weeks


    Full Text Available BACKGROUND Recent studies indicate that the traditional rural-urban dichotomy pointing to cities as places of better health in the developing world can be complicated by poverty differentials. Knowledge of spatial patterns is essential to understanding the processes that link individual demographic outcomes to characteristics of a place. A significant limitation, however, is the lack of spatial data and methods that offer flexibility in data inputs. OBJECTIVE This paper tackles some of the issues in calculating intra-urban child mortality by combining multiple data sets in Accra, Ghana and applying a new method developed by Rajaratnam et al. (2010 that efficiently uses summary birth histories for creating local-level measures of under-five child mortality (5q0. Intra-urban 5q0 rates are then compared with characteristics of the environment that may be linked to child mortality. METHODS Rates of child mortality are calculated for 16 urban zones within Accra for birth cohorts from 1987 to 2006. Estimates are compared to calculated 5q0 rates from full birth histories. 5q0 estimates are then related to zone measures of slum characteristics, housing quality, health facilities, and vegetation using a simple trendline R2 analysis. RESULTS Results suggest the potential value of the Rajaratnam et al. method at the micro-spatial scale. Estimated rates indicate that there is variability in child mortality between zones, with a spread of up to 50 deaths per 1,000 births. Furthermore, there is evidence that child mortality is connected to environmental factors such as housing quality, slum-like conditions, and neighborhood levels of vegetation.

  15. Geriatric trauma: demographics, injuries, and mortality. (United States)

    Keller, Julie M; Sciadini, Marcus F; Sinclair, Elizabeth; O'Toole, Robert V


    To identify injuries that elderly sustain during high-energy trauma and determine which are associated with mortality. Retrospective review of prospectively collected database. Academic trauma center. Patients selected from database of all trauma admissions from January 2004 through June 2009. Study population consisted of patients directly admitted from scene of injury who sustained high-energy trauma with at least one orthopaedic injury and were 65 years or older (n = 597). Review of demographics, trauma markers, injuries, and disposition statuses. Statistical analysis using χ test, Student t test, and logistic regression analysis. The most common fractures were of the rib, distal radius, pelvic ring, facial bones, proximal humerus, clavicle, ankle, and sacrum. The injuries associated with the highest mortality rates were fractures of the cervical spine with neurological deficit (47%), at the C2 level (44%), and of the proximal femur (25%), pelvic ring (25%), clavicle (24%), and distal humerus (24%). The fractures significantly associated with mortality were fractures of the clavicle (P = 0.001), foot joints (P = 0.001), proximal humerus or shaft and head of the humerus (P = 0.002), sacroiliac joint (P = 0.004), and distal ulna (P = 0.002). Elderly patients present with significantly worse injuries, remain in the hospital longer, require greater use of resources after discharge, and die at 3 times the rate of the younger population. Although the high mortality rates associated with cervical spine, hip, and pelvic ring fractures were not unexpected, the injuries that were statistically associated with mortality were unexpected. Injuries such as clavicle fracture were statistically associated with mortality. As our population ages and becomes more active, the demographic may gain in clinical importance. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

  16. Effects of wolf mortality on livestock depredations.

    Directory of Open Access Journals (Sweden)

    Robert B Wielgus

    Full Text Available Predator control and sport hunting are often used to reduce predator populations and livestock depredations, but the efficacy of lethal control has rarely been tested. We assessed the effects of wolf mortality on reducing livestock depredations in Idaho, Montana and Wyoming from 1987-2012 using a 25 year time series. The number of livestock depredated, livestock populations, wolf population estimates, number of breeding pairs, and wolves killed were calculated for the wolf-occupied area of each state for each year. The data were then analyzed using a negative binomial generalized linear model to test for the expected negative relationship between the number of livestock depredated in the current year and the number of wolves controlled the previous year. We found that the number of livestock depredated was positively associated with the number of livestock and the number of breeding pairs. However, we also found that the number of livestock depredated the following year was positively, not negatively, associated with the number of wolves killed the previous year. The odds of livestock depredations increased 4% for sheep and 5-6% for cattle with increased wolf control--up until wolf mortality exceeded the mean intrinsic growth rate of wolves at 25%. Possible reasons for the increased livestock depredations at ≤25% mortality may be compensatory increased breeding pairs and numbers of wolves following increased mortality. After mortality exceeded 25%, the total number of breeding pairs, wolves, and livestock depredations declined. However, mortality rates exceeding 25% are unsustainable over the long term. Lethal control of individual depredating wolves may sometimes necessary to stop depredations in the near-term, but we recommend that non-lethal alternatives also be considered.

  17. Regional analysis of road mortality in Europe. (United States)

    Eksler, V; Lassarre, S; Thomas, I


    Road accidents are the tenth leading cause of premature death worldwide and, based on current trends, are likely to become the third leading cause of disability-adjusted life years lost by 2020. Road mortality varies in time and space both between countries and also between regions within the same country. Identifying and understanding the background of regional differences may lead to better understanding of the sources of road accidents, and enable the application of more effective road safety policies. A Bayesian ecological regression model based on a unified generalized linear mixed model framework is introduced. Population density and country (affiliation) were used as covariates and were fitted into the model at the four levels of spatial aggregation known as 'nomenclature of statistical territorial units (NUTS) regional classification'. Population density has a significant influence on road mortality. For all countries together, the elasticity estimate is -0.32, meaning that a 10% increase in population density is linked to a 3.2% decrease in road fatalities. A multi-level model defined at the NUTS-3 level, taking into account the NUTS-2 aggregation, enables infraregional variances in road mortality to be taken into account and produces the most reliable estimates of the model parameters. Variation in the Bayes relative risk (the mortality ratio 'standardized' by population density and country effect) is highest at the NUTS-3 level, but is lower at country level and NUTS-2 level, which suggests that other important underlying factors are responsible for the variations in road mortality between regions. Mapping the Bayes relative risk enables the identification of regions that should be targeted by national and regional policies. Last but not least, a new ranking of European countries according to their road mortality risk, adjusted for population density, is presented.

  18. Mortality in Schizophrenia: Clinical and Serological Predictors (United States)

    Dickerson, Faith; Stallings, Cassie; Origoni, Andrea; Schroeder, Jennifer; Khushalani, Sunil; Yolken, Robert


    Persons with schizophrenia have a reduced life expectancy largely due to death from natural causes. Factors that have been previously associated with excess mortality include cigarette smoking and antipsychotic medication. The role of other environmental factors such as exposure to infectious agents has been the subject of only limited investigation. We prospectively assessed a cohort of persons with schizophrenia with a clinical evaluation and a blood sample from which antibodies to human herpes viruses and Toxoplasma gondii were measured. Mortality was determined with data from the National Death Index following a period of up to 11 years. We examined the role of demographic, serological, and clinical factors on mortality. A total of 25 (5%) of 517 persons died of natural causes. The standardized mortality ratio was 2.80 (95% CI 0.89, 6.38). After adjusting for age and gender, mortality from natural causes was predicted in separate models by cigarette smoking (relative risk [RR] = 4.66, P = .0029); lower cognitive score (RR = 0.96, P = .013); level of antibodies to Epstein–Barr virus (RR = 1.22, P = .0041) and to Herpes Simplex virus type 1 (RR = 1.19, P = .030); immunologic disease (RR = 3.14, P = .044); and genitourinary disease (RR = 2.70; P = .035). Because cigarette smoking confers an almost 5-fold risk of mortality, smoking cessation is an urgent priority. Having an elevated level of antibodies to Epstein–Barr virus and to Herpes Simplex virus type 1 are also significant predictors of death from natural causes. PMID:23943410

  19. Mortality in people with type 2 diabetes in the UK

    NARCIS (Netherlands)

    Mulnier, H.E.; Seaman, H.E.; Raleigh, V.S.; Soedamah-Muthu, S.S.; Colhoun, H.M.; Lawrenson, R.A.


    Aims Under-reporting of diabetes on death certificates contributes to the unreliable estimates of mortality as a result of diabetes. The influence of obesity on mortality in Type 2 diabetes is not well documented. We aimed to study mortality from diabetes and the influence of obesity on mortality in

  20. Sex differences in mortality by ethnic background

    DEFF Research Database (Denmark)

    Oksuzyan, Anna; Drefahl, Sven; Jacobsen, Rune


    migrant effect and predominantly male migration from non-Western countries to Denmark and Sweden in 1960-70s, as well as high fertility in their female spouses, we expect to find even smaller sex differential mortality among migrants than in the ethnic Danish and Swedish populations. We use high....... In this study we address whether the substantial differences in the gender gap that are observed between countries can also be observed for different immigrant groups. Previous research has indicated that migrants enjoy better health and lower mortality compared with the host population. Considering the healthy...

  1. Cognitive impairment and mortality among nonagenarians

    DEFF Research Database (Denmark)

    Andersen, Kjeld; Nybo, Hanne; Gaist, David;


    the impact of cognitive impairment on mortality over a 2-year period. No cognitive impairment was defined as a score of 24-30 points on the Mini Mental State Examination, mild cognitive impairment was defined as a score of 18-23 points, and severe impairment was defined as a score of 0-17 points. Cox...... regression analysis was applied to adjust for a number of known and suspected factors known or suspected of being associated with cognition and mortality (e.g. sociodemographic factors, sex, smoking, alcohol consumption, depressive symptoms, and physical abilities), and yielded hazard ratios (95% confidence...

  2. Adult mortality and children's transition into marriage

    Directory of Open Access Journals (Sweden)

    Sofya Krutikova


    Full Text Available Adult mortality due to HIV/AIDS and other diseases is posited to affect children through a number of pathways. On top of health and education outcomes, adult mortality can have significant effects on children by influencing demographic outcomes including the timing of marriage. This paper examines marriage outcomes for a sample of children interviewed in Tanzania in the early 1990s and re-interviewed in 2004. We find that while girls who became paternal orphans married at significantly younger ages, orphanhood had little effect on boys. On the other hand, non-parental deaths in the household affect the timing of marriage for boys.

  3. Pattern of mortality among Danish thorotrast patients

    DEFF Research Database (Denmark)

    Andersson, Michael; Juel, K; Storm, Hans Henrik


    The mortality pattern among 999 Danish patients who had been subjected to angiography of the carotid artery with the alpha-ray emitting X-ray contrast media Thorotrast during the period 1935-47 was assessed by record linkage with the National Death Registry through 1989. Standardized mortality...... neurological conditions and by diseases known to be induced by Thorotrast (cirrhosis and cancer of the liver, leukaemia and other haematological diseases), and it is suggested that unspecific effects induced by the alpha-radiation of Thorotrast may have contributed....

  4. Pattern of mortality among Danish thorotrast patients

    DEFF Research Database (Denmark)

    Andersson, Michael; Juel, K; Storm, Hans Henrik


    The mortality pattern among 999 Danish patients who had been subjected to angiography of the carotid artery with the alpha-ray emitting X-ray contrast media Thorotrast during the period 1935-47 was assessed by record linkage with the National Death Registry through 1989. Standardized mortality...... neurological conditions and by diseases known to be induced by Thorotrast (cirrhosis and cancer of the liver, leukaemia and other haematological diseases), and it is suggested that unspecific effects induced by the alpha-radiation of Thorotrast may have contributed....

  5. [Differential mortality in women of reproductive age]. (United States)

    Morelos, J B; Ehrenfeld, N


    "This paper begins by reviewing some conceptual frameworks for the study of female mortality and indicates some of its application problems. Next it presents results of mortality of women in reproductive-age classified by age, causes of death, and socio-demographic traits (marital status, schooling, and occupation) for ten states [in Mexico] differentiated according to level of development and well-being. The data suggests differences according to age, marital status, and schooling. Finally, testing of the mutual independence and partial independence hypotheses indicates that age, marital status, and schooling correlate to the degree of development of each state." (SUMMARY IN ENG) excerpt

  6. Changing mortality and average cohort life expectancy

    DEFF Research Database (Denmark)

    Schoen, Robert; Canudas-Romo, Vladimir


    of survivorship. An alternative aggregate measure of period mortality which has been seen as less sensitive to period changes, the cross-sectional average length of life (CAL) has been proposed as an alternative, but has received only limited empirical or analytical examination. Here, we introduce a new measure......, the average cohort life expectancy (ACLE), to provide a precise measure of the average length of life of cohorts alive at a given time. To compare the performance of ACLE with CAL and with period and cohort life expectancy, we first use population models with changing mortality. Then the four aggregate...

  7. Aging in the Context of Cohort Evolution and Mortality Selection



    This study examines historical patterns of aging through the perspectives of cohort evolution and mortality selection, where the former emphasizes the correlation across cohorts in the age dependence of mortality rates, and the latter emphasizes cohort change in the acceleration of mortality over the life course. In the analysis of historical cohort mortality data, I find support for both perspectives. The rate of demographic aging, or the rate at which mortality accelerates past age 70, is n...

  8. Mortality among hourly motor vehicle manufacturing workers. (United States)

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


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

  9. [Relation between continuity of care and mortality

    NARCIS (Netherlands)

    Uijen, A.A.; Schers, H.J.


    Continuity of care is one of the most important features of primary care. In this commentary we discuss the article by Maarsingh et al. regarding the relation between personal continuity (seeing the same care provider) and mortality. We raise some important points on the way continuity of care is

  10. Infant Mortality: Priority for Social Work. (United States)

    Combs-Orme, Terri


    Bemoans the failure of the social work profession to claim infant mortality as a professional priority in spite of evidence of the appropriateness of social work interventions. Stresses social work's role in the reduction of preventable infant deaths. (Author/KS)

  11. Predictors of mortality after aortic valve replacement

    NARCIS (Netherlands)

    Tjang, Yanto Sandy; van Hees, Yvonne; Koerfer, Reiner; Grobbee, Diederick E.; van der Heijden, Geert J. M. G.

    Aortic valve replacement (AVR) is recommended as a standard surgical procedure for aortic valve disease. Still the evidence for commonly claimed predictors of post-AVR prognosis, in particular mortality, appears scant. This systematic review reports on the evidence for predictors of post-AVR

  12. Topical beta-Blockers and Mortality

    NARCIS (Netherlands)

    Muskens, Rogier P. H. M.; Wolfs, Roger C. W.; Wittenian, Jacqueline C. M.; Hofman, Albert; de Jong, Paulus T. V. M.; Stricker, Bruno H. C.; Jansonius, Nomdo M.


    Purpose: To study the associations between long-term and short-term use of topical beta-blockers and mortality. Design: Prospective population-based cohort study. Participants: To examine long-term effects, 3842 participants aged 55 years and older were recruited. To examine short-term effects, 484

  13. Maternal mortality in Denmark, 1985-1994

    DEFF Research Database (Denmark)

    Andersen, Betina Ristorp; Westergaard, Hanne Brix; Bødker, Birgit


    OBJECTIVES: In Denmark, maternal mortality has been reported over the last century, both locally through hospital reports and in national registries. The purpose of this study was to analyze data from national medical registries of pregnancy-related deaths in Denmark 1985-1994 and to classify them...

  14. Political party affiliation, political ideology and mortality. (United States)

    Pabayo, Roman; Kawachi, Ichiro; Muennig, Peter


    Ecological and cross-sectional studies have indicated that conservative political ideology is associated with better health. Longitudinal analyses of mortality are needed because subjective assessments of ideology may confound subjective assessments of health, particularly in cross-sectional analyses. Data were derived from the 2008 General Social Survey-National Death Index data set. Cox proportional analysis models were used to determine whether political party affiliation or political ideology was associated with time to death. Also, we attempted to identify whether self-reported happiness and self-rated health acted as mediators between political beliefs and time to death. In this analysis of 32,830 participants and a total follow-up time of 498,845 person-years, we find that political party affiliation and political ideology are associated with mortality. However, with the exception of independents (adjusted HR (AHR)=0.93, 95% CI 0.90 to 0.97), political party differences are explained by the participants' underlying sociodemographic characteristics. With respect to ideology, conservatives (AHR=1.06, 95% CI 1.01 to 1.12) and moderates (AHR=1.06, 95% CI 1.01 to 1.11) are at greater risk for mortality during follow-up than liberals. Political party affiliation and political ideology appear to be different predictors of mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  15. IMF-lending programs and suicide mortality. (United States)

    Goulas, Eleftherios; Zervoyianni, Athina


    While the economic consequences of IMF programs have been extensively analyzed in the literature, much less is known about how key welfare indicators, including suicide-mortality rates, correlate with countries' participation in such programs. This paper examines the impact of IMF lending on suicide mortality, using data from 30 developing and transition countries that received non-concessionary IMF loans during 1991-2008. Our results support the hypothesis of a positive causal relationship between suicide mortality and participation in IMF programs but reveal no systematic suicide-increasing effect from the size of IMF loans. This holds after accounting for self-selection into programs, resulting from the endogeneity of a country's decision to resort to the IMF for funding, and after controlling for standard socio-economic influences on suicidal behaviour. In particular, we find a positive aggregate suicide-mortality differential due to IMF-program participation of between 4 and 14 percentage points. We also find that the positive association between suicides and program participation is stronger and more robust among males. Comparing age groups, individuals belonging to the age group 45-to-64 exhibit the highest increase in suicide due to program-participation, which amounts to over 18 percentage points. Overall, our results imply that when countries are exposed to IMF programs in an attempt to resolve their economic problems, social-safety nets need to be designed to protect the adversely-affected part of the population.

  16. Gangrenous cholecystitis: mortality and risk factors. (United States)

    Önder, Akın; Kapan, Murat; Ülger, Burak Veli; Oğuz, Abdullah; Türkoğlu, Ahmet; Uslukaya, Ömer


    As a serious complication of cholelithiasis, gangrenous cholecystitis presents greater mortality than noncomplicated cholecystitis. The aim of this study was to specify the risk factors on mortality. 107 consecutive patients who underwent surgery due to gangrenous cholecystitis between January 1997 and October 2011 were investigated retrospectively. The study included 60 (56.1%) females and 47 (43.9%) males, with a mean age of 60.7 ± 16.4 (21-88) years. Cardiovascular diseases were the most frequently accompanying medical issues (24.3%). Thirty-six complications (33.6%) developed in 29 patients, and surgical site infection was proven as the most common. Longer delay time prior to hospital admission, low white blood cell count, presence of diabetes mellitus, higher blood levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and total bilirubin, pericholecystic fluid in abdominal ultrasonography, and conversion from laparoscopic surgery to open surgery were identified as risk factors affecting mortality (P < 0.001, P = 0.001, P = 0.044, P = 0.005, P = 0.049, P = 0.009, P = 0.022, P = 0.011, and P = 0.004, respectively). Longer delay time prior to hospital admission and low white blood cell count were determined as independent risk factors affecting mortality.

  17. Incidence, etiology and mortality of cirrhosis

    DEFF Research Database (Denmark)

    Dam Fialla, Annette; Schaffalitzky de Muckadell, Ove B; Touborg Lassen, Annmarie


    Knowledge on the prognosis among patients with cirrhosis is mainly based on clinical trials with selected patient groups as well as population-based register studies with suboptimal diagnostic reliability. The aim of the study was to describe incidence, etiology, and mortality of well......-validated cirrhotic cases in a population-based cohort at Funen (population 470,000) between 1996 and 2006....

  18. Embryonic mortality in buffalo naturally mated

    Directory of Open Access Journals (Sweden)

    G. Campanile


    Full Text Available The aim of this work was to evaluate the incidence of embryonic mortality in three different period of year in buffaloes naturally mated. The trial was carried out in a buffalo farm located in Caserta province between 2000-2006. In this period were registered natural insemination on 200 buffaloes. Pregnancy diagnosis was carried out on Day 30, confirmed on Day 45 and every 15th days until 90 days after natural mating. Buffaloes that were pregnant on Day 30 but not on Day 45 or Day 90 were considered to have undergone embryonic (EM or fetal mortality (FM respectively. EM and FM were 8.8% and 13.4% respectively throughout the experimental period. A high incidence (P<0.01 of FM was found in the transitional period (December-March than in other months of the year. The incidence of embryonic mortality was significantly (P<0.01 higher between 28-60 days of gestation and lower after 71 day of gestation. The higher fetal mortality found in this study could be due the lower serum levels of progesterone normally found in transitional period in buffalo cows.

  19. Premature mortality in Japan due to ozone (United States)

    Nawahda, Amin; Yamashita, Ken; Ohara, Toshimasa; Kurokawa, Junichi; Ohizumi, Tsuyoshi; Chen, Fang; Akimoto, Hajime


    In Japan, all 47 prefectures conduct routine air quality monitoring at 1145 stations throughout the country to assess environmental effects. This study aims to provide a better understanding of possible estimations of premature mortality in Japan caused by exposure to monitored and modeled concentrations of tropospheric ozone during the period from January to December, 2005. The spatial distribution and temporal variation of ozone concentrations were modeled using the Models-3 Community Multiscale Air Quality modeling system coupled with the Regional Emission Inventory in Asia (CMAQ/REAS). Premature mortality caused by exposure to ozone was calculated assuming a relative risk (RR) value of 1.003 [95% Confidence Interval (CI): 1.001-1.004] for concentrations above 35 ppb according to the SOMO35 index (annual Sum of daily maximum 8-h Ozone Means Over 35 ppb) recommended by WHO (2008). Based on CMAQ/REAS simulations, the estimated all-cause premature mortality in 2005 is about 13,000 (95% CI: 4320-17,300) cases. This value is 2.5 times greater than the estimated premature mortality based on monitored ozone concentrations, which is 5220 (95% CI: 1740-6960) cases.

  20. Predictors of Mortality in Staphylococcus aureus Bacteremia (United States)

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


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

  1. A Genetic Analysis of Mortality in Pigs

    DEFF Research Database (Denmark)

    Varona, Luis; Sorensen, Daniel


    An analysis of mortality is undertaken in two breeds of pigs: Danish Landrace and Yorkshire. Zero-inflated and standard versions of hierarchical Poisson, binomial, and negative binomial Bayesian models were fitted using Markov chain Monte Carlo (MCMC). The objectives of the study were to investig...

  2. Infant mortality and child nutrition in Bangladesh. (United States)

    Dancer, Diane; Rammohan, Anu; Smith, Murray D


    The excess female infant mortality observed in South Asia has typically been attributed to gender discrimination in the intra-household allocation of food and medical care. However, studies on child nutrition find no evidence of gender differences. A natural explanation could be that in environments of high infant mortality of females, the surviving children are healthier, so that child nutrition cannot be studied independently of mortality. In this paper, we use data from the 2004 Bangladesh Demographic Health Survey to investigate if there are any gender differences in survival probabilities and whether this leads to differences in child nutrition. We argue the importance of establishing whether or not there exists a dependence relationship between the two random variables--infant mortality and child nutrition--and in order to detect this we employ a copula approach to model specification. The results suggest, for example, that while male children have a significantly lower likelihood of surviving their first year relative to female children, should they survive they have significantly better height-for-age Z-scores. From a policy perspective, household wealth and public health interventions such as vaccinations are found to be important predictors of better nutritional outcomes.

  3. Relative deprivation and mortality in South Africa. (United States)

    Salti, Nisreen


    This paper tests the relative income hypothesis by considering the relationship between mortality, income and relative deprivation in South Africa using individual-level data on income and five measures of relative deprivation each with a different reference group. We find that income tends to be protective of, and relative deprivation detrimental to health, but the latter often gives a better account of mortality than does income alone. For some population groups the fit is improved in specifications which include both income and relative deprivation. Overall, there seems to be solid evidence in support of the relative income hypothesis, particularly for the more economically disadvantaged population groups. Relative deprivation is especially significant when age is the reference group, suggesting that the comparison of socio-economic standing that has an impact on health tends to happen within cohorts. The results are robust to splitting the sample into urban/rural subsamples and to looking at the incidence of illness as the health outcome rather than mortality. While little is known about the mechanisms underlying the effect of relative deprivation on health and mortality, the consistent evidence in favor of age as a reference group, particularly in a context like South Africa's suggests that intra-cohort comparisons should be an avenue for more in depth investigation. 2009 Elsevier Ltd. All rights reserved.

  4. Sedentary behavior and residual-specific mortality (United States)

    Loprinzi, Paul D.; Edwards, Meghan K.; Sng, Eveleen; Addoh, Ovuokerie


    Background: The purpose of this study was to examine the association of accelerometer-assessed sedentary behavior and residual-specific mortality. Methods: Data from the 2003-2006 National Health and Nutrition Examination Survey (NHANES) were used (N = 5536), with follow-up through 2011. Sedentary behavior was objectively measured over 7 days via accelerometry. Results: When expressing sedentary behavior as a 60 min/day increase, the hazard ratio across the models ranged from 1.07-1.40 (P < 0.05). There was evidence of an interaction effect between sedentary behavior and total physical activity on residual-specific mortality (Hazard ratiointeraction [HR] = 0.9989; 95% CI: 0.9982-0.9997; P = 0.008). Conclusion: Sedentary behavior was independently associated with residual-specific mortality. However, there was evidence to suggest that residual-specific mortality risk was a function of sedentary behavior and total physical activity. These findings highlight the need for future work to not only examine the association between sedentary behavior and health independent of total physical activity, but evaluate whether there is a joint effect of these two parameters on health.

  5. Calprotectin - A Marker of Mortality in COPD?

    DEFF Research Database (Denmark)

    Holmgaard, Dennis B; Mygind, Lone; Titlestad, Ingrid


    Abstract Calprotectin comprises more than 45% of the cytosolic content of neutrophil granulocytes. Because pathogenesis, disease activity and disease progression in COPD are believed to be partly dependent of neutrophil driven inflammation we decided to investigate whether plasma level of calprot......Abstract Calprotectin comprises more than 45% of the cytosolic content of neutrophil granulocytes. Because pathogenesis, disease activity and disease progression in COPD are believed to be partly dependent of neutrophil driven inflammation we decided to investigate whether plasma level...... of calprotectin (p-calprotectin) was associated with all-cause mortality in patients with COPD. We measured p-calprotectin in blood samples from 460 patients with moderate to very severe COPD in stable phase. Patients were stratified into three groups according to p-calprotectin level. Outcome measure was all......-cause mortality. Analyses were adjusted for factors known to influence mortality using a Cox regression analysis. We found a time dependent correlation between p-calprotectin levels and mortality during the first 5 years of follow-up. Increasing levels of p-calprotectin were associated with concomitant increases...

  6. Neonatal tetanus mortality in coastal Kenya

    DEFF Research Database (Denmark)

    Bjerregaard, P; Steinglass, R; Mutie, D M


    livebirths. The neonatal and NNT mortality rates were higher in boys than in girls. Neonatal tetanus was not associated with mother's age, parity, or history of previous child death. The majority of the children (72%) were adequately protected at birth against NNT; in those with documented protection NNT...

  7. Association of Cardiometabolic Multimorbidity With Mortality

    DEFF Research Database (Denmark)

    Di Angelantonio, Emanuele; Kaptoge, Stephen; Wormser, David


    adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those...... individual participant data from the Emerging Risk Factors Collaboration (689,300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128,843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499......,808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates. EXPOSURES: A history of 2 or more of the following: diabetes mellitus...

  8. Association of Cardiometabolic Multimorbidity With Mortality

    NARCIS (Netherlands)

    Angelantonio, Di Emanuele; Kaptoge, Stephen; Wormser, David; Willeit, Peter; Butterworth, Adam S.; Bansal, Narinder; O’Keeffe, Linda M.; Gao, Pei; Wood, Angela M.; Burgess, Stephen; Freitag, Daniel F.; Pennells, Lisa; Peters, Sanne A.; Hart, Carole L.; Håheim, Lise Lund; Gillum, Richard F.; Nordestgaard, Børge G.; Psaty, Bruce M.; Yeap, Bu B.; Knuiman, Matthew W.; Nietert, Paul J.; Kauhanen, Jussi; Salonen, Jukka T.; Kuller, Lewis H.; Simons, Leon A.; Schouw, van der Yvonne T.; Barrett-Connor, Elizabeth; Selmer, Randi; Crespo, Carlos J.; Rodriguez, Beatriz; Verschuren, Monique W.M.; Salomaa, Veikko; Svärdsudd, Kurt; Harst, Van Der Pim; Björkelund, Cecilia; Wilhelmsen, Lars; Wallace, Robert B.; Brenner, Hermann; Amouyel, Philippe; Barr, Elizabeth L.M.; Iso, Hiroyasu; Onat, Altan; Trevisan, Maurizio; agostino, D' Ralph B.; Cooper, Cyrus; Kavousi, Maryam; Welin, Lennart; Roussel, Ronan; Hu, Frank B.; Sato, Shinichi; Davidson, Karina W.; Howard, Barbara V.; Leening, Maarten J.G.; Rosengren, Annika; Dörr, Marcus; Deeg, Dorly J.H.; Kiechl, Stefan; Stehouwer, Coen D.A.; Nissinen, Aulikki; Giampaoli, Simona; Donfrancesco, Chiara; Kromhout, Daan; Price, Jackie F.; Peters, Annette; Meade, Tom W.; Casiglia, Edoardo; Lawlor, Debbie A.; Gallacher, John; Nagel, Dorothea; Franco, Oscar H.; Assmann, Gerd; Dagenais, Gilles R.; Jukema, Wouter J.; Sundström, Johan; Woodward, Mark; Brunner, Eric J.; Khaw, Kay-Tee; Wareham, Nicholas J.; Whitsel, Eric A.; Njølstad, Inger; Hedblad, Bo; Wassertheil-Smoller, Sylvia; Engström, Gunnar; Rosamond, Wayne D.; Selvin, Elizabeth; Sattar, Naveed; Thompson, Simon G.; Danesh, John


    Importance The prevalence of cardiometabolic multimorbidity is increasing.

    Objective To estimate reductions in life expectancy associated with cardiometabolic multimorbidity.

