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PubMedDate not supplied

[Summary of the work of the Pathology Service of the Moscow Health Committee in 1996].

The activity of 57 clinical pathology departments including 2 centers (Moscow city center of pathology studies and phthysiopathology center) is summarized. 31,559 autopsies and about 1.5 million biopsies were performed. Analysis of lethal outcomes shows that cardiovascular diseases are the most frequent cause of death. Tumors, GI tract diseases, respiratory diseases are at the second, third and forth place, respectively. A sharp increase of deaths from tuberculosis is observed. The number of diagnosis discrepancy is 16.5% and is stable for the last five years. The main problems of pathology service are technical insufficiency and lack of staff.

Autopsy↗
PubMedDate not supplied

[Computed tomography in thoracic pathology].

The fundamental principles of computed tomography (CT), its clinical applications and costs are presented followed by the indications and results in diseases of the mediastinum, the oesophagus, heart and great vessels, and the lung and pleura. The CT scan can give the precise localization and density of mediastinal tumours and be used to distinguish thymomas, goiters, lymph nodes, lymphomas, neurinomas and different bronchogenic and pleuropericardial cystic formations. The operability of oesophageal cancer can also be determined. In cardiovascular diseases, the CT scan is particularly useful to identify inborn anomalies, aneurysms, aortic dissection or caval compression or thrombus formation. In lung diseases, the indications for a CT scan are particularly important in bronchopulmonary cancer, tuberculosis, bronchopathies and chronic lung diseases. In bronchogenic cancer, for example, the CT scan is not only a major diagnostic tool but is also particularly useful in determining the prognosis and for following the effectiveness of treatment. The CT scan can be used to identify both effusions of liquid and gas as well as pleural reactions producing thick membranes of importance for both aetiology and later follow-up. Bronchectasis can be identified on serial sections where the degree of extension can be measured. CT scan is also indicated in patients with emphysema, both for evaluating extension and follow-up. Finally the indications and contraindications for interventional computed tomography, particularly in guiding needle biopsies, is presented.

Cardiovascular Diseases↗
PubMed1994

A retrospective analysis of clinical diagnoses and autopsy findings in 3,042 cases during two different time periods.

The accuracy of clinical diagnoses was determined and compared between the two periods of time 1977 to 1978 and 1987 to 1988 based on the analysis of 3,042 autopsies at Huddinge University Hospital. The discrepancy rates were calculated by counting the number of missed or incompletely diagnosed major diseases and their complications. Moreover, sensitivity, specificity, and clinical accuracy for positive and negative diagnoses also were calculated for all cases of acute myocardial infarction and malignant tumors. The autopsy rate decreased from 80% to 39%. The autopsy successfully addressed the clinical questions in 97% of the cases. The selection of the cases possibly could explain the significant 5% increase in the proportion of clinically undetected major underlying diseases. The discrepancy rate was higher among the older patients. There were no significant changes in the diagnosis of cardiovascular diseases apart from thrombosis of the mesenteric artery, which more than doubled. The proportion of infectious diseases increased significantly from 27% to 32%. The number of cases with clinically missed tuberculosis was twice as high in the 1987 to 1988 period as in the 1977 to 1978 period and there was a marked increase in fungal and viral infections. There was no significant change in the clinical diagnosis of malignant tumors between the two periods. Approximately 15% of all major cancers were not diagnosed before autopsy; half of these tumors were lethal. We conclude that the role of the autopsy has not diminished in spite of advanced diagnostic methods and it remains an effective tool in the assessment of medical care.

Adolescent↗
PubMed1997

Antibiotics prescription for indigent patients in primary care.

