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Cesmat AP, Chaudry AM, Gupta S, Sivaraj K, Weickert TT, Simpson RJ, Syed FF. Prevalence and predictors of mitral annular disjunction and ventricular ectopy in mitral valve prolapse. Heart Rhythm 2024:S1547-5271(24)02662-6. [PMID: 38823669 DOI: 10.1016/j.hrthm.2024.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/03/2024] [Accepted: 05/27/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Mitral annular disjunction (MAD) is associated with ventricular arrhythmia in mitral valve prolapse (MVP). The proportional risk from MAD and other predictors of ventricular arrhythmia in MVP has not been well characterized. OBJECTIVE This study aimed to identify predictors of complex or frequent ventricular ectopy (cfVE) in MVP and to quantify risk of cfVE and mortality in MVP with MAD. METHODS We studied 632 adult patients with MVP on transthoracic echocardiography at the University of North Carolina Medical Center from 2016 to 2019 (median age, 64 [interquartile range, 52-74] years; 52.7% female; 16.3% African American). Resting and ambulatory electrocardiograms were used to identify cfVE. RESULTS MAD was present in 94 (14.9%) patients. Independent associations of MAD were bileaflet prolapse (odds ratio [95% CI], 4.25 [2.47-7.33]; P < .0001), myxomatous valve (2.17 [1.27-3.71]; P = .005), absence of hypertension (2.00 [1.21-3.32]; P = .007), electrocardiogram inferior or lateral lead T-wave inversion (2.07 [1.23-3.48]; P = .006), and female sex (1.99 [1.21-3.25]; P = .006). cfVE was frequent with MAD (39 [41.5%] vs 93 [17.3%] without; P < .0001). Independent cfVE predictors were MAD (hazard ratio [95% CI], 2.23 [1.47-3.36]; P = .0001), bileaflet prolapse (1.86 [1.25-2.76]; P = .002), heart failure (1.79 [1.16-2.77]; P = .009), lower left ventricular ejection fraction (0.14 [0.03-0.61]; P = .009), coronary artery disease (1.60 [1.05-2.43]; P = .03), and inferior or lateral lead T-wave inversion (1.51 [1.03-2.22]; P = .03). After a median of 40 (33-48) months, there was increased mortality with MAD (P = .04). CONCLUSION MAD in MVP is associated with bileaflet or myxomatous MVP, absence of hypertension, T-wave inversion, and female sex. There is increased cfVE and mortality with MAD, highlighting the need for closer follow-up of these patients.
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Affiliation(s)
- Andrew P Cesmat
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Abdul M Chaudry
- Department of Medicine, Southeast Health Medical Center, Dothan, Alabama
| | - Suhani Gupta
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Krishan Sivaraj
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Thelsa T Weickert
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ross J Simpson
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Faisal F Syed
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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2
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Abreu A, Máximo J, Leite-Moreira A. Preoperative smoking status and long-term survival after coronary artery bypass grafting: a competing risk analysis. Eur J Cardiothorac Surg 2024; 65:ezae183. [PMID: 38688560 PMCID: PMC11105951 DOI: 10.1093/ejcts/ezae183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/15/2024] [Accepted: 04/29/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES Patients with severe coronary artery disease who undergo coronary artery bypass grafting consistently demonstrate that continued smoking after surgery increases late mortality rates. Smoking may exert its harmful effects through the ongoing chronic process of atherosclerotic progression both in the grafts and the native system. However, it is not clear whether cardiac mortality is primary and solely responsible for the inferior late survival of current smokers. METHODS In this retrospective analysis, we included all consecutive patients undergoing primary isolated coronary artery bypass surgery from 1 January 2000 to 30 September 2015 in an Academic Hospital in Northern Portugal. The predictive or independent variable was the patients' smoking history status, a categorical variable with 3 levels: non-smoker (the comparator), ex-smoker for >1 year (exposure 1) and current smoker (exposure 2). The primary end point was long-term all-cause mortality. Secondary outcomes were long-term cause-specific mortality (cardiovascular and noncardiovascular). We fitted overall and Fine and Gray subdistribution hazard models. RESULTS We identified 5242 eligible patients. Follow-up was 99.7% complete (with 17 patients lost to follow-up). The median follow-up time was 12.79 years (interquartile range, 9.51-16.60). Throughout the study, there were 2049 deaths (39.1%): 877 from cardiovascular causes (16.7%), 727 from noncardiovascular causes (13.9%) and 445 from unknown causes (8.5%). Ex-smokers had an identical long-term survival than non-smokers [hazard ratio (HR) 0.99; 95% confidence interval (CI) 0.88, 1.12; P = 0.899]. Conversely, current smokers had a 24% increase in late mortality risk (HR 1.24; 95% CI 1.07, 1.44; P = 0.004) as compared to non-smokers. While the current smoker status increased the relative incidence of noncardiac death by 61% (HR 1.61; 95% CI 1.27, 2.05, P < 0.001), it did confer a 25% reduction in the relative incidence of cardiac death (HR 0.75; 95% CI 0.59, 0.97; P = 0.025). CONCLUSIONS Whereas ex-smokers have an identical long-term survival to non-smokers, current smokers exhibit an increase in late all-cause mortality risk at the expense of an increased relative incidence of noncardiac death. By subtracting the inciting risk factor, smoking cessation reduces the relative incidence of cardiac death.
