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PubMedDate not supplied

[The mortality determinants in 93 cases operated on for aortic stenosis].

We report 93 cases of severe aortic stenosis. We discuss their clinical data, hemodynamic parameters, and surgical outcome. The surgical mortality and variables determining this event evaluated in groups: A (deaths) and B (survivors). Functional class (mean = 2.5 vs 2.0 p less than 0.05) was statistically as determinant for mortality as were also: transaortic gradient (group A mean = 110 +/- 37 mmHg vs group B mean = 82 +/- 31 p less than 0.005), and ejection fraction (group A mean = 55 +/- 13.7 vs group B mean = 64 +/- 14.8 p less than 0.005). Neither time of cardiopulmonary bypass nor aortic clamping were determinants for mortality. Our results are similar to those reported in other groups. Mortality rates, are determined basically by deterioration of left ventricular function, and by the severity of transaortic gradient.

Age Factors↗
PubMed1990

Mortality determinants and prediction of outcome in high risk newborns.

The aim of this study was to determine independent patient-related predictors of mortality in high risk newborns admitted at our centre. The study population comprised 100 consecutive newborns each, from the premature unit (PU) and sick baby care unit (SBCU), respectively. Thirteen high risk factors (variables) for each of the two units, were entered into a multivariate regression analysis. Variables with independent predictive value for poor outcome (i.e., death) in PU were, weight less than 1 kg, hyaline membrane disease, neurologic problems, and intravenous therapy. High risk factors in SBCU included, blood gas abnormality, bleeding phenomena, recurrent convulsions, apnea, and congenital anomalies. Identification of these factors guided us in defining priority areas for improvement in our system of neonatal care. Also, based on these variables a simple predictive score for outcome was constructed. The prediction equation and the score were cross-validated by applying them to a 'test-set' of 100 newborns each for PU and SBCU. Results showed a comparable sensitivity, specificity and error rate.

Forecasting↗
PubMed1997

Infant and child mortality determinants in Bangladesh: are they changing?

From the data of the 1989 Bangladesh Fertility Survey, aggregate deaths reported at ages 0-12 and 13-60 months are used to estimate infant and child mortality. Multivariate analysis shows that preceding birth interval length, followed by survival status of the immediately preceding child, are the most important factors associated with differential infant and child mortality risks; sex of the index child and mother's and father's education are also significant. Demographic factors are influential during infancy as well as childhood, but social factors, particularly mother's and father's education, now emerge as significant predictors of infant mortality risks. This indicates a change in the role of socioeconomic factors, since the earlier Bangladesh Fertility Survey in 1975.

Adult↗
PubMed1997

Which features of smoking determine mortality risk in former cigarette smokers with diabetes? The World Health Organization Multinational Study Group.

OBJECTIVE: The effects of quitting smoking on mortality risk in individuals with diabetes is unknown and may differ from the benefits observed in the general population. We therefore determined the mortality risks in ex-smokers with diabetes, compared with subjects who have never smoked, by the number of years since quitting, the number of cigarettes smoked, and the number of years of smoking. RESEARCH DESIGN AND METHODS: An international cohort study of 4,427 individuals with diabetes was studied. Baseline examinations were performed in 1975-1977 when smoking habits were determined by questionnaire. Mortality follow-up continued until 1988. RESULTS: All-cause mortality risks were higher for recent quitters (1-9 years; relative risk [RR], 1.53 [95% CI 1.19-1.97]; P = 0.001) than for those who quit earlier (> or = 10 years; RR, 1.25 [95% CI 1.03-1.52]; P = 0.02), compared with subjects who have never smoked. These risks were highest in those who had smoked the longest (> or = 30 years: RR, 1.66 [95% CI 1.22-2.26]; P = 0.001; vs. 1-9 years: RR, 1.17 [95% CI 0.85-1.60]; P = 0.3). Risks were also highest in those who had smoked the most and least number of cigarettes. Adjustment for key confounders, which included a previous history of heart disease, proteinuria, and blood pressure, did not materially affect these relationships. CONCLUSIONS: Quitting smoking does reduce mortality risk in ex-smokers with diabetes, but risks remain high several years after quitting and are highly dependent on the duration of smoking. Thus, individuals with diabetes who smoke should be encouraged to quit as soon as possible in the course of disease.

