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PubMed1989

[An analysis of the survival and death rate of patients on periodic hemolysis treatment at the Hemodialysis Center of the Medical Academy in 1971-1987].

For a period of 17 years a total of 377 patients have been on hemodialysis treatment--242 men (64.2 per cent) and 135 women (35.8 per cent). During the first nine years the difference between men and women was significant (71.6 and 28.4 per cent respectively), in the next 8 years however it fell--accordingly 58.6 and 41.4 per cent. The age of patients on intermittent dialysis program was significantly increased--from 37.43 years during the first period, to 46.56 years during the second. Although almost all contraindications for dialysis treatment gradually dropped off, patient death rate has been constantly decreasing and in the last five years is steadily below 10 per cent. Survival is increasing and for the last year averages 5 years. The primary cause of death of patients on intermittent hemodialysis are cardiac complications--47.2 per cent of the decreased 176 patients.

Age Factors↗
PubMed1984

Appendicitis--a study of incidence, death rates and consumption of hospital resources.

The incidence of appendicitis in a population of 1.07 million is estimated based on discharge rates compiled by the Central Bureau of Statistics for the years 1977 and 1978. A crude incidence rate of 140 per 100,000 inhabitants is found with a male dominance (153 v. 126). The lowest incidence rate is found in the age group 0-4, whereas the highest rates are found for patients 15-24 years of age. Seventy-four per cent of all appendicitis cases is found in the age group 5-34 years. The mean length of stay was 6.5 days, but with differences between the counties studied of up to 60%. A yearly death rate of 0.30-0.37% with a male dominance is revealed. Appendicitis cases consume only 1.2% of all hospital discharges but 11.8% of all discharges for gastrointestinal diseases. A comparison with previous studies is performed and it is suggested that most of the reported reduction in incidence rates for appendicitis most probably is caused by a more reliable data base in the recent years.

Adolescent↗
PubMed2002

All-cause and cause-specific death rates by educational status for two million people in two American Cancer Society cohorts, 1959-1996.

Low socioeconomic status is associated with high mortality, but the extent to which socioeconomic status affects particular diseases and whether socioeconomic status effects have changed over time are uncertain. The authors used education as a marker for socioeconomic status in a study of two large American Cancer Society cohorts (follow-up, 1959-1996). Low education was associated with higher death rates in both cohorts from all causes and most specific causes, except breast cancer and external causes among women. Life expectancy in the more recent cohort was 4.8 years shorter for men and 2.7 years shorter for women for the least versus the most educated. The inverse relation between education and mortality was strongest for coronary heart disease, lung cancer, diabetes, and chronic obstructive pulmonary disease; moderate for colorectal cancer, external causes (men only), and stroke; weak for prostate cancer; and reversed for external causes among women. The direction of a weak gradient for breast cancer differed for those with and without prevalent breast cancer at baseline. Adjustment for conventional risk factors, probable intermediate variables between education and mortality, diminished but did not eliminate the observed educational/mortality gradients. Temporal trends showed increasing mortality differences by education for coronary heart disease, diabetes, and lung cancer for women.

Adult↗
PubMed1982

A mathematical model resolving normal human blood lymphocyte population x-ray survival curves into six components: radiosensitivity, death rate and size of two responding subpopulations.

The analysis was based on observations of survival decrease as a function of dose (range 0-5 Gy (= 500 rad) and time after irradiation in vitro. Since lymphocyte survival is also sensitive to culture conditions the effects of radiation were examined daily up to 3 days only, while survival of control cells remained ca. 90 per cent. The time-dependent changes were resolved as the death rates (first-order governed) of lethally-hit cells (apparent survivors), so rendering these distinguishable from the morphologically identical, true (ultimate) survivors. For 12 blood donors the estimated dose permitting 37 per cent ultimate survival (D37 value) averaged 0.72 +/- 0.18 (SD) Gy for the more radiosensitive lymphocyte fraction and 2.50 +/- 0.67 Gy for the less radiosensitive, each fraction proving homogeneously radiosensitive and the latter identifying substantially in kind with T-type (E-rosetting lymphocytes). The half-life of lethally-hit members of either fraction varied widely among the donors (ranges, 25-104 hours and 11-40 hours, respectively). Survival curves reconstructed by summating the numerical estimates of the six parameters according to the theoretical model closely matched those observed experimentally (range in multiple correlation coefficient, 0.9709-0.9994 for all donors). This signified the absence of any additional, totally radioresistant cell fraction.