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Affiliation(s)
- Armando Abreu
- Cardiovascular R&D Center—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João University Hospital Center, Porto, Portugal
| | - José Máximo
- Cardiovascular R&D Center—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João University Hospital Center, Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular R&D Center—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João University Hospital Center, Porto, Portugal
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3
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Abreu A, Máximo J, Saraiva F, Leite-Moreira A. Body mass index effect on long-term survival after coronary artery bypass surgery: a competing risk analysis. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad161. [PMID: 37740299 PMCID: PMC10534054 DOI: 10.1093/icvts/ivad161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/20/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES The aim of this sudy was to investigate the presence of an obesity paradox on the long-term mortality of patients undergoing primary isolated coronary artery bypass surgery and to uncover whether any discrepancy found could be attributable to cardiovascular or noncardiovascular causes. METHODS Retrospective analysis of 5242 consecutive patients with body mass index (BMI) over 18.5 kg/m2 undergoing primary isolated coronary artery bypass surgery, performed from 2000 to 2015, in a Portuguese level III Hospital. The primary end point was long-term all-cause mortality. Secondary outcomes were long-term cause-specific mortality (cardiovascular and noncardiovascular). We fitted overall, and cause-specific hazard models, with BMI forced both as a categorical (using World Health Organization predefined cutoffs) and as a continuous variable. RESULTS Follow-up was 99.7% complete. The median follow-up time was 12.79 years (interquartile range, 9.51-16.61). The cumulative incidence functions failed to uncover any difference in 15-year all-cause (log-rank test, P = 0.400), cardiovascular (Gray's test, P = 0.996) and noncardiovascular mortality (Gray's test, P = 0.305) between BMI categories. Likewise, extensive multivariable-adjusted Cox regression and cause-specific hazards models failed to demonstrate in-between category differences, with BMI forced as a categorical variable. On the other hand, using BMI as a continuous variable, the model identified the optimal BMI as between 25.8 and 30.3 kg/m2 (nadir around 28.9 kg/m2), albeit this was dependent on the definition of the reference value. CONCLUSIONS In this longitudinal, population-level analysis of patients undergoing isolated primary coronary artery bypass grafting, we could not attest to any protective effect of obesity on long-term survival.
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Affiliation(s)
- Armando Abreu
- Cardiovascular R&D Center—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João University Hospital Center, Porto, Portugal
| | - José Máximo
- Cardiovascular R&D Center—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João University Hospital Center, Porto, Portugal
| | - Francisca Saraiva
- Cardiovascular R&D Center—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular R&D Center—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João University Hospital Center, Porto, Portugal
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4
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Kang M, Hart CM, Kempker JA, Veeraraghavan S, Trammell AW. Pulmonary hypertension mortality trends in United States 1999-2019. Ann Epidemiol 2022; 75:47-52. [PMID: 36089225 PMCID: PMC9709717 DOI: 10.1016/j.annepidem.2022.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/22/2022] [Accepted: 09/05/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Pulmonary hypertension (PH) is a heterogenous, often progressive disorder leading to right heart failure and death. Previous analyses show stable PH mortality rates from 1980 to 2001 but increasing from 2001 to 2010 especially among women and non-Hispanic (NH) Black. This study seeks to identify recent trends in PH mortality in the United States from 1999 to 2019. METHODS Mortality rates among individuals more than or equal to 15 years of age were obtained from the Centers for Disease Control and Prevention's (CDC) Wide-Ranging Online Data for Epidemiology Research (WONDER) database. ICD-10 codes were used to identify individuals with PH. RESULTS Between 1999 and 2019, PH was included as a cause on 429,105 recorded deaths. The average age-adjusted PH mortality rate was 7.9 per 100,000 individuals and increased by 1.9% per year. Higher age-adjusted mortality rates were experienced by females and NH Black persons. The crude mortality rate was 105.4 per 100,000 among those decedents 85 or older. From 1999 to 2019, mortality in PH and left heart disease co-occurrence increased at nearly double the annual rate of the overall PH group. CONCLUSIONS Despite therapeutic advances for selected PH subgroups, the overall age-adjusted PH mortality rate increased significantly from 1999 to 2019 and previously reported racial disparities have persisted. These findings emphasize the need for additional study to improve outcomes in PH.