    Design, Setting, and Participants Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calcul

  9. Mortality due to lung cancer in Mexico. (United States)

    Ruíz-Godoy, L; Rizo Rios, P; Sánchez Cervantes, F; Osornio-Vargas, A; García-Cuellar, C; Meneses García, A


    The highest mortality due to cancer worldwide for both genders corresponds to lung cancer (1,179,000 deaths). In Mexico, the crude mortality rate due to lung cancer was of 5.01 per 10(5) inhabitants in 1979. The most important risk factor is smoking. The present study was aimed at analyzing the mortality due to lung cancer in Mexico, assessing data from each of the states constituting the Mexican Republic during the 1998-2004 period. Data were obtained from the National Institute of Statistics, Geography and Informatics (INEGI, for its initials in Spanish) corresponding to deaths due to lung cancer (1998-2004). We estimated the mean annual mortality rate (MAMR) for each of the 32 states of Mexico. We used the "World Population Standard". The MAMR was standardized according to age (ARS) direct method, and the standard error was determined by Poisson's approximation at a 95% confidence interval. To know the excess risk due to mortality, we calculated the standardized mortality ratios (SMRs) of ARS for each federal state, using the national rate as reference. In this period, 397,400 deaths due to malignant neoplasms were recorded, corresponding 45,578 (11.5%) to lung cancer; for men, 31,025 (68.1%) with MAMR of 8.9 and the respective ARS of 13.2 both x10(5) inhabitants. For women, results were 4553 (31.9%) deaths with MAMR of 4.1 and ARS of 5.4 both x10(5) inhabitants. The highest mortality rates due to lung cancer in both genders were observed in the north of Mexico, whereas for women this was observed in the central states. Although smoking is the main risk for lung cancer, there are other factors such as environmental pollution or exposure to toxicants that could be associated to this cancer. The years potentially lost due to lung cancer were 258,550 for men and 133,315 for women, with a total of 391,865 according to histopathology registry neoplasm malignant RHNM (1985-1995). Studies focused on the characterization and measurement of polluting agents would be a

  10. Rising mortality from cryptogenic fibrosing alveolitis. (United States)

    Johnston, I; Britton, J; Kinnear, W; Logan, R


    OBJECTIVE--To determine the pattern of mortality ascribed to cryptogenic fibrosing alveolitis and to identify factors that might be important in the aetiology of the disease; and to assess the validity of death certification of the disease. DESIGN--A retrospective examination of mortality ascribed to cryptogenic fibrosing alveolitis in England and Wales between 1979 and 1988 with analysis, by multiple logistic regression, of independent effects of age, sex, region of residence, and social class as indicated by occupation on data for 1979-87; also a retrospective review of hospital records of patients certified as having died of cryptogenic fibrosing alveolitis in Nottingham and of the certified cause of death of patients known to have had the disease. MAIN OUTCOME MEASURES--Time trends in mortality nationally; effects on mortality of age, sex, and region of residence; validity of death certification in Nottingham. RESULTS--The annual number of deaths ascribed to cryptogenic fibrosing alveolitis doubled from 336 in 1979 to 702 in 1988, the increase occurring mainly at ages over 65. Mortality standardised for age for both sexes likewise increased steadily over the period. Deaths due to cryptogenic fibrosing alveolitis were commoner in men (odds ratio 2.24, 95% confidence interval 2.11 to 2.33) and increased substantially with age, being 7.84 (7.24 to 8.49) times higher in subjects aged much greater than 75 than those aged 45-64. Odds ratios of death due to cryptogenic fibrosing alveolitis adjusted for age and sex were increased in the traditionally industrialised central areas of England and Wales (p less than 0.02, maximum odds ratio between regions 1.25), but no significant increase in odds of death was found for manual occupations. Of 23 people whose deaths were registered in Nottingham as having been due to cryptogenic fibrosing alveolitis, 19 were ascertained from clinical records to have had the disease. Only 17 of 45 patients known to have had cryptogenic

  11. Determinants of neonatal mortality in Indonesia

    Directory of Open Access Journals (Sweden)

    Agho Kingsley


    Full Text Available Abstract Background Neonatal mortality accounts for almost 40 per cent of under-five child mortality, globally. An understanding of the factors related to neonatal mortality is important to guide the development of focused and evidence-based health interventions to prevent neonatal deaths. This study aimed to identify the determinants of neonatal mortality in Indonesia, for a nationally representative sample of births from 1997 to 2002. Methods The data source for the analysis was the 2002–2003 Indonesia Demographic and Health Survey from which survival information of 15,952 singleton live-born infants born between 1997 and 2002 was examined. Multilevel logistic regression using a hierarchical approach was performed to analyze the factors associated with neonatal deaths, using community, socio-economic status and proximate determinants. Results At the community level, the odds of neonatal death was significantly higher for infants from East Java (OR = 5.01, p = 0.00, and for North, Central and Southeast Sulawesi and Gorontalo combined (OR = 3.17, p = 0.03 compared to the lowest neonatal mortality regions of Bali, South Sulawesi and Jambi provinces. A progressive reduction in the odds was found as the percentage of deliveries assisted by trained delivery attendants in the cluster increased. The odds of neonatal death were higher for infants born to both mother and father who were employed (OR = 1.84, p = 0.00 and for infants born to father who were unemployed (OR = 2.99, p = 0.02. The odds were also higher for higher rank infants with a short birth interval (OR = 2.82, p = 0.00, male infants (OR = 1.49, p = 0.01, smaller than average-sized infants (OR = 2.80, p = 0.00, and infant's whose mother had a history of delivery complications (OR = 1.81, p = 0.00. Infants receiving any postnatal care were significantly protected from neonatal death (OR = 0.63, p = 0.03. Conclusion Public health interventions directed at reducing neonatal death should

  12. Projecting the impact of AIDS on mortality. (United States)

    Stover, J; Way, P


    The authors describe the projected impact of AIDS on mortality, explain the reasons for the differences in mortality projections by major international organizations, and offer an approach to estimating the impact of AIDS upon life expectancy. Although AIDS has already significantly increased mortality in many countries, the impact of AIDS upon mortality is expected to grow substantially over the next 10 years and into future decades. By 2005, the population of the most severely affected countries in Africa will be 13-59 million less than it would have been without AIDS, and life expectancy may decline by as much as 27% in those countries. Uncertainty about current and future trends in HIV prevalence among adults has led to differences in the projections of future AIDS-related mortality. For example, while the UN projects that AIDS will reduce the population growth of the most severely affected countries in Africa by 13 million by 2005 and 30 million by 2025, the US Census Bureau projects the reduction to be 59 million by 2005 and 120 million by 2025. These differences are largely due to the use of different methodologies for projecting future levels of adult HIV prevalence. There are also differing estimates of current levels of HIV prevalence and differing assumptions about the length of the incubation period and the perinatal transmission rate. As data and projection methodologies improve, the differences in projections may be reduced for sub-Saharan Africa, while the growing epidemic in some of the largest countries of Asia may increase uncertainty about future global impacts.

  13. Statins and the cholesterol mortality paradox. (United States)

    Nunes, José Pedro L


    Large-scale randomised controlled trials, carried out in the context of secondary cardiovascular prevention, have shown that statins are superior to placebo: these drugs were shown to decrease cardiovascular events and total mortality. A further set of clinical trials compared high intensity to low/standard intensity LDL cholesterol lowering in the same setting (using either statins or a statin/ezetimibe association). In this case, a decrease in LDL cholesterol and a concomitant significant reduction in cardiovascular events were seen with intensive therapy, however with no change in total mortality. This phenomenon we may term the LDL cholesterol mortality paradox. It could be due either to the prevention (by high-intensity therapy) of episodes not severe enough to lead to the death of patients, or to high-intensity therapy leading to the death of some patients at the same time as preventing the death of others, with a null aggregate effect. Several types of adverse effects have been seen with statin therapy, such as a possible increased incidence of Diabetes mellitus and of myopathy. The decision to start high-intensity LDL cholesterol lowering (rather than low- or moderate-intensity statin treatment) should be evaluated on a case-by-case basis, taking into consideration the overall aspects of each patient, including the patient's preferences. High-intensity LDL cholesterol lowering, up to the present moment, has failed to produce a change in overall prognosis (total mortality), and should not therefore be mandatory in secondary cardiovascular prevention. It remains to be seen if a similar LDL cholesterol mortality paradox occurs with new drugs targeting plasma lipids.

  14. Increments to life and mortality tempo

    Directory of Open Access Journals (Sweden)

    Griffith Feeney


    Full Text Available This paper introduces and develops the idea of "increments to life." Increments to life are roughly analogous to forces of mortality: they are quantities specified for each age and time by a mathematical function of two variables that may be used to describe, analyze and model changing length of life in populations. The rationale is three-fold. First, I wanted a general mathematical representation of Bongaart's "life extension" pill (Bongaarts and Feeney 2003 allowing for continuous variation in age and time. This is accomplished in sections 3-5, to which sections 1-2 are preliminaries. It turned out to be a good deal more difficult than I expected, partly on account of the mathematics, but mostly because it requires thinking in very unaccustomed ways. Second, I wanted a means of assessing the robustness of the Bongaarts-Feeney mortality tempo adjustment formula (Bongaarts and Feeney 2003 against variations in increments to life by age. Section 6 shows how the increments to life mathematics accomplishes this with an application to the Swedish data used in Bongaarts and Feeney (2003. In this application, at least, the Bongaarts-Feeney adjustment is robust. Third, I hoped by formulating age-variable increments to life to avoid the slight awkwardness of working with conditional rather than unconditional survival functions. This third aim has not been accomplished, but this appears to be because it was unreasonable to begin with. While it is possible to conceptualize length of life as completely described by an age-varying increments to life function, this is not consistent with the Bongaarts-Feeney mortality tempo adjustment. What seems to be needed, rather, is a model that incorporates two fundamentally different kinds of changes in mortality and length of life, one based on the familiar force of mortality function, the other based on the increments to life function. Section 7 considers heuristically what such models might look like.

  15. Cancer Incidence and Mortality in China, 2007

    Institute of Scientific and Technical Information of China (English)

    Wan-qing Chen; Hong-mei Zeng; Rong-shou Zheng; Si-wei Zhang; Jie He


    Objective:Cancer incidence and mortality data collected from population-based cancer registries were analyzed to present the overall cancer statistics in Chinese registration areas by age,sex and geographic area in 2007.Methods:In 2010,48 cancer registries reported cancer incidence and mortality data of 2007 to National Central Cancer Registry of China.Of them,38 registries' data met the national criteria.Incidence and mortality were calculated by cancer sites,age,gender,and area.Age-standardized rates were described by China and World population.Results:The crude incidence rate for all cancers was 276.16/100,000 (305.22/100,000 for male and 246.46/100,000 for female; 284.71/100,000 in urban and 251.07/100,000 in rural).Age-standardized incidence rates by China and World population were 145.39/100,000 and 189.46/100,000 respectively.The crude mortality rate for all cancers was 177.09/100,000 (219.15/100,000 for male and 134.10/100,000 for female; 173.55/100,000 in urban and 187.49/100,000 in rural).Age-standardized mortality rates by China and World population were 86.06/100,000 and 116.46/100,000,respectively.The top 10 most frequently common cancer sites were the lung,stomach,colon and rectum,liver,breast,esophagus,pancreas,bladder,brain and lymphoma,accounting for 76.12% of the total cancer cases.The top 10 causes of cancer death were cancers of the lung,liver,stomach,esophagus,colon and rectum,pancreas,breast,leukemia,brain and lymphoma,accounting for 84.37% of the total cancer deaths.Conclusion:Cancer remains a major disease threatening people's health in China.Prevention and control should be enhanced,especially for the main cancers.

  16. Child mortality estimation: estimating sex differences in childhood mortality since the 1970s.

    Directory of Open Access Journals (Sweden)

    Cheryl Chriss Sawyer

    Full Text Available INTRODUCTION: Producing estimates of infant (under age 1 y, child (age 1-4 y, and under-five (under age 5 y mortality rates disaggregated by sex is complicated by problems with data quality and availability. Interpretation of sex differences requires nuanced analysis: girls have a biological advantage against many causes of death that may be eroded if they are disadvantaged in access to resources. Earlier studies found that girls in some regions were not experiencing the survival advantage expected at given levels of mortality. In this paper I generate new estimates of sex differences for the 1970s to the 2000s. METHODS AND FINDINGS: Simple fitting methods were applied to male-to-female ratios of infant and under-five mortality rates from vital registration, surveys, and censuses. The sex ratio estimates were used to disaggregate published series of both-sexes mortality rates that were based on a larger number of sources. In many developing countries, I found that sex ratios of mortality have changed in the same direction as historically occurred in developed countries, but typically had a lower degree of female advantage for a given level of mortality. Regional average sex ratios weighted by numbers of births were found to be highly influenced by China and India, the only countries where both infant mortality and overall under-five mortality were estimated to be higher for girls than for boys in the 2000s. For the less developed regions (comprising Africa, Asia excluding Japan, Latin America/Caribbean, and Oceania excluding Australia and New Zealand, on average, boys' under-five mortality in the 2000s was about 2% higher than girls'. A number of countries were found to still experience higher mortality for girls than boys in the 1-4-y age group, with concentrations in southern Asia, northern Africa/western Asia, and western Africa. In the more developed regions (comprising Europe, northern America, Japan, Australia, and New Zealand, I found

  17. Ethnicity and infant mortality in Malaysia. (United States)

    Dixon, G


    Malaysian infant mortality differentials are a worthwhile subject for study, because socioeconomic development has very clearly had a differential impact by ethnic group. The Chinese rates of infant mortality are significantly lower than the Malay or Indian rates. Instead of examining the obvious access to care issues, this study considered factors related to the culture of infant care. Practices include the Chinese confinement of the mother in the first month after childbirth ("pe'i yue") and Pillsbury's 12 normative rules for Malaysian Chinese care. Malay practices vary widely by region and history. Indian mothers are restricted by diet. Data-recording flaws do not permit analysis of Sarawak or Sabah. The general assumption that Western medicine favors better health for mothers and infants is substantiated among peninsular communities, however, there are also negative impacts which affect infant mortality. The complex interaction of factors impacting on infant mortality reported in seven previous studies is discussed. A review of these studies reveals that immediate causes are infections, injuries, and dehydration. Indirect causes are birth weight or social and behavioral factors such as household income or maternal education. Indirect factors, which are amenable to planned change and influence the biological proximate determinants of infant mortality, are identified as birth weight, maternal age at birth, short pregnancy intervals or prior reproductive loss, sex of the child, birth order, duration of breast feeding and conditions of supplementation, types of household water and sanitation, year of child's birth, maternal education, household income and composition, institution of birth, ethnicity, and rural residence. Nine factors are identified empirically as not significant: maternal hours of work in the child's first year, maternal occupation, distance from home to workplace, presence of other children or servants, incidence of epidemics in the child's first

  18. Copeptin Predicts Mortality in Critically Ill Patients (United States)

    Krychtiuk, Konstantin A.; Honeder, Maria C.; Lenz, Max; Maurer, Gerald; Wojta, Johann; Heinz, Gottfried; Huber, Kurt; Speidl, Walter S.


    Background Critically ill patients admitted to a medical intensive care unit exhibit a high mortality rate irrespective of the cause of admission. Besides its role in fluid and electrolyte balance, vasopressin has been described as a stress hormone. Copeptin, the C-terminal portion of provasopressin mirrors vasopressin levels and has been described as a reliable biomarker for the individual’s stress level and was associated with outcome in various disease entities. The aim of this study was to analyze whether circulating levels of copeptin at ICU admission are associated with 30-day mortality. Methods In this single-center prospective observational study including 225 consecutive patients admitted to a tertiary medical ICU at a university hospital, blood was taken at ICU admission and copeptin levels were measured using a commercially available automated sandwich immunofluorescent assay. Results Median acute physiology and chronic health evaluation II score was 20 and 30-day mortality was 25%. Median copeptin admission levels were significantly higher in non-survivors as compared with survivors (77.6 IQR 30.7–179.3 pmol/L versus 45.6 IQR 19.6–109.6 pmol/L; p = 0.025). Patients with serum levels of copeptin in the third tertile at admission had a 2.4-fold (95% CI 1.2–4.6; p = 0.01) increased mortality risk as compared to patients in the first tertile. When analyzing patients according to cause of admission, copeptin was only predictive of 30-day mortality in patients admitted due to medical causes as opposed to those admitted after cardiac surgery, as medical patients with levels of copeptin in the highest tertile had a 3.3-fold (95% CI 1.66.8, p = 0.002) risk of dying independent from APACHE II score, primary diagnosis, vasopressor use and need for mechanical ventilation. Conclusion Circulating levels of copeptin at ICU admission independently predict 30-day mortality in patients admitted to a medical ICU. PMID:28118414

  19. Maternal Mortality in Nepal: Unraveling the Complexity

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    Suwal, Juhee V.


    Full Text Available EnglishMaternal mortality has been recognised as a public health problem in the developing countries. The situation concerning maternal mortality in Nepal remained unexplored and vague until the early 1990s. By using 1996 Nepal Family Health Survey, this study discusses the maternal mortality situation in Nepal and analyses the differentials in maternal mortality by place of residence,region, ethnic and religious groups, age at death, and parity. Almost 28 percent of deaths of women in reproductive age was accountable to maternal causes.Logistic regression analysis shows ‘ethnicity,’ ‘age of women,’ and ‘number of births’ as strong predictors of maternal mortality. A number of policy recommendations are suggested to help lower maternal mortality.FrenchLa mortalité liée à la maternité est un des phénomènes de santé qui a étéidentifié dans les pays en voie de développement. La situation de la mortalitéliée à la maternité au Népal est restée inexplorée et assez vague jusqu’au débutdes années 1990. En utilisant les données du Nepal Family Health Survey de1996, cet article examine la situation de la mortalité liée à la maternité au Népalet analyse les différentiels des taux de mortalité par lieu de résidence, région,groupe ethnique et religieux, âge au décès, et parité. Presque 28 pourcent desdécès de femmes en âge de procréer sont liés à la maternité. L’analyse derégression logique démontre que « l’ethnicité », « l’âge des femmes », et le« nombre de naissances » sont de forts prédicteurs du taux des mortalités liées àla maternité.

  20. Predicting Factors for Mortality in Sigmoid Volvulus

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    Bilsel Baç


    Full Text Available Sigmoid colon is the most frequent site for a volvulus and volvulus of the sigmoid colon(SV is characterized by a high morbidity and mortality. The objective of this study was toevaluate predicting factors for mortality in the SV cases. Between January 1994 andDecember 2001, the records of patients operated on due to SV at Dicle University Hospital(DUH were retrospectively reviewed. The epidemiological, clinical, and laboratory featureswere evaluated as probable risk factors for mortality. Variables associated with SV weredetermined using logistic regression models. Of 90 patients, 80 (88.9% were male, and 10(11.1% were female. The mean age was 58.8±12.9 (19-85 and 63.6±16.1 (23-83 for thepatients with uneventful outcome (Group 1 and for the patients with fatal outcome (Group2, respectively (p=0.000. The period of symptoms before admission (PSBA were 2.2±0.73(1-4 days and 5.6±1.7 (2-10 days in Group 1 and Group 2 respectively (p=0.000. While the73.8 % of patients in the Group 1 were operated on an emergency state, 100 % of patients inthe Group 2 were operated on an emergency state (p=0.002. In the univariate analysis, othersignificant risk factors were significantly fluid-electrolyte imbalance, elevated abdominalpressure (EAP, cardiovascular disease, respiratory disease, leukocytosis, hypotension,presence of necrosis, and presence of major contamination (p=0.000. These variables wereentered into the logistic regression model for revealing the risk factors for mortality. Inmultivariate analysis, long PSBA [Odds Ratio (OR =17.17, 95% Confidence Interval (CI=2.86-103.07, P=0.002], presence of cardiovascular disease at the admission (OR=0.19,CI=0.001-0.52, P=0.019 and age (OR=0.87, CI=0.77-0.99, P=0.046 were foundsignificantly predictive for mortality. EAP, fluid-electrolyte imbalance, respiratory disease,and presence of major contamination were not statistically significant factors for mortalityafter sigmoid volvulus. In our study, we

  1. Mortality from Diabetes by Hispanic Groups: Evidence from the US National Longitudinal Mortality Study

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    Augustine J. Kposowa


    Full Text Available Diabetes is a leading cause of morbidity and mortality in the United States, especially in minority communities. In mortality research, Hispanics are frequently studied as a homogeneous group. The present study was undertaken to compare diabetes deaths among persons of Hispanic origin by disaggregating groups in order to determine whether the components in the Hispanic label have differential mortality. Data utilized were from the US National Longitudinal Mortality Study. Cox proportional hazards regression models were fitted to the data. Findings showed that individuals in the broader Hispanic label were 28% more likely to die from diabetes mellitus than non-Hispanic whites (ARR = 1.28, CI = 1.05, 1.55. When groups were broken down, it was observed that Mexicans were 50% more likely to die of diabetes than their non-Hispanic white counterparts. No other Hispanic origin group was significantly associated with diabetes mortality risk. Education and family income were strong predictors of mortality, regardless of Hispanic origin grouping. It was concluded from the analysis that future behavioral and social science research would be more informative if the broader Hispanic label was broken down into subcategories. Failure to do so might lead to drawing false inferences as a finding may well hold for one group within the Hispanic label, but not for others.

  2. Motor neuron disease mortality in Great Britain continues to rise: examination of mortality rates 1975 - 2004. (United States)

    Day, Thomas G; Scott, Martin; Perring, Roslyn; Doyle, Pat


    Motor neuron disease (MND) mortality rates are rising in Europe and the USA. The most comprehensive UK study was conducted more than 15 years ago. This study examines trends in mortality from MND in England & Wales, and Scotland, between 1975 and 2004. Age, gender, and cause-specific mortality rates were calculated for the period 1975-2004 using national data from England & Wales, and Scotland. Rates were directly age-standardized to the European standard population. Trends in mortality rates over time were examined for men and women separately, as well as by the age groups 0-59 years, and 60 or more years. MND mortality rates rose steadily over the 30-year period 1975-2004 in both sexes in England & Wales, and Scotland. There is a clear upward trend in all four groups (p for trend <0.001). All increases were largely restricted to the age group 60 years and above, with rates showing increases of 70-80%, and no evidence of a flattening of this trajectory. Rates for the 0-59 years age group remained stable over the period. There is evidence of a narrowing of the male-female gap in mortality rates for the age group over 60 years in England and Wales.

  3. Risk-Adjusted Mortality: Problems and Possibilities

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    Daniel Shine


    Full Text Available The ratio of observed-to-expected deaths is considered a measure of hospital quality and for this reason will soon become a basis for payment. However, there are drivers of that metric more potent than quality: most important are medical documentation and patient acuity. If hositals underdocument and therefore do not capture the full “expected mortality” they may be tempted to lower their observed/expected ratio by reducing “observed mortality” through limiting access to the very ill. Underdocumentation occurs because hospitals do not recognize, and therefore cannot seek to confirm, specific comorbidities conferring high mortality risk. To help hospitals identify these comorbidities, this paper describes an easily implemented spread-sheet for evaluating comorbid conditions associated, in any particular hospital, with each discharge. This method identifies comorbidities that increase in frequency as mortality risk increases within each diagnostic grouping. The method is inductive and therefore independent of any particular risk-adjustment technique.

  4. Cancer risk and mortality after kidney transplantation

    DEFF Research Database (Denmark)

    Engberg, Henriette; Wehberg, Sonja; Bistrup, Claus;


    to examine whether post-transplant cancer and all-cause mortality differed between Danish renal transplantation centres using standard immunosuppressive protocols including steroids (Centres 2, 3, 4) or a steroid-free protocol (Centre 1). The Danish Nephrology Registry, the Danish Civil Registration System......BACKGROUND: Kidney recipients receive immunosuppression to prevent graft rejection, and long-term outcomes such as post-transplant cancer and mortality may vary according to the different protocols of immunosuppression. METHODS: A national register-based historical cohort study was conducted......, the Danish National Cancer Registry and the Danish National Patient Register were used. A historical cohort of 1450 kidney recipients transplanted in 1995-2005 was followed up with respect to post-transplant cancer and death until 31 December 2011. RESULTS: Compared with Center 1 the adjusted post...

  5. Mortality rate in type 2 myocardial infarction

    DEFF Research Database (Denmark)

    Saaby, Lotte; Poulsen, Tina Svenstrup; Diederichsen, Axel Cosmus Pyndt


    , all hospitalized patients having cardiac troponin I measured were considered. The diagnosis of a myocardial infarction was according to the universal definition, and specified criteria were used in the classification of type 2 myocardial infarction. Follow-up was at least 1 year, with mortality......BACKGROUND: The classification of myocardial infarction into 5 types was introduced in 2007. The prognostic impact of this universal definition, with particular focus on type 2 myocardial infarction, has not been studied prospectively in unselected hospital patients. METHODS: During a 1-year period...... as the end point. RESULTS: A total of 3762 consecutive patients were studied, of whom 488 (13%) had a myocardial infarction. In 119 patients a type 2 myocardial infarction was diagnosed. After a median of 2.1 years (interquartile range, 1.6-2.5 years), 150 patients had died, with a mortality rate of 49% (58...

  6. Perinatal mortality: a hospital based study. (United States)

    Kameswaran, C; Bhatia, B D; Bhat, B V; Oumachigui, A


    Three thousand seven hundred and two deliveries between January and December, 1990 were the study subjects. The perinatal mortality rate (PNMR), stillbirth rate (SBR) and early neonatal death rates (ENDR) were found to be 57/1000, 35.1/1000 and 22.7/1000, respectively. The preterms had much higher PNMR, SBR and ENDR as compared to term babies. Term babies weighing > or = 2500 g had a PNMR of 18/1000. In preterm and term babies the mortality was reduced considerably with increase in birth weight (BW). The unbooked deliveries had significantly higher PNMR, SBR and ENDR compared to booked deliveries. The fall in PNMR compared to observations of a decade ago was due to a fall primarily in ENDR, with SBR remaining unchanged signifying failure of existing MCH set up. Nearly, 92% of ENDR were in first 72 hours which signifies the need for developing and strengthening the intensive care facilities along with timely referral of high risk mothers.

  7. Molecular alterations associated with breast cancer mortality.

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    Laura M Voeghtly

    Full Text Available BACKGROUND: Breast cancer is a heterogeneous disease and patients with similar pathologies and treatments may have different clinical outcomes. Identification of molecular alterations associated with disease outcome may improve risk assessment and treatments for aggressive breast cancer. METHODS: Allelic imbalance (AI data was generated for 122 invasive breast tumors with known clinical outcome. Levels and patterns of AI were compared between patients who died of disease (DOD and those with ≥5 years disease-free survival (DFS using Student t-test and chi-square analysis with a significance value of P5-years post-diagnosis mortality but not with death from disease within five years, suggesting that patients with short- and long-term mortality may have distinct genetic diseases.

  8. Impact of sudden mass mortality on suicides

    CERN Document Server

    Roehner, Bertrand M


    We show that a large scale mass mortality results in increased numbers of suicides. As a case in point, we consider the influenza epidemic of October 1918 in the United States. In this month, suicides peaked at a level of over 4s (where s denotes the desaisonalized standard deviation of the suicide rate) which means that one would expect such a jump to occur merely by chance only once in several centuries. The mechanism that we propose to explain this effect relies on two steps (i) Mass mortalities break family bonds for instance between parents and children or husbands and wives. (ii) Increased numbers of suicides then result from the well known fact that the severance of family bonds invariably produces more suicides.

  9. Cholesterol lowering, low cholesterol, and mortality. (United States)

    LaRosa, J C


    Cholesterol lowering in both primary and secondary prevention has been clearly demonstrated to lower coronary morbidity and, in secondary prevention, to lower coronary mortality as well. Putative dangers of cholesterol lowering remain unproven. Population studies linking low cholesterol to noncoronary mortalities do not demonstrate cause-and-effect relations. In fact, based on current studies, the opposite is more likely to be the case. Neither gender nor age should automatically exclude persons from cholesterol screening. Drug intervention, however, should be used conservatively, particularly in young adults and the elderly. Drugs should be used only after diet and lifestyle interventions have failed. The evidence linking high blood cholesterol to coronary atherosclerosis and cholesterol lowering to its prevention is broad-based and definitive. Concerns about cholesterol lowering and spontaneously low cholesterols should be pursued but should not interfere with the implementation of current public policies to reduce the still heavy burden of atherosclerosis in Western society.

  10. Predictors of mortality in rhinocerebral mycosis

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    Jayalakshmi Sita


    Full Text Available Introduction: Rhinocerebral mycosis is a rapidly progressive fatal opportunistic infection, predominantly affecting people in an immunocompromised state. Aggressive surgical therapy, with repeated debridement in combination with intravenous amphotericin B can lead to a high rate of cure. Aim: To determine the predictors of mortality in rhinocerebral mycosis. Materials and Methods: The demographic data, clinical features, radiological (MRI/CT findings, treatment details of patients with a diagnosis of rhinocerebral mycosis confirmed on histopathology were analyzed retrospectively. The outcome was assessed as alive and dead. Univariate analysis with odds ratio (OR was employed in data analysis. Chi-square test was used for P value. Results: There were 38 patients. The age range was 7-82 (mean 48.68 years; 30 (79% were males. Craniofacial pain was the most common initial presenting symptom, noted in 29 (76.3%. Rhino-orbital involvement was noted in 24 (63.2% and 12 (31.6% had associated focal neurological deficits. Immunocompromised state was noted in 24 (63.2%. Eighteen (47.4% patients died. The predictors for mortality: odds ratio (95% CI were 2.45 (1.01-3.89 for elderly age, 5.67 (4.13-7.21 for intracranial extension, 2.6 (1.26-3.94 for immunocompromised state, 2.62 (1.25-3.99 for infection with zygomycosis and 2.33 (1.01-3.65 for anemia. Conclusion: Rhinocerebral mycosis is associated with high mortality in spite of aggressive therapy. Intracranial extension with focal neurological deficits is a major predictor of mortality in rhinocerebral mycosis.

  11. Trends in Pulmonary Hypertension Mortality and Morbidity


    Alem Mehari; Orlando Valle; Gillum, Richard F


    Context. Few reports have been published regarding surveillance data for pulmonary hypertension, a debilitating and often fatal condition. Aims. We report trends in pulmonary hypertension. Settings and Design. United States of America; vital statistics, hospital data. Methods and Material. We used mortality data from the National Vital Statistics System (NVSS) for 1999–2008 and hospital discharge data from the National Hospital Discharge Survey (NHDS) for 1999–2009. Statistical Analysis Used....

  12. Fruit and vegetable consumption and mortality

    DEFF Research Database (Denmark)

    Leenders, Max; Sluijs, Ivonne; Ros, Martine M


    In this study, the relation between fruit and vegetable consumption and mortality was investigated within the European Prospective Investigation Into Cancer and Nutrition. Survival analyses were performed, including 451,151 participants from 10 European countries, recruited between 1992 and 2000 ...... body mass index and suggested in smokers. Inverse associations were stronger for raw than for cooked vegetable consumption. These results support the evidence that fruit and vegetable consumption is associated with a lower risk of death....

  13. A case of near miss maternal mortality

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    Akanksha Sood


    Full Text Available Eclampsia is a common cause of maternal morbidity and at times, mortality. Usually patients show dramatic improvement soon after delivery. But rarely eclampsia, dealt by obstetricians often, can herald an underlying life-threatening disease process requiring intensive care support and multi- disciplinary care. Such a case is being reported here. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 833-835

  14. Biplot models applied to cancer mortality rates. (United States)

    Osmond, C


    "A graphical method developed by Gabriel to display the rows and columns of a matrix is applied to tables of age- and period-specific cancer mortality rates. It is particularly useful when the pattern of age-specific rates changes with time. Trends in age-specific rates and changes in the age distribution are identified as projections. Three examples [from England and Wales] are given."

  15. Pattern and mortality in Colorado Desert plants. (United States)

    Wright, S J; Howe, H F


    We tested for intraspecific interference among Colorado Desert shrubs using an integrated analysis of spatial pattern and juvenile mortality. The data set included 7,000 woody perennials of 24 species in a mapped hectare of Joshua Tree National Monument, California. The site is dominated by Ambrosia dumosa (62.0% of the stems), with Larre tridentata a conspicuous secondary species (2.3% of the stems). Analyses of static pattern for common species showed: (1) aggregated adults and juveniles for Ambrosia dumosa, Erigonum fasciculatum, Mirabilis bigelovii, and Sphaeralcea ambigua, with more aggregation among juveniles than adults; (2) randomly distributed adults and juveniles for Krameria grayi, Opuntia rasmosissima, Simondsia chinensis, and Yucca schidigera. The summed volumes and distances between nearest conspecific neighbors were positively correlated for Ambrosia dumosa and Larrea tridentata, but not significantly correlated for eight remaining species with ≥100 individuals. Static pattern suggests only weak evidence for negative interactions in Ambrosia and Larrea, and little evidence for other species. Alternative mechanisms other than negative interaction that could give rise to these static patterns are discussed. Juvenile mortality was documented for four common species (Ambrosia dumosa, Eriogonum fasciculatum, Mirabilis bigelovii, and Sphaeralcea ambigua) that experienced substantial mortality. Analyses show: (1) the proportion of individuals that died was independent of the initial density of conspecifics; (2) distance to conspecific adults did not differ for juveniles that died versus those that survived; and (3) death was no more likely for juveniles that contacted other plants than for those that were isolated. The exception was a vine, Mirabilis bigelovii, whose juveniles survived better in contact with other plants. In sum, neither spatial pattern nor patterns of mortality showed clear evidence of negative intraspecific interference.

  16. Invited review: piglet mortality: management solutions. (United States)

    Kirkden, R D; Broom, D M; Andersen, I L


    Preweaning mortality varies greatly among herds and this is partly attributed to differences in farrowing house management. In this review, we describe the various management strategies than can be adopted to decrease mortality and critically examine the evidence that exists to support their use. First, we consider which management procedures are effective against specific causes of death: intrapartum stillbirth, hypothermia, starvation, disease, crushing, and savaging. The most effective techniques include intervention to assist dystocic sows, measures to prevent and treat sow hypogalactia, good farrowing house hygiene, providing newborn piglets with a warm microenvironment, early fostering of supernumerary piglets, methods that assist small and weak piglets to breathe and obtain colostrum, and intervention to prevent deaths from crushing and savaging. The provision of nest-building material and modifications to the pen to assist the sow when lying down may also be beneficial, but the evidence is less clear. Because most deaths occur around the time of farrowing and during the first few days of life, the periparturient period is a particularly important time for management interventions intended to reduce piglet mortality. A number of procedures require a stockperson to be present during and immediately after farrowing. Second, we consider the benefits of farrowing supervision for preweaning mortality in general, focusing particularly on methods for the treatment of dystocia and programs of piglet care that combine multiple procedures. Third, we discuss the need for good stockmanship if farrowing supervision is to be effective. Stockmanship refers not only to technical skills but also to the manner in which sows are handled because this influences their fearfulness of humans. We conclude that piglet survival can be improved by a range of management procedures, many of which occur in the perinatal period and require the supervision of farrowing by trained staff

  17. Job stress and mortality in older age

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    Beata Tobiasz-Adamczyk


    Full Text Available Objectives: This paper aims to assess the relationship between the determinants of the psychosocial work environment, as expressed in terms of JDC or ERI models, and all-cause mortality in older individuals. Materials and Methods: The baseline study was conducted on a cohort comprising a random sample of 65-year-old community-dwelling citizens of Kraków, Poland. All of the 727 participants (410 women, 317 men were interviewed in their households in the period between 2001 and 2003; a structured questionnaire was used regarding their occupational activity history, which included indexes measuring particular dimensions of their psychosocial work environment based on Karasek's Job Demand-Control model and Siegrist's Effort-Reward Imbalance model, as well as health-related quality of life and demographic data. Mortality was ascertained by monitoring City Vital Records for 7 years. Analyses were conducted separately for men and women, with the multivariate Cox proportional hazard model. Results: During a 7-year follow-up period, 59 participants (8.1% died, including 21 women (5.1% of total women and 38 men (12% (p < 0.05. Significant differences in the number of deaths occurred regarding disproportion between physical demands and control in men: those with low physical demands and low control died three times more often than those with high control, regardless of the level of demands. The multivariate Cox proportional hazard model showed that significantly higher risk of death was observed only in men with low physical demands and low control, compared to those with low physical demands and high control (Exp(B = 4.65, 95% CI: 1.64-13.2. Conclusions: Observed differences in mortality patterns are similar to the patterns of relationships observed in health-related quality of life (HRQoL level at the beginning of old age; however, the relationship between efforts and rewards or demands and control and mortality was not fully confirmed.