Adult↗
PubMed1994

What determines mortality risk in male former cigarette smokers?

OBJECTIVES: The purpose of this study was to examine what factors determine the mortality experience of male ex-cigarette smokers, those who no longer smoke at all and those who changed to pipe or cigar smoking. METHODS: A cohort study was undertaken with 18-year mortality data on 19,018 men. RESULTS: Ex-cigarette smokers had an intermediate mortality risk compared with never and current smokers. Ex-cigarette smokers who switched to pipe smoking had higher mortality than those who no longer smoked at all. The mortality rates for pipe and cigar smokers who were former cigarette smokers were higher than those for pipe or cigar smokers who had never smoked cigarettes. Ex-cigarette smokers who consumed more than 20 cigarettes per day for more than 20 years experienced increased mortality for both coronary heart disease and neoplasms, even after 30 years of cessation. CONCLUSIONS: These results support the notion that an elevated mortality risk may be seen for ex-cigarette smokers, even after they have given up smoking for many years. Ex-cigarette smokers who change to a pipe have a greater mortality risk than those who no longer smoke at all.

Adult↗
PubMed1998

Congenital diaphragmatic hernia: mortality determinants in a Hispanic population.

OBJECTIVES: Determine which factors were associated with mortality in our patients, specifically whether ventilatory parameters and arterial blood gas could be used to predict outcome. The role of delaying surgery and the presence of contra lateral pneumothorax were also assessed. BACKGROUND: Mortality among babies born with congenital diaphragmatic hernia remains high. The associated pulmonary hypoplasia and hypertension account for most of the overall mortality. There is no uniform consensus as to which parameters predict outcome. METHOD: Study population consisted of thirty-two patients with CDH managed during a ten-year period. Retrospective data obtained included: perinatal data, postnatal complications, ventilatory parameter data, arterial blood gas, type and age of surgery. Ventilatory index, oxygenation index and arterial to alveolar oxygen difference (A-aDO2) within the first 24 hours of life and after surgical correction were compared among the 23 patients who underwent surgical correction. Timing of surgery and frequency of pneumothorax were compared between survivors and non-survivors. Epi-Info Software Package was used for statistic analysis. RESULTS: Overall survival was 40%. Survival of surgically corrected infants was 61%. Non-survivors had significantly higher A-aDO2 than survivors (p < 0.05). No significant differences in pCO2, ventilatory index, or oxygenation index were identified between survivors and non survivors. Surgical repair performed after the first twenty-four hours of life, was associated with a higher survival rate (p < 0.05). Fourteen patients (39%) developed contralateral pneumothorax, eleven (79%) of these died. CONCLUSIONS: (1) contralateral pneumothorax was associated with higher mortality, 2) A-aDO2 was a better prognostic indicator than pCO2, ventilatory index, or oxygenation index, 3) delaying surgical repair was associated with better survival rate.

Age Factors↗
PubMed1995

Use of the APACHE II scoring system to determine mortality of gynecologic oncology patients in the intensive care unit.

OBJECTIVE: To determine if an elevated score on the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system is associated with mortality of acutely ill gynecologic oncology patients. METHODS: Gynecologic oncology patients admitted to the surgical intensive care unit (ICU) were identified from the ICU data base. Their admission APACHE II score and type of gynecologic cancer were also extracted from the data base. Charts were reviewed to determine the disease status and reason for admission to the surgical ICU. Patient mortality was correlated with APACHE II scores. RESULTS: Forty-five gynecologic oncology patients were admitted to the surgical ICU from June 1988 to January 1992. They had a mean age of 62 years and various cancers: ovarian (24), cervical (16), and endometrial (five). The mean APACHE II score was 12 (range 2-26). Eight of 45 (18%) patients died. There was a significant correlation between APACHE II scores and mortality; patients with an APACHE II score of 20 or greater had a 78% risk of death compared to a 3% risk if the score was less than 20 (P < .001, chi 2 test). CONCLUSION: Elevated APACHE II scores are associated with mortality in acutely ill gynecologic oncology patients.

APACHE↗
PubMed1990

Neonatal mortality determinants in Jamaica.