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Affiliation(s)
- Mohleen Kang
- Emory University School of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, GA; Atlanta VA Medical Center, Decatur, GA.
| | - Charles Michael Hart
- Emory University School of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, GA; Atlanta VA Medical Center, Decatur, GA
| | - Jordan A Kempker
- Emory University School of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, GA
| | - Srihari Veeraraghavan
- Emory University School of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, GA
| | - Aaron W Trammell
- Emory University School of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, GA; Atlanta VA Medical Center, Decatur, GA
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5
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Alfsen GC, Gulczyński J, Kholová I, Latten B, Martinez J, Metzger M, Michaud K, Pontinha CM, Rakislova N, Rotman S, Varga Z, Wassilew K, Zinserling V. Code of practice for medical autopsies: a minimum standard position paper for pathology departments performing medical (hospital) autopsies in adults. Virchows Arch 2021; 480:509-517. [PMID: 34888730 PMCID: PMC8660654 DOI: 10.1007/s00428-021-03242-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/17/2022]
Abstract
The medical autopsy (also called hospital or clinical autopsy) is a highly specialised medical procedure, which requires professional expertise and suitably equipped facilities. To ensure high standards of performance, the Working Group of Autopsy Pathology of the European Society of Pathology (ESP) suggests a code of practice as a minimum standard for centres performing medical autopsies. The proposed standards exclusively address autopsies in adults, and not forensic autopsies, perinatal/or paediatric examinations. Minimum standards for organisation, standard of premises, and staffing conditions, as well as minimum requirements for level of expertise of the postmortem performing specialists, documentation, and turnaround times of the medical procedure, are presented. Medical autopsies should be performed by specialists in pathology, or by trainees under the supervision of such specialists. To maintain the required level of expertise, autopsies should be performed regularly and in a number that ensures the maintenance of good practice of all participating physicians. A minimum number of autopsies per dedicated pathologist in a centre should be at least 50, or as an average, at least one autopsy per working week. Forensic autopsies, but not paediatric/perinatal autopsies may be included in this number. Turnaround time for final reports should not exceed 3 weeks (14 working days) for autopsies without fixation of brain/spinal cord or other time-consuming additional examinations, and 6 weeks (30 working days) for those with fixation of brain/spinal cord or additional examinations.
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Affiliation(s)
- G Cecilie Alfsen
- Department of Pathology, Akershus University Hospital, Loerenskog, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Jacek Gulczyński
- Department of Pathology and Neuropathology, Medical University of Gdańsk, Gdansk, Poland
| | - Ivana Kholová
- Pathology, Fimlab Laboratories, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Bart Latten
- Department of Forensic Pathology, Netherlands Forensic Institute, The Hague, The Netherlands.,Department of Pathology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Javier Martinez
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de León (CAULE), Leon, Spain
| | - Myriam Metzger
- Department of Pathology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne, Switzerland.,Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Carlos M Pontinha
- Department of Anatomical Pathology, Central Lisbon University Hospital Centre, Lisbon, Portugal
| | - Natalia Rakislova
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, 08036, Barcelona, Spain
| | - Samuel Rotman
- Service of Clinical Pathology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Zsuzsanna Varga
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | | | - Vsevolod Zinserling
- Department of Pathomorphology, Institute of Experimental Medicine V.A. Almazov National Research Center, Saint Petersburg, Russian Federation
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6
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Uddin M, Mohammed T, Metersky M, Anzueto A, Alvarez CA, Mortensen EM. Effectiveness of Beta-Lactam plus Doxycycline for Patients Hospitalized with Community-Acquired Pneumonia. Clin Infect Dis 2021; 75:118-124. [PMID: 34751745 DOI: 10.1093/cid/ciab863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite clinical practice guideline recommendations to use doxycycline as part of combination therapy for some patients hospitalized with pneumonia, there is minimal evidence supporting this recommendation. Our aim was to examine the association between beta-lactam plus doxycycline and mortality for patients hospitalized with community-acquired pneumonia. METHODS We identified patients > 65 years of age admitted to any United States Department of Veterans Affairs hospital in fiscal years 2002-2012 with a discharge diagnosis of pneumonia. We excluded those patients who did not receive antibiotic therapy concordant with the 2019 ATS/IDSA clinical practice guidelines. Using propensity score matching, we examined the association of doxycycline with 30- and 90-day mortality. RESULTS Our overall cohort was comprised of 70,533 patients and 5,282 (7.49%) received doxycycline. Unadjusted 30-day mortality was 6.4% for those who received a beta-lactam plus doxycycline vs. 9.1% in those who did not (p<0.0001), and 90-day mortality was 13.8% for those who received a beta-lactam + doxycycline vs. 16.8% for those who did not (p<0.0001). In the propensity score matched models, both 30- (odds ratio 0.72, 95% confidence interval, 0.63-0.84) and 90-day (0.83, 0.74-0.92) mortality were significantly lower for those who received doxycycline. CONCLUSIONS In this retrospective observational cohort study, we found that doxycycline use, as part of guideline-concordant antibiotic therapy, was associated with lower 30- and 90-day mortality than regimens without doxycycline. While this supports the safety and effectiveness of antibiotic regimes that include doxycycline, additional studies, especially randomized clinical trials, are needed to confirm this.