  18. Differential mortality by lifetime earnings in Germany

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    Rembrandt D. Scholz


    Full Text Available e estimate mortality rates by a measure of socio-economic status in a very large sample of male German pensioners aged~65 or older. Our analysis is entirely nonparametric. Furthermore, the data enable us to compare mortality experiences in eastern and western Germany conditional on socio-economic status. As a simple summary measure, we compute period life expectancies at age~65. Our findings show a lower bound of almost 50 percent (six years on the difference in life expectancy between the lowest and the highest socio-economic group considered. Within groups, we find similar values for the former GDR and western Germany. Our analysis contributes to the literature in three aspects. First, we provide the first population-based differential mortality study for Germany. Second, we use a novel measure of lifetime earnings as a proxy for socio-economic status that remains applicable to retired people. Third, the comparison between eastern and western Germany may provide some interesting insights for transformation countries.

  19. Morbidity and mortality of diabetes with surgery

    Directory of Open Access Journals (Sweden)

    L. L. Chuah


    Full Text Available The prevalence of Type 2 diabetes mellitus (T2DM has increased; as a result the number of patients with T2DM undergoing surgical procedures has also increased. This population is at high risk of macrovascular (cardiovascular disease, peripheral vascular disease or microvascular (retinopathy, nephropathy or neuropathy complications, both increasing their perioperative morbidity and mortality. Diabetes patients are more at risk of poor wound healing, respiratory infection, myocardial infarction, admission to intensive care, and increased hospital length of stay. This leads to increased inpatient costs. The outcome of perioperative glycaemia management remains a significant clinical problem without a universally accepted solution. The majority of evidence on morbidity and mortality of T2DM patients undergoing surgery comes from the setting of cardiac surgery; there was less evidence on non-cardiac surgery and bariatric surgery. Bariatric surgery is increasingly performed in patients with severe obesity complicated by T2DM, but is distinguished from general surgery as it immediately improves the glucose homeostasis postoperatively. The improvements in glycaemia are thought to be independent of weight loss and this requires different postoperative management. Patients usually have to follow specific preoperative diets which lead to improvement in glycaemia immediately before surgery. Here we review the available data on the mortality and morbidity of patients with T2DM who underwent elective surgery (cardiac, non-cardiac and bariatric surgery and the current knowledge of the impact that preoperative, intraoperative and postoperative glycaemic management has on operative outcomes.

  20. Urban poverty and infant mortality rate disparities. (United States)

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


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


    Directory of Open Access Journals (Sweden)



    Full Text Available OBJECTIVE: To evaluate the various causes of perinatal deaths and adopt strategies to improve perinatal outcome at a referral teaching hospital in North Kerala. METHODS: A prospective observational study conducted at Institute of Maternal and Child Health, Government Medical College, Kozhikode. All perinatal deaths during the period January 2013 to December 2014 were analysed and from this factors responsible for perinatal deaths were identified. RESULTS: Out of total 30,042 deliveries , there were 966 perinatal deaths during the study period. 566 were still births and 400 early neonatal deaths. The perinatal mortality rate was 31.1 per 1000 live births. Perinatal asphyxia was the major cause of perinatal mortality. The important factors contributing to perinatal asphyxia were prematurity (39%, abruptio placenta (19% and MSAF ( 12%. Among the antenatal factors, hypertensive disorders of pregnancy leading to iatrogenic elective preterm delivery were the most important. CONCLUSION: Perinatal asphyxia due to prematurity and low birth weight emerged as the most important cause of perinatal mortality in this study and hypertensive disorders of pregnancy were the most important antenatal complication leading to prematurity

  2. Measuring Mortality Information in Clinical Data Warehouses. (United States)

    Jones, Barrett; Vawdrey, David K


    The ability to track and report long-term outcomes, especially mortality, is essential for advancing clinical research. The purpose of this study was to present a framework for assessing the quality of mortality information in clinical research databases. Using the clinical data warehouse (CDW) at Columbia University Medical Center as a case study, we measured: 1) agreement in vital status between our institution's patient registration system and the U.S. Social Security Administration's Death Master File (DMF), 2) the proportion of patients marked as deceased according to the DMF records who had subsequent visits to our institution, and 3) the proportion of patients still living according to Columbia's CDW who were over 100 and 120 years of age. Of 33,295 deaths recorded in our institution's patient registration system, 13,167 (39.5%) did not exist in the DMF. Of 315,037 patients in our CDW who marked as deceased according to the DMF, 2.1% had a subsequent clinical encounter at our institution. The proportion of patients still living according to Columbia's CDW who were over 100 and 120 years of age was 43.6% and 43.1%, respectively. These measures may be useful to other clinical research investigators seeking to assess the quality of mortality data (1-4).

  3. [Maternal mortality in France, 2007-2009]. (United States)

    Saucedo, M; Deneux-Tharaux, C; Bouvier-Colle, M-H


    To monitor the maternal mortality which is an indicator of the quality of obstetric and intensive care, France has a specific approach since 1996. Recently linkages have been introduced to improve the inclusion of cases. Here are the results for the 2007 to 2009 period. The identification of the pregnancy associated deaths is lying on different data bases that are medical causes of death, birth register and hospital discharges. To document the cases, confidential enquiries are conducted by two assessors on the field; a committee of medical experts analyses the documents, select the underlying cause and assess the quality of health care. Two hundred and fifty-four obstetric deaths were identified from 2007 to 2009 giving the maternal mortality ratio (MMR) of 10.3 per 100,000 births. The maternal age and nationality, the region of deaths are associated to the MMR. The haemorrhages are the leading cause but their ratio is 1.9 versus 2.5 previously; this decrease results from the postpartum haemorrhage by uterine atony going down. The suboptimal care are still frequent (60%) but slightly less than before. The linkage method should be pursued. Maternal mortality is rather stable in France. We may reach more reduction as deaths due to atony decreased as suboptimal care did.

  4. Accidents in Canada: mortality and hospitalization. (United States)

    Riley, R; Paddon, P


    For Canadians under 45, accidents are the leading cause of both death and hospitalization. For the Canadian population as a whole, accidents rank fourth as a cause of death, after cardiovascular disease (CVD), cancer and respiratory disease. This article analyzes accident mortality and hospitalization in Canada using age-specific rates, age-standardized mortality rates (ASMR), and potential years of life lost (PYLL). The six major causes of accidental death for men are motor vehicle traffic accidents (MVTA), falls, drowning, fires, suffocation and poisoning. For women, the order is slightly different: MVTA, falls, fires, suffocation, poisoning and drowning. From 1971 to 1986, age-standardized mortality rates (ASMR) for accidents decreased by 44% for men and 39% for women. The largest decrease occurred in the under 15 age group. Accidents accounted for 11.5% of total hospital days in 1985, and 8% of hospital discharges. Because young people have the highest rates of accidental death, potential years of life lost (PYLL) are almost as high for accidents as for cardiovascular disease, although CVD deaths outnumbered accidental deaths by almost five to one in 1985.

  5. Observed and Expected Mortality in Cohort Studies. (United States)

    Richardson, David B; Keil, Alexander P; Cole, Stephen R; MacLehose, Richard F


    Epidemiologists often compare the observed number of deaths in a cohort with the expected number of deaths, obtained by multiplying person-time accrued in the cohort by mortality rates for a reference population (ideally, a reference that represents the mortality rate in the cohort in the absence of exposure). However, if exposure is hazardous (or salutary), this calculation will not consistently estimate the number of deaths expected in the absence of exposure because exposure will have affected the distribution of person-time observed in the study cohort. While problems with interpretation of this standard calculation of expected counts were discussed more than 2 decades ago, these discussions had little impact on epidemiologic practice. The logic of counterfactuals may help clarify this topic as we revisit these issues. In this paper, we describe a simple way to consistently estimate the expected number of deaths in such settings, and we illustrate the approach using data from a cohort study of mortality among underground miners. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail:

  6. Confronting mortality: faith and meaning across cultures. (United States)

    Paulson, Steve; Kellehear, Allan; Kripal, Jeffrey J; Leary, Lani


    Despite advances in technology and medicine, death itself remains an immutable certainty. Indeed, the acceptance and understanding of our mortality are among the enduring metaphysical challenges that have confronted human beings from the beginning of time. How have we sought to cope with the inevitability of our mortality? How do various cultural and social representations of mortality shape and influence the way in which we understand and approach death? To what extent do personal beliefs and convictions about the meaning of life or the notion of an afterlife affect how we perceive and experience the process of death and dying? Steve Paulson, executive producer and host of To the Best of Our Knowledge, moderated a discussion on death, dying, and what lies beyond that included psychologist Lani Leary, professor of philosophy and religion Jeffrey J. Kripal, and sociologist Allan Kellehear. The following is an edited transcript of the discussion that occurred February 5, 7:00-8:30 pm, at the New York Academy of Sciences in New York City.

  7. Body mass index and poststroke mortality

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Dehlendorff, Christian; Petersen, Hans Gregers


    Background: Obesity is an established cardiovascular risk factor. We studied the association between body mass index (BMI) and all-cause mortality after stroke. Methods: A registry started in 2001 with the aim to register all hospitalized stroke patients in Denmark now includes 21,884 patients...... in whom BMI was recorded. There are five BMI groups: underweight (BMI BMI 18.5-24.9), overweight (BMI 25.0-29.9), obese (BMI 30.0-34.9) and severely obese (BMI 6 35). All patients underwent an evaluation including stroke severity, computed tomography, and cardiovascular risk factors......% CI 0.66-0.81], obese (HR 0.84, 95% CI 0.73-0.98) and severely obese stroke patients (HR 0.84, 95% CI 0.64-1.10), while mortality was higher in underweight patients (HR 1.63, 95% CI 1.41-1.90). Conclusions: Poststroke mortality is inversely related to BMI: overweight and obese stroke patients have...

  8. Quantification of social contributions to earthquake mortality (United States)

    Main, I. G.; NicBhloscaidh, M.; McCloskey, J.; Pelling, M.; Naylor, M.


    Death tolls in earthquakes, which continue to grow rapidly, are the result of complex interactions between physical effects, such as strong shaking, and the resilience of exposed populations and supporting critical infrastructures and institutions. While it is clear that the social context in which the earthquake occurs has a strong effect on the outcome, the influence of this context can only be exposed if we first decouple, as much as we can, the physical causes of mortality from our consideration. (Our modelling assumes that building resilience to shaking is a social factor governed by national wealth, legislation and enforcement and governance leading to reduced levels of corruption.) Here we attempt to remove these causes by statistically modelling published mortality, shaking intensity and population exposure data; unexplained variance from this physical model illuminates the contribution of socio-economic factors to increasing earthquake mortality. We find that this variance partitions countries in terms of basic socio-economic measures and allows the definition of a national vulnerability index identifying both anomalously resilient and anomalously vulnerable countries. In many cases resilience is well correlated with GDP; people in the richest countries are unsurprisingly safe from even the worst shaking. However some low-GDP countries rival even the richest in resilience, showing that relatively low cost interventions can have a positive impact on earthquake resilience and that social learning between these countries might facilitate resilience building in the absence of expensive engineering interventions.

  9. Road traffic related mortality in Vietnam: Evidence for policy from a national sample mortality surveillance system

    Directory of Open Access Journals (Sweden)

    Ngo Anh D


    Full Text Available Abstract Background Road traffic injuries (RTIs are among the leading causes of mortality in Vietnam. However, mortality data collection systems in Vietnam in general and for RTIs in particular, remain inconsistent and incomplete. Underlying distributions of external causes and body injuries are not available from routine data collection systems or from studies till date. This paper presents characteristics, user type pattern, seasonal distribution, and causes of 1,061 deaths attributable to road crashes ascertained from a national sample mortality surveillance system in Vietnam over a two-year period (2008 and 2009. Methods A sample mortality surveillance system was designed for Vietnam, comprising 192 communes in 16 provinces, accounting for approximately 3% of the Vietnamese population. Deaths were identified from commune level data sources, and followed up by verbal autopsy (VA based ascertainment of cause of death. Age-standardised mortality rates from RTIs were computed. VA questionnaires were analysed in depth to derive descriptive characteristics of RTI deaths in the sample. Results The age-standardized mortality rates from RTIs were 33.5 and 8.5 per 100,000 for males and females respectively. Majority of deaths were males (79%. Seventy three percent of all deaths were aged from 15 to 49 years and 58% were motorcycle users. As high as 80% of deaths occurred on the day of injury, 42% occurred prior to arrival at hospital, and a further 29% occurred on-site. Direct causes of death were identified for 446 deaths (42% with head injuries being the most common cause attributable to road traffic injuries overall (79% and to motorcycle crashes in particular (78%. Conclusion The VA method can provide a useful data source to analyse RTI mortality. The observed considerable mortality from head injuries among motorcycle users highlights the need to evaluate current practice and effectiveness of motorcycle helmet use in Vietnam. The high number of

  10. [Mortality in 1990. Mortality levels as indicated in the 1990 population census]. (United States)

    Mina Valdes, A


    An abbreviated life table for Mexico is presented, based on findings of the 1990 census and deaths registered around 1990. The estimated life expectancy at birth in 1990 of 69.99 years was 3.5 years higher than the corresponding estimate based on the 1980 census. The gain in life expectancy averaged 3 years for ages 1-20 years, 2 years for ages 30-40 years, and 1-1.5 years for ages 45-65. The principal causes of general mortality were heart disease, accidents, malignant tumors, infectious intestinal diseases, and diabetes mellitus. The 5 principal causes of infant mortality were disorders arising in the perinatal period, infectious intestinal disorders, pneumonia and influenza, congenital anomalies, and nutritional deficiency disorders. Gains in life expectancy during the 1980s were significant because of the decline in infant mortality, but infant mortality levels remain high compared to those of other countries. Differentials in infant mortality rates in different states were significant, with 1990 rates ranging from 70/1000 in Oaxaca to 30 in the Federal District. The differentials in infant mortality rates were reflected in life expectancies. In the Federal District and the states of Nuevo Leon, Nayarit, and Tamaulipas, life expectancy exceeded the national average by 2-5 years. The proportion of deaths in the earliest age group that were not reported declined at the national level from around 20% in 1980 to around 10% in 1990. Census-based infant mortality estimates for 1990 were more reliable than those for 1980.

  11. Maternal mortality and severe maternal morbidity surveillance in Canada. (United States)

    Allen, Victoria M; Campbell, Melanie; Carson, George; Fraser, William; Liston, Robert M; Walker, Mark; Barrett, Jon


    The Canadian Perinatal Surveillance System has provided a comprehensive review of maternal mortality and severe maternal morbidity in Canada, and has identified several important limitations to existing national maternal data collection systems, including variability in the detail and quality of mortality data. The Canadian Perinatal Surveillance System report recommended the establishment of an ongoing national review and reporting system, as well as consistency in definitions and classifications of maternal mortality and severe maternal morbidity, in order to enhance surveillance of maternal mortality and severe maternal morbidity. Using review articles and studies that examined maternal mortality in general as opposed to maternal mortality associated with particular management strategies or conditions, maternal mortality and severe morbidity classifications, terminology, and comparative statistics were reviewed and employed to evaluate deficiencies in past and current methods of data collection and to seek solutions to address the need for enhanced and consistent national surveillance of maternal mortality and severe maternal morbidity in Canada.

  12. Geography of child mortality clustering within African families. (United States)

    Kuate-Defo, Barthélémy; Diallo, Khassoum


    After decades of sustained child mortality reductions, infant and early childhood mortality levels in Africa remain high. This can partly be ascribed to the concentration of child mortality within particular families, communities or geographic localities. Strong mortality clustering is indicative of marked social inequality and of an unequal distribution of health and health-related resources and infrastructures. It also signifies a concentration of nutritional and sanitary behaviors harmful to the good health and longevity of children. Finally, it likely points to the existence of particular genetic problems in certain families, or environmental problems within specific communities. Using nationally representative family level data from all sub-regions of Africa, two important findings emerge from this study. First, levels of mortality have generally declined in all countries over time, and as mortality decreases, mortality clustering tends to follow the same trend. Second, bio-demographic covariates have a more important effect on familial mortality clustering risks than socio-economic ones.

  13. CDC WONDER: Detailed Mortality - Underlying Cause of Death (United States)

    U.S. Department of Health & Human Services — The Detailed Mortality - Underlying Cause of Death data on CDC WONDER are county-level national mortality and population data spanning the years 1999-2009. Data are...

  14. Continuing the search for a fundamental law of mortality

    Energy Technology Data Exchange (ETDEWEB)

    Carnes, B.A.; Grahn, D. [Argonne National Lab., IL (United States); Olshansky, S.J. [Chicago Univ., IL (United States)


    for 170 years, scientists have attempted to explain why consistent temporal patterns of death are observed among individuals within populations. Historical efforts to identify a `law of mortality` from these patterns ended in 1935 when it was declared that such a law did not exist. These empirical tests for a law of mortality were constructed using mortality curves based on all causes of death. We predicted patterns of mortality consistent with the historical concept of a law would be revealed if mortality curves for species were constructed using only senescent causes of death. Using data on senescent mortality for laboratory animals and humans, we demonstrate patterns of mortality overlap when compared on a biologically comparable time scale. The results are consistent with the existence of a law of mortality following sexual maturity. The societal, medical, and research implications of such a law are discussed.

  15. Continuing the search for a fundamental law of mortality

    Energy Technology Data Exchange (ETDEWEB)

    Carnes, B.A.; Grahn, D. [Argonne National Lab., IL (United States); Olshansky, S.J. [Univ. of Chicago, IL (United States)


    For 170 years, scientists have attempted to explain why consistent temporal patterns of death are observed among individuals within populations. Historical efforts to identify a {open_quotes}law of mortality{close_quotes} from these patterns ended in 1935 when it was declared that such a law did not exist. These empirical tests for a law of mortality were constructed using mortality curves based on all causes of death. We predicted that patterns of mortality consistent with the historical concept of a law would be revealed if mortality curves for species were constructed using only senescent causes of death. Using data on senescent mortality for laboratory animals and humans, we demonstrate that patterns of mortality overlap when compared on a biologically comparable time scale. These results are consistent with the existence of a law of mortality following sexual maturity as asserted by Benjamin Gompertz and Raymond Pearl. The societal, medical, and research implications of such a law are discussed.

  16. United States Mortality Database, 1988-1992 - Direct Download (United States)

    U.S. Geological Survey, Department of the Interior — This map layer contains mortality information for United States Health Service Areas (805 groups of counties). Included are mortality rates by sex and race (white...

  17. CDC WONDER: Compressed Mortality - Underlying Cause of Death (United States)

    U.S. Department of Health & Human Services — The CDC WONDER Mortality - Underlying Cause of Death online database is a county-level national mortality and population database spanning the years since 1979...

  18. Trends and Disparities in Child Mortality in India. (United States)

    Behl, A S


    This secondary analysis of Indias National Family Health Survey data assessed India's recent trends in child mortality rates and disparities. Nationally, declines in average child mortality rates from 1992 to 2005 were statistically significant, but declines in inequality were not. Urban areas had lower child mortality rates than rural areas but higher inequalities. Interstate differences in child mortality rates were significant, with rates in the highest-mortality states four to six times higher than in the lowest-mortality states. Significant child health disparities persist despite declines in child mortality rates. Implementing low-cost, effective interventions in districts with the highest number of child deaths could accelerate reductions in child mortality and decrease inequalities.

  19. HIV exposure and related newborn morbidity and mortality in the ...

    African Journals Online (AJOL)

    HIV exposure and related newborn morbidity and mortality in the University ... of the University Teaching Hospital of Yaoundé from July 2006 to December 2007. ... Using Univariate analysis, risk factors associated to mortality in both groups ...

  20. Child malnutrition and mortality in Swaziland: Situation analysis of ...

    African Journals Online (AJOL)

    Child malnutrition and mortality in Swaziland: Situation analysis of the ... is a major confounding factor for child morbidity and mortality in developing countries. ... and nutrition knowledge, insufficient human resources in child health care; ...

  1. Increased Mortality in Bulimia Nervosa and Other Eating Disorders

    National Research Council Canada - National Science Library

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


    .... 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. Method...

  2. Coffee Drinking and Mortality in 10 European Countries

    DEFF Research Database (Denmark)

    Gunter, Marc J; Murphy, Neil; Cross, Amanda J


    Background: The relationship between coffee consumption and mortality in diverse European populations with variable coffee preparation methods is unclear. Objective: To examine whether coffee consumption is associated with all-cause and cause-specific mortality. Design: Prospective cohort study. ...

  3. [On the increase in mortality in Italy in 2015: analysis of seasonal mortality in the 32 municipalities included in the Surveillance system of daily mortality]. (United States)

    Michelozzi, Paola; De' Donato, Francesca; Scortichini, Matteo; De Sario, Manuela; Asta, Federica; Agabiti, Nera; Guerra, Ranieri; de Martino, Annamaria; Davoli, Marina


    the Italian National Institute of Statistics (Istat) estimated an increase in mortality in Italy of 11.3% between January and August 2015 compared to the previous year. During summer 2015, an excess in mortality, attributed to heat waves, was observed. to estimate the excess mortality in 2015 using data from the rapid mortality surveillance system (SiSMG) operational in 32 Italian cities. time series models were used to estimate the excess in mortality among the elderly (65+ years) in 2015 by season (winter and summer). Excess mortality was defined as the difference between observed daily and expected (baseline) mortality for the five previous years (2009- 2013); seasonal mortality in 2015 was compared with mortality observed in 2012, 2013, and 2014. An analysis by cause of death (cardiovascular and respiratory), gender, and age group was carried out in Rome. data confirm an overall estimated excess in mortality of +11% in 2015. Seasonal analysis shows a greater excess in winter (+13%) compared to the summer period (+10%). The excess in winter deaths seems to be attributable to the peak in influenza rather than to low temperatures. Summer excess mortality was attributed to the heat waves of July and August 2015. The lower mortality registered in Italy during summer 2014 (-5.9%) may have contributed to the greater excess registered in 2015. In Rome, cause-specific analysis showed a higher excess among the very old (85+ years) mainly for cardiovascular and respiratory causes in winter. In summer, the excess was observed among both the elderly and in the adult population (35-64 years). results suggest the need for a more timely use of mortality data to evaluate the impact of different risk factors. Public health measures targeted to susceptible subgroups should be enhanced (e.g., Heat Prevention Plans, flu vaccination campaigns).

  4. Vitamin D status and cause-specific mortality

    DEFF Research Database (Denmark)

    Skaaby, Tea; Husemoen, Lise Lotte Nystrup; Pisinger, Charlotta


    Vitamin D deficiency is associated with an increased risk of all-cause mortality in observational studies. The specific causes of death underlying this association lack clarity. We investigated the association between vitamin D status and cause-specific mortality.......Vitamin D deficiency is associated with an increased risk of all-cause mortality in observational studies. The specific causes of death underlying this association lack clarity. We investigated the association between vitamin D status and cause-specific mortality....

  5. Mortality among 5-17 year old children in Kenya


    Osano, Bonface Ombaba; Were, Fred; Mathews, Shanaaz


    Introduction Global mortality trends have changed over time and are expected to continue changing with a reduction in communicable diseases and an increase of non-communicable disease. Increased survival of children beyond five years may change mortality patterns for these children. There are few studies in Africa that explore the causes of mortality in children over five years. The objective of this study was to determine the mortality rate and clinical profiles of children aged 5-17 years w...

  6. Mortality in a cohort of Danish patients with fibromyalgia

    DEFF Research Database (Denmark)

    Dreyer, Lene; Kendall, Sally; Danneskiold-Samsøe, Bente


    A previous study demonstrated an association between self-reported widespread body pain and increased mortality. The aim of this study was to analyze whether fibromyalgia (FM) and FM-like symptoms are related to increased mortality.......A previous study demonstrated an association between self-reported widespread body pain and increased mortality. The aim of this study was to analyze whether fibromyalgia (FM) and FM-like symptoms are related to increased mortality....

  7. Vitamin D status and cause-specific mortality

    DEFF Research Database (Denmark)

    Skaaby, Tea; Husemoen, Lise Lotte Nystrup; Pisinger, Charlotta;


    Vitamin D deficiency is associated with an increased risk of all-cause mortality in observational studies. The specific causes of death underlying this association lack clarity. We investigated the association between vitamin D status and cause-specific mortality.......Vitamin D deficiency is associated with an increased risk of all-cause mortality in observational studies. The specific causes of death underlying this association lack clarity. We investigated the association between vitamin D status and cause-specific mortality....

  8. Heat Mortality Versus Cold Mortality: A Study of Conflicting Databases in the United States. (United States)

    Dixon, P. G.; Brommer, D. M.; Hedquist, B. C.; Kalkstein, A. J.; Goodrich, G. B.; Walter, J. C.; Dickerson, C. C., IV; Penny, S. J.; Cerveny, R. S.


    Studies, public reports, news reports, and Web sites cite a wide range of values associated with deaths resulting from excessive heat and excessive cold. For example, in the United States, the National Climatic Data Center's Storm Data statistics of temperature- related deaths are skewed heavily toward heat-related deaths, while the National Center for Health Statistics Compressed Mortality Database indicates the reverse—4 times more people die of “excessive cold” conditions in a given year than of “excessive heat.” In this study, we address the fundamental differences in the various temperature-related mortality databases, assess their benefits and limitations, and offer suggestions as to their use. These datasets suffer from potential incompleteness of source information, long compilation times, limited quality control, and the subjective determination of a direct versus indirect cause of death. In general, these separate mortality datasets should not be combined or compared, particularly with regard to policy determination. The use of gross mortality numbers appears to be one of the best means of determining temperature-related mortality, but those data must be detrended into order to remove a persistent winter-dominant death maximum and are difficult to obtain on a regional daily basis.

  9. Social Capital and Human Mortality: Explaining the Rural Paradox with County-Level Mortality Data (United States)

    Jensen, Leif; Haran, Murali


    The “rural paradox” refers to standardized mortality rates in rural areas that are unexpectedly low in view of well-known economic and infrastructural disadvantages there. We explore this paradox by incorporating social capital, a promising explanatory factor that has seldom been incorporated into residential mortality research. We do so while being attentive to spatial dependence, a statistical problem often ignored in mortality research. Analyzing data for counties in the contiguous United States, we find that: (1) the rural paradox is confirmed with both metro/non-metro and rural-urban continuum codes, (2) social capital significantly reduces the impacts of residence on mortality after controlling for race/ethnicity and socioeconomic covariates, (3) this attenuation is greater when a spatial perspective is imposed on the analysis, (4) social capital is negatively associated with mortality at the county level, and (5) spatial dependence is strongly in evidence. A spatial approach is necessary in county-level analyses such as ours to yield unbiased estimates and optimal model fit. PMID:25392565

  10. The modal age at death and the shifting mortality hypothesis

    DEFF Research Database (Denmark)

    Canudas-Romo, Vladimir


    The modal age at death is used to study the shifting mortality scenario experienced by low mortality countries. The relations of the life table functions at the modal age are analyzed using mortality models. In the models the modal age increases over time, but there is an asymptotic approximation...

  11. Cardiovascular and noncardiovascular mortality among men and women starting dialysis

    DEFF Research Database (Denmark)

    Carrero, Juan J; de Jager, Dinanda J; Verduijn, Marion;


    Although women have a survival advantage in the general population, women on dialysis have similar mortality to men. We hypothesized that this paired mortality risk during dialysis may be explained by a relative excess of cardiovascular-related mortality in women....

  12. Breast cancer mortality in mammographic screening in Europe

    DEFF Research Database (Denmark)

    Njor, Sisse Helle; Nyström, Lennarth; Moss, Sue


    To estimate the impact of service mammography screening on breast cancer mortality using European incidence-based mortality (IBM) studies (or refined mortality studies). IBM studies include only breast cancer deaths occurring in women with breast cancer diagnosed after their first invitation...

  13. Correlations between Google search data and Mortality Rates


    Risk, James


    Inspired by correlations recently discovered between Google search data and financial markets, we show correlations between Google search data mortality rates. Words with negative connotations may provide for increased mortality rates, while words with positive connotations may provide for decreased mortality rates, and so statistical methods were employed to determine to investigate further.

  14. Decomposing changes in life expectancy: Compression versus shifting mortality

    Directory of Open Access Journals (Sweden)

    Marie-Pier Bergeron-Boucher


    Full Text Available Background: In most developed countries, mortality reductions in the first half of the 20th century were highly associated with changes in lifespan disparities. In the second half of the 20th century, changes in mortality are best described by a shift in the mortality schedule, with lifespan variability remaining nearly constant. These successive mortality dynamics are known as compression and shifting mortality, respectively. Objective: To understand the effect of compression and shifting dynamics on mortality changes, we quantify the gains in life expectancy due to changes in lifespan variability and changes in the mortality schedule, respectively. Methods: We introduce a decomposition method using newly developed parametric expressions of the force of mortality that include the modal age at death as one of their parameters. Our approach allows us to differentiate between the two underlying processes in mortality and their dynamics. Results: An application of our methodology to the mortality of Swedish females shows that, since the mid-1960s, shifts in the mortality schedule were responsible for more than 70Š of the increase in life expectancy. Conclusions: The decomposition method allows differentiation between both underlying mortality processes and their respective impact on life expectancy, and also determines when and how one process has replaced the other.

  15. Surgical inpatient cancer-related mortality in a Nigerian tertiary ...

    African Journals Online (AJOL)

    Surgical inpatient cancer-related mortality in a Nigerian tertiary hospital. ... One hundred and eight (63.2 %) were male. The yearly mortality ... The leading causes of mortality were cancer of prostate 50(29.2 %) and breast cancer 40(23.4 %).

  16. Causes of mortality of red-cockaded woodpecker cavity trees (United States)

    Richard N. Conner; D. Craig Rudolph; David L. Kulhavy; Ann E. Snow


    Over a 13-year period we examined the mortality of cavity trees (n = 453) used by red-cockaded woodpeckers (Picoides borealis) on national forests in eastern Texas. Bark beetles (53%), wind snap (30%), and fire (7%) were the major causes of cavity tree mortality. Bark beetles were the major cause of mortality in loblolly (Pinus taeda...