The Jamaican Perinatal Survey included among its objectives the quantification of the island's neonatal mortality rate, the identification of the causes of these deaths (Wigglesworth Classification), and the determination of characteristics of both mother and infant that are associated with increased mortality. A death questionnaire was completed on babies who were born between September 1986 and August 1987, and who died in the neonatal period throughout the island of Jamaica. The neonatal mortality rate was 17.9 per 1000 live births with early and late rates of 16.0 and 1.9 per 1000, respectively. The major contributors to neonatal demise were prematurity and intrapartum asphyxia (74 per cent). Twins had a seven-fold greater risk of dying than singletons. Babies born to mothers under 15 years had a four-fold greater risk of dying than those of mothers 25-29 years. The neonatal mortality rate for Jamaica is high, with room for improvement, particularly in the prevention of perinatal asphyxia.

Asphyxia Neonatorum↗
PubMed1987

Use of an antigen detection assay to determine mortality of Dirofilaria immitis after thiacetarsamide therapy.

The use of an antigen detection enzyme immunoassay (EIA) to determine the post-treatment infection status of 16 dogs naturally infected with Dirofilaria immitis was investigated. Dogs were treated with thiacetarsamide at a dose rate of 12mg/4.5kg twice daily for 2 days, bled at regular intervals and necropsied 9 weeks later. The infection status of all dogs at necropsy was compared to the ratios of optical density (OD) values from the EIA using fresh plasma samples (day 60/day 0 = R60) and dogs were divided into 2 groups. Using the R60 ratios, those dogs with fewer than 2 live adult worms or immature worms at necropsy ("cleared" dogs) could be differentiated with 95% confidence from those dogs with more than 1 live adult worm ("non-cleared" dogs). Changes in the average OD values from the plasma of "cleared" dogs and "non-cleared" dogs were similar up to 46 days after treatment but diverged significantly thereafter. The efficacy of thiacetarsamide was 50% if all worms were considered and 75% if the presence of immature worms was ignored. The benefits of antigen detection assays for diagnosis and improved patient assessment and the use of an R60 ratio to assess the efficacy of adulticides such as thiacetarsamide are discussed in relation to their practical significance for clinicians.

Animals↗
PubMed1997

Mortality determinants in massive pediatric burns. An analysis of 103 children with > or = 80% TBSA burns (> or = 70% full-thickness).

OBJECTIVE: Survivors and nonsurvivors among 103 consecutive pediatric patients with massive burns were compared in an effort to define the predictors of mortality in massively burned children. SUMMARY BACKGROUND DATA: Predictors of mortality in burns that are used commonly are age, burn size, and inhalation injury. In the past, burns over 80% of the body surface area that are mostly full-thickness often were considered fatal, especially in children and in the elderly. In the past 15 years, advances in burn treatment have increased rates of survival in those patients treated at specialized burn centers. The purpose of this study was to document the extent of improvement and to define the current predictors of mortality to further focus burn care. METHODS: Beginning in 1982, 103 children ages 6 months to 17 years with burns covering at least 80% of the body surface (70% full-thickness), were treated in the authors' institution by early excision and grafting and have been observed to determine outcome. The authors divided collected independent variables from the time of injury into temporally related groups and analyzed the data sequentially and cumulatively through univariate statistics and through pooled, cross-sectional multivariate logistic regression to determine which variables predict the probability of mortality. RESULTS: The mortality rate for this series of massively burned children was 33%. Lower age, larger burn size, presence of inhalation injury, delayed intravenous access, lower admission hematocrit, lower base deficit on admission, higher serum osmolarity at arrival to the authors' hospital, sepsis, inotropic support requirement, platelet count < 20,000, and ventilator dependency during the hospital course significantly predict increased mortality. CONCLUSIONS: The authors conclude that mortality has decreased in massively burned children to the extent that nearly all patients should be considered as candidates for survival, regardless of age, burn size, presence of inhalation injury, delay in resuscitation, or laboratory values on initial presentation. During the course of hospitalization, the development of sepsis and multiorgan failure is a harbinger of poor outcome, but the authors have encountered futile cases only rarely. The authors found that those patients who are most apt to die are the very young, those with limited donor sites, those who have inhalation injury, those with delays in resuscitation, and those with burn-associated sepsis or multiorgan failure.