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Affiliation(s)
- Moe Uddin
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Turab Mohammed
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Mark Metersky
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Antonio Anzueto
- Department of Medicine, South Texas Veterans Health Care System, San Antonio, Texas, USA.,Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Carlos A Alvarez
- VA North Texas Health Care System, Dallas, Texas, USA.,Department of Pharmacy Practice, Texas Tech University Health Sciences Center Jerry H. Hodge School of Pharmacy, Dallas, Texas, USA
| | - Eric M Mortensen
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA.,VA North Texas Health Care System, Dallas, Texas, USA
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7
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Beach TG, Sue LI, Intorcia AJ, Glass MJ, Walker JE, Arce R, Nelson CM, Serrano GE. Acute Brain Ischemia, Infarction and Hemorrhage in Subjects Dying with or Without Autopsy-Proven Acute Pneumonia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.03.22.21254139. [PMID: 33791728 PMCID: PMC8010760 DOI: 10.1101/2021.03.22.21254139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Stroke is one of the most serious complications of Covid-19 disease but it is still unclear whether stroke is more common with Covid-19 pneumonia as compared to non-Covid-19 pneumonia. We investigated the concurrence rate of autopsy-confirmed acute brain ischemia, acute brain infarction and acute brain hemorrhage with autopsy-proven acute non-Covid pneumonia in consecutive autopsies in the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND), a longitudinal clinicopathological study of normal aging and neurodegenerative diseases. Of 691 subjects with a mean age of 83.4 years, acute pneumonia was histopathologically diagnosed in 343 (49.6%); the concurrence rates for histopathologically-confirmed acute ischemia, acute infarction or subacute infarction was 14% and did not differ between pneumonia and non-pneumonia groups while the rates of acute brain hemorrhage were 1.4% and 2.0% of those with or without acute pneumonia, respectively. In comparison, in reviews of Covid-19 publications, reported clinically-determined rates of acute brain infarction range from 0.5% to 20% while rates of acute brain hemorrhage range from 0.13% to 2%. In reviews of Covid-19 autopsy studies, concurrence rates for both acute brain infarction and acute brain hemorrhage average about 10%. Covid-19 pneumonia and non-Covid-19 pneumonia may have similar risks tor concurrent acute brain infarction and acute brain hemorrhage when pneumonia is severe enough to cause death. Additionally, acute brain ischemia, infarction or hemorrhage may not be more common in subjects dying of acute pneumonia than in subjects dying without acute pneumonia.
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Affiliation(s)
| | - Lucia I Sue
- Banner Sun Health Research Institute, Sun City, AZ
| | | | | | | | - Richard Arce
- Banner Sun Health Research Institute, Sun City, AZ
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8
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Beach TG, Russell A, Sue LI, Intorcia AJ, Glass MJ, Walker JE, Arce R, Nelson CM, Hidalgo T, Chiarolanza G, Mariner M, Scroggins A, Pullen J, Souders L, Sivananthan K, Carter N, Saxon-LaBelle M, Hoffman B, Garcia A, Callan M, Fornwalt BE, Carew J, Filon J, Cutler B, Papa J, Curry JR, Oliver J, Shprecher D, Atri A, Belden C, Shill HA, Driver-Dunckley E, Mehta SH, Adler CH, Haarer CF, Ruhlen T, Torres M, Nguyen S, Schmitt D, Fietz M, Lue LF, Walker DG, Mizgerd JP, Serrano GE. Increased Risk of Autopsy-Proven Pneumonia with Sex, Season and Neurodegenerative Disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.01.07.21249410. [PMID: 33442709 PMCID: PMC7805471 DOI: 10.1101/2021.01.07.21249410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
There has been a markedly renewed interest in factors associated with pneumonia, a leading cause of death worldwide, due to its frequent concurrence with pandemics of influenza and Covid-19 disease. Reported predisposing factors to both bacterial pneumonia and pandemic viral lower respiratory infections are wintertime occurrence, older age, obesity, pre-existing cardiopulmonary conditions and diabetes. Also implicated are age-related neurodegenerative diseases that cause parkinsonism and dementia. We investigated the prevalence of autopsy-proven pneumonia in the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND), a longitudinal clinicopathological study, between the years 2006 and 2019 and before the beginning of the Covid-19 pandemic. Of 691 subjects dying at advanced ages (mean 83.4), pneumonia was diagnosed postmortem in 343 (49.6%). There were 185 subjects without dementia or parkinsonism while clinicopathological diagnoses for the other subjects included 319 with Alzheimer's disease dementia, 127 with idiopathic Parkinson's disease, 72 with dementia with Lewy bodies, 49 with progressive supranuclear palsy and 78 with vascular dementia. Subjects with one or more of these neurodegenerative diseases all had higher pneumonia rates, ranging between 50 and 61%, as compared to those without dementia or parkinsonism (40%). In multivariable logistic regression models, male sex and a non-summer death both had independent contributions (ORs of 1.67 and 1.53) towards the presence of pneumonia at autopsy while the absence of parkinsonism or dementia was a significant negative predictor of pneumonia (OR 0.54). Male sex, dementia and parkinsonism may also be risk factors for Covid-19 pneumonia. The apolipoprotein E4 allele, as well as obesity, chronic obstructive pulmonary disease, diabetes, hypertension, congestive heart failure, cardiomegaly and cigarette smoking history, were not significantly associated with pneumonia, in contradistinction to what has been reported for Covid-19 disease.