  17. Proximity to mining industry and cancer mortality. (United States)

    Fernández-Navarro, Pablo; García-Pérez, Javier; Ramis, Rebeca; Boldo, Elena; López-Abente, Gonzalo


    Mining installations are releasing toxic substances into the environment which could pose a health problem to populations in their vicinity. We sought to investigate whether there might be excess cancer-related mortality in populations residing in towns lying in the vicinity of Spanish mining industries governed by the Integrated Pollution Prevention and Control Directive, and the European Pollutant Release and Transfer Register Regulation, according to the type of extraction method used. An ecologic study was designed to examine municipal mortality due to 32 types of cancer, across the period 1997 through 2006. Population exposure to pollution was estimated on the basis of distance from town of residence to pollution source. Poisson regression models, using the Bayesian conditional autoregressive model proposed by Besag, York and Molliè and Integrated Nested Laplace Approximations for Bayesian inference, were used: to analyze risk of dying from cancer in a 5-kilometer zone around mining installations; effect of type of industrial activity; and to conduct individual analyses within a 50-kilometer radius of each installation. Excess mortality (relative risk, 95% credible interval) of colorectal cancer (1.097, 1.041-1.157), lung cancer (1.066, 1.009-1.126) specifically related with proximity to opencast coal mining, bladder cancer (1.106, 1.016-1.203) and leukemia (1.093, 1.003-1.191) related with other opencast mining installations, was detected among the overall population in the vicinity of mining installations. Other tumors also associated in the stratified analysis by type of mine, were: thyroid, gallbladder and liver cancers (underground coal installations); brain cancer (opencast coal mining); stomach cancer (coal and other opencast mining installations); and myeloma (underground mining installations). The results suggested an association between risk of dying due to digestive, respiratory, hematologic and thyroid cancers and proximity to Spanish mining

  18. Early neonatal lamb mortality: postmortem findings. (United States)

    Holmøy, I H; Waage, S; Granquist, E G; L'Abée-Lund, T M; Ersdal, C; Hektoen, L; Sørby, R


    An investigation of stillbirth and early neonatal lamb mortality was conducted in sheep flocks in Norway. Knowledge of actual causes of death are important to aid the interpretation of results obtained during studies assessing the risk factors for lamb mortality, and when tailoring preventive measures at the flock, ewe and individual lamb level. This paper reports on the postmortem findings in 270 liveborn lambs that died during the first 5 days after birth. The lambs were from 17 flocks in six counties. A total of 27% died within 3 h after birth, 41% within 24 h and 80% within 2 days. Most lambs (62%) were from triplet or higher order litters. In 81% of twin and larger litters, only one lamb died. The most frequently identified cause of neonatal death was infectious disease (n=97, 36%); 48% (n=47) of these died from septicaemia, 25% (n=24) from pneumonia, 22% (n=21) from gastrointestinal infections and 5% (n=5) from other infections. Escherichia coli accounted for 65% of the septicaemic cases, and were the most common causal agent obtained from all cases of infection (41%). In total, 14% of neonatal deaths resulted from infection by this bacterium. Traumatic lesions were the primary cause of death in 20% (n=53) of the lambs. A total of 46% of these died within 3 h after birth and 66% within 24 h. Severe congenital malformations were found in 10% (n=27) of the lambs, whereas starvation with no concurrent lesions was the cause of death in 6% (n=17). In 16% (n=43) of the lambs, no specific cause of death was identified, lambs from triplet and higher order litters being overrepresented among these cases. In this study, the main causes of neonatal lamb mortality were infection and traumatic lesions. Most neonatal deaths occurred shortly after birth, suggesting that events related to lambing and the immediate post-lambing period are critical for lamb survival.

  19. Maternal mortality in Denmark, 1985-1994. (United States)

    Andersen, Betina Ristorp; Westergaard, Hanne Brix; Bødker, Birgit; Weber, Tom; Møller, Margrete; Sørensen, Jette Led


    In Denmark, maternal mortality has been reported over the last century, both locally through hospital reports and in national registries. The purpose of this study was to analyze data from national medical registries of pregnancy-related deaths in Denmark 1985-1994 and to classify them according to the UK Confidential Enquiry into Maternal Deaths (CEMD). All deaths of women with a registered pregnancy within 12 months prior to the death were identified by comparing the Danish medical registries, death certificates, and relevant codes according to International Classification of Diseases (ICD-10). All cases were classified using the UK CEMD classification. Cases of maternal death were further evaluated by an audit group. 311 cases were classified. 92 deaths (29.6%) occurred 42 days), 1 woman died from a direct obstetric cause, 46 from indirect causes, and 172 from fortuitous causes. Hypertensive disorders of pregnancy were the major cause of direct maternal deaths. The rate of maternal deaths constituted 9.8/100,000 maternities (i.e. the number of women delivering registrable live births at any gestation or stillbirths at 24 weeks of gestation or later). This is the first systematic report on deaths in Denmark based on data from national registries. The maternal mortality rate in Denmark is comparable to the rates in other developed countries. Fortunately, statistics are low, but each case represents potential learning. Obstetric care has changed and classification methods differ between countries. Prospective registration and registry linkage seem to be a way to ensure completion. This retrospective study has provided the background for a prospective study on registration and evaluation of maternal mortality in Denmark.

  20. [Multiple pregnancies. Neonatal morbidity and mortality]. (United States)

    Lenclen, R; Chassevent, J; Blanc, P; Hoenn, E; Olivier-Martin, M; Paupe, A; Philippe, H J


    The increase in the number of multiple pregnancies and the high incidence of prematurity in this type of pregnancy justifies a pediatric evaluation. A retrospective study (1985-1989) compared the perinatal and neonatal characteristics of children resulting from 14 multifetal (at least 3 fetuses) pregnancies, with a gestational age of less than 34 weeks, with 27 children resulting from monofetal pregnancies of the same duration. Neonatal morbidity and mortality appeared to be similar in both groups. Thus at this very early time of onset of labour (mean gestational age of 30 weeks), fetal multiplicity expressed itself neither by any particular neonatal pathology nor by malnutrition.

  1. Island mortality in the past: some evidence from Greece. (United States)

    Gavalas, Vasilis S


    This paper explores the course of infant and childhood mortality in the Greek island of Paros from the end of the nineteenth until the mid-twentieth century. For this purpose the method of family reconstitution has been applied to two towns on the island. Official population statistics have been used to derive basic mortality estimates for the Cyclades and Greece as a whole. Reference to other studies concerning island mortality is also made. Hence, there appears the chance to compare insular with mainland mortality and realise that insular mortality presented some distinct features. It is shown that island populations presented lower mortality than the national average until the first decades of the twentieth century. However, by the 1950s Greece's infant and childhood mortality had dropped to the same or even to lower levels than those of the islands.

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

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


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

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

    DEFF Research Database (Denmark)

    Mortensen, P B; Juel, K


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

  4. Statistical Analysis of Factors Affecting Child Mortality in Pakistan. (United States)

    Ahmed, Zoya; Kamal, Asifa; Kamal, Asma


    Child mortality is a composite indicator reflecting economic, social, environmental, healthcare services, and their delivery situation in a country. Globally, Pakistan has the third highest burden of fetal, maternal, and child mortality. Factors affecting child mortality in Pakistan are investigated by using Binary Logistic Regression Analysis. Region, education of mother, birth order, preceding birth interval (the period between the previous child birth and the index child birth), size of child at birth, and breastfeeding and family size were found to be significantly important with child mortality in Pakistan. Child mortality decreased as level of mother's education, preceding birth interval, size of child at birth, and family size increased. Child mortality was found to be significantly higher in Balochistan as compared to other regions. Child mortality was low for low birth orders. Child survival was significantly higher for children who were breastfed as compared to those who were not.

  5. Mortality Dynamics of Spodoptera frugiperda (Lepidoptera: Noctuidae) Immatures in Maize (United States)

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


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

  6. Differential mortality among semiskilled applicants of disability pension

    DEFF Research Database (Denmark)

    Hasle, H; Jeune, B; Skytthe, A


    The mortality experience among 4,440 applicants for disability pension has been examined during a period of observation of ten years. All applicants were males and had been member of the Danish Semiskilled Workers' Union. The reference group consists of age matched male members of the same union....... The applicants for disability pension experienced a considerable excess mortality when compared with the reference group. The higher mortality risk is still present more than ten years after the application has been settled. The persons who were refused disability pension experienced an elevated mortality, too....... In opposition to previous studies it is not found informative to put forward a common estimate of the elevated mortality rate because the group of disability applicants is very heterogeneous concerning their mortality experience; the excess mortality is most elevated among persons granted the high level pension...

  7. Increased mortality in hypernatremic burned patients

    Directory of Open Access Journals (Sweden)

    Lange, Thomas


    Full Text Available Introduction: In-hospital hypernatremia develops usually iatrogenically from inadequate or inappropriate fluid prescription. In severely burned patient an extensive initial fluid resuscitation is necessary for burn shock survival. After recovering of cellular integrity the circulating volume has to be normalized. Hereby extensive water and electrolyte shifts can provoke hypernatremia. Purpose: Is a hypernatremic state associated with increased mortality? Method: Retrospective study for the incidence of hypernatremia and survival in 40 patients with a totally burned surface area (TBSA >10%. Age, sex, TBSA, ABSI-Score and fluid resuscitation within the first 24 hours were analyzed. Patients were separated in two groups without (Group A or with (Group B hypernatremia. Results: Hypernatremia occurred on day 5±1.4. No significant difference for age, sex, TBSA, ABSI-Score and fluid resuscitation within the first 24 hours were calculated. In Group A all patients survived, while 3 of the hypernatremic patient in Group B died during ICU-stay (Odds-ratio = 1.25; 95% CI 0.971–1.61; p=0.046. Conclusion: Burned patients with an in-hospital acquired hypernatremia have an increased mortality risk. In case of a hypernatremic state early intervention is obligatory. There is a need of a fluid removal strategy in severely burned patient to avoid water imbalance.

  8. NoSQL for mere mortals

    CERN Document Server

    Sullivan, Dan


    The Easy, Common-Sense Guide to Solving Real Problems with NoSQL The" Mere Mortals" "(r)" tutorials have earned worldwide praise as the clearest, simplest way to master essential database technologies. Now, there s one for today s exciting new NoSQL databases. "NoSQL for Mere Mortals" guides you through solving real problems with NoSQL and achieving unprecedented scalability, cost efficiency, flexibility, and availability. Drawing on 20+ years of cutting-edge database experience, Dan Sullivan explains the advantages, use cases, and terminology associated with all four main categories of NoSQL databases: key-value, document, column family, and graph databases. For each, he introduces pragmatic best practices for building high-value applications. Through step-by-step examples, you ll discover how to choose the right database for each task, and use it the right way. Coverage includes --Getting started: What NoSQL databases are, how they differ from relational databases, when to use them, and when "not" to Data m...


    Tan, Wei Leong; Soelar, Shahrul Aiman; Mohd Suan, Mohd Azri; Hussin, Narwani; Cheah, Wee Kooi; Verasahib, Khebir; Goh, Pik Pin


    Leptospirosis is endemic in Southeast Asia, Central and South America, the Caribbean, and Oceania. Malaysia was categorized as a probable endemic country without any available data. Thus, this study was conducted to determine incidence, case fatality rate and mortality rate of leptospirosis. Leptospirosis is a notifiable disease in Malaysia since 2010 whereby probable or confirmed cases must be notified to relevant health district office. There were 3,665 and 4,457 probable and laboratory confirmed leptospirosis cases notified in 2012 and 2013, respectively. In the 2-year period, the most common age group of patients was 19 years old or less (23.3%) with male:female ratio of 2.61:1. Students consisted about 16.9% of patients, followed by agriculture-based or plantation workers (14.7%). Overall age-standardized incidence rate of leptospirosis in Malaysia for 2012 and 2013 was 29.02 per 100,000. Overall case fatality rate was 1.47% for 2-year period and overall age-standardized mortality rate was 0.45 per 100,000. Leptospirosis is an emerging public health concern in Malaysia and may pose a significant health impact and burden to the nation in the coming years if not well controlled.

  10. Perinatal mortality in Indonesia: an unfinished agenda

    Directory of Open Access Journals (Sweden)

    Riawati Jahja


    Full Text Available Perinatal mortality is a profound issue in maternal and child health due to its close relation with the maternal condition. There exist Millennium Development Goals (MDGs which are to be achieved by 2015. These are coupled with a continuing need for comprehensively monitoring and identifying factors associated with perinatal mortality, which is a primary concern for developing countries inclusive of Indonesia. Previous and on-going health programs could have brought about strategic interventions but as different attributes can emerge due to epidemiological transition, and given the fact that associated factors may remain persistent, forward thinking strategies in public health are forever in need of renewal.     Results from our research show that educational variables, poor awareness towards proper antenatal care visits and weak services at the front-line of healthcare delivery (community outreach worsen the condition of childbearing women, raising the question of biological risk factors in line with socio-economic variables.

  11. [Morbidity and mortality of carotid endarterectomy]. (United States)

    Rodríguez Pérez, A; Cabrera Morán, V; Abad Vázquez, C; Muñoz Falcón, L; Hernández Ruiz, A; Hermida Anllo, M; Cárdenes Romero, I


    In order to investigate the peroperative complications in carotid surgery, a cohort of 64 patients operated of carotid endarterectomy (EC) were evaluated. A total 78 EC were performed, 56 unilateral (EC-U) and 11 bilateral (EC-B). All the cases were managed in a similar manner regarding surgical technique, monitoring, anesthetic management and pre and postoperative care. A temporary shunt was inserted in 6 cases. The hospital mortality has been 0. We registered the following postoperative complications: arterial hypertension in 23.1 of EC-U and 18.2% of EC-B, cervical hematoma in 5.3% (EC-U) and 13.6% (EC-B), TIA in 5.3% (EC-U) and 4.5% (EC-B), stroke 1.7% (EC-U) and 4.5% (EC-B), vocal cord injury in 3.5% of EC-U and chest pain with angina in 1.7% of EC-U. A review of the mortality and morbidity in carotid surgery is done.

  12. Maternal Mortality Among Migrants in Western Europe

    DEFF Research Database (Denmark)

    Pedersen, Grete Skøtt; Grøntved, Anders; Mortensen, Laust Hvas


    . Results were derived from a random-effects meta-analysis, and statistical heterogeneity assessed by the I (2) statistic. In sub-analyses we also calculated summary estimates stratified by direct and indirect death causes. We included 13 studies with more than 42 million women and 4,995 maternal deaths......To examine whether an excess risk of maternal mortality exists among migrant women in Western Europe. We searched electronic databases for studies published 1970 through 2013 for all observational studies comparing maternal mortality between the host country and a defined migrant population....... Compared with indigenous born women, the pooled risk estimate (RR) was 2.00 with 95 % confidence interval (CI) of 1.72, 2.33. Migrant women had a non-significantly higher risk of dying from direct than indirect death causes; pooled RRs of 2.65 CI 1.88, 3.74 and 1.83 CI 1.37, 2.45. This meta...

  13. Trends in Pulmonary Hypertension Mortality and Morbidity

    Directory of Open Access Journals (Sweden)

    Alem Mehari


    Full Text Available Context. Few reports have been published regarding surveillance data for pulmonary hypertension, a debilitating and often fatal condition. Aims. We report trends in pulmonary hypertension. Settings and Design. United States of America; vital statistics, hospital data. Methods and Material. We used mortality data from the National Vital Statistics System (NVSS for 1999–2008 and hospital discharge data from the National Hospital Discharge Survey (NHDS for 1999–2009. Statistical Analysis Used. We present age-standardized rates. Results. Since 1999, the numbers of deaths and hospitalizations as well as death rates and hospitalization rates for pulmonary hypertension have increased. In 1999 death rates were higher for men than for women; however, by 2002, no differences by gender remained because of the increasing death rates among women and the declining death rates among men; after 2003 death rates for women were higher than for men. Death rates throughout the reporting period 1999–2008 were higher for blacks than for whites. Hospitalization rates in women were 1.3–1.6 times higher than in men. Conclusions. Pulmonary hypertension mortality and hospitalization numbers and rates increased from 1999 to 2008.

  14. [Excess mortality associated with influenza in Spain in winter 2012]. (United States)

    León-Gómez, Inmaculada; Delgado-Sanz, Concepción; Jiménez-Jorge, Silvia; Flores, Víctor; Simón, Fernando; Gómez-Barroso, Diana; Larrauri, Amparo; de Mateo Ontañón, Salvador


    An excess of mortality was detected in Spain in February and March 2012 by the Spanish daily mortality surveillance system and the «European monitoring of excess mortality for public health action» program. The objective of this article was to determine whether this excess could be attributed to influenza in this period. Excess mortality from all causes from 2006 to 2012 were studied using time series in the Spanish daily mortality surveillance system, and Poisson regression in the European mortality surveillance system, as well as the FluMOMO model, which estimates the mortality attributable to influenza. Excess mortality due to influenza and pneumonia attributable to influenza were studied by a modification of the Serfling model. To detect the periods of excess, we compared observed and expected mortality. In February and March 2012, both the Spanish daily mortality surveillance system and the European mortality surveillance system detected a mortality excess of 8,110 and 10,872 deaths (mortality ratio (MR): 1.22 (95% CI:1.21-1.23) and 1.32 (95% CI: 1.29-1.31), respectively). In the 2011-12 season, the FluMOMO model identified the maximum percentage (97%) of deaths attributable to influenza in people older than 64 years with respect to the mortality total associated with influenza (13,822 deaths). The rate of excess mortality due to influenza and pneumonia and respiratory causes in people older than 64 years, obtained by the Serfling model, also reached a peak in the 2011-2012 season: 18.07 and 77.20, deaths per 100,000 inhabitants, respectively. A significant increase in mortality in elderly people in Spain was detected by the Spanish daily mortality surveillance system and by the European mortality surveillance system in the winter of 2012, coinciding with a late influenza season, with a predominance of the A(H3N2) virus, and a cold wave in Spain. This study suggests that influenza could have been one of the main factors contributing to the mortality excess

  15. Mortality and predictors of mortality in rheumatoid arthritis--a role for mannose-binding lectin?

    DEFF Research Database (Denmark)

    Troelsen, Lone N; Garred, Peter; Jacobsen, Søren


    genotypes (YA/YA, YA/XA, XA/XA, YA/YO, XA/YO, YO/YO) were determined; MBL serum concentrations were measured. The vital status and causes of death were assessed in a prospective study. RESULTS: The median followup was 10.3 years. The overall risk of death was 4% per year. Comparing mortality in the RA...

  16. Hopelessly mortal: The role of mortality salience, immortality and trait self-esteem in personal hope. (United States)

    Wisman, Arnaud; Heflick, Nathan A


    Do people lose hope when thinking about death? Based on Terror Management Theory, we predicted that thoughts of death (i.e., mortality salience) would reduce personal hope for people low, but not high, in self-esteem, and that this reduction in hope would be ameliorated by promises of immortality. In Studies 1 and 2, mortality salience reduced personal hope for people low in self-esteem, but not for people high in self-esteem. In Study 3, mortality salience reduced hope for people low in self-esteem when they read an argument that there is no afterlife, but not when they read "evidence" supporting life after death. In Study 4, this effect was replicated with an essay affirming scientific medical advances that promise immortality. Together, these findings uniquely demonstrate that thoughts of mortality interact with trait self-esteem to cause changes in personal hope, and that literal immortality beliefs can aid psychological adjustment when thinking about death. Implications for understanding personal hope, trait self-esteem, afterlife beliefs and terror management are discussed.

  17. [Maternal mortality in the IMSS: an analysis from the perspective of mortality and lethality]. (United States)

    Velasco-Murillo, Vitelio; Navarrete-Hernández, Eduardo


    To assess the incidence of hospital maternal mortality in the population covered by the Mexican Institute of Social Security (IMSS) from 2000 to 2003, utilizing the rates of the main causes of morbidity and lethality, in order to gain a better understanding of this epidemiological picture. We collected information from 3,357,346 hospital deliveries and 832 maternal deaths that occurred in the medical units of the IMSS during the above-mentioned years. For the specific analysis of mortality, morbidity and lethality, deliveries and deaths with diagnoses of mild preeclampsia, severe preeclampsia, eclampsia, placenta previa, postpartum hemorrhage, chorioamnionitis and puerperal sepsis were selected, based on the criteria of International Diseases Classification, Tenth Revision. For statistical differences we used the chi(2). Maternal mortality registered a reduction of 25.1% (39 x 100,000 live births in 2000 and 29.2% in 2003). Morbidity increased by 6.6%. Morbidity and lethality caused by preeclampsia, obstetrical hemorrhages and puerperal sepsis (56.7% of the total deaths) showed a significant decrease in most cases. Specific morbidity showed no changes. We observed a decrease in the rate of hospital maternal mortality during the years of the study, linked to a reduction in lethality of these three main causes. This epidemiological picture may demonstrate the optimal quality in obstetrical care, because no reported changes in morbidity levels were registered.

  18. Rational reconstruction of frailty-based mortality models by a generalisation of Gompertz' law of mortality

    NARCIS (Netherlands)

    Willemse, W.J.; Kaas, R.


    A generalisation of Gompertz' distribution is proposed, and it is shown that continuous heterogeneous mortality models with Gamma distributed frailty have lifetime random variables distributed as the difference of two such generalised Gompertz random variables. With this result, limitations of exist

  19. Medieval monastic mortality: hazard analysis of mortality differences between monastic and nonmonastic cemeteries in England. (United States)

    DeWitte, Sharon N; Boulware, Jessica C; Redfern, Rebecca C


    Scholarship on life in medieval European monasteries has revealed a variety of factors that potentially affected mortality in these communities. Though there is some evidence based on age-at-death distributions from England that monastic males lived longer than members of the general public, what is missing from the literature is an explicit examination of how the risks of mortality within medieval monastic settings differed from those within contemporaneous lay populations. This study examines differences in the hazard of mortality for adult males between monastic cemeteries (n = 528) and non-monastic cemeteries (n = 368) from London, all of which date to between AD 1050 and 1540. Age-at-death data from all cemeteries are pooled to estimate the Gompertz hazard of mortality, and "monastic" (i.e., buried in a monastic cemetery) is modeled as a covariate affecting this baseline hazard. The estimated effect of the monastic covariate is negative, suggesting that individuals in the monastic communities faced reduced risks of dying compared to their peers in the lay communities. These results suggest better diets, the positive health benefits of religious behavior, better living conditions in general in monasteries, or selective recruitment of healthy or higher socioeconomic status individuals.

  20. [Liver cirrhosis mortality in Mexico. II. Excess mortality and pulque consumption]. (United States)

    Narro-Robles, J; Gutiérrez-Avila, J H; López-Cervantes, M; Borges, G; Rosovsky, H


    Over the years high cirrhosis mortality rates have been reported in Mexico City and in the surrounding states (Hidalgo, Tlaxcala, Puebla and the State of Mexico); on the contrary, well defined areas, such as the northern states, have shown a considerably lower mortality rate. This situation may indicate that some factors such as the pattern of alcoholic intake and other environmental characteristics could explain this striking difference. To determine the role of alcohol, the availability and consumption of alcohol at regional and state level were compared with cirrhosis mortality rates. A high and statistically significant correlation was found with pulque availability and consumption (r = 72-92%, p less than 0.01) in all periods of time under examination. On the contrary, a statistically significant negative association was observed with beer consumption and a positive, but not significant correlation, with distilled alcoholic beverages. Infectious hepatitis incidence, prevalence of exclusive use of native languages (as an indirect index of ethnic background) and nutritional deficiencies were also studied as possible risk factors. Nutritional deficiencies and the prevalence of exclusive use of náhuatl and otomí languages were positively correlated. These results can be useful to conduct further epidemiological studies still needed to determine the etiologic role of pulque consumption as well as of the other risk factors. Nonetheless, the current data stress the need to implement public health programs to reduce alcohol consumption, especially pulque, and to minimize the impact of these risk factors in high mortality areas.

  1. Rational reconstruction of frailty-based mortality models by a generalisation of Gompertz' law of mortality

    NARCIS (Netherlands)

    W.J. Willemse; R. Kaas


    A generalisation of Gompertz' distribution is proposed, and it is shown that continuous heterogeneous mortality models with Gamma distributed frailty have lifetime random variables distributed as the difference of two such generalised Gompertz random variables. With this result, limitations of exist

  2. Early mortality experience in a large military cohort and a comparison of mortality data sources

    Directory of Open Access Journals (Sweden)

    Smith Besa


    Full Text Available Abstract Background Complete and accurate ascertainment of mortality is critically important in any longitudinal study. Tracking of mortality is particularly essential among US military members because of unique occupational exposures (e.g., worldwide deployments as well as combat experiences. Our study objectives were to describe the early mortality experience of Panel 1 of the Millennium Cohort, consisting of participants in a 21-year prospective study of US military service members, and to assess data sources used to ascertain mortality. Methods A population-based random sample (n = 256,400 of all US military service members on service rosters as of October 1, 2000, was selected for study recruitment. Among this original sample, 214,388 had valid mailing addresses, were not in the pilot study, and comprised the group referred to in this study as the invited sample. Panel 1 participants were enrolled from 2001 to 2003, represented all armed service branches, and included active-duty, Reserve, and National Guard members. Crude death rates, as well as age- and sex-adjusted overall and age-adjusted, category-specific death rates were calculated and compared for participants (n = 77,047 and non-participants (n = 137,341 based on data from the Social Security Administration Death Master File, Department of Veterans Affairs (VA files, and the Department of Defense Medical Mortality Registry, 2001-2006. Numbers of deaths identified by these three data sources, as well as the National Death Index, were compared for 2001-2004. Results There were 341 deaths among the participants for a crude death rate of 80.7 per 100,000 person-years (95% confidence interval [CI]: 72.2,89.3 compared to 820 deaths and a crude death rate of 113.2 per 100,000 person-years (95% CI: 105.4, 120.9 for non-participants. Age-adjusted, category-specific death rates highlighted consistently higher rates among study non-participants. Although there were advantages and

  3. Mortality in Central Java: results from the indonesian mortality registration system strengthening project

    Directory of Open Access Journals (Sweden)

    Irianto Joko


    Full Text Available Abstract Background Mortality statistics from death registration systems are essential for health policy and development. Indonesia has recently mandated compulsory death registration across the entire country in December 2006. This article describes the methods and results from activities to ascertain causes of registered deaths in two pilot registration areas in Central Java during 2006-2007. The methods involved several steps, starting with adaptation of international standards for reporting causes of registered deaths for implementation in two sites, Surakarta (urban and Pekalongan (rural. Causes for hospital deaths were certified by attending physicians. Verbal autopsies were used for home deaths. Underlying causes were coded using ICD-10. Completeness of registration was assessed in a sample of villages and urban wards by triangulating data from the health sector, the civil registration system, and an independent household survey. Finally, summary mortality indicators and cause of death rankings were developed for each site. Findings A total of 10,038 deaths were registered in the two sites during 2006-2007; yielding annual crude death rates of 5.9 to 6.8 per 1000. Data completeness was higher in rural areas (72.5% as compared to urban areas (52%. Adjusted life expectancies at birth were higher for both males and females in the urban population as compared to the rural population. Stroke, ischaemic heart disease and chronic respiratory disease are prominent causes in both populations. Other important causes are diabetes and cancer in urban areas; and tuberculosis and diarrhoeal diseases in rural areas. Conclusions Non-communicable diseases cause a significant proportion of premature mortality in Central Java. Implementing cause of death reporting in conjunction with death registration appears feasible in Indonesia. Better collaboration between health and registration sectors is required to improve data quality. These are the first local

  4. Maternal mortality ratio in Lebanon in 2008: a hospital-based reproductive age mortality study (RAMOS). (United States)

    Hobeika, Elie; Abi Chaker, Samer; Harb, Hilda; Rahbany Saad, Rita; Ammar, Walid; Adib, Salim


    International agencies have recently assigned Lebanon to the group H of countries with "no national data on maternal mortality," and estimated a corresponding maternal mortality ratio (MMR) of 150 per 100,000 live births. The Ministry of Public Health addressed the discrepancy perceived between the reality of the maternal mortality ratio experience in Lebanon and the international report by facilitating a hospital-based reproductive age mortality study, sponsored by the World Health Organization Representative Office in Lebanon, aiming at providing an accurate estimate of a maternal mortality ratio for 2008. The survey allowed a detailed analysis of maternal causes of deaths. Reproductive age deaths (15-49 years) were initially identified through hospital records. A trained MD traveled to each hospital to ascertain whether recorded deaths were in fact maternal deaths or not. ICD10 codes were provided by the medical controller for each confirmed maternal deaths. There were 384 RA death cases, of which 13 were confirmed maternal deaths (339%) (numerator). In 2008, there were 84823 live births in Lebanon (denominator). The MMR in Lebanon in 2008 was thus officially estimated at 23/100,000 live births, with an "uncertainty range" from 153 to 30.6. Hemorrhage was the leading cause of death, with double the frequency of all other causes (pregnancy-induced hypertension, eclampsia, infection, and embolism). This specific enquiry responded to a punctual need to correct a clearly inadequate report, and it should be relayed by an on-going valid surveillance system. Results indicate that special attention has to be devoted to the management of peri-partum hemorrhage cases. Arab, postpartum hemorrhage, development, pregnancy management, verbal autopsy

  5. Mortality trends among Alaska Native people: successes and challenges

    Directory of Open Access Journals (Sweden)

    Peter Holck


    Full Text Available Background . Current mortality rates are essential for monitoring, understanding and developing policy for a population's health. Disease-specific Alaska Native mortality rates have been undergoing change. Objective . This article reports recent mortality data (2004–2008 for Alaska Native/American Indian (AN/AI people, comparing mortality rates to US white rates and examines changes in mortality patterns since 1980. Design . We used death record data from the state of Alaska, Department of Vital Statistics and SEER*Stat software from the National Cancer Institute to calculate age-adjusted mortality rates. Results . Annual age-adjusted mortality from all-causes for AN/AI persons during the period 2004–2008 was 33% higher than the rate for US whites (RR=1.33, 95% CI 1.29–1.38. Mortality rates were higher among AN/AI males than AN/AI females (1212/100,000 vs. 886/100,000. Cancer remained the leading cause of death among AN/AI people, as it has in recent previous periods, with an age-adjusted rate of 226/100,000, yielding a rate ratio (RR of 1.24 compared to US whites (95% CI 1.14–1.33. Statistically significant higher mortality compared to US white mortality rates was observed for nine of the ten leading causes of AN/AI mortality (cancer, unintentional injury, suicide, alcohol abuse, chronic obstructive pulmonary disease [COPD], cerebrovascular disease, chronic liver disease, pneumonia/influenza, homicide. Mortality rates were significantly lower among AN/AI people compared to US whites for heart disease (RR=0.82, the second leading cause of death. Among leading causes of death for AN/AI people, the greatest disparities in mortality rates with US whites were observed in unintentional injuries (RR=2.45 and suicide (RR=3.53. All-cause AN/AI mortality has declined 16% since 1980–1983, compared to a 21% decline over a similar period among US whites. Conclusion . Mortality rates and trends are essential to understanding the health of a

  6. Global Inequalities in Youth Mortality, 2007-2012

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    Gopal K. Singh, PhD


    Full Text Available Objectives: There is limited cross-national research on youth mortality. We examined age- and gender variations in all-cause mortality among youth aged 15-34 years across 52 countries. Methods: Using the 2014 WHO mortality database, mortality rates for all countries were computed for the latest available year between 2007 and 2012. Rates, rate ratios, and ordinary least squares (OLS and Poisson regression were used to analyze international variation in mortality. Results: Mortality rates among youth aged 15-34 years varied from a low of 28.4 deaths per 100,000 population for Hong Kong to a high of 250.6 for Russia and 619.1 for South Africa. For men aged 15-34, Singapore and Hong Kong had the lowest mortality rates (≈40 per 100,000, compared with South Africa and Russia with rates of 589.7 and 383.3, respectively. Global patterns in mortality among women were similar. Youth aged 15-24 in South Africa had 14 times higher mortality and those in the Philippines, Mexico, Russia, Colombia, and Brazil had 5-7 times higher mortality than those in Hong Kong. Youth aged 25-34 in Russia and South Africa had, respectively, 10 and 29 times higher mortality than their counterparts in Hong Kong. United States (US had the 12th highest mortality rate among youth aged 15-24 and the 13th highest rate among youth aged 25-34. Overall, the US youth had 2-3 times higher rates of mortality than their counterparts in many industrialized countries including Hong Kong, Singapore, Netherlands, Switzerland, Germany, Norway, and Sweden. Income inequality, unemployment rate, and human development explained 50-66% of the global variance in youth mortality. Compared to the countries with low unemployment and income inequality and high human development levels, countries with high unemployment and income inequality and low human development had, respectively, 343%, 213%, and 205% higher risks of youth mortality. Conclusions and Global Health Implications: Marked international

  7. Serotonin's role in piglet mortality and thriftiness. (United States)

    Dennis, R L; McMunn, K A; Cheng, H W; Marchant-Forde, J N; Lay, D C


    Improving piglet survivability rates is of high priority for swine production as well as for piglet well-being. Dysfunction in the serotonin (5-HT) system has been associated with growth deficiencies, infant mortalities, or failure to thrive in human infants. The aim of this research was to determine if a relationship exists between infant mortality and failure to thrive (or unthriftiness), and umbilical 5-HT concentration in piglets. Umbilical blood was collected from a total of 60 piglets from 15 litters for analysis of 5-HT and tryptophan (Trp; the AA precursor to 5-HT) concentrations. Behavior was scan sampled for the first 2 days after birth. Brain samples were also taken at 8 h after birth from healthy and unthrifty piglets (n = 4/group). The raphe nucleus was dissected out and analyzed for 5-HT and dopamine concentrations as well as their major metabolites 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA), respectively. Data were analyzed by ANOVA. Piglets that died within 48 h of birth (n = 14) had significantly lower umbilical blood 5-HT concentrations at the time of their birth compared to their healthy counterparts (n = 46, P = 0.003). However, no difference in Trp was detected (P 0.38). Time spent under the heat lamp and sleeping were positively correlated with umbilical 5-HT levels (P = 0.004 and P = 0.02, respectively), while inactivity had a negative correlation with 5-HT levels (P = 0.04). In the raphe nucleus, the center for brain 5-HT biosynthesis, unthrifty piglets had a greater concentration of 5-HIAA (P = 0.02) and a trend for higher concentrations of 5-HT (P = 0.07) compared with healthy piglets. Dopamine levels did not differ between thrifty and unthrifty piglets (P = 0.45); however, its metabolite HVA tended to be greater in unthrifty piglets (P = 0.05). Our results show evidence of serotonergic dysfunction, at both the central and peripheral levels, accompanying early piglet mortalities. These data suggest a possible route for

  8. Factors associated with mortality in tuberculosis patients

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    Roya Alavi-Naini


    Full Text Available Background: Tuberculosis (TB is one of the main causes of morbidity and mortality in different societies. Understanding factors leading to death following diagnosis of TB is important to predict prognosis in TB patients. The aim of this study was to identify common risk factors associated with death in patients with an in-hospital diagnosis of TB, in a city in Iran with the highest prevalence and incidence of TB in the country. Materials and Methods: A retrospective study was conducted at a university-affiliated hospital, Zahedan, in the south-east of Iran, which is a referral center for TB. To identify factors leading to death, medical records of 715 patients ≥15 years old with pulmonary TB from February 2002 to February 2011 have been evaluated. Registered factors included smoking, human immune deficiency virus (HIV infection, using drugs, lung cancer, drug hepatitis following anti-TB medications, diabetes mellitus, previous TB treatment, anemia; and results of sputum smears. Univariate comparison and multiple logistic regression were performed to identify factors associated with mortality in TB patients. Results: Among 715 registered TB patients, 375 (52.5% patients were male; among those, 334 (53% were in the alive group and 41 (54% in the death group. Seventy-five (10.5% of the total number of TB patients died during TB treatment. The multivariate model showed that anemia (AOR: 19.8, 95% CI: 5.6-35.5, positive sputum smear (AOR: 13.4, 95% CI: 6.8-33.6, smoking (AOR: 12.9, 95% CI: 3.9-27.3, drug hepatitis (AOR: 12.3, 95% CI: 6.7-24.7, diabetes mellitus (AOR: 9.7, 95% CI: 2.9-32.0, drug use (AOR: 7.8, 95% CI: 2.4-25.5, and history of previous TB (AOR: 6.8, 95% CI: 2.2-21.3 were major risk factors for death in TB patients. Conclusion: Monitoring co-morbid conditions like diabetes mellitus and anemia are important to reduce death rate in TB patients. Preventive measures for smoking and drug addiction also play an important role to decrease

  9. Tree mortality predicted from drought-induced vascular damage (United States)

    Anderegg, William R. L.; Flint, Alan L.; Huang, Cho-ying; Flint, Lorraine E.; Berry, Joseph A.; Davis, Frank W.; Sperry, John S.; Field, Christopher B.