Adolescent↗
PubMed2002

Cardiovascular and diabetes mortality determined by nutrition during parents' and grandparents' slow growth period.

Overfeeding and overeating in families are traditions that are often transferred from generation to generation. Irrespective of these family traditions, food availability might lead to overfeeding, in its turn leading to metabolic adaptations. Apart from selection, could these adaptations to the social environment have transgenerational effects? This study will attempt to answer the following question: Can overeating during a child's slow growth period (SGP), before their prepubertal peak in growth velocity influence descendants' risk of death from cardiovascular disease and diabetes? Data were collected by following three cohorts born in 1890, 1905 and 1920 in Overkalix parish in northern Sweden up until death or 1995. The parents' or grandparents' access to food during their SGP was determined by referring to historical data on harvests and food prices, records of local community meetings and general historical facts. If food was not readily available during the father's slow growth period, then cardiovascular disease mortality of the proband was low. Diabetes mortality increased if the paternal grandfather was exposed to a surfeit of food during his slow growth period. (Odds Ratio 4.1, 95% confidence interval 1.33-12.93, P=0.01). Selection bias seemed to be unlikely. A nutrition-linked mechanism through the male line seems to have influenced the risk for cardiovascular and diabetes mellitus mortality.

Cardiovascular Diseases↗
PubMed1998

Simplification of adult mosquito bioassays through use of time-mortality determinations in glass bottles.

A simple method is described for treating 250-ml glass Wheaton bottles with insecticide, and using them as test chambers for detecting insecticide resistance in mosquito and sandfly populations. The methods for treating bottles, obtaining baseline data, and applying this technique to insects from the field are described. Sample data are presented from tests run on different vector species using a variety of insecticides. Time-mortality data from the bottle bioassay are presented alongside results from biochemical detection methods applied to the same mosquito population. The potential role, advantages, and limitations of the time-mortality bottle method are discussed.

Aedes↗
PubMed1995

The Lao People's Democratic Republic: maternal mortality and female mortality: determining causes of deaths.

A sample of 380 female deaths in the age group 15-49 years from 16 provinces of the Lao People's Democratic Republic were analyzed to determine the most likely cause of death. 127 deaths were classified as maternal, 28% occurred during pregnancy and the remaining 72% within six weeks of the termination of pregnancy. Almost three quarters of all maternal deaths were directly related to obstetrical complications during pregnancy or childbirth. Many of these deaths could probably have been avoided, if appropriate obstetric care had been available. The level of attention to problems related to maternity and childbirth needs to be raised at all responsible levels of the health service system. This must start at the health facility where attending nurses and midwives should be oriented towards pregnancy-related problems and early detection of high-risk women, with appropriate supervisory support. District and national administrations should also focus more on maternity services within their Primary Health Care programme.

Adolescent↗
PubMed1976

Bochdalek hernias in infants: factors determining mortality.

From 1950 through 1974, 76 infants with Bochdalek hernias have been surgically repaired. Mortality has been confined to those admitted at under 30 hr of age, and the highest mortality has been among those infants admitted within the first 8 hr of life. A recent increase in mortality is explained by the arrival of a new group of infants who arrived intubated, had large diaphragmatic defects, required postoperative ventilatory assistance, and had hypoplastic lungs at autopsy. Six infants might have benefited from an early intervention to hasten closure of their patent ductus arteriosus. Since we cannot be positive that intubation of these infants prior to arrival will not have a deleterious effect, we urge great discretion in choosing which infants to intubate.

Age Factors↗
PubMed1985

Critical factors in determining mortality from abdominal aortic trauma.

Aortic injuries remain highly lethal. Major factors contributing to death in these patients appear to be free peritoneal hemorrhage and associated abdominal vascular trauma. These conditions often manifest as profound shock upon hospital presentation and portend a grim prognosis. Potential means to improve survival include: 1, vigorous resuscitation and prompt operative intervention in patients with penetrating abdominal trauma presenting in a state of shock; 2, careful search and control of associated vascular injuries prior to definitive aortic repair, and 3, constant vigilance to coagulation function, core temperature and acid-base status.

Abdomen↗