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Affiliation(s)
| | | | - Lucia I. Sue
- Banner Sun Health Research Institute, Sun City, AZ
| | | | | | | | - Richard Arce
- Banner Sun Health Research Institute, Sun City, AZ
| | | | - Tony Hidalgo
- Banner Sun Health Research Institute, Sun City, AZ
| | | | | | | | - Joel Pullen
- Banner Sun Health Research Institute, Sun City, AZ
| | | | | | - Niana Carter
- Banner Sun Health Research Institute, Sun City, AZ
| | | | | | | | | | | | | | | | - Brett Cutler
- Banner Sun Health Research Institute, Sun City, AZ
| | - Jaclyn Papa
- Banner Sun Health Research Institute, Sun City, AZ
| | | | - Javon Oliver
- Banner Sun Health Research Institute, Sun City, AZ
| | | | - Alireza Atri
- Banner Sun Health Research Institute, Sun City, AZ
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | | | | | | | - Shyamal H. Mehta
- Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
| | - Charles H. Adler
- Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
| | | | | | | | | | | | | | - Lih-Fen Lue
- Banner Sun Health Research Institute, Sun City, AZ
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9
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Mohandas R, Diao Y, Chamarthi G, Krishnan S, Agrawal N, Wen X, Dass B, Shukla AM, Gopal S, Koç M, Segal MS. Circulating endothelial cells as predictor of long-term mortality and adverse cardiovascular outcomes in hemodialysis patients. Semin Dial 2020; 34:163-169. [PMID: 33280176 DOI: 10.1111/sdi.12943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Circulating endothelial cells (CEC) are thought to be markers of endothelial injury. We hypothesized that the numbers of CEC may provide a novel means for predicting long-term survival and cardiovascular events in hemodialysis patients. 54 hemodialysis patients underwent enumeration of their CEC number. We retrospectively analyzed their survival and incidence of adverse cardiovascular events. 22 deaths (41%) were noted over the median follow up period of 3.56 years (IQR 1.43-12) and 6 were attributed to cardiovascular deaths (11%) of which 1 (4%) was in the low CEC (CEC<20 cells/ml) and 5 (19%) in the high CEC (CEC≥20 cells/ml) group. High CEC was associated with worse cardiovascular survival (p = 0.05) and adverse cardiac events (p = 0.01). In multivariate analysis, CEC >20 cells/ml was associated with a 4-fold increased risk of adverse cardiac events (OR, 4.16 [95% CI,1.38-12.54],p = 0.01) while all-cause mortality and cardiovascular mortality were not statistically different. In this hemodialysis population, a single measurement of CEC was a strong predictor of long term future adverse cardiovascular events. We propose that CEC may be a novel biomarker for assessing cardiovascular risk in dialysis patients.
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Affiliation(s)
- Rajesh Mohandas
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, FL, USA.,Renal Section, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Yanpeng Diao
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, FL, USA
| | - Gajapathiraju Chamarthi
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, FL, USA
| | - Suraj Krishnan
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, FL, USA
| | - Nikhil Agrawal
- Division of Nephrology, Beth Israel Deaconess, Boston, MA, USA
| | - Xuerong Wen
- College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Bhagwan Dass
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, FL, USA
| | - Ashutosh M Shukla
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, FL, USA.,Renal Section, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Saraswathi Gopal
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, FL, USA
| | - Mehmet Koç
- Division of Nephrology, Marmara University School of Medicine, Istanbul, Turkey
| | - Mark S Segal
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, FL, USA.,Renal Section, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
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Trends in forensic autopsy rates in Central Norway during the period 2007–2017: Can media attention impact autopsy practices? FORENSIC SCIENCE INTERNATIONAL: REPORTS 2020. [DOI: 10.1016/j.fsir.2020.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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11
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So R, Jørgensen JT, Lim YH, Mehta AJ, Amini H, Mortensen LH, Westendorp R, Ketzel M, Hertel O, Brandt J, Christensen JH, Geels C, Frohn LM, Sisgaard T, Bräuner EV, Jensen SS, Backalarz C, Simonsen MK, Loft S, Cole-Hunter T, Andersen ZJ. Long-term exposure to low levels of air pollution and mortality adjusting for road traffic noise: A Danish Nurse Cohort study. ENVIRONMENT INTERNATIONAL 2020; 143:105983. [PMID: 32736159 DOI: 10.1016/j.envint.2020.105983] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The association between air pollution and mortality is well established, yet some uncertainties remain: there are few studies that account for road traffic noise exposure or that consider in detail the shape of the exposure-response function for cause-specific mortality outcomes, especially at low-levels of exposure. OBJECTIVES We examined the association between long-term exposure to particulate matter [(PM) with a diameter of <2.5 µm (PM2.5), <10 µm (PM10)], and nitrogen dioxide (NO2) and total and cause-specific mortality, accounting for road traffic noise. METHODS We used data on 24,541 females (age > 44 years) from the Danish Nurse Cohort, who