    The projected responses of forest ecosystems to warming and drying associated with twenty-first-century climate change vary widely from resiliency to widespread tree mortality1, 2, 3. Current vegetation models lack the ability to account for mortality of overstorey trees during extreme drought owing to uncertainties in mechanisms and thresholds causing mortality4, 5. Here we assess the causes of tree mortality, using field measurements of branch hydraulic conductivity during ongoing mortality in Populus tremuloides in the southwestern United States and a detailed plant hydraulics model. We identify a lethal plant water stress threshold that corresponds with a loss of vascular transport capacity from air entry into the xylem. We then use this hydraulic-based threshold to simulate forest dieback during historical drought, and compare predictions against three independent mortality data sets. The hydraulic threshold predicted with 75% accuracy regional patterns of tree mortality as found in field plots and mortality maps derived from Landsat imagery. In a high-emissions scenario, climate models project that drought stress will exceed the observed mortality threshold in the southwestern United States by the 2050s. Our approach provides a powerful and tractable way of incorporating tree mortality into vegetation models to resolve uncertainty over the fate of forest ecosystems in a changing climate.

  10. Osteoporosis-Related Mortality: Time-Trends and Predictive Factors

    Directory of Open Access Journals (Sweden)

    Nelly Ziadé


    Full Text Available Osteoporosis is one of the leading causes of handicap worldwide and a major contributor to the global burden of diseases. In particular, osteoporosis is associated with excess mortality. We reviewed the impact of osteoporosis on mortality in a population by defining three categories: mortality following hip fractures, mortality following other sites of fractures, and mortality associated with low bone mineral density (BMD. Hip fractures, as well as other fractures at major sites are all associated with excess mortality, except at the forearm site. This excess mortality is higher during the first 3-6 months after the fracture and then declines over time, but remains higher than the mortality of the normal population up to 22 years after the fracture. Low BMD is also associated with high mortality, with hazard ratios of around 1.3 for every decrease in 1 standard deviation of bone density at 5 years, independently of fractures, reflecting a more fragile population. Finally predictors of mortality were identified and categorised in demographic known factors (age and male gender and in factors reflecting a poor general health status such as the number of comorbidities, low mental status, or level of social dependence. Our results indicate that the management of a patient with osteoporosis should include a multivariate approach that could be based on predictive models in the future.

  11. Factors contributing to amphibian road mortality in a wetland

    Institute of Scientific and Technical Information of China (English)

    Haijun GU; Qiang DAI; Qian WANG; Yuezhao WANG


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

  12. Warm Season Temperature-Mortality Relationships in Chisinau (Moldova

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    Roman Corobov


    Full Text Available Results of the epidemiological study of relationships between air temperature and daily mortality in Chisinau (Moldova are presented. The research’s main task included description of mortality dependence on different temperature variables and identification of thermal optimum (minimal mortality temperature, MMT. Total daily deaths were used to characterize the mortality of urban and rural populations in April–September of 2000–2008, excluding the extremely warm season of 2007. The simple moving average procedure and 2nd-order polynomials were used for daily mean (Tmean, maximum (Tmax, and minimum (Tmin temperatures and mortality approximation. Thermal optimum for mortality in Chisinau (15.2 deaths was observed at Tmean, Tmax, and Tmin about 22°C, 27-28°C, and 17-18°C, respectively. Considering these values as certain cut-points, the correlations between temperature and mortality were estimated below and above MMTs. With air temperatures below its optimal value, each additional 1°C increase of Tmean (Tmax, Tmin was accompanied by 1.40% (1.35%, 1.52% decrease in daily mortality. The increase of Tmean and Tmax above optimal values was associated with ~2.8% and 3.5% increase of mortality; results for Tmin were not statistically significant. The dependency of mortality on apparent temperature was somewhat weaker below MMT; a significant relationship above MMT was not identified.

  13. Influenza excess mortality from 1950-2000 in tropical Singapore.

    Directory of Open Access Journals (Sweden)

    Vernon J Lee

    Full Text Available INTRODUCTION: Tropical regions have been shown to exhibit different influenza seasonal patterns compared to their temperate counterparts. However, there is little information about the burden of annual tropical influenza epidemics across time, and the relationship between tropical influenza epidemics compared with other regions. METHODS: Data on monthly national mortality and population was obtained from 1947 to 2003 in Singapore. To determine excess mortality for each month, we used a moving average analysis for each month from 1950 to 2000. From 1972, influenza viral surveillance data was available. Before 1972, information was obtained from serial annual government reports, peer-reviewed journal articles and press articles. RESULTS: The influenza pandemics of 1957 and 1968 resulted in substantial mortality. In addition, there were 20 other time points with significant excess mortality. Of the 12 periods with significant excess mortality post-1972, only one point (1988 did not correspond to a recorded influenza activity. For the 8 periods with significant excess mortality periods before 1972 excluding the pandemic years, 2 years (1951 and 1953 had newspaper reports of increased pneumonia deaths. Excess mortality could be observed in almost all periods with recorded influenza outbreaks but did not always exceed the 95% confidence limits of the baseline mortality rate. CONCLUSION: Influenza epidemics were the likely cause of most excess mortality periods in post-war tropical Singapore, although not every epidemic resulted in high mortality. It is therefore important to have good influenza surveillance systems in place to detect influenza activity.

  14. Disparities in cervical and breast cancer mortality in Brazil

    Directory of Open Access Journals (Sweden)

    Vania Reis Girianelli


    Full Text Available OBJECTIVE To analyze cervical and breast cancer mortality in Brazil according to socioeconomic and welfare indicators. METHODS Data on breast and cervical cancer mortality covering a 30-year period (1980-2010 were analyzed. The data were obtained from the National Mortality Database, population data from the Brazilian Institute of Geography and Statistics database, and socioeconomic and welfare information from the Institute of Applied Economic Research. Moving averages were calculated, disaggregated by capital city and municipality. The annual percent change in mortality rates was estimated by segmented linear regression using the joinpoint method. Pearson’s correlation coefficients were conducted between average mortality rate at the end of the three-year period and selected indicators in the state capital and each Brazilian state. RESULTS There was a decline in cervical cancer mortality rates throughout the period studied, except in municipalities outside of the capitals in the North and Northeast. There was a decrease in breast cancer mortality in the capitals from the end of the 1990s onwards. Favorable socioeconomic indicators were inversely correlated with cervical cancer mortality. A strong direct correlation was found with favorable indicators and an inverse correlation with fertility rate and breast cancer mortality in inner cities. CONCLUSIONS There is an ongoing dynamic process of increased risk of cervical and breast cancer and attenuation of mortality because of increased, albeit unequal, access to and provision of screening, diagnosis and treatment.

  15. Winter Season Mortality: Will Climate Warming Bring Benefits? (United States)

    Kinney, Patrick L.; Schwartz, Joel; Pascal, Mathilde; Petkova, Elisaveta; Tertre, Alain Le; Medina, Sylvia; Vautard, Robert


    Extreme heat events are associated with spikes in mortality, yet death rates are on average highest during the coldest months of the year. Under the assumption that most winter excess mortality is due to cold temperature, many previous studies have concluded that winter mortality will substantially decline in a warming climate. We analyzed whether and to what extent cold temperatures are associated with excess winter mortality across multiple cities and over multiple years within individual cities, using daily temperature and mortality data from 36 US cities (1985-2006) and 3 French cities (1971-2007). Comparing across cities, we found that excess winter mortality did not depend on seasonal temperature range, and was no lower in warmer vs. colder cities, suggesting that temperature is not a key driver of winter excess mortality. Using regression models within monthly strata, we found that variability in daily mortality within cities was not strongly influenced by winter temperature. Finally we found that inadequate control for seasonality in analyses of the effects of cold temperatures led to spuriously large assumed cold effects, and erroneous attribution of winter mortality to cold temperatures. Our findings suggest that reductions in cold-related mortality under warming climate may be much smaller than some have assumed. This should be of interest to researchers and policy makers concerned with projecting future health effects of climate change and developing relevant adaptation strategies. PMID:26495037

  16. Residential mobility, well-being, and mortality. (United States)

    Oishi, Shigehiro; Schimmack, Ulrich


    We tested the relation between residential mobility and well-being in a sample of 7,108 American adults who were followed for 10 years. The more residential moves participants had experienced as children, the lower the levels of well-being as adults. As predicted, however, the negative association between the number of residential moves and well-being was observed among introverts but not among extraverts. We further demonstrated that the negative association between residential mobility and well-being among introverts was explained by the relative lack of close social relationships. Finally, we found that introverts who had moved frequently as children were more likely to have died during the 10-year follow-up. Among extraverts, childhood residential mobility was unrelated to their mortality risk as adults. These findings indicate that residential moves can be a risk factor for introverts and that extraversion can be an interpersonal resource for social relationships and well-being in mobile societies.

  17. Mortality of American alligators attributed to cannibalism (United States)

    Delany, Michael F.; Woodward, Allan R.; Kiltie, Richard A.; Moore, Clinton T.


    Mortality of juvenile (Alligator mississippiensis) attributed to cannibalism on Orange Lake, Florida was examined. Alligator web tags used in mark–recapture studies were found in 12% of 267 stomachs sampled from alligators ≥168 cm TL. Captive alligators retained 76% of force-fed tags during a 588-d tag-retention trial. Models relating the probability of tag recovery to the annual probabilities of juvenile survival, cannibalism, tag retention, adult survival, and adult harvest suggested that cannibalism may on average remove 6–7% of the juvenile alligator population annually. Vulnerability continued to 140 cm TL (age 6–8 yr). Cannibalism of juveniles may serve to regulate the alligator population on Orange Lake. Alligator cannibalism may vary widely among populations, depending on demography and environmental conditions. The role and importance of cannibalism in alligator population dynamics should be more fully assessed and environmental and population factors that influence cannibalism identified to better evaluate management programs.

  18. Post-mortal lesions in freshwater environment. (United States)

    Vanin, Stefano; Zancaner, Silvano


    Postmortem animal feeding activity may cause considerable damage to bodies resulting in the modification of wounds, loss of identifying features and injury. Certain postmortem lesions may appear inflicted or non-inflicted antemortem injuries. At present, apart from cases in sea water, no data are available about post mortal lesions performed by aquatic organisms. This note that represents the first report concerning colonisation of a dead body by crustaceans a few hours after death, describes injuries caused by the amphipod Niphargus elegans on the face, and in particular on the eye region, of a young man dead by drowning. The lesions recorded in this case are comparable with the lesions caused by ants. The high plasticity in the food choice can allow Amphipoda to colonise drowning bodies in every moment after dead, however the benthonic behaviour of these animals suggests a more important role in the colonisation during post-mortem submersion periods.

  19. Vitamin D - Prevalence, mortality and bone pain

    DEFF Research Database (Denmark)

    Durup, Darshana Tiffany; Schwarz, Peter


    database, which came from the Copenhagen General Practitioners Laboratory was accessed and data from 2004-2010 included 25-hydroxyvitamin D measurements from almost 250,000 citizens from the Copenhagen area (the CopD study). It was found that 54.4% and 21.6% suffered from vitamin D insufficiency...... without hyperparathyroidism had decreased mortality compared to subjects suffering from hypovitaminosis D and raised serum PTH. Among 21.195 patients who had serum parathyroid hormone and serum calcium measured besides 25-hydroxyvitamin D, 10.5% of suffered from hyperparathyroidism secondary to vitamin D...... of pain questionnaires and quantified by the use of pressure algometry. The pain will decrease by normalization of vitamin D. To invent an animal model for clinical osteomalacic bone pain, fifty seven-month-old, female Spraque-Dawley rats were maintained four months on synthetic diets containing...

  20. Morbidity and mortality of complex spine surgery

    DEFF Research Database (Denmark)

    Karstensen, Sven; Bari, Tanvir; Gehrchen, Martin


    adverse events (AEs). PURPOSE: This study aimed to determine the mortality and examine the incidence of morbidity in patients undergoing complex spinal surgery, including pediatric patients, and to validate the SAVES system in a European population. STUDY DESIGN: A prospective, consecutive cohort study......BACKGROUND CONTEXT: Most literature on complications in spine surgery has been retrospective or based on national databases with few variables. The Spine AdVerse Events Severity (SAVES) system has been found reliable and valid in two Canadian centers, providing precise information regarding all...... was conducted using the SAVES version 2010 in the period from January 1, 2013 until December 31, 2013. A retrospective analysis was performed on all patients operated from November 1, 2011 until October 31, 2012 for comparison. PATIENT SAMPLE: Patients undergoing spinal surgery at a tertiary referral center...

  1. Cause-specific mortality after stroke

    DEFF Research Database (Denmark)

    Mogensen, Ulla Brasch; Olsen, Tom Skyhøj; Andersen, Klaus Kaae


    We investigated cause-specific mortality in relation to age, sex, stroke severity, and cardiovascular risk factor profile in the Copenhagen Stroke Study cohort with 10 years of follow-up. In a Copenhagen community, all patients admitted to the hospital with stroke during 1992-1993 (n = 988) were...... registered on admission. Evaluation included stroke severity, computed tomography scan, and a cardiovascular risk profile. Cause of death within 10 years according to death certificate information was classified as stroke, heart/arterial disease, or nonvascular disease. Competing-risks analyses were...... performed by cause-specific Cox regression after multiple imputation of missing data, assuming that values were missing at random. Death was due to stroke in 310 patients (31%), to heart/arterial disease in 209 patients (21%), and to nonvascular diseases in 289 patients (29%); 180 patients were still alive...

  2. Family aggregation of cardiovascular disease mortality

    DEFF Research Database (Denmark)

    Silventoinen, Karri; Hjelmborg, Jacob; Möller, Sören


    Background: Familial factors play an important role in the variation of risk factors of cardiovascular diseases (CVD), but less is known about how they affect the risk of death from CVD. We estimated familial aggregation of CVD mortality for twins offering the maximum level of risk due to genetic...... deaths from myocardial infarct and 4855 deaths occurred from stroke, with 1092 deaths from ischaemic stroke and 1159 deaths from haemorrhagic stroke. Relative recurrence risk ratios (RRRs) with 95% confidence intervals (95% CIs) for monozygotic and dizygotic twins were calculated. Results......: In the analyses pooling men and women, the RRR for monozygotic twins was 1.49 (95% CI 1.40-1.57) for CHD and 1.81 for any stroke (95% CI 1.54-2.09). The highest RRR was found for haemorrhagic stroke (3.53 95% CI 2.01-5.04). For dizygotic twins, the RRRs were generally lower. Conclusions: Family aggregation...


    Directory of Open Access Journals (Sweden)

    Vivek Manchanda


    Full Text Available Background: To assess the prognosis of surgical neonates at admission and the factors responsible for mortality in neonates.Material and Methods: A prospective study was conducted in a tertiary level hospital over 15 months and various clinical and biochemical parameters were collected and analyzed using STATA® and SPSS®.Results: On multivariate analysis of 165 neonates, early gestational age, respiratory distress and shock at presentation were the factors of poor prognosis in neonates. The factors could be related to poor antenatal care and sepsis acquired before transfer of the baby to the nursery. Conclusion: The improvement in antenatal care and asepsis during transfer and handling the babies is of utmost importance to improve the prognosis of surgical neonates.

  4. Anxiety Predicts Mortality in ICD Patients

    DEFF Research Database (Denmark)

    Kikkenborg Berg, Selina; Caspar Thygesen, Lau; Hastrup Svendsen, Jesper


    BACKGROUND: Although highly effective in preventing arrhythmic death, patients receiving an implantable cardioverter defibrillator (ICD) may still experience psychological difficulties such as anxiety, depression, and reduced quality of life. The objectives of this study were to describe patient...... receiving ICD between January 1, 2011 and June 30, 2011 (n = 499). The following instruments were used: SF-36, Hospital Anxiety and Depression Scale, HeartQoL, EQ-5D, and the Multidimensional Fatigue Inventory. RESULTS: The response rate was 72%. Mean age was 65.5 years and 82% patients were males. Fifty...... of perceived health, quality of life, and fatigue; for example, physical health 39.8 versus 44.3 points, compared to secondary prevention indication. Anxiety, poor perceived health, fatigue, and low quality of life were all predictors of mortality, anxiety being the strongest with an adjusted odds ratio of 4...

  5. Can mass media interventions reduce child mortality? (United States)

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


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

  6. The escape problem for mortal walkers

    CERN Document Server

    Grebenkov, D S


    We introduce and investigate the escape problem for random walkers that may eventually die, decay, bleach, or lose activity during their diffusion towards an escape or reactive region on the boundary of a confining domain. In the case of a first-order kinetics (i.e., exponentially distributed lifetimes), we study the effect of the associated death rate onto the survival probability, the exit probability, and the mean first passage time. We derive the upper and lower bounds and some approximations for these quantities. We reveal three asymptotic regimes of small, intermediate and large death rates. General estimates and asymptotics are compared to several explicit solutions for simple domains, and to numerical simulations. These results allow one to account for stochastic photobleaching of fluorescent tracers in bio-imaging, degradation of mRNA molecules in genetic translation mechanisms, or high mortality rates of spermatozoa in the fertilization process. This is also a mathematical ground for optimizing stor...

  7. Perinatal mortality at pre-Columbian Teotihuacan. (United States)

    Storey, R


    The skeletal population of 166 individuals from a low-status apartment compound of the pre-Columbian city of Teotihuacan contained 52 perinatal individuals. The most perilous time of the lifespan was around birth, as revealed by life table analysis. Femur length was not increasing during the last month of gestation, and individuals were probably shorter somatically at birth than modern standards or historic-period Arikara skeletal controls. The possibility of intrauterine growth retardation is investigated through paleo-pathological indicators of prenatal growth arrest. The evidence of prenatal stress and the high rate of mortality at birth seem to indicate that this New World preindustrial urban population faced similar health and nutritional stresses as Old World preindustrial cities.

  8. Smoking reduction, smoking cessation, and mortality

    DEFF Research Database (Denmark)

    Godtfredsen, Nina S; Holst, Claus; Prescott, Eva


    The authors investigated the association between changes in smoking habits and mortality by pooling data from three large cohort studies conducted in Copenhagen, Denmark. The study included a total of 19,732 persons who had been examined between 1967 and 1988, with reexaminations at 5- to 10-year...... intervals and a mean follow-up of 15.5 years. Date of death and cause of death were obtained by record linkage with nationwide registers. By means of Cox proportional hazards models, heavy smokers (>or=15 cigarettes/day) who reduced their daily tobacco intake by at least 50% without quitting between...... the first two examinations and participants who quit smoking were compared with persons who continued to smoke heavily. After exclusion of deaths occurring in the first 2 years of follow-up, the authors found the following adjusted hazard ratios for subjects who reduced their smoking: for cardiovascular...

  9. Cancer mortality and morbidity among rubber workers. (United States)

    Monson, R R; Fine, L J


    Mortality and morbidity from cancer among a cohort of 13,570 white male rubber workers were examined. Each man worked for at least 5 years at the Akron, Ohio, plant of the B. F. Goodrich Company. The potential period of follow-up was from January 1, 1940 to June 30, 1976. Departmental work histories were based primarily on records maintained by Local no. 5, United Rubber Workers. The occurrence of cancer was measured by death certificates and by a survey of Akron-area hospital tumor registries from 1964 to 1974. Two types of analyses were made: 1) an external comparison of mortality rates of rubber workers versus rates of U.S. white males, and 2) an internal comparison of cancer morbidity rates among persons who were employed in various work areas of the plant. Excess cases of specific cancers (observed/expected numbers) among workers in specific work areas included: stomach and intestine: rubber making (30/14.4); lung: tire curing (31/14.1), fuel cells and/or deicers (46/29.1); bladder: chemical plant (6/2.4), and tire building (16/10.7); skin cancer: tire assembly (12/1.9); brain cancer: tire assembly (8/2.0); lymphatic cancer: tire building (8/3.2); and leukemia: calendering (8/2.2), tire curing (8/2.6), tire building (12/7.5), elevators (4/1.4), tubes (4/1.6), and rubber fabrics (4/1.1). Agents that may be responsible for these excesses were considered.

  10. Diabetes and perinatal mortality in twin pregnancies.

    Directory of Open Access Journals (Sweden)

    Zhong-Cheng Luo

    Full Text Available BACKGROUND: Diabetes in pregnancy has been associated with a paradoxically reduced risk of neonatal death in twin pregnancies. Risk "shift" may be a concern in that the reduction in neonatal deaths may be due to an increase in fetal deaths (stillbirths. This study aimed to clarify the impact of diabetes on the risk of perinatal death (neonatal death plus stillbirth in twin pregnancies. METHODS: This was a retrospective cohort study of twin births using the largest available dataset on twin births (the U.S. matched multiple birth data 1995-2000; 19,676 neonates from diabetic pregnancies, 541,481 from non-diabetic pregnancies. Cox proportional hazard models were applied to estimate the adjusted hazard ratios (aHR of perinatal death accounting for twin cluster-level dependence. RESULTS: Comparing diabetic versus non-diabetic twin pregnancies, overall perinatal mortality rate was counterintuitively lower [2.1% versus 3.3%, aHR 0.70 (95% confidence intervals 0.63-0.78]. Individually, both stillbirth and neonatal mortality rates were lower in diabetic pregnancies, but we identified significant differences by gestational age and birth weight. Diabetes was associated with a survival benefit in pregnancies completed before 32 weeks [aHR 0.55 (0.48-0.63] or with birth weight =2500 g [aHR 2.20 (1.55-3.13]. CONCLUSIONS: Diabetes in pregnancy appears to be "protective" against perinatal death in twin pregnancies ending in very preterm or very low birth weight births. Prospective studies are required to clarify whether these patterns of risk are real, or they are artifacts of unmeasured confounders. Additional data correlating these outcomes with the types of diabetes in pregnancy are also needed to distinguish the effects of pre-gestational vs. gestational diabetes.

  11. Lower lung cancer mortality in obesity. (United States)

    Leung, Chi C; Lam, Tai H; Yew, Wing W; Chan, Wai M; Law, Wing S; Tam, Cheuk M


    Malignancy is the leading cause of death in Hong Kong, and lung cancer tops the list of all cancer deaths. A cohort of clients aged ≥65 years, enrolled at 18 elderly health centres in Hong Kong from 2000 to 2003, was followed up prospectively through linkage with the territory-wide death registry for causes of death until 31 December 2008, using the identity card number as unique identifier. All subjects with suspected cancer, significant weight loss of >5% within past 6 months or obstructive lung disease at the baseline were excluded. After a total of 423 061 person-years of follow-up, 932, 690 and 1433 deaths were caused by lung cancer, other tobacco-related malignancies and non-tobacco-related malignancies, respectively. Body mass index (BMI) was independently (and negatively) associated with death from lung cancer after adjustment for other baseline variables, whereas there was only a minor or no effect for other smoking-related malignancies and non-tobacco-related malignancies. Obesity with BMI ≥30 [adjusted hazard ratio (HR), 0.55, 95% confidence interval (CI) 0.38-0.80] was associated with reduced lung cancer mortality, which was more prominent than the opposing effect of underweight (adjusted HR, 1.38, 95% CI 1.05-1.79). Consistent effects of BMI were observed after stratification into never-smokers and ever-smokers and in sensitivity analysis after excluding deaths within the first 3 years. Obesity was associated with lower lung cancer mortality in this prospective cohort analysis. As the effect was rather specific for lung cancer, further studies are indicated to explore the underlying mechanism.

  12. Mortality and Embolic Potential of Cardiac Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Dias, Ricardo Ribeiro, E-mail:; Fernandes, Fábio; Ramires, Félix José Alvarez; Mady, Charles; Albuquerque, Cícero Piva; Jatene, Fábio Biscegli [Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP (Brazil)


    Cardiac tumors are rare, mostly benign with high embolic potential. To correlate the histological type of cardiac masses with their embolic potential, implantation site and long term follow up in patients undergoing surgery. Between January 1986 and December 2011, we retrospectively analyzed 185 consecutive patients who underwent excision of intracardiac mass (119 females, mean age 48±20 years). In 145 patients, the left atrium was the origin site. 72% were asymptomatic and prior embolization was often observed (19.8%). The diagnosis was established by echocardiography, magnetic resonance and histological examination. Most tumors were located in the left side of the heart. Myxoma was the most common (72.6%), followed by fibromas (6.9%), thrombi (6.4%) and sarcomas (6.4%). Ranging from 0.6cm to 15cm (mean 4.6 ± 2.5cm) 37 (19.8%) patients had prior embolization, stroke 10.2%, coronary 4.8%, peripheral 4.3% 5.4% of hospital death, with a predominance of malignant tumors (40% p < 0.0001). The histological type was a predictor of mortality (rhabdomyomas and sarcomas p = 0.002) and embolic event (sarcoma, lipoma and fibroelastoma p = 0.006), but not recurrence. Tumor size, atrial fibrillation, cavity and valve impairment were not associated with the embolic event. During follow-up (mean 80±63 months), there were 2 deaths (1.1%) and two recurrences 1 and 11 years after the operation, to the same cavity. Most tumors were located in the left side of the heart. The histological type was predictor of death and preoperative embolic event, while the implantation site carries no relation with mortality or to embolic event.

  13. Vitamin D, cardiovascular disease and mortality. (United States)

    Pilz, Stefan; Tomaschitz, Andreas; März, Winfried; Drechsler, Christiane; Ritz, Eberhard; Zittermann, Armin; Cavalier, Etienne; Pieber, Thomas R; Lappe, Joan M; Grant, William B; Holick, Michael F; Dekker, Jacqueline M


    A poor vitamin D status, i.e. low serum levels of 25-hydroxyvitamin D [25(OH)D], is common in the general population. This finding is of concern not only because of the classic vitamin D effects on musculoskeletal outcomes, but also because expression of the vitamin D receptor (VDR) and vitamin D metabolizing enzymes in the heart and blood vessels suggests a role of vitamin D in the cardiovascular system. VDR-knockout mice suffer from cardiovascular disease (CVD), and various experimental studies suggest cardiovascular protection by vitamin D, including antiatherosclerotic, anti-inflammatory and direct cardio-protective actions, beneficial effects on classic cardiovascular risk factors as well as suppression of parathyroid hormone (PTH) levels. In epidemiological studies, low levels of 25(OH)D are associated with increased risk of CVD and mortality. Data from randomized controlled trials (RCTs) are sparse and have partially, but not consistently, shown some beneficial effects of vitamin D supplementation on cardiovascular risk factors (e.g. arterial hypertension). We have insufficient data on vitamin D effects on cardiovascular events, but meta-analyses of RCTs indicate that vitamin D may modestly reduce all-cause mortality. Despite accumulating data suggesting that a sufficient vitamin D status may protect against CVD, we still must wait for results of large-scale RCTs before raising general recommendations for vitamin D in the prevention and treatment of CVD. In current clinical practice, the overall risks and costs of vitamin D supplementation should be weighed against the potential adverse consequences of untreated vitamin D deficiency.

  14. Changes in mortality in Pakistan 1960-88. (United States)

    Sathar, Z A


    General trends in Pakistan infant/child mortality, adult mortality, differentials in mortality, and prospects for future declines in mortality are presented. Future mortality declines are desired and recognized by government policy. Paucity of data and quality control issues cloud an accurate presentation of trends. The crude death rate (CDR) has nonetheless declined in 4 decades form 40-50/1000 in 1900 to 10-12/1000 in the late 1970s and early 1980s. The 1984-88 Pakistan Demographic Survey (PDS) reports a CDR of 10.8/1000. Life expectancy is expected to improve. The majority of deaths are infant/child related. Government policy aims to have 1 trained traditional birth attendant/village in order to improve maternal and child care. Although official statistics are in dispute, there is general agreement that infant mortality has declined particularly in neonatal mortality, i.e., infant mortality is now at 56-62/1000 and neonatal mortality 48/1000 in 1988. Data are derived from the Pakistan Fertility Survey (PFS), and Population Labor Force and Migration Survey (PLM) in the 1960-70s, the 1976-79 Population Growth Surveys (PGS), and the 1984-88 PDS. Lower death rates have also occurred among adults. Sex differentials in mortality have reversed, although the sex ratio still favors males; the improvement may be due to better reporting of female mortality. Life expectancy has improved for women, and there are gains over males. The disadvantage at 15-40 years has been eliminated. Differential mortality is expressed geographically, where urban mortality is much lower than in rural areas. There is a relationship between mothers who have some education and lower infant mortality. Labor force participation effects on mortality are dependent on the reasons for work: economic necessity or in pursuance of a career and supplemental income. Findings on the relationship between income or social class and mortality are equivocal. Improvements are dependent on further fertility

  15. The Local Beneath the National and Global - Institutional Education, Credentialed Natural Resource Management (NRM) and Rural Community (Un) Sustainability (United States)

    Franklin, Janice


    The implementation of strategies for national and global outcomes has in some instances left rural community resources and practices devalued and disturbed and rural people demoralised with the result that local community sustainability has been compromised. Formal education in Australia is about many things, but is rarely sympathetic towards…

  16. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016 : a systematic analysis for the Global Burden of Disease Study 2016

    NARCIS (Netherlands)

    Postma, Maarten


    BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify

  17. Regional variations in mortality rates of pancreatic cancer in China:Results from 1990-1992 national mortality survey

    Institute of Scientific and Technical Information of China (English)

    Ke-Xin Chen; Peizhong Peter Wang; Si-Wei Zhang; Lian-Di Li; Feng-Zhu Lu; Xi-Shan Hao


    AIM: To examine the regional variations in mortality rates of pancreatic cancer in China.METHODS: Aggregated mortality data of pancreatic cancer were extracted from the 1990-1992 national death of all causes and its mortality survey in China. Age specific and standardized mortality rates were calculated at both national and provincial levels with selected characteristics including sex and residence status.RESULTS: Mortality of pancreatic cancer ranked the ninth and accounted for 1.38 percent of the total malignancy deaths. The crude and age standardized mortality rates of pancreatic cancer in China in the period of 1990-1992 were 1.48/100 000 and 1.30/100 000, respectively. Substantial regional variations in mortality rates across China were observed with adjusted mortality rates ranging from 0.43/100 000 to 3.70/100 000 with an extremal value of 8.7.Urban residents had significant higher pancreatic mortality than rural residents.CONCLUSION: The findings of this study show different mortality rates of this disease and highlight the importance of further investigation on factors, which might contribute to the observed epidemiological patterns.

