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PubMed1992

Cardiovascular causes of death at Tshepong Hospital in 1 year, 1989-1990. A necropsy study.

Cardiovascular disease is the third most common cause of death in Tshepong Hospital in the western Transvaal, and the most common cause of death in patients older than 35 years. A prospective study was undertaken which included limited necropsies in 90 of the 167 cardiovascular disease deaths over 1 year. A reliable mortality pattern for cardiovascular deaths is described. Additionally, attention is paid to co-existing conditions. Conditions relating to cardiovascular disease, such as hypertension, benign hypertensive nephrosclerosis, atherosclerosis and obesity, were also evaluated. Cerebrovascular conditions were found in 32% of cardiovascular deaths. Intracerebral haemorrhage was found in 50% and cerebral infarction in 29% of cases. Fifty-seven per cent of cardiovascular deaths were due to cardiac conditions, the most common being pulmonary hypertension (31%), dilated cardiomyopathy and chronic rheumatic valvular disease (17% each) and hypertensive heart disease (14%). Forty-nine per cent of subjects were hypertensive, while 40% exhibited benign nephrosclerosis and only 3% of the examined vessels had signs of severe atherosclerosis. Tuberculosis was present in 13% of cases. The clinical diagnosis was the same as the final necropsy diagnosis in 38% of cases. These results emphasise the importance of performing necropsies to obtain reliable mortality statistics.

Adolescent↗
PubMed2002

[Correction of asthenovegetative disorders in the postoperative period in pulmonary tuberculosis patients].

UNLABELLED: 58 patients with asthenia were observed during postoperative period after surgery treatment of tuberculosis. All of the patients were divided into two groups: 34 patients taking anti tuberculosis drugs and Stimol, and 24 patients taking only anti tuberculosis drugs. Following method where used to appreciate states of the patients: scales of Symptoms Check List--90, acid-base and gas state of blood, EKG, ECHOKG, KIG, Contactles Spirometry. RESULTS: Treatment with using of Stimol leads to quicker regress of asthenia to improvement in both cardiovascular and respiratory systems and normalization of gas state of blood. Effect of this medicine can be connected with positive influence on cardiac and respiratory functions of the body due to normalization vegetative prevision and improvement of metabolism in cells of drain and cardiomyocyties.

Asthenia↗
PubMed1977

The Yugoslavia Cardiovascular Disease Study. 3. Death by cause and area.

In the seven years following initial examination (1964--65) 758 deaths were observed in 11,121 Yugoslav men aged 35--62. The mortality rate was similar to that found for men in the Framingham (Massachusetts) study. However, coronary heart disease (CHD) mortality was much lower in Yugoslavia but mortality from cancer, accidents and violence and respiratory disease was much higher. The excess cancer mortality was chiefly from stomach cancer. The excess respiratory mortality was from both tuberculosis and chronic obstructive respiratory disease. Within Yugoslavia there were area differences in mortality by cause but little difference in total mortality: in Tuzla (Bosnia) there was a higher respiratory disease mortality but a lower mortality from accidents and violence than in Remetinec (Croatia). In the rural areas of the study there was a higher mortality from respiratory diseases and accidents and violence than in urban areas but a counterbalancing lower mortality from cardiovascular diseases. The low coronary death rates and high cancer of the stomach death rates in this population present an important epidemiological challenge.

Accidents↗
PubMed1997

Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study.

BACKGROUND: Prevention and control of disease and injury require information about the leading medical causes of illness and exposures or risk factors. The assessment of the public-health importance of these has been hampered by the lack of common methods to investigate the overall, worldwide burden. The Global Burden of Disease Study (GBD) provides a standardised approach to epidemiological assessment and uses a standard unit, the disability-adjusted life year (DALY), to aid comparisons. METHODS: DALYs for each age-sex group in each GBD region for 107 disorders were calculated, based on the estimates of mortality by cause, incidence, average age of onset, duration, and disability severity. Estimates of the burden and prevalence of exposure in different regions of disorders attributable to malnutrition, poor water supply, sanitation and personal and domestic hygiene, unsafe sex, tobacco use, alcohol, occupation, hypertension, physical inactivity, use of illicit drugs, and air pollution were developed. FINDINGS: Developed regions account for 11.6% of the worldwide burden from all causes of death and disability, and account for 90.2% of health expenditure worldwide. Communicable, maternal, perinatal, and nutritional disorders explain 43.9%; non-communicable causes 40.9%; injuries 15.1%; malignant neoplasms 5.1%; neuropsychiatric conditions 10.5%; and cardiovascular conditions 9.7% of DALYs worldwide. The ten leading specific causes of global DALYs are, in descending order, lower respiratory infections, diarrhoeal diseases, perinatal disorders, unipolar major depression, ischaemic heart disease, cerebrovascular disease, tuberculosis, measles, road-traffic accidents, and congenital anomalies. 15.9% of DALYs worldwide are attributable to childhood malnutrition and 6.8% to poor water, and sanitation and personal and domestic hygiene. INTERPRETATION: The three leading contributors to the burden of disease are communicable and perinatal disorders affecting children. The substantial burdens of neuropsychiatric disorders and injuries are under-recognised. The epidemiological transition in terms of DALYs has progressed substantially in China, Latin America and the Caribbean, other Asia and islands, and the middle eastern crescent. If the burdens of disability and death are taken into account, our list differs substantially from other lists of the leading causes of death. DALYs provide a common metric to aid meaningful comparison of the burden of risk factors, diseases, and injuries.