Adult↗
PubMed1986

Modeling of selection processes with age-dependent birth and death rates.

Two simple models for the competition and selection in age-dependent populations are developed and analyzed mathematically. Following Eigen, competition is introduced by the condition of constant overall-number of the population. In the first model this condition is satisfied by regulation of a dilution flux and in the second case by regulation of a food density. The calculation of maximal fitness is given explicitly for both situations. It is shown that fitness depends in a complicated way on the age-dependence of the birth and death rates. Therefore species have to develop special aging strategies in order to survive in a population under selection pressure. In general, early reproduction is of advantage and increases fitness.

Age Factors↗
PubMed1989

Plasma glutamate levels, lymphocyte reactivity and death rate in patients with bronchial carcinoma.

Elevated glutamate concentrations are commonly observed in patients with advanced carcinoma, and glutamate was recently found to inhibit the membrane transport of cystine and to impair the function of macrophages and lymphocytes in vitro. We therefore investigated the possibility that elevated plasma glutamate levels may be quantitatively correlated with reduced lymphocyte reactivity and an impaired host response to the tumor. Here we report the results of a study on patients with bronchial carcinoma, which show that patients with plasma glutamate levels above 120 microM have a lower lymphocyte response to mitogens and a substantially higher death rate than those with glutamate levels below 120 microM. This correlation does not prove a causal role of glutamate, but it confirms predictions from the in vitro laboratory data.

Amino Acids↗
PubMedDate not supplied

Selenium: geochemical distribution and associations with human heart and cancer death rates and longevity in China and the United States.

The geochemistry of available soil Se varies enormously in different localities, and the corresponding amounts moving up through crops to food vary accordingly. In a belt extending from northeastern to south central China, the available soil Se was measured by human blood Se levels. Severe deficiency occurred at 8-26 ng/mL; subadequate amounts occurred in large areas with 32-83 ng/mL; adequate amounts of 200-300 ng/mL occurred in large cities; and toxic amounts of 3000-7800 ng/mL occurred in terrace areas where runoff from the uplands evaporated, and in certain other soils. Some heart deaths (Keshan Disease) occurred in children 1 to 10 yr of age in the most deficient areas, but were prevented by 230-900 micrograms/wk Se supplementation. One mg Se/wk was the adult dosage. In Se deficient areas, the life span of adults was lowered severely (35 to 45 yr), with heart muscle damage common at autopsy. Se and Zn deficiencies are apparently associated with stomach cancer. The geochemistry of Se in the USA is also highly variable, blood Se ranging from 100-350 ng/mL. Se data for individuals are limited; however, ischemic heart death correlated inversely with blood Se in 25 cities of 22 states (r = -.70; p less than .01). Counties of Wisconsin and Florida are highly variable in human heart death and cancer death rates, as are the 50 states, suggesting Se geographic variability.

Animals↗
PubMed1998

Cumulative risk adjusted mortality chart for detecting changes in death rate: observational study of heart surgery.

OBJECTIVE: To detect changes in mortality after surgery, with allowance being made for variations in case mix. DESIGN: Observational study of postoperative mortality from January 1992 to August 1995. SETTING: Regional cardiothoracic unit. SUBJECTS: 3983 patients aged 16 and over who had open heart operations. MAIN OUTCOME MEASURES: Preoperative risk factors and postoperative mortality in hospital within 30 days were recorded for all surgical heart operations. Mortality was adjusted for case mix using a preoperative estimate of risk based on additive Parsonnet factors. The number of operations required for statistical power to detect a doubling of mortality was examined, and control limits at a nominal significance level of P=0.01 for detection of an adverse trend were determined. RESULTS: Total mortality of 7.0% was 26% below the Parsonnet predictor (P<0.0001). There was a highly significant variation in annual case mix (Parsonnet scores 8.7-10.6, P<0.0001). There was no significant variation in mortality after adjustment for case mix (odds ratio 1-1.5, P=0.18) with monitoring by calendar year. With continuous monitoring, however, nominal 99% control limits based on 16 expected deaths were crossed on two occasions. CONCLUSIONS: Hospital league tables for mortality from heart surgery will be of limited value because year to year differences in death rate can be large (odds ratio 1.5) even when the underlying risk or case mix does not change. Statistical quality control of a single series with adjustment for case mix is the only way to take into account recent performance when informing a patient of the risk of surgery at a particular hospital. If there is an increase in the number of deaths the chances of the next patient surviving surgery can be calculated from the last 16 deaths.