OBJECTIVE: A drug use evaluation focusing on prescribed antibiotics among Greek indigent and Social Security patients. METHOD: Four hundred and forty-six indigent patients insured by Social Care and 332 patients insured under Social Security Funds were interviewed and their prescription records reviewed. RESULTS: Although 88.5% of indigent patients stated that they had received instructions on antibiotic use and had understood these instructions, only 45.9% could correctly repeat these instructions. Only 9.9% read the enclosed leaflets and 59.4% reported asking the pharmacist for advice, 54.1% of these patients were unaware of the dosage of their medication, and the length of treatment was only written in 13% of cases. The most common diseases among indigent patients were respiratory infection (11.7%) and dental problems (10.1%). The latter ranked 11th among the insured patients (3.7%). Tuberculosis (3.3%) was still one of the most common diseases among the indigent patients. Overall, 30.9% of the prescribed daily defined dose (DDD) of medication for the indigent patients were for cardiovascular drugs (16.9% of the cost), 19.5% were for nervous system drugs (8.9% of the cost), 13.5% for gastrointestinal tract drugs (14.1% of the cost) and only 4.3% were antibiotics (but 16.9% of the cost). The most frequently prescribed antimicrobials were penicillins (45.6%), cephalosporins (19.7%), macrolides (12.6%) and quinolones (9.6%). Antituberculous agents made up 13.7% of the antibiotic prescriptions. The most widely prescribed antibiotics were amoxycillin + clavulanate (19.3%), amoxycillin (7.9%), cefaclor (5.6%), clarythromycin (5.1%) and rifampicin + isoniazid (6.3%). CONCLUSION: The present study emphasizes the need for more information on drug use among indigent patients and their information needs.

Adolescent↗
PubMed2004

[Causes of death among HIV infected adults in French Guyana and the French West Indies in the era of highly active antiretroviral therapy (HAART)].

OBJECTIVE: The survey "Mortality 2000" had for aim to describe the distribution of causes of death in HIV-infected adults in France. METHOD: Hospital wards involved in the management of HIV infection prospectively reported deaths occurring in 2000. The causes of death were documented using a standardized questionnaire. RESULTS: In French Guyana and the French West Indies the five referent wards reported 81 deaths. The main underlying causes of death were AIDS-related (67%), non-AIDS and non-hepatitis related cancer (9%), cardiovascular disease (7%), bacterial infections (5%), and end stage liver disease (4%). Among AIDS-related deaths, the more frequent diseases were histoplasmosis and toxoplasmosis in Guyana and atypical mycobacterial infection, tuberculosis, and cytomegalovirus disease in the West Indies. Median age was 43 years, transmission of HIV infection was heterosexual in 79%; 56% lived in poor socio-economic conditions, and 30% were born abroad. One out of five had been recently diagnosed with HIV infection and one out of three had never received antiretroviral treatment. CONCLUSION: In 2000, two in three death cases in HIV-infected adults were AIDS-related in French Guyana and the French West Indies. Improved strategies for screening HIV infection before the occurrence of AIDS are still needed taking into consideration poor socio-economic and migrant conditions.

Adult↗
PubMedDate not supplied

Why Londoners have low death rates from ischaemic heart disease and stroke.

OBJECTIVE: To explain the low death rates from cardiovascular disease in London. SETTING: London and the other counties of England and Wales. SUBJECTS: Women living in London during 1901-10 and people in London dying during 1968-78. RESULTS: At the beginning of the twentieth century young women aged 15-34 in London had remarkably low death rates, largely because of low rates for tuberculosis and other infectious diseases and low mortality during childbirth. Their low death rates contrasted with the high rates in girls under 15 years. CONCLUSIONS: Large numbers of young women had migrated into London from agricultural counties in southern England and went into domestic service, where the diet was usually very good. Recent findings suggest that a mother's nutrition and health has a major effect on the risk of cardiovascular disease in the next generation. The low cardiovascular mortality in London is consistent with this, and contrasts with the high mortality from other common diseases.

Cause of Death↗
PubMed2001

Rapid socio-cultural change and health in the Arctic.