Adolescent↗
PubMed1980

Socio-economic determinants of mortality in industrialized countries.

In the early 1950s, it was generally considered that social mortality differentials appeared during the 1st stages of industrialization and would be resolved with the socialization of health services. Admittedly, at that time, the spectacular progress achieved through antibiotics encouraged the belief that health was merely a matter of medicine and that the institution of a social security scheme would suffice for minimizing the risks of death that were not directly involved in the natural differences between individuals. 30 years have passed and the expectation of life has lengthened (although less than anticipated), but the social differences remain. They are, in fact, by no means attributable to lack of medical science. The elimination of the most discriminating causes of death (alcoholism, accidents, suicide, tuberculosis, etc.) is less dependent on further scientific progress than on a complete change in living conditions and behavior. The reduction in the excess mortality of the poorer classes from other causes (cancer, cardiovascular diseases, etc.) again calls more for a thorough cultural transformation of the least privileged social categories than for the discovery of new therapies or increased expenditure on hospitals. Faced with a mortality that is already very unequal (selection, differential risks), the various social categories behave in basically different ways, which, while aggravating the real inequities, lead to an apparent morbidity that is inversely proportional to true morbidity and to a more prompt and frequent use of medical care among the social categories in which true morbidity is lowest. Inequality with respect to death is only 1 dimension of social inequality. It was an illusion to imagine that 1 could be eliminated without the other. Today that illusion has been destroyed. That does not mean that the present situation must be accepted. Inequality with respect of death is still 1 of the most disgraceful consequences of social inequality and its abolition must still be our aim. Obviously, however, this aim cannot be achieved through the health services alone.

Americas↗
PubMed1980

Follow-up studies of world war II and Korean conflict prisoners. III. Mortality to January 1, 1976.

Mortality through 1975 in US Army veterans released from prisoner-of-war camps following World War II (Europe, Pacific) and the Korean conflict and in several non-prisoner groups is compared using death rates and standard mortality ratios. The World War II Pacific and Korean conflict experience reveal increased risk of dying among former prisoners which, though diminishing with time, persist for 9 and 13 years, respectively. Mortality from tuberculosis and from trauma contributes to the increase among Pacific ex-prisoners, while for Korea the increase is limited to trauma. An excess of deaths due to cirrhosis of the liver in all three former prisoner groups appeared from about the 10th follow-up year. While the reported mortality experience for World War II spans 30 calendar years and for Korea 22 years, no evidence of increased aging among former prisoners of war is seen in mortality from the chronic and degenerative diseases.

Adult↗
PubMed2000

Private health care.

During the last decade there has been considerable international mobilisation around shrinking the role of States in health care. The World Bank reports that, in many low and middle-income countries, private sources of finance comprise the largest share of total national health expenditures. Private sector health care is ubiquitous, reaches throughout the population, preferred by the people and is significant from both economic as well as health perspective. Resources are limited, governments are weak, and a new approach is needed. This paper provides a broad overview and raises key issues with regard to private health care. The focus is on provision of health care by private medical providers. On the background of the world's common health problems and interventions available to tackle them, the place of private health care in the overall context is first discussed. The concept of privatisation within the various forms of health care systems is then explained. The paper then describes the genesis and key elements of rapidly enhancing role of the private sector in health care and points to the paucity of literature from low and middle-income countries. Common concerns about private health care are outlined. Two illustrative examples--tuberculosis, the top infectious killer among the poor and coronary heart disease, the top non-infectious killer among the rich--are presented to understand the current and possible role of private sector in provision of health care. Highlighting the need to distinguish between health care as a public good or a market commodity, the paper leaves it to the reader to draw conclusions.

Cardiovascular Diseases↗
PubMed1991

Correlation of clinical diagnosis with autopsy findings.