were recruited in 1993 or 1999, and linked to the Danish Causes of Death Register for follow-up on date of death and its cause, until the end of 2013. Annual mean concentrations of PM2.5, PM10, and NO2 at the participants' residences since 1990 were estimated using the Danish DEHM/UBM/AirGIS dispersion model, and annual mean road traffic noise levels (Lden) were estimated using the Nord2000 model. We examined associations between the three-year running mean of PM2.5, PM10, and NO2 with total and cause-specific mortality by using time-varying Cox Regression models, adjusting for individual characteristics and residential road traffic noise. RESULTS During the study period, 3,708 nurses died: 843 from cardiovascular disease (CVD), 310 from respiratory disease (RD), and 64 from diabetes. In the fully adjusted models, including road traffic noise, we detected associations of three-year running mean of PM2.5 with total (hazard ratio; 95% confidence interval: 1.06; 1.01-1.11), CVD (1.14; 1.03-1.26), and diabetes mortality (1.41; 1.05-1.90), per interquartile range of 4.39 μg/m3. In a subset of the cohort exposed to PM2.5 < 20 µg/m3, we found even stronger association with total (1.19; 1.11-1.27), CVD (1.27; 1.01-1.46), RD (1.27; 1.00-1.60), and diabetes mortality (1.44; 0.83-2.48). We found similar associations with PM10 and none with NO2. All associations were robust to adjustment for road traffic noise. DISCUSSION Long-term exposure to low-levels of PM2.5 and PM10 is associated with total mortality, and mortality from CVD, RD, and diabetes. Associations were even stronger at the PM2.5 levels below EU limit values and were independent of road traffic noise.
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Affiliation(s)
- Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Centre for Epidemiological Research, Nykøbing F Hospital, Nykøbing F, Denmark
| | | | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Amar J Mehta
- Denmark Statistics, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Heresh Amini
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Laust H Mortensen
- Denmark Statistics, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rudi Westendorp
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, United Kingdom
| | - Ole Hertel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | - Camilla Geels
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Lise M Frohn
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Torben Sisgaard
- Institute of Environmental and Occupational Medicine, Department of Public Health, Aarhus University, Denmark
| | | | | | | | - Mette Kildevæld Simonsen
- Diakonissestiftelsen, Frederiksberg, Denmark; Research Unit for Dietary Studies, The Parker Institute Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Centre for Air Pollution, Energy and Health Research (CAR), University of Sydney, Sydney, Australia
| | - Zorana Jovanovic Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Centre for Epidemiological Research, Nykøbing F Hospital, Nykøbing F, Denmark.
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Stolpe S, Stang A. Nichtinformative Codierungen bei kardiovaskulären Todesursachen: Auswirkungen auf die Mortalitätsrate für ischämische Herzerkrankungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1458-1467. [DOI: 10.1007/s00103-019-03050-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Zhao Z, Huo L, Wang L, Wang L, Fu Z, Li Y, Wu X. Survival of Chinese people with type 2 diabetes and diabetic kidney disease: a cohort of 12 -year follow-up. BMC Public Health 2019; 19:1498. [PMID: 31706298 PMCID: PMC6842464 DOI: 10.1186/s12889-019-7859-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/28/2019] [Indexed: 01/13/2023] Open
Abstract
Background The prevalence of type 2 diabetes has grown significantly in China. However, little is known about the survival outcome of people with type 2 diabetes and diabetic kidney disease (DKD). The purpose of this study is to examine the survival of this population and the risk factors for mortality in one suburb cohort of Beijing, China. Methods Four hundred and forty-five people with DKD (48.8% male, age at onset of diabetes 48.8 ± 11.0 years, age at enrollment 57.5 ± 11.6 years) were enrolled in one suburb of Beijing, China between January 1st, 2003 and December 31st, 2015. Mortality ascertainment was censored by December 31st, 2015. Survival analysis was performed by Kaplan–Meier analysis, and Cox proportional hazards regression models were served for risk factor analysis of mortality. The Chiang method was used to estimate life expectancy by age. Results A total of 78 deaths were identified during the 3232 person-years of follow-up. Multivariate Cox regression analysis showed significantly higher risks of mortality with respect to older age, higher systolic blood pressure (SBP), lower body mass index (BMI) and lower estimated glomerular filtration rate (eGFR). The life expectancy at age of 50 was estimated to be 12.3 (95%, CI: 9.0–16.1) years. Circulatory disease was the leading cause of death in this population (accounting for 43.6% of all deaths), followed by diabetic complications (33.3%) and respiratory disease (6.4%). Conclusions Data from one Chinese cohort from 2003 through 2015 showed that people with DKD faced higher risk of death and shorter life expectancy. Factors significantly increasing risk of death included older age, higher SBP, lower BMI and lower eGFR. There is an urgent need to early detection, closely monitoring and effective intervention on DKD.