  18. [Morbidity and mortality related to gastroenteroanastomosis in advanced gastric cancer]. (United States)

    Berrospi, F; Ruiz, E; Morante, C; Celis, J; Montalbelti, J A


    Determination of the postoperative morbidity and mortality after gastroenterostomy in patients with unresectable gastric cancer. Retrospective review of clinical records of all patients with obstructive distal gastric cancer who underwent gastroenterostomy at the Instituto de Enfermedades Neoplásicas between 1980 and 1993. The following factors were analyzed: age, sex, hemoglobin, albumin, preoperative risk, ascites, extent of disease, operative time, hospital stay, morbidity and mortality. 198 gastroenterostomy were done with a morbidity and mortality rates of 20% and 10%, respectively. Pneumonia was the principal cause of postoperative morbidity and mortality. High operative risk, adjacent organ invasion by the tumor and peritoneal metastasis were factors associated with increased postoperative morbidity (p > 0.05). High operative risk was the only prognostic factor for postoperative mortality (p < 0.01). Because of high postoperative morbidity and mortality, gastroenterostomy should not be done in patients with unresectable gastric cancer and high preoperative risk.

  19. Circadian aspects of post-operative morbidity and mortality

    DEFF Research Database (Denmark)

    Kvaslerud, T.; Hansen, M.V.; Rosenberg, J.;


    concerning post-operative circadian disturbances. We also present the literature concerning circadian variation in post-operative morbidity and mortality. PubMed and the Cochrane database were searched for papers using a combination of 'circadian,' 'surgery,' 'post-operative,' 'mortality' and 'morbidity.......' Eleven relevant studies were found, and seven of these were excluded due to the use of time of surgery and not time of morbidity or mortality as the main variable. The results from the four articles showed a circadian distribution of morbidity and mortality that mimics the one seen without surgery....... There is a peak incidence of myocardial ischemia, fatal thromboembolism and sudden unexpected death in the morning hours. A circadian variation exists in post-operative morbidity and mortality. The observed circadian variation in post-operative morbidity and mortality may warrant a chronopharmacological approach...

  20. Depression and risk of mortality in people with diabetes mellitus

    DEFF Research Database (Denmark)

    van Dooren, Fleur E P; Nefs, Giesje; Schram, Miranda T


    OBJECTIVE: To examine the association between depression and all-cause and cardiovascular mortality in people with diabetes by systematically reviewing the literature and carrying out a meta-analysis of relevant longitudinal studies. RESEARCH DESIGN AND METHODS: PUBMED and PSYCINFO were searched...... for articles assessing mortality risk associated with depression in diabetes up until August 16, 2012. The pooled hazard ratios were calculated using random-effects models. RESULTS: Sixteen studies met the inclusion criteria, which were pooled in an overall all-cause mortality estimate, and five...... in a cardiovascular mortality estimate. After adjustment for demographic variables and micro- and macrovascular complications, depression was associated with an increased risk of all-cause mortality (HR = 1.46, 95% CI = 1.29-1.66), and cardiovascular mortality (HR = 1.39, 95% CI = 1.11-1.73). Heterogeneity across...

  1. Trends in maternal mortality in the United States. (United States)

    Neggers, Yasmin H


    Maternal mortality is a major global concern. Although a notable decline in maternal mortality in the United States occurred during the mid-20th century, this progress stalled during the late 20th century. Furthermore, maternal mortality rates have increased during the early 21st century. Around the year 2000 the maternal mortality rate began to rise and has since nearly doubled. Given that at least half of maternal deaths in the U.S. are preventable, the rise in maternal deaths in the U.S. is historic and worrisome. This overview will try to provide a context for understanding the problem of this rise in maternal mortality in the U.S. by briefly discussing how maternal mortality rates are reported from National Vital Statistics data and from a National Surveillance system. Trends and causes of maternal deaths and the difficulty with interpreting these trends will be discussed.

  2. [Situation of maternal mortality in Peru, 2000 - 2012]. (United States)

    dl Carpio Ancaya, Lucy


    We perform an analysis concerning the situation of maternal mortality in Peru, based on the information of the System of Epidemiologic Surveillance of Maternal Mortality of the General Directorate of Epidemiology of the Ministry of Health and the Family and Health Demographic Survey. We can see a decrease in the rates of maternal mortality between 2000 and 2012. The direct causes are the same but in different proportions according to the natural regions, being the hemorrhage the first cause of maternal mortality. The coverage of birth attention in health establishments has increased in the last years but it is still necessary to improve the capacity of quick response and the quality of the health services. Maternal mortality in Peru is related to inequity and lack of women empowerment to excerpt their rights, specially the sexual and reproductive rights. It is necessary to strengthen the strategies that have been implemented in order to accomplish of the reduction in maternal mortality in Peru.

  3. Polyandry Has No Detectable Mortality Cost in Female Mammals. (United States)

    Lemaître, Jean-François; Gaillard, Jean-Michel


    In several taxonomic groups, females mate with several males during a single reproductive cycle. Although there is evidence that polyandry provides some benefits to females, it often involves mortality costs. However, empirical evidences of mortality costs of polyandry have so far been reported only in invertebrates. Whether polyandry has mortality costs in vertebrates is currently unknown. In the present study, we aimed to fill the gap by investigating the relationships between the level of polyandry (measured either by male relative testes mass or the percentage of multiple paternities) and female patterns of mortality across mammals. While we found that the two metrics of female mortality co-varied with pace of life, we did not find any evidence that polyandry leads to either decreased median lifespan or increased aging rate in mammals. We discuss such an absence of detectable mortality costs of polyandry in female mammals in light of recent advances in the study of mammalian reproductive biology and life-history tactics.

  4. [Falls mortality trends in México, 1979-2010]. (United States)

    Celis-de la Rosa, Alfredo de Jesús; Méndez-Magaña, Ana; Orozco-Valerio, María; Baez-Baez, Guadalupe Laura; Dávalos-Guzmán, Julio César


    To analyze the mortality trend by accidental falls in Mexico, from 1979 to 2010. We used official mortality data in México. Variables included were mortality cause, place of lesion, age, sex, year of mortality registration, size of the town of occurrence, state, occupation, workplace falls. During that period, 124,509 deaths by accidental and intentional falls were registered; of these 77.03% were men. From 1989 (3.20 per 100,000) to 2010 (1.99 per 100,000), the mortality trend was falling (β = -0.053/ 100,000, p ≤ 0.001). In the majority of states, we found a decreased between 1993-1997 and 2006 to 2010, except in Aguascalientes, Puebla, Baja California Sur, Durango and Nuevo León. This is the first study in México that showed the descending trend of mortality in accidental falls in the last two decades.

  5. A life course approach to mortality in Mexico. (United States)

    Saenz, Joseph L; Wong, Rebeca


    Research on early life socioeconomic status (SES), education and mortality is less established in developing countries. This analysis aims to determine how SES and education are patterned across the life course and associated with adult mortality in Mexico. Data comes from 2001-2012 Mexican Health & Aging Study (Mexican adults age 50+, n= 11,222). Cox proportional hazard models predict mortality using baseline covariates. In unadjusted analyses, similar mortality was seen across levels of early life SES. Lower early life SES was associated with better survival after accounting for education in the younger cohort. Lower education was only associated with mortality in the younger cohort. Early life SES was associated with education but the relationship between education and mortality differed across cohorts in Mexico. Selective survival and differential returns to education may explain differences.

  6. An extension of relational methods in mortality estimations

    Directory of Open Access Journals (Sweden)


    Full Text Available Actuaries and demographers have a long tradition of utilising collateral data to improve mortality estimates. Three main approaches have been used to accomplish the improvement- mortality laws, model life tables, and relational methods. The present paper introduces a regression model that incorporates all of the beneficial principles from each of these approaches. The model is demonstrated on mortality data pertaining to various groups of life insured people in Sweden.

  7. Socio-economic determinants of mortality in Latin America. (United States)

    Behm, H


    The characteristics and sources of socioeconomic differentials of mortality in Latin America, in so far as they are currently known, are examined in an attempt to clarify the present situation and its perspectives. Mortality in a population is a function of the frequency of illness (incidence) and the probability of dying of the sick individual (lethality). Information on the socioeconomic differentials of mortality in Latin America is systematically reviewed with attention directed to the following: differentials among Latin American countries, regional differences within countries, urban-rural contrasts in mortality, mortality and income level and level of education, and mortality and ethnic groups. Latin America shows considerable heterogeneity with respect to the risk of dying, which varies from 202/1000 births in Bolivia to 38/1000 in Uruguay. It is estimated that more than 1/2 of the children born in Latin America are exposed to a mortality rate of over 120/1000. A study of the urban and rural populations of 12 Latin American countries revealed that the risk for rural populations exceeds that for urban populations by 30-60%. There is extensive evidence showing that mortality is higher in the working class and is associated with lower levels of education and income. Mortality was also higher in certain indigenous groups. Socioeconomic differentials of mortality are more marked in Latin America than in the developed nations. The mother's level of educational attainment is the variable most significantly associated with infant and child mortality. The prospect of reducing the current mortality levels is dependent primarily upon the implementation of policies aimed at a more egalitarian distribution of the benefits of socioeconomic development among the population.

  8. Siberian Pine Decline and Mortality in Southern Siberian Mountains (United States)

    Kharuk, V. I.; Im, S. T.; Oskorbin, P. A.; Petrov, I. A.; Ranson, K. J.


    The causes and resulting spatial patterns of Siberian pine mortality in eastern Kuznetzky Alatau Mountains, Siberia were analyzed based on satellite (Landsat, MODIS) and dendrochronology data. Climate variables studied included temperature, precipitation and Standardized Precipitation-Evapotranspiration Index (SPEI) drought index. Landsat data analysis showed that stand mortality was first detected in the year 2006 at an elevation of 650 m, and extended up to 900 m by the year 2012. Mortality was accompanied by a decrease in MODIS derived vegetation index (EVI).. The area of dead stands and the upper mortality line were correlated with increased drought. The uphill margin of mortality was limited by elevational precipitation gradients. Dead stands (i.e., >75% tree mortality) were located mainly on southern slopes. With respect to slope, mortality was observed within a 7 deg - 20 deg range with greatest mortality occurring on convex terrain. Tree radial incrementmeasurements correlate and were synchronous with SPEI (r sq = 0.37, r(sub s) = 80). Increasing synchrony between tree ring growth and SPEI indicates that drought has reduced the ecological niche of Siberian pine. The results also showed the primary role of drought stress on Siberian pine mortality. A secondary role may be played by bark beetles and root fungi attacks. The observed Siberian pine mortality is part of a broader phenomenon of "dark needle conifers" (DNC, i.e., Siberian pine, fir and spruce) decline and mortality in European Russia, Siberia, and the Russian Far East. All locations of DNC decline coincided with areas of observed drought increase. The results obtained are one of the first observations of drought-induced decline and mortality of DNC at the southern border of boreal forests. Meanwhile if model projections of increased aridity are correct DNC, within the southern part of its range may be replaced by drought-resistant Pinus silvestris and Larix sibirica.

  9. Iran Mortality and Measures of Risk: Rankings for Public policy


    M Aalabaf-Sabaghi


    "nBackground: This paper offers mortality risk rankings for Iranian mortality data. It extends methods to include mixed co­horts, tests changes in mortality risks, compares measures of risk and discusses public policy implications."nMethods: The methodology used in risk measures takes current practice and extends it to include variations in population dy­nam­ics. The specification is presented and compared with existing literature."nResults: Our findings...

  10. Leukemia Cancer Mortality Trend in Iran, From 1995 to 2004


    Fazeli, Zeinab; Pourhoseingholi, Mohamad Amin; Vahedi, Mohsen; Abadi, Alireza; Fazeli Bavand-Pour, Fatemeh Sadat; Baghestani, Ahmad Reza


    Background Cancer is the third most common cause of death in Iran, the leukemia cancer is one of the most important causes of cancer mortality. Regarding cancer mortality, data would be important to monitor the program screening effects, earlier diagnosis, demographic data and other prognostic factors. The aim of this study was mortality rates evaluating, then leukemia cancer trends among the Iranian population within almost a period of a decade, i.e. from 1995 to 2004. Methods National death...

  11. Child health and mortality in Guinea-Bissau

    DEFF Research Database (Denmark)

    Kovsted, Jens Anders; Pörtner, Claus Christian; Tarp, Finn


    This paper studies factors that influence child health in Bissau, the capital of Guinea-Bissau. This environment is characterised by high infant mortality, but not by malnutrition. We show that although maternal education is important in determining child health and mortality this effect diminishes...... or disappears when health knowledge is introduced as an explanatory variable. It emerges that health knowledge has large and positive effects on both child mortality and health when instrumented for to capture endogeneity...

  12. Comparative efficacy of tandem autologous versus autologous followed by allogeneic hematopoietic cell transplantation in patients with newly diagnosed multiple myeloma: a systematic review and meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Kharfan-Dabaja Mohamed A


    Full Text Available Abstract Background Despite advances in understanding of clinical, genetic, and molecular aspects of multiple myeloma (MM and availability of more effective therapies, MM remains incurable. The autologous-allogeneic (auto-allo hematopoietic cell transplantation (HCT strategy is based on combining cytoreduction from high-dose (chemo- or chemoradio-therapy with adoptive immunotherapy. However, conflicting results have been reported when an auto-allo HCT approach is compared to tandem autologous (auto-auto HCT. A previously published meta-analysis has been reported; however, it suffers from serious methodological flaws. Methods A systematic search identified 152 publications, of which five studies (enrolling 1538 patients met inclusion criteria. All studies eligible for inclusion utilized biologic randomization. Results Assessing response rates by achievement of at least a very good partial response did not differ among the treatment arms [risk ratio (RR (95% CI = 0.97 (0.87-1.09, p = 0.66]; but complete remission was higher in the auto-allo HCT arm [RR = 1.65 (1.25-2.19, p = 0.0005]. Event-free survival did not differ between auto-allo HCT group versus auto-auto HCT group using per-protocol analysis [hazard ratio (HR = 0.78 (0.58-1.05, p = 0.11] or using intention-to-treat analysis [HR = 0.83 (0.60-1.15, p = 0.26]. Overall survival (OS did not differ among these treatment arms whether analyzed on per-protocol [HR = 0.88 (0.33-2.35, p = 0.79], or by intention-to-treat [HR = 0.80 (0.48-1.32, p = 0.39] analysis. Non-relapse mortality (NRM was significantly worse with auto-allo HCT [RR (95%CI = 3.55 (2.17-5.80, p  Conclusion Despite higher complete remission rates, there is no improvement in OS with auto-allo HCT; but this approach results in higher NRM in patients with newly diagnosed MM. At present, totality of evidence suggests that an auto-allo HCT approach for patients with newly diagnosed

  13. Long-term survival and late events after allogeneic stem cell transplantation from HLA-matched siblings for acute myeloid leukemia with myeloablative compared to reduced-intensity conditioning: a report on behalf of the acute leukemia working party of European group for blood and marrow transplantation

    Directory of Open Access Journals (Sweden)

    Avichai Shimoni


    Full Text Available Abstract Background Myeloablative (MAC and reduced-intensity conditioning (RIC are established approaches for allogeneic stem cell transplantation (SCT in acute myeloid leukemia (AML. Most deaths after MAC occur within the first 2 years after SCT, while patients surviving leukemia-free for 2 years can expect a favorable long-term outcome. However, there is paucity of data on the long-term outcome (beyond 10 years and the pattern of late events following RIC due to the relative recent introduction of this approach. Methods We analyzed long-term outcomes in a cohort of 1423 AML patients, age ≥50 years, after SCT from HLA-matched siblings, during the years 1997–2005, median follow-up 8.3 years (0.1–17. Results The 10-year leukemia-free survival (LFS was 31 % (95CI, 27–35 and 32 % (28–35 after MAC and RIC, respectively (P = 0.57. The 10-year GVHD/ relapse-free survival (GRFS, a surrogate for quality of life was 22 % (18–25 and 21 % (18–24, respectively (P = 0.79. The 10-year non-relapse mortality (NRM was higher and relapse rate was lower after MAC, throughout the early and late post-transplant course. The 10-year LFS among 584 patients surviving leukemia-free 2 years after SCT was 71 % (65–76 and 73 % (67–78 after MAC and RIC, respectively (P = 0.76. Advanced leukemia at SCT was the major predictor of LFS subsequent to the 2-year landmark. Relapse was the major cause of late death after both regimens; however, NRM and in particular chronic graft-versus-host disease and second cancers were more common causes of late death after MAC. Conclusions Long-term LFS and GRFS are similar after RIC and MAC. Most events after RIC or MAC occur within the first 2 years after SCT. Patients who are leukemia-free 2 years after SCT can expect similar good subsequent outcome after both approaches.

  14. Impact of conditioning intensity in T-replete haplo-identical stem cell transplantation for acute leukemia: a report from the acute leukemia working party of the EBMT

    Directory of Open Access Journals (Sweden)

    Marie T. Rubio


    Full Text Available Abstract Background Increasing numbers of patients are receiving haplo-identical stem cell transplantation (haplo-SCT for treatment of acute leukemia with reduced intensity (RIC or myeloablative (MAC conditioning regimens. The impact of conditioning intensity in haplo-SCT is unknown. Methods We performed a retrospective registry-based study comparing outcomes after T-replete haplo-SCT for patients with acute myeloid (AML or lymphoid leukemia (ALL after RIC (n = 271 and MAC (n = 425. Regimens were classified as MAC or RIC based on published criteria. Results A combination of post-transplant cyclophosphamide (PT-Cy with one calcineurin inhibitor and mycophenolate mofetil (PT-Cy-based regimen for graft-versus-host disease (GVHD prophylaxis was used in 66 (25 % patients in RIC and 125 (32 % in MAC groups. Patients of RIC group were older and had been transplanted more recently and more frequently for AML with active disease at transplant. Percentage of engraftment (90 vs. 92 %; p = 0.58 and day 100 grade II to IV acute GVHD (24 vs. 29 %, p = 0.23 were not different between RIC and MAC groups. Multivariable analyses, run separately in AML and ALL, showed a trend toward higher relapse incidence with RIC in comparison to MAC in AML (hazard ratio (HR 1.34, p = 0.09, and no difference in both AML and ALL in terms of non-relapse mortality (NRM chronic GVHD and leukemia-free survival. There was no impact of conditioning regimen intensity in overall survival (OS in AML (HR = 0.97, p = 0.79 but a trend for worse OS with RIC in ALL (HR = 1.44, p = 0.10. The main factor impacting outcomes was disease status at transplantation (HR ≥ 1.4, p ≤ 0.01. GVHD prophylaxis with PT-Cy-based regimen was independently associated with reduced NRM (HR 0.63, p = 0.02 without impact on relapse incidence (HR 0.99, p = 0.94. Conclusions These data suggest that T-replete haplo-SCT with both RIC and MAC, in particular

  15. [Regional early mortality in relation to social and hospital structure]. (United States)

    Obladen, M


    Detailed analysis of governmental mortality statistics yields information on regional differences in the care for preterm infants in West Germany. 68% of newborn infants dying within the first 7 days of life are of low birth weight. In the 11 states, highest/lowest early neonatal mortality fell from 11.6/6.0 to 6.2/3.1 during the years 1978 to 1982. In the 31 administrative districts, a small negative correlation (r = -0.37) exists for neonatal mortality and tax revenue. Increased regional mortality indicates diminished regionalization of perinatal care for preterm infants.

  16. Social inequalities in neonatal mortality and living condition

    Directory of Open Access Journals (Sweden)

    Annelise C. Gonçalves


    Full Text Available Objective: To evaluate the association between the spatial distribution of neonatal mortality and living conditions, and to analyze trends in the social inequalities, related to this mortality, in Salvador, Bahia, Brazil, 2000 - 2006. Methods: The city's Information Zones, the unit of analysis used in this study, were grouped into strata reflecting high, intermediate, low and very low living conditions, based on a living conditions index (LCI. Neonatal mortality rates were calculated for each stratum. Spearman's correlation, linear regression and relative risks were used in the data analysis. Results: Neonatal mortality in Salvador was found to be associated with living conditions, with risks of 53, 56 and 59% greater, respectively, in the intermediate, low and very low strata, when compared to the high living conditions stratum. Only the intermediate living conditions stratum shows a significant decline in neonatal mortality (β = -0.93; p = 0.039. In the stratum of high living conditions, it was observed a stagnation of this mortality. Conclusions: Poorer living conditions were associated to higher risks of neonatal mortality. The slight decline in social inequalities, found in neonatal mortality, was due to a decline in the intermediate living conditions stratum. Although dependent on the access to quality healthcare services and life support technologies, a more consistent reduction in the neonatal mortality and its associated inequalities will only be achieved when broader-reaching public policies are implemented, improving the living conditions, and mainly focusing on priority groups.

  17. Mortality of atomic bomb survivors predicted from laboratory animals (United States)

    Carnes, Bruce A.; Grahn, Douglas; Hoel, David


    Exposure, pathology and mortality data for mice, dogs and humans were examined to determine whether accurate interspecies predictions of radiation-induced mortality could be achieved. The analyses revealed that (1) days of life lost per unit dose can be estimated for a species even without information on radiation effects in that species, and (2) accurate predictions of age-specific radiation-induced mortality in beagles and the atomic bomb survivors can be obtained from a dose-response model for comparably exposed mice. These findings illustrate the value of comparative mortality analyses and the relevance of animal data to the study of human health effects.

  18. A new drought tipping point for conifer mortality (United States)

    Kolb, Thomas E.


    (Huang et al 2015 Environ. Res. Lett. 10 024011) present a method for predicting mortality of ponderosa pine (Pinus ponderosa) and pinyon pine (Pinus edulis) in the Southwestern US during severe drought based on the relationship between the standardized precipitation-evapotranspiration index (SPEI) and annual tree ring growth. Ring growth was zero when SPEI for September to July was -1.64. The threshold SPEI of -1.64 was successful in distinguishing areas with high tree mortality during recent severe drought from areas with low mortality, and is proposed to be a tipping point of drought severity leading to tree mortality. Below, I discuss this work in more detail.

  19. Socio-economic transition, inequality, and mortality in Lithuania. (United States)

    Kalediene, Ramune; Petrauskiene, Jadvyga


    The study assessed inequalities in mortality of Lithuanian urban and rural populations throughout the period of socio-economic transition (1990-2000). Mortality from major causes of death, except cancers in females, was higher among the rural population. Inequality in mortality increased during the period of transition, especially among males, mainly due to more rapidly improving health of the urban population. Cardiovascular diseases and external causes made the largest contribution to the inequality. Differences in mortality of urban and rural populations point to greater social and psychological stress affecting the rural population, unhealthy life styles, inequities in accessibility of health care and lack of preventive programs in rural areas.

  20. A cohort study on mortality and exposure to polychlorinated biphenyls. (United States)

    Hsieh, S F; Yen, Y Y; Lan, S J; Hsieh, C C; Lee, C H; Ko, Y C


    In 1979, an outbreak of food poisoning ("Yu-Cheng") occurred in Central Taiwan, ROC, involving more than 2000 people. The event was caused by ingestion of rice oil contaminated with polychlorinated derivatives of biphenyls, dibenzofurans, and quaterphenyls. A retrospective cohort study on mortality was undertaken, and possible long-term health effects in the affected individuals were studied. The mortality experience of 1940 victims (929 males, 1011 females) between 1980 and 1991 was compared with the expected numbers, which were calculated from national and local mortality rates. By the end of 1991, 102 deaths were identified, thus producing a standardized mortality ratio (SMR) of overall mortality of 0.99 for males and 1.34 for females. Total cancer mortality was lower than in each comparison group. Mortality from liver diseases was elevated significantly (SMR = 3.22), especially during the first 3 y after the food-poisoning event (SMR = 10.76). Increased clinical severity of polychlorinated biphenyl intoxication was associated with increased mortality from all causes and from liver diseases. In summary, there was a positive association between mortality and intoxication dose, and severe polychlorinated biphenyl poisoning acutely affected mainly the liver. A continued follow-up of this cohort would be valuable in the study of long-term health effects of polychlorinated biphenyl poisoning.

  1. Biodemography of old-age mortality in humans and rodents. (United States)

    Gavrilova, Natalia S; Gavrilov, Leonid A


    The growing number of persons living beyond age 80 underscores the need for accurate measurement of mortality at advanced ages and understanding the old-age mortality trajectories. It is believed that exponential growth of mortality with age (Gompertz law) is followed by a period of deceleration, with slower rates of mortality increase at older ages. This pattern of mortality deceleration is traditionally described by the logistic (Kannisto) model, which is considered as an alternative to the Gompertz model. Mortality deceleration was observed for many invertebrate species, but the evidence for mammals is controversial. We compared the performance (goodness-of-fit) of two competing models-the Gompertz model and the logistic (Kannisto) model using data for three mammalian species: 22 birth cohorts of U.S. men and women, eight cohorts of laboratory mice, and 10 cohorts of laboratory rats. For all three mammalian species, the Gompertz model fits mortality data significantly better than the "mortality deceleration" Kannisto model (according to the Akaike's information criterion as the goodness-of-fit measure). These results suggest that mortality deceleration at advanced ages is not a universal phenomenon, and survival of mammalian species follows the Gompertz law up to very old ages.

  2. Impact of screening mammography on breast cancer mortality. (United States)

    Bleyer, Archie; Baines, Cornelia; Miller, Anthony B


    The degree to which observed reductions in breast cancer mortality is attributable to screening mammography has become increasingly controversial. We examined this issue with three fundamentally different approaches: (i) Chronology--the temporal relationship of the onset of breast cancer mortality decline and the national implementation of screening mammography; (ii) Magnitude--the degree to which breast cancer mortality declined relative to the amount (penetration) of screening mammography; (iii) Analogy--the pattern of mortality rate reductions of other cancers for which population screening is not conducted. Chronology and magnitude were assessed with data from Europe and North America, with three methods applied to magnitude. A comparison of eight countries in Europe and North America does not demonstrate a correlation between the penetration of national screening and either the chronology or magnitude of national breast cancer mortality reduction. In the United States, the magnitude of the mortality decline is greater in the unscreened, younger women than in the screened population and regional variation in the rate of breast cancer mortality reduction is not correlated with screening penetrance, either as self-reported or by the magnitude of screening-induced increase in early-stage disease. Analogy analysis of United States data identifies 14 other cancers with a similar distinct onset of mortality reduction for which screening is not performed. These five lines of evidence from three different approaches and additional observations discussed do not support the hypothesis that mammography screening is a primary reason for the breast cancer mortality reduction in Europe and North America.

  3. A Synthesis of Human-related Avian Mortality in Canada

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    Anna M. Calvert


    Full Text Available Many human activities in Canada kill wild birds, yet the relative magnitude of mortality from different sources and the consequent effects on bird populations have not been systematically evaluated. We synthesize recent estimates of avian mortality in Canada from a range of industrial and other human activities, to provide context for the estimates from individual sources presented in this special feature. We assessed the geographic, seasonal, and taxonomic variation in the magnitude of national-scale mortality and in population-level effects on species or groups across Canada, by combining these estimates into a stochastic model of stage-specific mortality. The range of estimates of avian mortality from each source covers several orders of magnitude, and, numerically, landbirds were the most affected group. In total, we estimate that approximately 269 million birds and 2 million nests are destroyed annually in Canada, the equivalent of over 186 million breeding individuals. Combined, cat predation and collisions with windows, vehicles, and transmission lines caused > 95% of all mortality; the highest industrial causes of mortality were the electrical power and agriculture sectors. Other mortality sources such as fisheries bycatch can have important local or species-specific impacts, but are relatively small at a national scale. Mortality rates differed across species and families within major bird groups, highlighting that mortality is not simply proportional to abundance. We also found that mortality is not evenly spread across the country; the largest mortality sources are coincident with human population distribution, while industrial sources are concentrated in southern Ontario, Alberta, and southwestern British Columbia. Many species are therefore likely to be vulnerable to cumulative effects of multiple human-related impacts. This assessment also confirms the high uncertainty in estimating human-related avian mortality in terms of species

  4. Predictors of maternal mortality in institutional deliveries in Nigeria

    African Journals Online (AJOL)


    7. Hospital Services Management Board, Katsina, Nigeria. 8. Department of Obstetrics & Gynaecology, ... Key words: maternal mortality; maternal death; predictors .... instrumental delivery, symphysiotomy, or assisted ..... For this reason,.

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

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    Dolejs J


    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

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

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    Kenneth Hill

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

  7. Child mortality estimation: appropriate time periods for child mortality estimates from full birth histories.

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    Jon Pedersen

    Full Text Available BACKGROUND: Child mortality estimates from complete birth histories from Demographic and Health Surveys (DHS surveys and similar surveys are a chief source of data used to track Millennium Development Goal 4, which aims for a reduction of under-five mortality by two-thirds between 1990 and 2015. Based on the expected sample sizes when the DHS program commenced, the estimates are usually based on 5-y time periods. Recent surveys have had larger sample sizes than early surveys, and here we aimed to explore the benefits of using shorter time periods than 5 y for estimation. We also explore the benefit of changing the estimation procedure from being based on years before the survey, i.e., measured with reference to the date of the interview for each woman, to being based on calendar years. METHODS AND FINDINGS: Jackknife variance estimation was used to calculate standard errors for 207 DHS surveys in order to explore to what extent the large samples in recent surveys can be used to produce estimates based on 1-, 2-, 3-, 4-, and 5-y periods. We also recalculated the estimates for the surveys into calendar-year-based estimates. We demonstrate that estimation for 1-y periods is indeed possible for many recent surveys. CONCLUSIONS: The reduction in bias achieved using 1-y periods and calendar-year-based estimation is worthwhile in some cases. In particular, it allows tracking of the effects of particular events such as droughts, epidemics, or conflict on child mortality in a way not possible with previous estimation procedures. Recommendations to use estimation for short time periods when possible and to use calendar-year-based estimation were adopted in the United Nations 2011 estimates of child mortality.

  8. The association between BMI and mortality using offspring BMI as an indicator of own BMI: large intergenerational mortality study


    Davey Smith, George; Sterne, Jonathan AC; Fraser, Abigail; Tynelius, Per; Lawlor, Debbie A; Rasmussen, Finn


    Objectives To obtain valid estimates of the association between body mass index (BMI) and mortality by using offspring BMI as an instrumental variable for own BMI. Design Cohort study based on record linkage, with 50 years of follow-up for mortality. Associations of offspring BMI with all cause and cause specific maternal and paternal mortality were estimated as hazard ratios per standard deviation of offspring BMI. Setting A large intergenerational prospective population based database cover...

