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PubMed1978

Factors contributing to the declining mortality rate in renal transplantation.

Recent modifications and refinements in the management of patients with renal allografts have diminished the mortality rate at our hospital to 2 per cent and 5 per cent at one year for patients receiving kidneys from related and cadaveric sources, respectively. Of 186 receiving transplants since 1974, seven (4 per cent) have died within one year of operation. The incidence of wound infections has been reduced from approximately 25 per cent in 1972 to 2 per cent since 1976 by the use of a single high dose of broad-spectrum antibiotics administered at the time of induction of anesthesia for any surgical procedure. Risk and limitations of immunosuppression have been better appreciated, ultrasound is used more often in the diagnosis of partial obstruction or perinephric fluid collections, and needle biopsy of the transplanted kidney has reduced the morbidity inherent in open biopsy. The contribution of sepsis as a cause of death has declined. The diminishing hazard of renal transplantation has made it an increasingly attractive treatment for end-stage kidney disease.

Anti-Bacterial Agents↗
PubMed2004

Height, frailty, and the standard of living: modelling the effects of diet and disease on declining mortality and increasing height.

Explanations of historical trends in both mortality and human height differ over the relative contributions of better nutrition and reduced exposure to disease. This paper explores theoretical models in which interactions between diet and disease determine both mortality and height. One model assumes that adult height is directly related to frailty, the relative risk of dying. The second model links frailty to differences between attained and potential height. Diet plays a small role in the transition to low mortality in the first model. The second model assigns a large role to diet in historical mortality trends, but implies that mortality will be unrelated to height in the future.

Anthropometry↗
PubMed2002

Trends in legionnaires disease, 1980-1998: declining mortality and new patterns of diagnosis.

New diagnostic tests and empirical therapy for pneumonia may have important ramifications for the identification, treatment, and control of legionnaires disease (LD). To determine trends in the epidemiology of LD, we analyzed data for 1980-1998 from the passive surveillance system of the Centers for Disease Control and Prevention. During this time period, there were 6757 confirmed cases of LD (median annual number, 360 cases/year). Diagnosis by culture and by direct fluorescent antibody and serologic testing decreased significantly; diagnosis by urine antigen testing increased from 0% to 69%. The frequency of isolates other than Legionella pneumophila serogroup 1 (LP1) decreased from 38% to 4% (P=.003). The case-fatality rate decreased significantly, from 34% to 12% (P<.001) for all cases, from 46% to 14% (P<.0001) for nosocomial cases, and from 26% to 10% (P=.05) for community-acquired cases. LD-related mortality has decreased dramatically. The decrease in culture-based diagnosis limits the recognition of non-LP1 disease and impairs outbreak investigation, because fewer Legionella isolates are provided for further examination.

Adult↗
PubMed2004

Declining mortality from kidney cancer in Europe.

Mortality rates from kidney cancer increased throughout Europe up until the late 1980s or early 1990s. Trends in western European countries, the European Union (EU) and selected central and eastern European countries have been updated using official death certification data for kidney cancer abstracted from the World Health Organisation (WHO) database over the period 1980-1999. In EU men, death rates increased from 3.92 per 100,000 (age standardised, world standard) in 1980-81 to 4.63 in 1994-95, and levelled off at 4.15 thereafter. In women, corresponding values were 1.86 in 1980-81, 2.04 in 1994-95 and 1.80 in 1998-99. Thus, the fall in kidney cancer mortality over the last 5 years was over 10% for both sexes in the EU. The largest falls were in countries with highest mortality in the early 1990s, such as Germany, Denmark and the Netherlands. Kidney cancer rates levelled off, but remained very high, in the Czech Republic, Baltic countries, Hungary, Poland and other central European countries. Thus, in the late 1990s, a greater than three-fold difference in kidney cancer mortality was observed between the highest rates in the Czech Republic, the Baltic Republics and Hungary, and the lowest ones in Romania, Portugal and Greece. Tobacco smoking is the best recognised risk factor for kidney cancer, and the recent trends in men, mainly in western Europe, can be related to a reduced prevalence of smoking among men. Tobacco, however, cannot account for the recent trends registered in women.

Adult↗