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PubMedDate not supplied

The use of logit models to investigate social and biological factors in infant mortality. III. Neonatal mortality.

Infant mortality data for England and Wales, cross-classified by mother's age, parity and social class have been published on two occasions, the first giving the relevant data for 1949/50, the second for 1975, some 25 years later. Published analyses of these separate data sets have been based on graphical and tabular analysis. This paper develops the methodology from an earlier paper by Murrells et al. to the analysis of the neonatal data.

Adolescent↗
PubMedDate not supplied

The use of logit models to investigate social and biological factors in infant mortality. IV: Post-neonatal mortality.

Infant mortality data for England and Wales, cross-classified by mother's age, parity and social class have been published on two occasions, the first giving the relevant data for 1949/50, the second for 1975, some 25 years later. Published analyses of these separate data sets have been based on graphical and tabular analysis. This paper describes the application of logit models using the methodology presented by Murrells et al. to investigate post-neonatal deaths.

Adolescent↗
PubMed2005

Association of right ventricular dysfunction with in-hospital mortality in patients with acute pulmonary embolism and reduction in mortality in patients with right ventricular dysfunction by pulmonary embolectomy.

Twenty-one of 64 patients (33%) with pulmonary embolisms with right ventricular (RV) dilation and 6 of 126 patients (5%) with pulmonary embolisms without RV dilation died during hospitalization (p <0.001). In the 64 patients with RV dilation, in-hospital mortality occurred in 2 of 18 hemodynamically unstable patients (11%) who underwent pulmonary embolectomy, in 2 of 6 hemodynamically stable patients (33%) treated with thrombolytic therapy plus intravenous heparin, and in 17 of 40 hemodynamically stable patients (43%) treated with intravenous heparin (p <0.025 comparing pulmonary embolectomy with no pulmonary embolectomy).

Adult↗
PubMed2001

Perinatal mortality in twins and factors influencing mortality in Japan, 1980--98.

The perinatal mortality rate (PMR) in twins was analysed using Japanese vital statistics during the period 1980-98. There was a total of 1992 twin perinatal deaths. The PMR in twins significantly decreased from 91 per 1000 births in 1980 to 31 per 1000 in 1998. The PMR was higher in males than females, but the differences between the sexes decreased over time. It was significantly higher in the second-born than the first-born of the twins. The fetal death rate was 2.8 times higher in monozygotic than dizygotic twins. The PMR decreased to one-sixth for the maternal age group > or =40 years, one-fifth for <20 years, and between one-third and a half for 20--39 years during the period 1980--98. It was lowest for birthweights (BW) between 2500 g and 2999 g during the entire period; the PMR decreased with gestational age (GA) up to 38--39 weeks and increased thereafter. The effect of BW on the PMR was greater than that of GA except in the shorter GA group. The proportion of twin perinatal deaths with extremely low BW (<1000 g) increased from 50% in 1980 to 68% in 1998. Thus, the declining PMR was unlikely to be due to the improvement in BW in twins. It is likely that it is related to the improved medical management of twins during the perinatal period and the first week of life.

Algorithms↗
PubMed1991

Mortality prediction models in intensive care: acute physiology and chronic health evaluation II and mortality prediction model compared.

OBJECTIVE: To compare the Acute Physiology and Chronic Health Evaluation (APACHE II) score with the Mortality Prediction Model (MPM). DESIGN: A prospective study. SETTING: A nine-bed ICU in a 300-bed, nonteaching secondary hospital. PATIENTS: Three hundred thirty-two consecutive, unselected adults. MEASUREMENTS AND MAIN RESULTS: We found a good correlation between APACHE II and MPM; their performance expressed as area under the receiver operating characteristics curve was nearly the same. Goodness-of-fit between observed and expected occurrences was better for APACHE II than for admission MPM, which overestimated deaths. Because we evaluate patients early, often in the Emergency Department, we felt that a "lead-time bias" could explain this discrepancy. Reevaluation after initial stabilization improved the performance of the MPM model to the level of APACHE II. CONCLUSIONS: Our investigation indicates that both APACHE II and MPM are good predictors of hospital outcome in our population, but the level of intensive care services received before conventional ICU admission modifies accuracy of predictive models. In any study of outcome using comparative studies of classification systems, confounding biases should be measured.

Adult↗
PubMed1984

Perinatal mortality in rural India: intervention through primary health care. II Neonatal mortality.

Early neonatal mortality is unacceptably high in most developing countries. A large majority of births in rural areas of these countries occur at home, attended by relatives or traditional birth attendants and without easy access to skilled professional care. Under these circumstances cause of death has to be based on lay descriptions of terminal events. Analysis of cause of death shows that 74% of the early neonatal deaths are amenable to intervention. Admittance to hospital of the "at risk" neonates is not practicable. Intervention through primary health care can be effective if based on scientific principles and offered through female community health workers. Objectives of domiciliary care given by these workers should be to educate and guide the mother to protect the delicate newborn from the effects of adverse environmental conditions, to ensure adequate nutrition, and to prevent infections. Interventions supporting beneficial traditional cultural practices as well as simple techniques for care of the newborn are discussed.

Adult↗
PubMed1997

A community-based investigation of maternal mortality from obstetric haemorrhage in rural Zimbabwe. Maternal Mortality Study Group.