  9. [Socioeconomic inequalities and infant mortality in Bolivia]. (United States)

    Maydana, Edgar; Serral, Gemma; Borrell, Carme


    To evaluate socioeconomic inequalities and its relation to infant mortality in Bolivia's municipalities in 2001. An ecological study based on data from the 2001 National Census on Population and Housing (Censo Nacional de Población y Vivienda) covering the 327 municipalities in Bolivia's nine departments. The dependent variable was the infant mortality rate (IMR); the independent variables were indirect socioeconomic indicators (the percentage of illiterates older than 15 years of age, and the building materials and sanitation features of the houses). The geographic distribution of each indicator was determined and the associations between IMR and each socioeconomic indicator were calculate using Spearman's rank correlation coefficient and adjusted with Poisson regression models. The resulting IMR for Bolivia in 2001 was 67 per 1000 live births. Rates ranged from <0.1 per 1000 live births in the Magdalena municipality, Beni department, to 170.0 per 1000 live births in the Caripuyo municipality, Potosí department. The mean rate of illiteracy per municipality was 17.5%; the mean percentage of houses without running water was 90.4%, and for those lacking sanitation services, 67.6%. The IMR was inversely associated with all of the socioeconomic indicators studied. The highest relative risk was found in housing without sanitation services. Multifactorial models adjusted for illiteracy showed that the following indicators were still strongly associated with the IMR: no sanitation services (Relative risk (RR)=1.54; 95% Confidence Interval (95%CI)=1.38-1.66); adobe, stone, or mud walls (RR=1.54; 95%CI: 1.43-1.67); and, corrugated metal, straw, or palm branch roof (RR=1.34; 95%CI: 1.26-1.43). A significant association was found between poor socioeconomic status and high IMR in Bolivia's municipalities in 2001. The municipalities in the country's central and southeastern areas had lower socioeconomic status and higher IMR. The lack of education, absence of basic sanitation

  10. Donor Killer Immunoglobulin-Like Receptor Profile Bx1 Imparts a Negative Effect and Centromeric B-Specific Gene Motifs Render a Positive Effect on Standard-Risk Acute Myeloid Leukemia/Myelodysplastic Syndrome Patient Survival after Unrelated Donor Hematopoietic Stem Cell Transplantation. (United States)

    Bao, Xiaojing; Wang, Miao; Zhou, Huifen; Zhang, Huanhuan; Wu, Xiaojin; Yuan, Xiaoni; Li, Yang; Wu, Depei; He, Jun


    Donor killer immunoglobulin-like receptor (KIR) group B profiles (Bx) and homozygous of centromeric motif B (Cen-B/B) are the most preferable KIR gene content motifs for hematopoietic stem cell transplantation (HSCT). The risk of transplant from Bx1 donors and the benefit of the presence of Cen-B (regardless of number) were observed for standard-risk acute myeloid leukemia/myelodysplastic syndrome (AML/MDS) patients in this 4-year retrospective study. A total of 210 Chinese patients who underwent unrelated donor HSCT were investigated. Donor KIR profile Bx was associated with significantly improved overall survival (OS; P = .026) and relapse-free survival (RFS; P = .021) and reduced nonrelapse mortality (NRM; P = .017) in AML/MDS patients. A significantly lower survival rate was observed for transplants from Bx1 donors compared with Bx2, Bx3, and Bx4 donors for patients in first complete remission (n = 82; OS: P = .024; RFS: P = .021). Transplant from donors with Cen-B resulted in improved OS (HR = .256; 95% CI, .084 to .774; P = .016) and RFS (HR = .252; 95% CI, .084 to .758; P = .014) in AML/MDS patients at standard risk. However, this particular effect did not increase with a higher number of Cen-B motifs (cB/B versus cA/B; OS: P = .755; RFS: P = .768). No effect was observed on high-risk AML/MDS, acute lymphoblastic leukemia/non-Hodgkin lymphoma, and chronic myelogenous leukemia patients. Avoiding the selection of HSCT donors of KIR profile Bx1 is strongly advisable for standard-risk AML/MDS patients. The presence of the Cen-B motif rather than its number was more important in donor selection for the Chinese population.

  11. Donor chimerism early after reduced-intensity conditioning hematopoietic stem cell transplantation predicts relapse and survival. (United States)

    Koreth, John; Kim, Haesook T; Nikiforow, Sarah; Milford, Edgar L; Armand, Philippe; Cutler, Corey; Glotzbecker, Brett; Ho, Vincent T; Antin, Joseph H; Soiffer, Robert J; Ritz, Jerome; Alyea, Edwin P


    The impact of early donor cell chimerism on outcomes of T cell-replete reduced-intensity conditioning (RIC) hematopoietic stem cell transplantation (HSCT) is ill defined. We evaluated day 30 (D30) and 100 (D100) total donor cell chimerism after RIC HSCT undertaken between 2002 and 2010 at our institution, excluding patients who died or relapsed before D30. When available, donor T cell chimerism was also assessed. The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), relapse, and nonrelapse mortality (NRM). We evaluated 688 patients with hematologic malignancies (48% myeloid and 52% lymphoid) and a median age of 57 years (range, 18 to 74) undergoing RIC HSCT with T cell-replete donor grafts (97% peripheral blood; 92% HLA-matched), with a median follow-up of 58.2 months (range, 12.6 to 120.7). In multivariable analysis, total donor cell and T cell chimerism at D30 and D100 each predicted RIC HSCT outcomes, with D100 total donor cell chimerism most predictive. D100 total donor cell chimerism D100 total donor cell chimerism or T cell chimerism. Low donor chimerism early after RIC HSCT is an independent risk factor for relapse and impaired survival. Donor chimerism assessment early after RIC HSCT can prognosticate for long-term outcomes and help identify high-risk patient cohorts who may benefit from additional therapeutic interventions. Copyright © 2014 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  12. Salvaged single-unit cord blood transplantation for 26 patients with hematologic malignancies not in remission

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    W. Yao


    Full Text Available Treatments for patients with hematologic malignancies not in remission are limited, but a few clinical studies have investigated the effects of salvaged unrelated cord blood transplantation (CBT. We retrospectively studied 19 patients with acute leukemia, 5 with myelodysplastic syndrome (MDS with refractory anemia with excess blasts [RAEB], and 2 with non-Hodgkin's lymphoma who received 1 CBT unit ≤2 loci human leukocyte antigen (HLA-mismatched after undergoing myeloablative conditioning regimens between July 2005 and July 2014. All of them were in non-remission before transplantation. The infused total nucleated cell (TNC dose was 4.07 (range 2.76-6.02×107/kg and that of CD34+ stem cells was 2.08 (range 0.99-8.65×105/kg. All patients were engrafted with neutrophils that exceeded 0.5×109/L on median day +17 (range 14-37 days and had platelet counts of >20×109/L on median day +35 (range 17-70 days. Sixteen patients (61.5% experienced pre-engraftment syndrome (PES, and six (23.1% patients progressed to acute graft-versus-host disease (GVHD. The cumulative incidence rates of II-IV acute GVHD and chronic GVHD were 50% and 26.9%, respectively. After a median follow-up of 27 months (range 5-74, 14 patients survived and 3 relapsed. The estimated 2-year overall survival (OS, disease-free survival (DFS, and non-relapse mortality (NRM rates were 50.5%, 40.3%, and 35.2%, respectively. Salvaged CBT might be a promising modality for treating hematologic malignancies, even in patients with a high leukemia burden.

  13. Potent graft-versus-leukemia effect after reduced-intensity allogeneic SCT for intermediate-risk AML with FLT3-ITD or wild-type NPM1 and CEBPA without FLT3-ITD. (United States)

    Labouré, Gaëlle; Dulucq, Stéphanie; Labopin, Myriam; Tabrizi, Reza; Guérin, Estelle; Pigneux, Arnaud; Lafarge, Xavier; Leguay, Thibaut; Bouabdallah, Krimo; Dilhuydy, Marie-Sarah; Duclos, Cédric; Lascaux, Axelle; Marit, Gérald; Mahon, François-Xavier; Boiron, Jean-Michel; Milpied, Noël; Vigouroux, Stéphane


    To investigate the role of reduced-intensity allogeneic (RIC-allo) stem cell transplant (SCT) as postremission therapy in adult intermediate-risk patients with acute myelogenous leukemia (AML) with FLT3-ITD or wild-type NPM1 and CEBPA without FLT3-ITD, we conducted a single-center retrospective study between January 2001 and December 2010. Sixty-six patients were included: 37 treated with RIC-alloSCT and 29 with nonallogeneic SCT therapies. Both groups were comparable concerning age, WBC count at diagnosis, gender, karyotype, genotype, and number of courses of chemotherapy to reach complete remission (CR1). Median follow-up after CR1 was 37 months (range, 11-112 months) and 48 months (range, 9-83 months) in the allo and no-allo groups, respectively. In the allo versus no-allo groups, the 3-year cumulative incidence of relapse (CIR) rates were 25% ± 8% versus 61% ± 9%; P = .005. The 3-year nonrelapse mortality (NRM), overall survival (OS), and relapse-free survival (RFS) were 22% ± 7% versus 4% ± 4% (P = .005), 52% ± 9% versus 44% ± 10% (P = .75), and 53% ± 9% versus 35% ± 9% (P = .28), respectively. Multivariate analysis indicated that CIR was reduced by allo (hazard ratio [HR], 0.32; P = .01). A landmark analysis performed at day 185 after CR1 confirmed a lower CIR after allo. RIC-allo reduces the risk of relapse, suggesting a potent graft-versus-leukemia (GVL) effect in these patients at a high risk of relapse.

  14. Out of control mortality matters: the effect of perceived uncontrollable mortality risk on a health-related decision

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    Gillian V. Pepper


    Full Text Available Prior evidence from the public health literature suggests that both control beliefs and perceived threats to life are important for health behaviour. Our previously presented theoretical model generated the more specific hypothesis that uncontrollable, but not controllable, personal mortality risk should alter the payoff from investment in health protection behaviours. We carried out three experiments to test whether altering the perceived controllability of mortality risk would affect a health-related decision. Experiment 1 demonstrated that a mortality prime could be used to alter a health-related decision: the choice between a healthier food reward (fruit and an unhealthy alternative (chocolate. Experiment 2 demonstrated that it is the controllability of the mortality risk being primed that generates the effect, rather than mortality risk per se. Experiment 3 showed that the effect could be seen in a surreptitious experiment that was not explicitly health related. Our results suggest that perceptions about the controllability of mortality risk may be an important factor in people’s health-related decisions. Thus, techniques for adjusting perceptions about mortality risk could be important tools for use in health interventions. More importantly, tackling those sources of mortality that people perceive to be uncontrollable could have a dual purpose: making neighbourhoods and workplaces safer would have the primary benefit of reducing uncontrollable mortality risk, which could lead to a secondary benefit from improved health behaviours.

  15. The Association of Geographic Coordinates with Mortality in People with Lower and Higher Education and with Mortality Inequalities in Spain.

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    Enrique Regidor

    Full Text Available Geographic patterns in total mortality and in mortality by cause of death are widely known to exist in many countries. However, the geographic pattern of inequalities in mortality within these countries is unknown. This study shows mathematically and graphically the geographic pattern of mortality inequalities by education in Spain.Data are from a nation-wide prospective study covering all persons living in Spain's 50 provinces in 2001. Individuals were classified in a cohort of subjects with low education and in another cohort of subjects with high education. Age- and sex-adjusted mortality rate from all causes and from leading causes of death in each cohort and mortality rate ratios in the low versus high education cohort were estimated by geographic coordinates and province.Latitude but not longitude was related to mortality. In subjects with low education, latitude had a U-shaped relation to mortality. In those with high education, mortality from all causes, and from cardiovascular, respiratory and digestive diseases decreased with increasing latitude, whereas cancer mortality increased. The mortality-rate ratio for all-cause death was 1.27 in the southern latitudes, 1.14 in the intermediate latitudes, and 1.20 in the northern latitudes. The mortality rate ratios for the leading causes of death were also higher in the lower and upper latitudes than in the intermediate latitudes. The geographic pattern of the mortality rate ratios is similar to that of the mortality rate in the low-education cohort: the highest magnitude is observed in the southern provinces, intermediate magnitudes in the provinces of the north and those of the Mediterranean east coast, and the lowest magnitude in the central provinces and those in the south of the Western Pyrenees.Mortality inequalities by education in Spain are higher in the south and north of the country and lower in the large region making up the central plateau. This geographic pattern is similar to

  16. Assessing the relationship between global warming and mortality: Lag effects of temperature fluctuations by age and mortality categories

    Energy Technology Data Exchange (ETDEWEB)

    Yu Weiwei, E-mail: [School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD 4050, Brisbane (Australia); Mengersen, Kerrie [Discipline of Mathematical Sciences, Faculty of Science and Technology, Queensland University of Technology, Brisbane (Australia); Hu Wenbiao [School of Population Health and Institute of Health and Biomedical Innovation, University of Queensland, Brisbane (Australia); Guo Yuming [School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD 4050, Brisbane (Australia); Pan Xiaochuan [School of Public Health, Peking University, Beijing 100191 (China); Tong Shilu, E-mail: [School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD 4050, Brisbane (Australia)


    Although interests in assessing the relationship between temperature and mortality have arisen due to climate change, relatively few data are available on lag structure of temperature-mortality relationship, particularly in the Southern Hemisphere. This study identified the lag effects of mean temperature on mortality among age groups and death categories using polynomial distributed lag models in Brisbane, Australia, a subtropical city, 1996-2004. For a 1 deg. C increase above the threshold, the highest percent increase in mortality on the current day occurred among people over 85 years (7.2% (95% CI: 4.3%, 10.2%)). The effect estimates among cardiovascular deaths were higher than those among all-cause mortality. For a 1 deg. C decrease below the threshold, the percent increases in mortality at 21 lag days were 3.9% (95% CI: 1.9%, 6.0%) and 3.4% (95% CI: 0.9%, 6.0%) for people aged over 85 years and with cardiovascular diseases, respectively. These findings may have implications for developing intervention strategies to reduce and prevent temperature-related mortality. - Highlights: > A longer lag effects in cold days and shorter lag effects in hot days. > The very old people were most vulnerable to temperature stress. > The cardiovascular mortality was also sensitive to the temperature variation. - In Brisbane, the lag effects lasted longer for cold temperatures, and shorter for hot temperatures. Elderly people and cardiovascular mortality were vulnerable to temperature stress.

  17. [Political crises in Africa and infant and child mortality]. (United States)

    Garenne, M


    Many African countries experienced severe political crises after independence, and in a number of cases the crises had significant demographic consequences, especially for child mortality. Data based on maternity histories allowed the reconstruction of child mortality trends over the past 20-30 years in Uganda, Ghana, Rwanda, Madagascar, and Mozambique. The indicator used was the child mortality quotient (number of deaths of under-5 children per 1000 births). Uganda's child mortality declined from 227/1000 in 1960 to 154/1000 in 1970, but the trend was reversed in 1971, when Idi Amin Dada came to power, and the rate reached 204/1000 in 1982 before beginning to decline again. The level of mortality remained high, however, and was still 160/1000 in 1988. Ghana suffered a political and economic crisis during 1979-84. Child mortality rose from 130/1000 in 1978 to 175/1000 in 1983. Mortality rates began a rapid decline after structural adjustment programs were begun, possibly due to improved management of health services. The child mortality rate in Rwanda increased from around 220/1000 in 1960 to 240/1000 in 1975, before beginning a decline in the late 1970s that reached 140/1000 by 1990. The period of political stability and relative prosperity during the 15-year reign of Juvenal Habyarimana was associated with the decline. Political crises marked by student and peasant uprisings were associated with Madagascar's child mortality rate increase from about 145/1000 in 1960 to 185/1000 in 1985. Mozambique was beset by civil war after independence, in which destruction of the health infrastructure was a strategy. The child mortality rate increased from 270/1000 to 470/1000 between 1975 and 1986, a peak war year. The factors by which political crises affect mortality so profoundly remain to be explained, but particular attention should be given to studying the health sector.

  18. One-year mortality after severe COPD exacerbation in Bulgaria

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    Evgeni Mekov


    Full Text Available Introduction One-year mortality in COPD patients is reported to be between 4% and 43%, depending on the group examined. Aim To examine the one-year mortality in COPD patients after severe exacerbation and the correlation between mortality and patients’ characteristics and comorbidities. Methods A total of 152 COPD patients hospitalized for severe exacerbation were assessed for vitamin D status, diabetes mellitus (DM, arterial hypertension (AH, and metabolic syndrome (MS. Data were gathered about smoking status and number of exacerbations in previous year. CAT and mMRC questionnaires were completed by all patients. Pre- and post-bronchodilatory spirometry was performed. One-year mortality was established from national death register. Results One-year mortality is 7.2%. DM, MS, and VD are not predictors for one-year mortality. However there is a trend for increased mortality in patients with AH (9.5% vs. 2.1%, p = 0.107. There is increased mortality in patients with mMRC > 2 (11.1 vs. 0%, p = 0.013. The presence of severe exacerbation in the previous year is a risk factor for mortality (12.5% vs. 1.4%, p = 0.009. There is a trend for increased mortality in the group with FEV1  80% may be factors for good prognosis. Risk factors for increased mortality are age, FEV1 value, severe exacerbation in previous year and reduced quality of life.

  19. Short-term effects of daily air pollution on mortality (United States)

    Wan Mahiyuddin, Wan Rozita; Sahani, Mazrura; Aripin, Rasimah; Latif, Mohd Talib; Thach, Thuan-Quoc; Wong, Chit-Ming


    The daily variations of air pollutants in the Klang Valley, Malaysia, which includes Kuala Lumpur were investigated for its association with mortality counts using time series analysis. This study located in the tropic with much less seasonal variation than typically seen in more temperate climates. Data on daily mortality for the Klang Valley (2000-2006), daily mean concentrations of air pollutants of PM10, SO2, CO, NO2, O3, daily maximum O3 and meteorological conditions were obtained from Malaysian Department of Environment. We examined the association between pollutants and daily mortality using Poisson regression while controlling for time trends and meteorological factors. Effects of the pollutants (Relative Risk, RR) on current-day (lag 0) mortality to seven previous days (lag 7) and the effects of the pollutants from the first two days (lag 01) to the first eight days (lag 07) were determined. We found significant associations in the single-pollutant model for PM10 and the daily mean O3 with natural mortality. For the daily mean O3, the highest association was at lag 05 (RR = 1.0215, 95% CI = 1.0013-1.0202). CO was found not significantly associated with natural mortality, however the RR's of CO were found to be consistently higher than PM10. In spite of significant results of PM10, the magnitude of RR's of PM10 was not important for natural mortality in comparison with either daily mean O3 or CO. There is an association between daily mean O3 and natural mortality in a two-pollutants model after adjusting for PM10. Most pollutants except SO2, were significantly associated with respiratory mortality in a single pollutant model. Daily mean O3 is also important for respiratory mortality, with over 10% of mortality associated with every IQR increased. These findings are noteworthy because seasonal confounding is unlikely in this relatively stable climate, by contrast with more temperate regions.

  20. Global justice, poverty and maternal mortality

    Directory of Open Access Journals (Sweden)

    Flor de María Cáceres M


    Full Text Available Global justice is currently situated in an ambiance of tension and debate, facing a series of statements attempting to explain relationships among countries, based on the background of agreements already accomplished by supranational agencies. This network of relationships, not always fair nor equitable, has resulted in an increased accumulation of wealth in just a few hands and poverty in a growing number of people in poor countries and geographic areas with restrictions to access both to resources and to technological and scientific advances. Poverty, exclusion and inequalities limit all together the opportunities for development in these communities, with the outcome of serious consequences such as the deterioration in basic indicators of development. Maternal mortality rate (mm is considered a sentinel indicator since it belongs in most cases to premature deaths which would be avoidable through proper measures in education, health promotion and timely access to quality health services. The purpose of this essay is to defend the thesis that the lack of global justice has limited the scope of the goals related to poverty and mm reduction

  1. Laser induced mortality of Anopheles stephensi mosquitoes (United States)

    Keller, Matthew D.; Leahy, David J.; Norton, Bryan J.; Johanson, Threeric; Mullen, Emma R.; Marvit, Maclen; Makagon, Arty


    Small, flying insects continue to pose great risks to both human health and agricultural production throughout the world, so there remains a compelling need to develop new vector and pest control approaches. Here, we examined the use of short (mosquitoes, which were chosen as a representative species. The mortality of mosquitoes exposed to laser pulses of various wavelength, power, pulse duration, and spot size combinations was assessed 24 hours after exposure. For otherwise comparable conditions, green and far-infrared wavelengths were found to be more effective than near- and mid-infrared wavelengths. Pulses with larger laser spot sizes required lower lethal energy densities, or fluence, but more pulse energy than for smaller spot sizes with greater fluence. Pulse duration had to be reduced by several orders of magnitude to significantly lower the lethal pulse energy or fluence required. These results identified the most promising candidates for the lethal laser component in a system being designed to identify, track, and shoot down flying insects in the wild.

  2. Mortality And Morbidity Pattern In Youth

    Directory of Open Access Journals (Sweden)

    Pandit Daksha D


    Full Text Available Youths from an important segment in any society. The youth population has a significant role to play in the development of the Country as they are nation’s strength, hopes and future. Thus, it is pertinent to study the health situation of youth in India. Data regarding morbidity are not available. Data on morbidity condition of the youth population, if made available will help to design the preventive measures. A retrospective study was carried out by studying 2884 cases in the age group of 15 to 24 years from the records of B.Y.L Nair Charitable Hospital, Bombay. Out of 55.83% females in the study group, 51.24% of cases were due to pregnancy and related disorders. Out of the total cases admitted during the study period 23.06% were between 15 to 24 years of age group. Mortality rate was 2.08%. Other causes of morbidity were accidents (12.44%, gastrointestinal disorders (7.80%, respiratory disorders (5.96% and psychological disorders (5.38%.

  3. Green space and mortality following ischemic stroke. (United States)

    Wilker, Elissa H; Wu, Chih-Da; McNeely, Eileen; Mostofsky, Elizabeth; Spengler, John; Wellenius, Gregory A; Mittleman, Murray A


    Residential proximity to green space has been associated with physical and mental health benefits, but whether green space is associated with post-stroke survival has not been studied. Patients ≥ 21 years of age admitted to the Beth Israel Deaconess Medical Center (BIDMC) between 1999 and 2008 with acute ischemic stroke were identified. Demographics, presenting symptoms, medical history and imaging results were abstracted from medical records at the time of hospitalization for stroke onset. Addresses were linked to average Normalized Difference Vegetation Index, distance to roadways with more than 10,000 cars/day, and US census block group. Deaths were identified through June 2012 using the Social Security Death Index. There were 929 deaths among 1645 patients with complete data (median follow up: 5 years). In multivariable Cox models adjusted for indicators of medical history, demographic and socioeconomic factors, the hazard ratio for patients living in locations in the highest quartile of green space compared to the lowest quartile was 0.78 (95% Confidence Interval: 0.63-0.97) (p-trend = 0.009). This association remained statistically significant after adjustment for residential proximity to a high traffic road. Residential proximity to green space is associated with higher survival rates after ischemic stroke in multivariable adjusted models. Further work is necessary to elucidate the underlying mechanisms for this association, and to better understand the exposure-response relationships and susceptibility factors that may contribute to higher mortality in low green space areas. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. A study of mortality in dermatology

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    Nair Pradeep


    Full Text Available BACKGROUND AND AIMS: Certain dermatological conditions are life-threatening and can cause mortality. The aim of this study is to find out the dermatological diseases leading to death in our indoor patients. METHODS: A record-based retrospective descriptive study of dermatology cases who died during the period of 1995 to 2001. RESULTS: The total number of cases analyzed was thirty-seven. There were 24 males and 13 females. The maximum number of deaths occurred in the age group 61-70. Vesiculobullous disorders were the commonest cause of death, found in 18 cases (48.6%, followed by drug reactions in 5 (13.5%, malignancies in 5 (13.5% and collagen vascular disease in 2 cases ((5.40%. Pemphigus was the commonest fatal vesiculobullous disorder (13 cases - 35.13%, and toxic epidermal necrolysis the commonest drug reaction (3 cases - 8.10%. CONCLUSION: Area of skin involvement, electrolyte imbalance and septicemia were important factors leading to death in pemphigus and toxic epidermal necrolysis. We advocate that such patients should be managed in burns unit or ICU units.

  5. Long-Term Mortality Trends Infographic (United States)

    This infographic shows the National Cancer Institute 10-year Mortality Trends. The graphs show the Average Annual Percent of Change (AAPC) 2002-2011. For Men, Liver & IBD: 2.6*, Soft Tissue inc. Heart: 0.8*, Pancreas: 0.3*, Melanoma: 0.3*, Bladder: 0, Brain & ONS: -0.4, Oral Cavity: -0.5, Esophagus: -0.5*, Kidney: -0.8*, Leukemia: -0.9*, Myeloma: -1.1*, All Sites: -1.8*, Non Hodgkin Lymphoma: -2.3*, Larynx: -2.5*, Lung and Bronchus: -2.6*, Colon and Rectum: -3.9*, Stomach: -3.1*, and Prostate: -3.3*. For Women, Liver & IBD: 1.9*, Corpus & Uterus: 1.0*, Pancreas: 0.4*, Bladder: -0.4*, Kidney: -0.9*, Brain & ONS: -0.9*, Leukemia: -1.1*, Gallbladder: -1.2*, Lung & Bronchus: -1.2*, Cervix: -1.3*, All Sites: -1.4*, Esophagus: -1.5*, Myeloma: -1.6*, Breast: -1.9*, Oral Cavity: -2.0*, Ovary: -2.0*, Stomach: -2.7*, Colon & Rectum: -2.9*, and Non-Hodgkin Lymphoma: -3.1*. * AAPC is significantly different from zero (p<.05). Source: Special section of the Annual Report to the Nation on the Status of Cancer, 1975-2011

  6. [Survival and mortality in ESRD patients]. (United States)

    Chantrel, F; de Cornelissen, F; Deloumeaux, J; Lange, C; Lassalle, M


    This chapter provides a set of indicators on survival, life expectancy and causes of death of patients in chronic renal failure treated by dialysis or transplantation beginning a first replacement therapy between 2002 and 2011. Age strongly influences survival on dialysis. Thus, one year survival of patients under age 65 is over 90%. After 5 years, among patients over 85 years, it is more than 15%. The presence of diabetes or one or more cardiovascular comorbidities also significantly worse patient survival. In terms of trend, we do not find significant improvement in the 2-year survival between patients in the cohort 2006-2007 and the 2008-2009 cohort. Cardiovascular diseases account for 27% of causes of death to infectious diseases (12%) and cancer (10%). Life expectancy of patients is highly dependent on their treatment. Thus, a transplant patient aged 30 has a life expectancy of 41 years versus 23 years for a dialysis patient. Transplant patients have a mortality rate much lower than those of dialysis patients. Thus, between 60 and 69 years, for 1000 patients in dialysis in 2011, 127 died within the year. For 1000 patients of the same age, who have a functioning kidney transplant, 24 died within the year. Copyright © 2013 Elsevier Masson SAS. All rights reserved.


    Directory of Open Access Journals (Sweden)



    Full Text Available The purpose of the research was to determine the regularities of influence of mammalian embryos heterogeneity and effectiveness of cryoconservation steps on their viability by using the developed simulation model. The model is based on analytical expressions that reflect the main causes of embryonic mortality during in vitro and in vivo cultivation, crioconservation and embryo transplantation. Reduction of viability depends on a set of biological factors such as the animal special, donor and recipient state, quality of embryos, and of technological ones such as the efficiency of cryopreservation method, and embryo transplantation. Fulfilled computer experiment showed, that divergence of embryos viability depending on biological parameters variations changes in a range from 0 to 100%, whereas efficiency index of chosen technology has an inaccuracy about 1%. The comparative analysis of alternative technologies of embryos cryopreservation showed the maximum efficiency of stages of use of the cryoprotectant, freezing regime and in vitro and in vivo cultivation of biological object. The application of computer modeling gives an opportunity to reduce the range of embryos viability results, obtained in different experiments is many times, thereby to shorten the time, monetary costs and the slaughter of laboratory animals in obtaining reliable results.

  8. Compression and plasticity of old-age mortality

    NARCIS (Netherlands)

    Engelaer, Frouke Maria


    In this thesis we first studied the start of the epidemiologic transition in rural Ghana and describe the changes in mortality. This is followed by studies on the compression of mortality and morbidity during the transition in Japan and the Netherlands. Finally, we examined the plasticity of mortali

  9. Beverage-Specific Alcohol Sale and Cardiovascular Mortality in Russia

    Directory of Open Access Journals (Sweden)

    Y. E. Razvodovsky


    Full Text Available Objective. Recent research evidence suggests that the consumption of different types of alcoholic beverage may have a differential effect on cardiovascular diseases (CVD mortality rates. The aim of this study was to examine the relation between the consumption of different beverage types and CVD mortality rates in Russia across the later-Soviet and post-Soviet periods. Method. Age-standardized male and female CVD mortality data for the period 1970–2005 and data on beverage-specific alcohol sales were obtained Russian State Statistical Committee (Rosstat. Time-series analytical modeling techniques (ARIMA were used to examine the relation between the sales of different alcoholic beverages and CVD mortality rates. Results. Vodka consumption as measured by sales was significantly associated with both male and female CVD mortality rates: a 1 liter increase in vodka sales would result in a 5.3% increase in the male CVD mortality rate and a 3.7% increase in the female rate. The consumption of beer and wine were not associated with CVD mortality rates. Conclusions. The findings from this study suggest that public health efforts should focus on both reducing overall consumption and changing beverage preference away from distilled spirits in order to reduce cardiovascular mortality rates in Russia.

  10. Self-Forgiveness and Mortality in Late Life (United States)

    Krause, Neal; Hayward, R. David


    The purpose of this study is to see if older people who are able to forgive themselves have a lower mortality risk than older adults who are not able to forgive themselves. In addition, it is hypothesized that the relationship between self-forgiveness and mortality will be contingent upon the level of an older individual's education. More…

  11. Rising under-5 mortality in Africa: Who bears the brunt?

    NARCIS (Netherlands)

    A.J. Houweling (Tanja); A.E. Kunst (Anton); K. Moser (Kath); J.P. Mackenbach (Johan)


    textabstractOBJECTIVES: To identify the socioeconomic and geographical groups in which the recent under-5 mortality increase observed in several African countries was most pronounced, and to explore the contribution of a number of proximate determinants of under-5 mortality. METHODS: Time trends in

  12. Severe mortality impact of the 1957 influenza pandemic in Chile

    DEFF Research Database (Denmark)

    Chowell, Gerardo; Simonsen, Lone; Fuentes, Rodrigo


    INTRODUCTION: Epidemiological studies of the 1957 influenza pandemic are scarce, particularly from lower income settings. METHODS: We analyzed the spatial-temporal mortality patterns of the 1957 influenza pandemic in Chile including detailed age-specific mortality data from a large city and inves...

  13. Global Mortality Impact of the 1957-1959 Influenza Pandemic

    DEFF Research Database (Denmark)

    Viboud, Cécile; Simonsen, Lone; Fuentes, Rodrigo


    BACKGROUND: Quantitative estimates of the global burden of the 1957 influenza pandemic are lacking. Here we fill this gap by modeling historical mortality statistics. METHODS: We used annual rates of age- and cause-specific deaths to estimate pandemic-related mortality in excess of background lev...

  14. Mortality experience of cockpit crewmembers from Japan Airlines. (United States)

    Kaji, M; Tango, T; Asukata, I; Tajima, N; Yamamoto, K; Yamamoto, Y; Hokari, M


    The purpose of this study was to evaluate the long-term mortality and causes of death among cockpit crewmembers. A total of 2,327 cockpit crewmembers registered at Japan Airlines between August 1, 1952, and December 31, 1988, were traced to assess mortality. Medical records were also reviewed. The mortality rates for the cockpit crewmembers were compared to those for the general Japanese population using standardized mortality ratios (SMR's). As of December 31, 1988, 59 (2.5%) of 2,327 individuals were deceased, and the leading causes of death were accidents, malignant neoplasms, and cardiovascular diseases. The overall mortality rate for the cockpit crew was significantly lower than the national standard (SMR = 0.66, p < 0.001; 95% C.I. 0.50-0.85). However, marked differences were found in cause-specific mortality, where mortality due to accidents was significantly increased (SMR = 2.43, p < 0.001; 95% C.I. 1.63-3.50), while deaths from cancer were similar, and those for cerebral vascular accidents (CVA) and coronary artery disease (CAD) were lower than comparable rates for the general population. We conclude that cockpit crewmembers had a better total mortality experience compared to the general Japanese population, except for deaths due to accidents.

  15. [Infant mortality in the indigenous population: backwardness and contrasts]. (United States)

    Fernandez Ham, P


    Some 6.4 million speakers of indigenous languages were enumerated in the 1990 Mexican census. The same census provided the basis for an indirect estimate of infant mortality using data on the numbers of live born and surviving children. Municipios with 40% or more of the population speaking an indigenous language were studied. The overall estimated infant mortality rate for indigenous municipios was 55.1/1000 live births, the equivalent of the Mexican infant mortality rate around 1982. Mexico's national infant mortality rate in 1990 was 34.8/1000. Great contrasts were found in indigenous infant mortality rates. Campeche, Quintana Roo, and Yucatan, the states of the Mayan region, had a low rate of 35.09/1000, very close to the national average. Infant mortality levels were relatively low in the indigenous populations of Hidalgo, the state of Mexico, and Michoacan, with rates of 44 to 48. Chiapas, Oaxaca, Puebla, Durango, Guerrero, and San Luis Potosi had rates of 55 to 65. The highest rates were in states with few indigenous municipios, including Chihuahua, Jalisco, and Nayarit. The Huichol of Jalisco had the highest rate at 100.01/1000. Infant mortality levels were found to be correlated in different degrees with socioeconomic indicators. The highest infant mortality rates were in the indigenous regions with the poorest socioeconomic conditions.