Adolescent↗
PubMed1994

Cardiovascular causes of loss of consciousness in patients with presumed epilepsy: a cause of the increased sudden death rate in people with epilepsy?

UNLABELLED: BACKGROUND, METHODS, AND RESULTS: Syncope and seizures are often indistinguishable clinically. We present a series of 12 patients diagnosed as having epilepsy. Despite normal or nonspecific electroencephalographic findings, 11 of 12 patients were treated or offered treatment with long-term anticonvulsant agents. Subsequently, diagnoses of arrhythmic or neurally mediated syncope were made in all patients using Holter monitoring, long-term ambulatory loop electrocardiographic recording, or tilt-table studies. Arrhythmias included torsades de pointes (four patients), atrioventricular nodal reentrant supraventricular tachycardia (one patient), and sinus arrest (two patients). The remaining five patients had neurally mediated syncope with hypotension and bradycardia, including asystole in two patients. Treatment for the documented cardiovascular abnormalities resulted in the alleviation of syncopal symptoms. CONCLUSIONS: Because the observed cardiovascular abnormalities are potentially fatal, this series suggests that undiagnosed cardiac syncope may contribute to the documented increased sudden death rate in patients with presumed epilepsy. Cardiac causes of loss of consciousness should be considered in patients with presumed epilepsy, atypical premonitory symptoms (such as nausea, lightheadedness, or palpitations), nondiagnostic electroencephalograms, and failure to respond to anticonvulsant therapy.

Adolescent↗
PubMed1993

Regional lung cancer death rates unrelated to smoking? The case of The Netherlands.

It has been observed in various countries that regional variation in lung cancer mortality can hardly be explained by differences in current smoking. This paper addresses the question of whether mortality variation within. The Netherlands in 1980-1984 is due to differences in past instead of current smoking. A first indication of the role of past smoking is that, within male birth cohorts, regional mortality patterns have been very stable for over 30 years. Reliable data on smoking in 1972 explain 40% of the mortality variation among women, but only 2% of that among men. A crude indicator on smoking in 1930 explained 43% of the mortality variation among men aged 75+ years (correlation = 0.66). The lack of a relationship with smoking in 1972 appears to be due to a radical change in regional smoking differences, which caused smoking in 1972 to be unrelated to smoking in 1930; long time lags, so that these changes were not yet followed by changes in regional mortality differences. It is concluded that the explanation of regional lung cancer death rates sometimes has to go far back in time. Studying determinants of lung cancer by means of regional analyses requires a more detailed control for smoking history than has been usual.

Aged↗
PubMed1986

High-K diets reduce brain haemorrhage and infarcts, death rate and mesenteric arteriolar hypertrophy in stroke-prone spontaneously hypertensive rats.