The colonization of the circumpolar peoples has had a profound influence on their health. History tells about devastating epidemics and the introduction of alcohol. The last 50 years have witnessed an unprecedented societal development in Greenland and a rapid epidemiological transition. Physical health and survival have improved but at the expense of mental health. The incidence of tuberculosis and the infant mortality rate have decreased because of improved socioeconomic conditions and health care. Mental health has deteriorated parallel to the rapid modernization of Greenlandic society. Chronic diseases are on the increase due to changing life styles, and environmental pollution with mercury and persistent organic pollutants may pose a threat to future generations of Inuit.

Arctic Regions↗
PubMed1990

Public-health epidemiology in Vanuatu.

Vanuatu, which formerly was known as the New Hebrides, is an archipelago in the southwest Pacific Ocean with a tropical humid climate. The national health system and the state of health of the population generally are satisfactory. The main diseases of public-health importance are malaria and tuberculosis. Their epidemiology and control are discussed. An epidemic of Plasmodium falciparum malaria, which commenced in 1980, is described; this possibly can be explained by an increase in chloroquine-resistant P. falciparum over the same period. Other diseases also are reviewed. Many tropical diseases of great significance elsewhere are not of much significance in Vanuatu. Medical advice for visiting travellers is provided.

Adolescent↗
PubMed1980

Causes of death in a subarctic population.

Some of the main causes of death prior to 1900 are mentioned, including disastrous epidemics of high mortality such as plague, smallpox and the so-called hunger epidemics. Also discussed are two chronic diseases remarkable for Iceland in old times i.e., leprosy and hydatid disease. In the first third of the 20th century, infectious diseases still were the main cause of death in Iceland. The importance of tuberculosis in this connection is stressed. The very high infant mortality up to the beginning of this century is stressed. The changes in the main causes of death in the last decades are described and the growing influence of degenerative vascular diseases and cancer in that connection pointed out. Last, the remarkable fall in the infant mortality and increasing life expectancy from the beginning of this century with growing prosperity of the nation is stressed.

Cardiovascular Diseases↗
PubMed1992

Effects of early-life conditions on adult mortality: a review.

"This paper considers the effects of health conditions in childhood on an individual's mortality risks as an adult. It examines epidemiologic evidence on some of the major mechanisms expected to create a linkage between childhood and adult mortality and reviews demographic and epidemiologic studies for evidence of the hypothesized linkages....Many empirical studies support the notion that childhood conditions play a major role in adult mortality, but only in the case of respiratory tuberculosis has the demographic importance of a specific mechanism been established by cohort studies. One's date and place of birth also appear to be persistently associated with risks of adult death in a wide variety of circumstances. An individual's height, perhaps the single best indicator of nutritional and disease environment in childhood, has recently been linked to adult mortality, especially from cardiovascular diseases. Further research is needed, however, before causal mechanisms can be identified."

Adult↗
PubMed1986

[Sudden death. Cardiac and noncardiac causes].

The present review systematically reports the literature on a phenomenon that is hard to understand not so much in terms of pathological anatomy as in its physiopathological aspects: sudden death. An analysis is presented of the various cardiac and non-cardiac causes that can create the electrical instability of the heart that will end in sudden death. The anatomopathological need for careful study of the structures responsible for the creation of the electrical impulse and its conduction inside the heart is also emphasised.

Asthma↗
PubMed1982

Methodological issues involving the standardized mortality ratio and proportionate mortality ratio in occupational studies.

The algebraic relationship between the standardized mortality ratio (SMR) and the proportionate mortality ratio (PMR) is derived. This relationship clearly shows that the validity of PMR as a risk assessment index depends on the homogeneity of the age-specific overall SMRs and the value of the "average" overall SMR (usually estimated by the age-adjusted overall SMR). Based on actual data from various epidemiologic studies, the adequacy, or lack of it, of using the PMR or the converted SMR is examined. Variations of the PMR method using different bases can be useful. Incomplete death ascertainment, which is a common problem in PMR studies, can lead to biased estimates.

Adult↗