We investigated 110 cases, selected at random out of the total of 1876 autopsies performed in the Institute of Pathological Anatomy and Histology at the University of Ferrara-Arcispedale Santa Anna on patients who had died at the hospital during 1983-87. Clinical data were taken from 'necropsy request forms' filled in by clinicians and from medical records. We then evaluated the extent of agreement and disagreement, expressed as underdiagnosis (false-negative) and overdiagnosis (false-positive), between the clinical and pathological records with regard to primary disease and to cause of death. Agreement between the diagnoses was 81% for primary disease and 58% for cause of death. The diagnoses of neoplastic, cerebrovascular and cardiovascular diseases showed the closest agreement. Among the neoplasms, those of the liver, gall-bladder, pancreas, retroperitoneal space and prostate were most often overlooked in clinical diagnoses. We had conflicting results for cancer of the lung and of the colon-rectum, for which there was a high level of agreement, but also a large number of false-positive cases and cases in which they were found by chance at autopsy. For cerebrovascular diseases, false-negative and false-positive diagnoses were seen most often for cause of death. With regard to cardiovascular diseases, a relatively uniform distribution was found for myocardial infarction among the three categories, and a high rate of agreement was found for pulmonary embolism. Of all diseases, bronchopneumonia was associated with the highest percentage of false-negative diagnoses for cause of death. Our data on digestive diseases show the strongest agreement on diagnosis of primary disease in relation to cirrhosis of the liver; a high rate of agreement on cause of death was confirmed for alimentary bleeding. Active tuberculosis was detected only at autopsy. We conclude that autopsy is a valid tool for investigation, despite the availability of sophisticated diagnostic techniques.

Adult↗
PubMed1992

[Age-dependent alterations in clinical features of pulmonary tuberculosis].

Age-related changes in clinical features of 182 patients diagnosed as having pulmonary tuberculosis from positive culture results of tubercle bacilli were extensively investigated. The percentage of cases detected using mass miniature radiophotography (MMR) was highest in the patients aged 30-39 years, and then decreased with increasing age. It was only 16-19% in those aged 60 years or older. Certain conditions, such as cardiovascular diseases, hypertension, diabetes mellitus, malignancy and other lung diseases, were common in the patients aged 60 years or older. Systemic symptoms, including weight loss and anorexia, and physical abnormalities, including fever and crackles, were common in these patients. Anemia tended to be predominant in the patients aged 60 years or older. The middle/lower lobes were involved more frequently in these patients, in whom the disease distribution was more than one lobe, or disseminated. Positive smear results and negative anergy were more frequently noted in the patients aged 60 years or older. The mortality from tuberculosis in these patients was 4% (7 cases). Although gastrointestinal disorder due to antitubercular drugs was more common in the patients aged 80 years or older, eosinophilia was less frequently observed. Today, improved conditions, better sanitation and the development of new chemotherapeutic agents have contributed to the decline of tuberculosis among the general population. But more efficient procedures that allow the early detection or diagnosis of pulmonary tuberculosis in the elderly should be achieved as soon as possible.

Adult↗
PubMed1982

Melioidosis.

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Animals↗
PubMed1977

Cause specific mortality of coal miners.

The purpose of this study was to compare the cause specific mortality of the U.S. coal miner to the mortality of the total U.S. male population. A 10% sample was taken of those men covered by the United Mine Workers Health and Retirement Funds on January 1, 1959, and the resultant 23,232 miners were followed through December 31, 1971. The overall SMR was 102.1, and there was higher than expected mortality in several categories of nonmalignant respiratory disease, accidents and stomach cancer. The excess in stomach cancer occurred only for those men 70 years of age or older.

Accidents↗
PubMed1990

Development, prerequisites and specific scope of general thoracic surgery: analysis of requirements and capacity for the Federal Republic of Germany (West). The German Society for Thoracic and Cardiovascular Surgery.

In the 1970s and 1980s the measures for providing the inhabitants of the FRG with regionally distributed facilities in thoracic and cardiovascular surgery took almost only heart surgery into account. In the field of thoracic surgery, by contrast, several centers were closed or used for other purposes. This development was due to the decline in tuberculosis, but also partly to the lack of exact statistics concerning thoracic surgery. The result has been a considerable deficit in the provision of specialized care for the population and stagnation in research. A nationwide questionnaire in 1989 showed that in 78.4% of the surgery departments asked general thoracic surgery was undertaken only occasionally (less than 100 interventions a year); 42.8% of the operations were undertaken by non-specialized surgeons. Malignant diseases dominated the case-load. Because of the lack of sufficient thoracic surgery departments with appropriate specialized knowledge, it must be assumed that many patients with cancer of the thoracic organs are receiving either no, inefficient, or too late a treatment of their disease. Reorganisation of general thoracic surgery is necessary in order to provide the population with adequate facilities in this field. The existing thoracic surgery centers should be enlarged and attached to the universities in order to ensure research and teaching. Specialized treatment of thoracic surgical diseases can be achieved by reorganizing general surgery departments in the regional hospitals which already undertake thoracic interventions and by establishing additional thoracic surgery departments under qualified leadership.

Germany, West↗