  16. Multiple mortality events in bats: a global review (United States)

    O'Shea, Thomas J.; Cryan, Paul; Hayman, David TH; Plowright, Raina K.; Streicker, Daniel G.


    Despite conservation concerns for many species of bats, factors causing mortality in bats have not been reviewed since 1970. Here, we review and qualitatively describe trends in the occurrence and apparent causes of multiple mortality events (MMEs) in bats around the world.

  17. Constant mortality and fertility over age in Hydra

    DEFF Research Database (Denmark)

    Schaible, R.; Scheuerlein, A.; Danko, M. J.


    Senescence, the increase in mortality and decline in fertility with age after maturity, was thought to be inevitable for all multicellular species capable of repeated breeding. Recent theoretical advances and compilations of data suggest that mortality and fertility trajectories can go up or down...

  18. Dietary patterns and mortality in Danish men and women

    DEFF Research Database (Denmark)

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


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

  19. A Study On Neonatal Mortality In Jamnagar District Of Gujarat

    Directory of Open Access Journals (Sweden)

    Yadav Sudha


    Full Text Available Research question: Which are the maternal, socio-demographic and neonatal attributes responsible for neonatal mortality in rural areas of Gujarat? Objectives: (i To know various maternal, socio-demographic and neonatal factors responsible for neonatal mortality in rural areas of Gujarat (ii To estimate neonatal mortality rate in the area. Setting: Rural areas of six Primary Health Centers of Jamnagar district of Gujarat State. Study design: Community based cohort study. Sample size: Population of 40512 Participants: Members of the family in which neonatal deaths occurred. Outcome variable: Neonatal mortality Analysis: Sample proportions. Results: Neonatal mortality rate on the basis of follow-up of births during one year was found to be 47.27 per thousand live births. The major maternal and socio-demographic factors responsible for neonatal mortality were; maternal age, illiteracy, lack of antenatal care, closely spaced pregnancies, delivery conducted at home, delivery conducted untrained personnel and delayed initiation of breast feeding. The major neonatal factors responsible for mortality in neonates were; low birth weight, prematurity, first order of birth, early phase of neonatal period, male gender of the child. The leading causes of neonatal mortality were found to be prematurity, birth asphyxia, neonatal infections and congenital anomalies.

  20. Weight at Birth and All-Cause Mortality in Adulthood

    DEFF Research Database (Denmark)

    Baker, Jennifer Lyn; Olsen, Lina Wøhlk; Sørensen, Thorkild I.A.


    :: We investigated the association of birth weight with adult all-cause mortality using a Danish school-based cohort of 216,464 men and women born from 1936 through 1979. The cohort was linked to vital statistic registers. The main outcome was all-cause mortality from ages 25 through 68 years...

  1. Mortality Factor Survey of Severe Acute Respiratory Syndrome in Taiwan

    Directory of Open Access Journals (Sweden)

    Tei-Chu Liu


    Conclusion: The mortality rate of intubation patients was 115 times higher than that of those who did not require intubation. Therefore, special care must be taken with SARS disease with severe infiltration chest X-ray images and respiratory distress. Positive medical treatment should be performed to lower the mortality rate.

  2. Calculating the Rate of Senescence From Mortality Data

    DEFF Research Database (Denmark)

    Koopman, Jacob J E; Rozing, Maarten P; Kramer, Anneke


    The rate of senescence can be inferred from the acceleration by which mortality rates increase over age. Such a senescence rate is generally estimated from parameters of a mathematical model fitted to these mortality rates. However, such models have limitations and underlying assumptions. Notably...

  3. Low infant mortality among Palestine refugees despite the odds (United States)

    Khader, Ali; Sabatinelli, Guido


    Abstract Objective To present data from a 2008 infant mortality survey conducted in Jordan, Lebanon, the Syrian Arab Republic, the Gaza Strip and the West Bank and analyse infant mortality trends among Palestine refugees in 1995–2005. Methods Following the preceding birth technique, mothers who were registering a new birth were asked if the preceding child was alive or dead, the day the child was born and the date of birth of the neonate whose birth was being registered. From this information, neonatal, infant and early child mortality rates were estimated. The age at death for early child mortality was determined by the mean interval between successive births and the mean age of neonates at registration. Findings In 2005–2006, infant mortality among Palestine refugees ranged from 28 deaths per 100 000 live births in the Syrian Arab Republic to 19 in Lebanon. Thus, infant mortality in Palestine refugees is among the lowest in the Near East. However, infant mortality has stopped decreasing in recent years, although it remains at a level compatible with the attainment of Millennium Development Goal 4. Conclusion Largely owing to the primary health care provided by the United Nations Relief and Works Agency (UNRWA) for Palestine Refugees in the Near East and other entities, infant mortality among Palestine refugees had consistently decreased. However, it is no longer dropping. Measures to address the most likely reasons – early marriage and childbearing, poor socioeconomic conditions and limited access to good perinatal care – are needed. PMID:21479095

  4. Fetal, Infant, and Maternal Mortality During Periods of Economic Instability (United States)

    Brenner, M. H.


    One of the most sensitive indicators of the general socioeconomic level of a nation is the infant mortality rate. Evidence indicates that economic recessions and upswings have played a significant role in fetal, infant, and maternal mortality in the last 45 years. (RJ)

  5. Air Pollution and Infant Mortality in Mexico City (United States)

    Historic air pollution episodes of the 1950s led to acute increases in infant mortality, and some recent epidemiologic studies suggest that infant or child mortality may still result from air pollution at current levels. To investigate the evidence for such an association, we con...

  6. High mortality among heart failure patients treated with antidepressants

    DEFF Research Database (Denmark)

    Veien, Karsten Tang; Videbæk, Lars; Schou, Morten


    This study was designed to assess whether pharmacologically treated depression was associated with increased mortality risk in systolic heart failure (SHF) patients.......This study was designed to assess whether pharmacologically treated depression was associated with increased mortality risk in systolic heart failure (SHF) patients....

  7. Mortality among men and women in same-sex marriage

    DEFF Research Database (Denmark)

    Frisch, Morten; Brønnum-Hansen, Henrik


    OBJECTIVES: We studied overall mortality in a demographically defined, complete cohort of gay men and lesbians to address recent claims of markedly shorter life spans among homosexual persons. METHODS: We calculated standardized mortality ratios (SMRs) starting 1 year after the date of same...

  8. Psychological Distress and Mortality: Are Women More Vulnerable? (United States)

    Ferraro, Kenneth F.; Nuriddin, Tariqah A.


    Does psychological distress increase mortality risk? If it does, are women more vulnerable than men to the effect of distress on mortality? Drawing from cumulative disadvantage theory, these questions are addressed with data from a 20-year follow-up of a national sample of adults ages 25-74. Event history analyses were performed to examine…

  9. Clinical factors influencing mortality risk in hospital acquired sepsis. (United States)

    López-Mestanza, Cristina; Andaluz-Ojeda, David; Gómez-López, Juan Ramón; Bermejo Martín, Jesús F


    Identification of factors that confer an increased risk of mortality in hospital acquired sepsis (HAS) is necessary to help prevent, and improve the outcome of, this condition. To evaluate the clinical characteristics and factors associated with mortality in patients with HAS. Retrospective study of patients with HAS in a major Spanish Hospital from 2011 to 2015. Data from adults receiving any of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes associated with sepsis were collected. Those fulfilling the SEPSIS-2 definition with no evidence of infection during the first 48 hours following hospitalization were included (n=196). A multivariate analysis was employed to identify the risk factors of mortality. HAS patients were found to have many of the risk factors associated with cardiovascular disease (male sex, ageing, antecedent of cardiac disease, arterial hypertension, dyslipemia, smoking habit) and cancer. Vascular disease or chronic kidney disease were associated with 28 day mortality. Time from hospital admission to sepsis diagnosis, and the presence of organ failure were risk factors for 28-day and hospital mortality. Experiencing more than one episode of sepsis increased the risk of hospital mortality. "Sepsis Code" for the early identification of sepsis was protective against hospital mortality. We have identified a number of major factors associated to mortality in patients suffering from HAS. Implementation of surveillance programmes for the early identification and treatment of sepsis translate into a clear benefit. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  10. Rising under-5 mortality in Africa: Who bears the brunt?

    NARCIS (Netherlands)

    A.J. Houweling (Tanja); A.E. Kunst (Anton); K. Moser (Kath); J.P. Mackenbach (Johan)


    textabstractOBJECTIVES: To identify the socioeconomic and geographical groups in which the recent under-5 mortality increase observed in several African countries was most pronounced, and to explore the contribution of a number of proximate determinants of under-5 mortality. METHODS: Time trends in

  11. Morbidity and mortality in children with obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Jennum, Poul; Ibsen, Rikke Falkner; Kjellberg, Jakob


    Little is known about the diagnostic patterns of obstructive sleep apnoea (OSA) in children. A study was undertaken to evaluate morbidity and mortality in childhood OSA.......Little is known about the diagnostic patterns of obstructive sleep apnoea (OSA) in children. A study was undertaken to evaluate morbidity and mortality in childhood OSA....

  12. Mortality associated with bilirubin levels in insurance applicants. (United States)

    Fulks, Michael; Stout, Robert L; Dolan, Vera F


    Determine the relationship between bilirubin levels with and without other liver function test (LFT) elevations and relative mortality in life insurance applicants. By use of the Social Security Death Master File mortality was determined in 1,905,664 insurance applicants for whom blood samples were submitted to the Clinical Reference Laboratory. There were 50,174 deaths observed in this study population. Results were stratified by 3 age/sex groups: females, age <60; males, age <60; and all, age 60+. The median follow-up was 12 years. Relative mortality increased as bilirubin decreased below bilirubin levels seen for the middle 50% of the population. The known association of smoking with lower bilirubin values explained only part of the additional elevated risk at low bilirubin levels. In the absence of other LFT elevations, relative mortality remained unchanged as bilirubin increased beyond levels seen for the middle 50% of the population. When a bilirubin elevation was combined with other LFT elevations, mortality further increased only at the highest elevations of other LFTs, seen only in <2.5% of applicants. Isolated elevations of bilirubin in this healthy screening population were not associated with excess mortality but values below the midpoint were. Other investigations have suggested a cardiovascular cause may underlie the excess mortality associated with low bilirubin. In association with other LFT elevations, bilirubin elevation further increases the mortality risk only at the highest elevations of other LFTs.

  13. Aging in the context of cohort evolution and mortality selection. (United States)

    Zheng, Hui


    This study examines historical patterns of aging through the perspectives of cohort evolution and mortality selection, where the former emphasizes the correlation across cohorts in the age dependence of mortality rates, and the latter emphasizes cohort change in the acceleration of mortality over the life course. In the analysis of historical cohort mortality data, I find support for both perspectives. The rate of demographic aging, or the rate at which mortality accelerates past age 70, is not fixed across cohorts; rather, it is affected by the extent of mortality selection at young and late ages. This causes later cohorts to have higher rates of demographic aging than earlier cohorts. The rate of biological aging, approximating the rate of the senescence process, significantly declined between the mid- and late-nineteenth century birth cohorts and stabilized afterward. Unlike the rate of demographic aging, the rate of biological aging is not affected by mortality selection earlier in the life course but rather by cross-cohort changes in young-age mortality, which cause lower rates of biological aging in old age among later cohorts. These findings enrich theories of cohort evolution and have implications for the study of limits on the human lifespan and evolution of aging.

  14. Aging in the Context of Cohort Evolution and Mortality Selection (United States)

    Zheng, Hui


    This study examines historical patterns of aging through the perspectives of cohort evolution and mortality selection, where the former emphasizes the correlation across cohorts in the age dependence of mortality rates, and the latter emphasizes cohort change in the acceleration of mortality over the life course. In the analysis of historical cohort mortality data, I find support for both perspectives. The rate of demographic aging, or the rate at which mortality accelerates past age 70, is not fixed across cohorts; rather, it is affected by the extent of mortality selection at young and late ages. This causes later cohorts to have higher rates of demographic aging than earlier cohorts. The rate of biological aging, approximating the rate of the senescence process, significantly declined between the mid- and late-nineteenth century birth cohorts and stabilized afterward. Unlike the rate of demographic aging, the rate of biological aging is not affected by mortality selection earlier in the life course but rather by cross-cohort changes in young-age mortality, which cause lower rates of biological aging in old age among later cohorts. These findings enrich theories of cohort evolution and have implications for the study of limits on the human lifespan and evolution of aging. PMID:24889261

  15. Morbidity and mortality in patients with craniopharyngioma after surgery.

    LENUS (Irish Health Repository)

    Crowley, R K


    Craniopharyngioma (CP) is a benign tumour of the suprasellar region that is associated with increased morbidity and mortality in comparison with other causes of hypopituitarism. We aimed to establish the rate and causes of mortality and morbidity in patients with CP who attended our centre.

  16. Bone alkaline phosphatase and mortality in dialysis patients

    NARCIS (Netherlands)

    C. Drechsler; M. Verduijn; S. Pilz; R.T. Krediet; F.W. Dekker; C. Wanner; M. Ketteler; E.W. Boeschoten; V. Brandenburg


    Serum alkaline phosphatase (AP) is associated with vascular calcification and mortality in hemodialysis patients, but AP derives from various tissues of origin. The aim of this study was to assess the effect of bone-specific AP (BAP) on morbidity and mortality in dialysis patients. From a prospectiv

  17. Mortality by Level of Emphysema and Airway Wall Thickness

    DEFF Research Database (Denmark)

    Johannessen, Ane; Skorge, Trude Duelien; Bottai, Matteo;


    There is limited knowledge of the prognostic value of quantitative computed tomography (CT) measures of emphysema and airway wall thickness (AWT) on mortality.......There is limited knowledge of the prognostic value of quantitative computed tomography (CT) measures of emphysema and airway wall thickness (AWT) on mortality....

  18. Child Mortality in a Developing Country: A Statistical Analysis (United States)

    Uddin, Md. Jamal; Hossain, Md. Zakir; Ullah, Mohammad Ohid


    This study uses data from the "Bangladesh Demographic and Health Survey (BDHS] 1999-2000" to investigate the predictors of child (age 1-4 years) mortality in a developing country like Bangladesh. The cross-tabulation and multiple logistic regression techniques have been used to estimate the predictors of child mortality. The…

  19. Income inequality, individual income, and mortality in Danish adults

    DEFF Research Database (Denmark)

    Osler, Merete; Prescott, Eva; Grønbaek, Morten


    To analyse the association between area income inequality and mortality after adjustment for individual income and other established risk factors.......To analyse the association between area income inequality and mortality after adjustment for individual income and other established risk factors....

  20. BMI and Lifetime Changes in BMI and Cancer Mortality Risk

    NARCIS (Netherlands)

    Taghizadeh, Niloofar; Boezen, H Marike; Schouten, Jan P; Schröder, Carolien P; de Vries, Elisabeth G. E.; Vonk, Judith M


    Body Mass Index (BMI) is known to be associated with cancer mortality, but little is known about the link between lifetime changes in BMI and cancer mortality in both males and females. We studied the association of BMI measurements (at baseline, highest and lowest BMI during the study-period) and

  1. Vulnerability to temperature-related mortality in Seoul, Korea (United States)

    Son, Ji-Young; Lee, Jong-Tae; Anderson, G. Brooke; Bell, Michelle L.


    Studies indicate that the mortality effects of temperature may vary by population and region, although little is known about the vulnerability of subgroups to these risks in Korea. This study examined the relationship between temperature and cause-specific mortality for Seoul, Korea, for the period 2000-7, including whether some subgroups are particularly vulnerable with respect to sex, age, education and place of death. The authors applied time-series models allowing nonlinear relationships for heat- and cold-related mortality, and generated exposure-response curves. Both high and low ambient temperatures were associated with increased risk for daily mortality. Mortality risk was 10.2% (95% confidence interval 7.43, 13.0%) higher at the 90th percentile of daily mean temperatures (25 °C) compared to the 50th percentile (15 °C). Mortality risk was 12.2% (3.69, 21.3%) comparing the 10th (-1 °C) and 50th percentiles of temperature. Cardiovascular deaths showed a higher risk to cold, whereas respiratory deaths showed a higher risk to heat effect, although the differences were not statistically significant. Susceptible populations were identified such as females, the elderly, those with no education, and deaths occurring outside of a hospital for heat- and cold-related total mortality. Our findings provide supportive evidence of a temperature-mortality relationship in Korea and indicate that some subpopulations are particularly vulnerable.

  2. Mortality Causes in Children 1-59 Months in Iran

    Directory of Open Access Journals (Sweden)

    T Sanaei-Shoar


    Full Text Available Background: Mortality rate indicator for children under 5 years old is one of the important indicators in countries' development. Identifying the most common causes of mortality is one of the most important attempts to reduce mortality in children less than 5 years. The purpose of this study was to identify distribution of the mortality causes in Iranian children less than 5 years.Methods: This cross-sectional study has been carried out based on the results of data from the Child Mortality Surveillance System since 2007 to 2008. To determine the causes of death questionnaires have been designed which include personal data of the deceased child, medical history, and information on procedures at the time of hospitalization or death.Results: Of 5926 deaths on children under 5 years which the questionnaires were filled out, 63.2% were postneonatal deaths (1-11 month. Totally 60% of mortalities occurred in the rural areas and 52% of them had been among boys. The most common causes of mortality were the congenital and chromosomal abnormalities with 23.4%. The most incidences among diseases were respiratory system diseases.Conclusions: Carrying out more epidemiologic studies, providing health programs to control and prevent diseases with high incidences and delivering more specialized health facilities and services could be the proper strategies to reduce under 5 mortality rates in Iran.

  3. Mortality of marine planktonic copepods : global rates and patterns

    DEFF Research Database (Denmark)

    Hirst, A.G.; Kiørboe, Thomas


    Using life history theory we make predictions of mortality rates in marine epi-pelagic copepods from field estimates of adult fecundity, development times and adult sex ratios. Predicted mortality increases with temperature in both broadcast and sac spawning copepods, and declines with body weight...

  4. The Mediterranean diet in relation to mortality and CVD

    DEFF Research Database (Denmark)

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


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

  5. Longitudinal Changes in Leukocyte Telomere Length and Mortality in Humans

    DEFF Research Database (Denmark)

    Bendix, Laila; Thinggaard, Mikael; Fenger, Mogens;


    Leukocyte telomere length (LTL) ostensibly shortens with age and has been moderately associated with mortality. In humans, these findings have come almost solely from cross-sectional studies. Only recently has LTL shortening within individuals been analyzed in longitudinal studies. Such studies...... are relevant to establish LTL dynamics as biomarkers of mortality as well as to disentangle the causality of telomeres on aging....

  6. Mortality in 272 European regions, 2002-2004: an update

    NARCIS (Netherlands)

    Bonneux, L.G.A.; Huisman, C.C.; de Beer, J.A.A.


    This paper presents a comprehensive update of life expectancy and mortality in 2002–2004 in the modern European Union (EU-27) and EFTA countries. We focus on causes of death at younger ages (0–64 year). EUROSTAT delivered updated population numbers and mortality data by sex, age and cause of death

  7. Vitamin D levels and mortality in type 2 diabetes

    DEFF Research Database (Denmark)

    Joergensen, Christel; Gall, Mari-Anne; Schmedes, Anne;


    To evaluate vitamin D as a predictor of all-cause and cardiovascular mortality and risk of progression to micro- or macroalbuminuria in type 2 diabetic patients.......To evaluate vitamin D as a predictor of all-cause and cardiovascular mortality and risk of progression to micro- or macroalbuminuria in type 2 diabetic patients....

  8. An exact law can test biological theories of mortality. (United States)

    Azbel, Mark Ya


    Wild animals rarely grow old, and die due to extrinsic hazards. So, natural selection favors genes with good early effects even when they lead to senescence and death at later ages. This implies the Medawar accumulation of late-acting deleterious effects and Williams-Kirkwood life-history trade-off: mortality of a generation strongly depends on its early age life history. Human and protected animal populations live in evolutionary unprecedented conditions, and survive to old age. Quantitative analysis of their mortality establishes that in such conditions a dominant fraction of mortality yields an exact law. In contrast to mortality, the law is biologically non-specific (i.e. independent of genotypes, phenotypes, life history, old age diseases, and all other relevant factors, describing the population and its environment from conception to the age of death). It is universal for species as remote as humans and flies and may lead to the formulation of a biologically non-specific thermodynamic mechanism of mortality. The law predicts that mortality may be significantly decreased and reversed to its value at a much younger age. The reversal is consistent with demographic data. For instance, Swedish females, born in 1916, at 48 years restored the mortality rate they had at 20; Japanese females, born in 1927, at 28 restored the life expectancy they had 8 years earlier. The law quantitatively tests mortality theories and establishes their limitations.

  9. Circadian aspects of post-operative morbidity and mortality

    DEFF Research Database (Denmark)

    Kvaslerud, T.; Hansen, M.V.; Rosenberg, J.;


    concerning post-operative circadian disturbances. We also present the literature concerning circadian variation in post-operative morbidity and mortality. PubMed and the Cochrane database were searched for papers using a combination of 'circadian,' 'surgery,' 'post-operative,' 'mortality' and 'morbidity...

  10. Triage and mortality in 2875 consecutive trauma patients

    DEFF Research Database (Denmark)

    Meisler, Rikke; Thomsen, A B; Abildstrøm, H


    Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage.......Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage....

  11. Autumn Weather and Winter Increase in Cerebrovascular Disease Mortality

    LENUS (Irish Health Repository)

    McDonagh, R


    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

  12. Decreased mortality of abdominal aortic aneurysms in a peripheral county

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Henneberg, E W; Fasting, H


    To analyse the effect on the mortality associated with abdominal aortic aneurysms, due to the establishment of a decentralised vascular surgical unit in the county of Viborg.......To analyse the effect on the mortality associated with abdominal aortic aneurysms, due to the establishment of a decentralised vascular surgical unit in the county of Viborg....

  13. [Mortality and morbidity in surgery for abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Banke, A.B.; Andersen, Jakob Steen; Heslet, L.


    INTRODUCTION: Patients undergoing surgery for ruptured abdominal aortic aneurysm (rAAA) have a mortality of 40-50%. The purpose of the present investigation is to document the mortality and morbidity of such patients at Rigshospitalet (RH) in 2005. The results are compared with the best results...

  14. Monitoring child mortality through community health worker reporting of births and deaths in Malawi: validation against a household mortality survey. (United States)

    Amouzou, Agbessi; Banda, Benjamin; Kachaka, Willie; Joos, Olga; Kanyuka, Mercy; Hill, Kenneth; Bryce, Jennifer


    The rate of decline in child mortality is too slow in most African countries to achieve the Millennium Development Goal of reducing under-five mortality by two-thirds between 1990 and 2015. Effective strategies to monitor child mortality are needed where accurate vital registration data are lacking to help governments assess and report on progress in child survival. We present results from a test of a mortality monitoring approach based on recording of births and deaths by specially trained community health workers (CHWs) in Malawi. Government-employed community health workers in Malawi are responsible for maintaining a Village Health Register, in which they record births and deaths that occur in their catchment area. We expanded on this system to provide additional training, supervision and incentives. We tested the equivalence between child mortality rates obtained from data on births and deaths collected by 160 randomly-selected and trained CHWs over twenty months in two districts to those computed through a standard household mortality survey. CHW reports produced an under-five mortality rate that was 84% (95%CI: [0.71,1.00]) of the household survey mortality rate and statistically equivalent to it. However, CHW data consistently underestimated under-five mortality, with levels of under-estimation increasing over time. Under-five deaths were more likely to be missed than births. Neonatal and infant deaths were more likely to be missed than older deaths. This first test of the accuracy and completeness of vital events data reported by CHWs in Malawi as a strategy for monitoring child mortality shows promising results but underestimated child mortality and was not stable over the four periods assessed. Given the Malawi government's commitment to strengthen its vital registration system, we are working with the Ministry of Health to implement a revised version of the approach that provides increased support to CHWs.

  15. Heat-Related Mortality in India: Excess All-Cause Mortality Associated with the 2010 Ahmedabad Heat Wave (United States)

    Azhar, Gulrez Shah; Mavalankar, Dileep; Nori-Sarma, Amruta; Rajiva, Ajit; Dutta, Priya; Jaiswal, Anjali; Sheffield, Perry; Knowlton, Kim; Hess, Jeremy J.; Azhar, Gulrez Shah; Deol, Bhaskar; Bhaskar, Priya Shekhar; Hess, Jeremy; Jaiswal, Anjali; Khosla, Radhika; Knowlton, Kim; Mavalankar, Mavalankar; Rajiva, Ajit; Sarma, Amruta; Sheffield, Perry


    Introduction In the recent past, spells of extreme heat associated with appreciable mortality have been documented in developed countries, including North America and Europe. However, far fewer research reports are available from developing countries or specific cities in South Asia. In May 2010, Ahmedabad, India, faced a heat wave where the temperatures reached a high of 46.8°C with an apparent increase in mortality. The purpose of this study is to characterize the heat wave impact and assess the associated excess mortality. Methods We conducted an analysis of all-cause mortality associated with a May 2010 heat wave in Ahmedabad, Gujarat, India, to determine whether extreme heat leads to excess mortality. Counts of all-cause deaths from May 1–31, 2010 were compared with the mean of counts from temporally matched periods in May 2009 and 2011 to calculate excess mortality. Other analyses included a 7-day moving average, mortality rate ratio analysis, and relationship between daily maximum temperature and daily all-cause death counts over the entire year of 2010, using month-wise correlations. Results The May 2010 heat wave was associated with significant excess all-cause mortality. 4,462 all-cause deaths occurred, comprising an excess of 1,344 all-cause deaths, an estimated 43.1% increase when compared to the reference period (3,118 deaths). In monthly pair-wise comparisons for 2010, we found high correlations between mortality and daily maximum temperature during the locally hottest “summer” months of April (r = 0.69, pheat (May 19–25, 2010), mortality rate ratios were 1.76 [95% CI 1.67–1.83, pheat wave in Ahmedabad, Gujarat, India had a substantial effect on all-cause excess mortality, even in this city where hot temperatures prevail through much of April-June. PMID:24633076

  16. Social and demographic effects of anthropogenic mortality: a test of the compensatory mortality hypothesis in the red wolf.

    Directory of Open Access Journals (Sweden)

    Amanda M Sparkman

    Full Text Available Whether anthropogenic mortality is additive or compensatory to natural mortality in animal populations has long been a question of theoretical and practical importance. Theoretically, under density-dependent conditions populations compensate for anthropogenic mortality through decreases in natural mortality and/or increases in productivity, but recent studies of large carnivores suggest that anthropogenic mortality can be fully additive to natural mortality and thereby constrain annual survival and population growth rate. Nevertheless, mechanisms underlying either compensatory or additive effects continue to be poorly understood. Using long-term data on a reintroduced population of the red wolf, we tested for evidence of additive vs. compensatory effects of anthropogenic mortality on annual survival and population growth rates, and the preservation and reproductive success of breeding pairs. We found that anthropogenic mortality had a strong additive effect on annual survival and population growth rate at low population density, though there was evidence for compensation in population growth at high density. When involving the death of a breeder, anthropogenic mortality was also additive to natural rates of breeding pair dissolution, resulting in a net decrease in the annual preservation of existing breeding pairs. However, though the disbanding of a pack following death of a breeder resulted in fewer recruits per litter relative to stable packs, there was no relationship between natural rates of pair dissolution and population growth rate at either high or low density. Thus we propose that short-term additive effects of anthropogenic mortality on population growth in the red wolf population at low density were primarily a result of direct mortality of adults rather than indirect socially-mediated effects resulting in reduced recruitment. Finally, we also demonstrate that per capita recruitment and the proportion of adults that became

  17. Competing risks to breast cancer mortality in Catalonia

    Directory of Open Access Journals (Sweden)

    Espinàs Josep-Alfons


    Full Text Available Abstract Background Breast cancer mortality has experienced important changes over the last century. Breast cancer occurs in the presence of other competing risks which can influence breast cancer incidence and mortality trends. The aim of the present work is: 1 to assess the impact of breast cancer deaths among mortality from all causes in Catalonia (Spain, by age and birth cohort and 2 to estimate the risk of death from other causes than breast cancer, one of the inputs needed to model breast cancer mortality reduction due to screening or therapeutic interventions. Methods The multi-decrement life table methodology was used. First, all-cause mortality probabilities were obtained by age and cohort. Then mortality probability for breast cancer was subtracted from the all-cause mortality probabilities to obtain cohort life tables for causes other than breast cancer. These life tables, on one hand, provide an estimate of the risk of dying from competing risks, and on the other hand, permit to assess the impact of breast cancer deaths on all-cause mortality using the ratio of the probability of death for causes other than breast cancer by the all-cause probability of death. Results There was an increasing impact of breast cancer on mortality in the first part of the 20th century, with a peak for cohorts born in 1945–54 in the 40–49 age groups (for which approximately 24% of mortality was due to breast cancer. Even though for cohorts born after 1955 there was only information for women under 50, it is also important to note that the impact of breast cancer on all-cause mortality decreased for those cohorts. Conclusion We have quantified the effect of removing breast cancer mortality in different age groups and birth cohorts. Our results are consistent with US findings. We also have obtained an estimate of the risk of dying from competing-causes mortality, which will be used in the assessment of the effect of mammography screening on breast

  18. Mortality disparities in Appalachia: reassessment of major risk factors. (United States)

    Borak, Jonathan; Salipante-Zaidel, Catherine; Slade, Martin D; Fields, Cheryl A


    To determine the predictive value of coal mining and other risk factors for explaining disproportionately high mortality rates across Appalachia. Mortality and covariate data were obtained from publicly available databases for 2000 to 2004. Analysis employed ordinary least square multiple linear regression with age-adjusted mortality as the dependent variable. Age-adjusted all-cause mortality was independently related to Poverty Rate, Median Household Income, Percent High School Graduates, Rural-Urban Location, Obesity, Sex, and Race/Ethnicity, but not Unemployment Rate, Percent Uninsured, Percent College Graduates, Physician Supply, Smoking, Diabetes, or Coal Mining. Coal mining is not per se an independent risk factor for increased mortality in Appalachia. Nevertheless, our results underscore the substantial economic and cultural disadvantages that adversely impact health in Appalachia, especially in the coal-mining areas of Central Appalachia.

  19. Conflict-related mortality: an analysis of 37 datasets. (United States)

    Guha-Sapir, Debarati; Panhuis, Willem Gijsbert


    Mortality rates are among the main indicators of the human impact of armed conflict and many surveys have assessed this impact both for targeting and evaluating humanitarian aid programmes. Almost no epidemiological analysis such as calculating relative risk was performed nor were reference values clearly described. Here the aim is to review published mortality rates for a better understanding of age-specific mortality in armed conflict. Published mortality rates from conflict situations were collected and pre-conflict reference rates composed. We calculated the relative risk of dying in conflict compared to pre-conflict for children under 5 and people older than five years old. Although limited by reporting inadequacies, the results confirm the high vulnerability of children or = 5 year olds. Although not entirely new, this observation is not fully understood. Further systematic epidemiological research is needed to estimate and understand the impact of armed conflict on mortality.

  20. Mortality among Danish merchant seamen from 1970 to 1985

    DEFF Research Database (Denmark)

    Brandt, L P; Kirk, N U; Jensen, O C;


    in 1970 were included. Computerized linkage with the Danish Mortality Register gave information about the deceased persons' date and cause of death. An increased overall mortality among all groups of seamen was found, being highest for deck and engine crew members. The overall mortality was strongly...... dependent on age and marital status. The highest mortality rate ratios (MRR) were found among young seamen and unmarried seamen. MRRs of 1.90 and 2.47 for cancer of the respiratory system were found among engine officers and crew. The MRRs for accidents and suicide were increased for all seamen, and were...... highest for crew members, among whom the MRR from accidents was stable within age groups but fell for suicide with increasing age. The same pattern was found with cirrhosis of the liver, although this was positively associated with increasing age. Excess mortality from ischemic heart disease was only...