Male stroke-prone spontaneously hypertensive rats (SHRSP) were fed 4% NaCl diets containing either 0.75% normal K or 2.11% high K, starting at 6 weeks of age. After 8 months on these diets 69% of 58 SHRSP rats on 0.75% K had died, whereas 2% of 95 rats of 2.11% K died, a 98% reduction in mortality, P less than 0.000 001. After 20 weeks the daytime and night-time blood pressure (BP) of each rat were measured intra-arterially. We selected two groups precisely matched for BP. One matched SHRSP group (BP 182 mmHg) ate the 0.75% K diet and 30 of 47 rats died (64% mortality). The other matched SHRSP group (BP 182 mmHg) ate the 2.11% K diet, and two of 35 died (6% mortality, a 91% reduction of mortality, P less than 0.0001). Seemingly, the striking reduction in mortality rate with the 2.11% hig-K diet does not depend on a lowering of BP. High-K diets do not change body Na or K. The dry weight of mesenteric arterioles was reduced by 22% on 2.11% K diet versus 75% K (7.5 versus 9.7 mg) (P less than 0.001), indicating a greatly reduced hypertensive hypertrophy. In nine surviving SHRSP on 0.75% K, 13 of 36 brain hemisphere slides (four slides per rat) showed infarcts (36%). In 11 surviving SHRSP on 2.11% K, one of 44 brain slides showed infarcts (2%, a 94.5% reduction, P less than 0.0001). Brain haemorrhage was reduced by 92% on the 2.11% K diet. High-K diets allow cerebral arteries to carry very high BPs without sustaining damage to the artery wall, thereby drastically reducing brain infarcts and lowering the death rate.

Animals↗
PubMed2005

Dental death rate prevalence in smokers and non smokers adults with periodontal disease.

The current study target was to evaluate the dental loss pattern in an adult population with periodontal disease who was treated at the Periodontal Chair, Dentistry Faculty, National University of Rosario, Argentina. The sample was of 203 patients, 130 women and 73 men; 75 of them were blond cigarette smokers and 128 of them were not in that habit. Inclusion criteria as follows: good systemic condition given by the absence of illnesses that may be risky for the development of a periodontal disease, and the presence of at least one teeth with insertion loss of 2 mm. minimum in its proximal faces. The age average of the group was 37,83 years (IC 95% 34,46-41,19) for smokers, and 40,98 (IC 95% 38,27- 43,69) years for non smokers. Regarding females, 85 of them were non smokers and 45 had that habit; concerning men 43 were non smokers and 30 were indeed. The independence test made under smoking and sex variables showed no significant relation between them. Regarding smoker group the smoked cigarette average per day (daily doses) was 13,27 cigarettes (IC 95% 10,96-15,57) and the time since habit started in measure of months was 193,57 (IC 95% 160,43-226,81). The death rate for tooth loss in each group was 4,71 teeth (CI 95 % 3,43-5,98) for smokers and 5,05 teeth (CI 95% 4,07-6,03) for non-smokers. Setting the probability of error of type I equal to 0.05, this study demonstrated that in this group of patients with periodontal disease, the tooth loss in smoker individuals was similar to the tooth loss in non-smoker individuals.

Adolescent↗
PubMed1991

Lack of correlation between objective response and death rate in multiple myeloma patients treated with oral melphalan and prednisone.

An analysis of survival by response category was performed on 76 patients with stage II and III multiple myeloma, who were treated with oral melphalan and prednisone. The analysis demonstrated a survival advantage for responders over non-responders only in stage III patients (32.3 months for responders vs. 15.6 months for non-responders, p = 0.03). However, two possible sources of error must be considered: a) the poor prognosis of early responders that may adversely affect the survival of all responders, and b) the bias introduced by the 'guarantee time' of responders (i.e., the time on-study required to detect the response). Exclusion from the analysis of the unfavourable subgroup of 'early' responders (median survival 14.7 mos.) provided an improvement of the difference in survival between the remaining 'slow' responders and non-responders in stage III (p = 0.005) as well as in the series as a whole (p = 0.025). Because of the consistent 'guarantee time' of slow responders, the Mantel-Byar test (which credits survival to responders only after the response has been obtained) was then applied. The survival advantage of slow responders over non-responders, previously observed in all patients, particularly those with stage III, was not confirmed by the Mantel-Byar test (chi-square 0.831 and 1.457, respectively), thus supporting the hypothesis of an equal death rate over time in each response category. It therefore appears that the usual response criteria (which require at least a 50% reduction of the myeloma protein) should perhaps be reassessed, as they seem to be an inadequate parameter for evaluation of treatment effectiveness in multiple myeloma.

Administration, Oral↗
PubMed2002

Female sex hormones regulate macrophage function after trauma-hemorrhage and prevent increased death rate from subsequent sepsis.