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Affiliation(s)
- Zihou Zhao
- First Clinical Medical College, Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Lili Huo
- Department of Endocrinology, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, People's Republic of China
| | - Lianying Wang
- Department of Endocrinology, Capital University Beijing Friendship Hospital Pinggu Campus, No.59 Xinping North Road, Pinggu District, Beijing, 101200, People's Republic of China
| | - Lijuan Wang
- Department of Endocrinology, Capital University Beijing Friendship Hospital Pinggu Campus, No.59 Xinping North Road, Pinggu District, Beijing, 101200, People's Republic of China
| | - Zuodi Fu
- Department of Endocrinology, Capital University Beijing Friendship Hospital Pinggu Campus, No.59 Xinping North Road, Pinggu District, Beijing, 101200, People's Republic of China
| | - Yufeng Li
- Department of Endocrinology, Capital University Beijing Friendship Hospital Pinggu Campus, No.59 Xinping North Road, Pinggu District, Beijing, 101200, People's Republic of China
| | - Xiaohong Wu
- Department of Endocrinology, First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, People's Republic of China.
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Nolan JP, Berg RA, Andersen LW, Bhanji F, Chan PS, Donnino MW, Lim SH, Ma MHM, Nadkarni VM, Starks MA, Perkins GD, Morley PT, Soar J. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Template for In-Hospital Cardiac Arrest: A Consensus Report From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia). Circulation 2019; 140:e746-e757. [PMID: 31522544 DOI: 10.1161/cir.0000000000000710] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Utstein-style reporting templates provide a structured framework with which to compare systems of care for cardiac arrest. The 2004 Utstein reporting template encompassed both out-of-hospital and in-hospital cardiac arrest. A 2015 update of the Utstein template focused on out-of-hospital cardiac arrest, which makes this update of the in-hospital template timely. Representatives of the International Liaison Committee on Resuscitation developed an updated in-hospital Utstein reporting template iteratively by meeting face-to-face, by teleconference, and by online surveys between 2013 and 2018. Data elements were grouped by hospital factors, patient variables, pre-event factors, cardiac arrest and postresuscitation processes, and outcomes. Elements were classified as core or supplemental by use of a modified Delphi process. Variables were described as core if they were considered essential. Core variables should enable reasonable comparisons between systems and are considered essential for quality improvement programs. Together with core variables, supplementary variables are considered useful for research.
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15
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Nolan JP, Berg RA, Andersen LW, Bhanji F, Chan PS, Donnino MW, Lim SH, Ma MHM, Nadkarni VM, Starks MA, Perkins GD, Morley PT, Soar J. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Template for In-Hospital Cardiac Arrest: A Consensus Report From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia). Resuscitation 2019; 144:166-177. [PMID: 31536777 DOI: 10.1016/j.resuscitation.2019.08.021] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Utstein-style reporting templates provide a structured framework with which to compare systems of care for cardiac arrest. The 2004 Utstein reporting template encompassed both out-of-hospital and in-hospital cardiac arrest. A 2015 update of the Utstein template focused on out-of-hospital cardiac arrest, which makes this update of the in-hospital template timely. Representatives of the International Liaison Committee on Resuscitation developed an updated in-hospital Utstein reporting template iteratively by meeting face-to-face, by teleconference, and by online surveys between 2013 and 2018. Data elements were grouped by hospital factors, patient variables, pre-event factors, cardiac arrest and postresuscitation processes, and outcomes. Elements were classified as core or supplemental by use of a modified Delphi process. Variables were described as core if they were considered essential. Core variables should enable reasonable comparisons between systems and are considered essential for quality improvement programs. Together with core variables, supplementary variables are considered useful for research.
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16
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Ordi J, Castillo P, Garcia-Basteiro AL, Moraleda C, Fernandes F, Quintó L, Hurtado JC, Letang E, Lovane L, Jordao D, Navarro M, Bene R, Nhampossa T, Ismail MR, Lorenzoni C, Guisseve A, Rakislova N, Varo R, Marimon L, Sanz A, Cossa A, Mandomando I, Maixenchs M, Munguambe K, Vila J, Macete E, Alonso PL, Bassat Q, Martínez MJ, Carrilho C, Menéndez C. Clinico-pathological discrepancies in the diagnosis of causes of death in adults in Mozambique: A retrospective observational study. PLoS One 2019; 14:e0220657. [PMID: 31490955 PMCID: PMC6730941 DOI: 10.1371/journal.pone.0220657] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/20/2019] [Indexed: 11/18/2022] Open
Abstract
Background Clinico-pathological discrepancies are more frequent in settings in which limited diagnostic techniques are available, but there is little information on their actual impact. Aim We assessed the accuracy of the clinical diagnoses in a tertiary referral hospital in sub-Saharan Africa by comparison with post-mortem findings. We also identified potential risk factors for misdiagnoses. Methods One hundred and twelve complete autopsy procedures were performed at the Maputo Central Hospital (Mozambique), from November 2013 to March 2015. We reviewed the clinical records. Major clinico-pathological discrepancies were assessed using a modified version of the Goldman and Battle classification. Results Major diagnostic discrepancies were detected in 65/112 cases (58%) and were particularly frequent in infection-related deaths (56/80 [70%] major discrepancies). The sensitivity of the clinical diagnosis for toxoplasmosis was 0% (95% CI: 0–37), 18% (95% CI: 2–52) for invasive fungal infections, 25% (95% CI: 5–57) for bacterial sepsis, 34% (95% CI: 16–57), for tuberculosis, and 46% (95% CI: 19–75) for bacterial pneumonia. Major discrepancies were more frequent in HIV-positive than in HIV-negative patients (48/73 [66%] vs. 17/39 [44%]; p = 0.0236). Conclusions Major clinico-pathological discrepancies are still frequent in resource constrained settings. Increasing the level of suspicion for infectious diseases and expanding the availability of diagnostic tests could significantly improve the recognition of common life-threatening infections, and thereby reduce the mortality associated with these diseases. The high frequency of clinico-pathological discrepancies questions the validity of mortality reports based on clinical data or verbal autopsy.