In the rural province Masvingo in Zimbabwe, 25% of maternal deaths were caused by obstetric haemorrhage, which had a cause specific maternal mortality rate (MMR) of 40 per 100,000 live births. Forty per cent of cases were due to a ruptured uterus, and 30% to an atonic uterus. Forty-two per cent were more than 35 years old and 44% para 5 or more. In spite of antenatal coverage for 85% of the women, 42% died outside any health facility. Fifty per cent of the women had had no intervention whatsoever before death from haemorrhage. The most important factor for prevention at community level is provision of emergency transport, which would have saved 50% of the women. Other non-health service factors contributing to the adverse outcome were found in actions of the patient herself or a traditional birth attendant. In the health services avoidable factors were identified in 58% of women. More effective antenatal attention to high risk factors, especially high age and parity, appropriate use of maternity waiting shelters, action programmes for management and haemorrhage at all levels, basic resources for resuscitation, improved surgical skills with supervision and available transport for referrals are all necessary parts of a programme to prevent maternal deaths from obstetric haemorrhage.

Adult↗
PubMed2003

Trends in dementia mortality from two National Mortality Followback Surveys.

The National Center for Health Statistics conducted National Mortality Followback Surveys (NMFS) in 1986 and 1993. The next-of-kin's report of a physician's diagnosis of AD before death and a listing of AD or other dementia as the underlying cause increased significantly among women but remained stable among men. Currently, AD is among the top 10 leading causes of death in elderly white men and women in the United States.

Activities of Daily Living↗
PubMed2003

Perinatal mortality in triplet births in Japan: time trends and factors influencing mortality.

Perinatal mortality rates (PMRs) in triplets were analyzed using Japanese Vital Statistics during the period of 1980-1998. The total number of perinatal deaths in triplets was 1051. The PMR significantly decreased from 214 per 1000 births in 1980 to 39 in 1998, a reduction of 82%. PMRs in triplets were 11.1-fold higher in 1980 and 6.9-fold higher in 1998 than in singletons, indicating that PMRs improved more in triplets than in singletons during the last two decades in Japan. The PMR was the highest in the third-born, followed by the second- and the first-born triplets in each period. As for maternal age, the PMR was 1.5-3.7 times higher in the < 25 years of age group than the other age groups. Additionally, the PMR was the lowest for birthweight (BW) >or= 2000 g during the entire period. In addition, the PMR decreased with gestational age (GA) of up to 38-39 weeks and increased thereafter. The effects of BW on the PMR were stronger than the effects of GA. The proportion of perinatal deaths in triplets with extremely low BW (< 1000 g) was 74% in 1980-1989 and increased to 82% in 1990-1998. The declining PMR was unlikely to be due to the improvement in BW in triplets. It is likely that it was related to the improved medical management of triplets during the perinatal period and the first week of life. Information obtained in the present study may be useful in counseling pregnant woman about triplet births.

Birth Order↗
PubMed2000

The National Morbidity, Mortality, and Air Pollution Study. Part II: Morbidity and mortality from air pollution in the United States.

BACKGROUND: Epidemiologic time-series studies conducted in a number of cities have identified, in general, an association between daily changes in concentration of ambient particulate matter (PM) and daily number of deaths (mortality). Increased hospitalization (a measure of morbidity) among the elderly for specific causes has also been associated with PM. These studies have raised concerns about public health effects of particulate air pollution and have contributed to regulatory decisions in the United States. However, scientists have pointed out uncertainties that raise questions about the interpretation of these studies. One limitation to previous time-series studies of PM and adverse health effects is that the evidence for an association is derived from studies conducted in single locations using diverse analytic methods. Statistical procedures have been used to combine the results of these single location studies in order to produce a summary estimate of the health effects of PM. Difficulties with this approach include the process by which cities were selected to be studied, the different analytic methods applied to each single study, and the variety of methods used to measure or account for variables included in the analysis. These individual studies were also not able to account for the effects of gaseous air pollutants in a systematic manner.

Adolescent↗
PubMed1992

The mortality of British Airways pilots, 1966-1989: a proportional mortality study.

Of 446 deaths among serving and retired British Airways pilots between 1966 and 1989, 411 were analysed using the Proportional Mortality Ratio (PMR) technique. After removal of the predictable excess of aircraft accidents, excesses of cancer (PMR 1.31) and other accidents (1.60) were balanced by deficits in diseases of the circulatory (0.83) and respiratory (0.49) systems. While lung cancer was close to expectation (1.10), consistent excesses were shown in all analyses for malignant melanoma (6.68), cirrhosis of the liver (2.88), colon cancer (2.30) and brain/CNS cancer (2.68). Consideration of these ratios in relation to pilots' lifestyle and occupation leads to the conclusion that the brain/CNS cancer excess must be studied further.

Aerospace Medicine↗
PubMed1996

Mortality soon after discharge from a major teaching hospital: linking mortality and morbidity.

In this pilot study, data held by the Registrar of Births, Deaths and Marriages was linked to the Patient Master Index at St Vincent's Hospital Melbourne in order to identify early post discharge deaths, and inpatient records were linked with the Victorian Inpatient Minimum Database. Between July 1991 and December 1993 there were 831 deaths within 28 days of discharge. Injuries and poisoning were the commonest cause of death in younger patients who had attended the emergency department. These were responsible for 64% of deaths under the age of 40 years. There were deaths from cardiovascular disease which had been unrecognised during the hospital stay. There is also the need to identify in hospital those at risk of suicide. Amongst inpatients who were discharged home or transferred, the risk of death was greatest in the days immediately following discharge. Policies relating to the transfer of patients need to be reviewed as the study found that 30% of patients who had been transferred to long term care facilities died within four days. In conclusion, linking mortality and morbidity data can highlight areas of hospital care where there is the potential to prevent premature death, and improve management. The outcome of coronial investigations should be transmitted to hospitals for quality assurance purposes.

Adult↗