OBJECTIVE: To determine whether reduction of circulating female sex hormones by ovariectomy causes suppression of macrophage (Mphi) function after trauma-hemorrhage and increases susceptibility to subsequent sepsis. SUMMARY BACKGROUND DATA: Studies indicate that immune functions are markedly depressed in males but not in proestrus females after trauma-hemorrhage. Although male sex steroids are immunosuppressive, it remains unknown whether female sex hormones are immunoprotective after trauma-hemorrhage. METHODS: Circulating female sex hormones were reduced by ovariectomy of 8-week-old female CBA/J mice. Two weeks afterward, ovariectomy and proestrus sham-ovariectomy mice were subjected to laparotomy (i.e., soft tissue trauma) and hemorrhagic shock (35 +/- 5 mm Hg for 90 minutes, then resuscitated) or sham operation. Two hours afterward, splenic and peritoneal Mphi and Kupffer cells were isolated and cytokine production was assessed. In a second series of experiments, animals were subjected to sepsis by cecal ligation and puncture at 24 hours after trauma-hemorrhage or sham operation, and survival was assessed. RESULTS: Release of interleukin-1 and interleukin-6 by splenic and peritoneal Mphi from proestrus mice was maintained after trauma-hemorrhage, whereas release of interleukin-1 and interleukin-6 by Mphi from ovariectomized mice was depressed by approximately 50%. In contrast, trauma-hemorrhage resulted in a fourfold increase of Kupffer cell release of tumor necrosis factor-alpha in ovariectomized females and a fivefold increase in plasma concentrations of tumor necrosis factor-alpha. Release of tumor necrosis factor-alpha and plasma concentrations were unchanged in proestrus mice under such conditions. When proestrus and ovariectomized animals were subjected to sepsis by cecal ligation and puncture at 24 hours after trauma-hemorrhage or sham operation, ovariectomized mice had a significantly higher death rate than proestrus mice. CONCLUSIONS: These findings suggest that female sex hormones play a critical role in maintaining immune responses after trauma-hemorrhage by suppressing the elaboration of tumor necrosis factor-alpha and prevent the increased lethality from subsequent sepsis. Thus, female sex hormones may be a useful adjunct in preventing trauma-induced immunodepression and increased susceptibility to subsequent sepsis.

Analysis of Variance↗
PubMed2002

Enhanced severity of secondary dengue-2 infections: death rates in 1981 and 1997 Cuban outbreaks.

OBJECTIVE: To understand the possible effect that length of time has on disease severity with sequential dengue infections. METHODS: Death and hospitalization rates for dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) per 10,000 secondary dengue-2 infections were compared in the same age group for two dengue-2 (DEN-2) epidemics in Cuba. The first DEN-2 epidemic affected all of Cuba in 1981; the second one, in 1997, impacted only the city of Santiago de Cuba. The sensitizing infection for DHF/DSS for each of the DEN-2 epidemics was dengue-1 (DEN-1) serotype virus, which was transmitted in 1977-1979, that is, 4 years and 20 years before the two DEN-2 epidemics. Using published seroepidemiological data from the cities of Havana and Santiago de Cuba, we estimated the rates at which persons aged 15-39 years old and those 40 years and older were hospitalized or died of DHF/DSS in Havana and in all of Cuba in 1981 and in just Santiago de Cuba in 1997. RESULTS: Among adults 15-39 years old the death rate per 10,000 secondary DEN-2 infections was 38.5 times as high in Santiago de Cuba in 1997 as in Havana in 1981. As a further indication of the increased severity coming with a longer period between the initial DEN-1 infection and the secondary DEN-2 infection, the case fatality rate for that same age group was 4.7 times as high in Santiago in 1997 as it was in Havana in 1981. CONCLUSION: We found a marked increase in severity with the longer of the two intervals (20 years) between an initial DEN-1 infection and a secondary DEN-2 infection. Such a difference may be due to subtle shifts in causative dengue strains or to changes with the passage of time in the circulating population of human dengue antibodies. These observations have important implications for dengue control, pathogenic mechanisms, and vaccine development.

Adolescent↗