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Affiliation(s)
- Jaume Ordi
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- * E-mail:
| | - Paola Castillo
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Alberto L. Garcia-Basteiro
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Amsterdam Institute for Global Health and Development (AIGHD), Academic Medical Center, Amsterdam, The Netherlands
| | - Cinta Moraleda
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Llorenç Quintó
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Juan Carlos Hurtado
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Emili Letang
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Service of Infectious Diseases, Hospital del Mar, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Dercio Jordao
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Mireia Navarro
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Rosa Bene
- Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Mamudo R. Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Assucena Guisseve
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Natalia Rakislova
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Rosauro Varo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Lorena Marimon
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Ariadna Sanz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Jordi Vila
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Pedro L. Alonso
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Miguel J. Martínez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud, Madrid, Spain
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Tseng ZH, Olgin JE, Vittinghoff E, Ursell PC, Kim AS, Sporer K, Yeh C, Colburn B, Clark NM, Khan R, Hart AP, Moffatt E. Prospective Countywide Surveillance and Autopsy Characterization of Sudden Cardiac Death: POST SCD Study. Circulation 2019; 137:2689-2700. [PMID: 29915095 DOI: 10.1161/circulationaha.117.033427] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 02/28/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Studies of out-of-hospital cardiac arrest and sudden cardiac death (SCD) use emergency medical services records, death certificates, or definitions that infer cause of death; thus, the true incidence of SCD is unknown. Over 90% of SCDs occur out-of-hospital; nonforensic autopsies are rarely performed, and therefore causes of death are presumed. We conducted a medical examiner-based investigation to determine the precise incidence and autopsy-defined causes of all SCDs in an entire metropolitan area. We hypothesized that postmortem investigation would identify actual sudden arrhythmic deaths among presumed SCDs. METHODS Between February 1, 2011, and March 1, 2014, we prospectively identified all incident deaths attributed to out-of-hospital cardiac arrest (emergency medical services primary impression, cardiac arrest) between 18 to 90 years of age in San Francisco County for autopsy, toxicology, and histology via medical examiner surveillance of consecutive out-of-hospital deaths, all reported by law. We obtained comprehensive records to determine whether out-of-hospital cardiac arrest deaths met World Health Organization (WHO) criteria for SCD. We reviewed death certificates filed quarterly for missed SCDs. Autopsy-defined sudden arrhythmic deaths had no extracardiac cause of death or acute heart failure. A multidisciplinary committee adjudicated final cause. RESULTS All 20 440 deaths were reviewed; 12 671 were unattended and reported to the medical examiner. From these, we identified 912 out-of-hospital cardiac arrest deaths; 541 (59%) met WHO SCD criteria (mean 62.8 years, 69% male) and 525 (97%) were autopsied. Eighty-nine additional WHO-defined SCDs occurred within 3 weeks of active medical care with the death certificate signed by the attending physician, ineligible for autopsy but included in the countywide WHO-defined SCD incidence of 29.6/100 000 person-years, highest in black men (P<0.0001). Of 525 WHO-defined SCDs, 301 (57%) had no cardiac history. Leading causes of death were coronary disease (32%), occult overdose (13.5%), cardiomyopathy (10%), cardiac hypertrophy (8%), and neurological (5.5%). Autopsy-defined sudden arrhythmic deaths were 55.8% (293/525) of overall, 65% (78/120) of witnessed, and 53% (215/405) of unwitnessed WHO-defined SCDs (P=0.024); 286 of 293 (98%) had structural cardiac disease. CONCLUSIONS Forty percent of deaths attributed to stated cardiac arrest were not sudden or unexpected, and nearly half of presumed SCDs were not arrhythmic. These findings have implications for the accuracy of SCDs as defined by WHO criteria or emergency medical services records in aggregate mortality data, clinical trials, and cohort studies.
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Affiliation(s)
- Zian H Tseng
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (Z.H.T., J.E.O.)
| | - Jeffrey E Olgin
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (Z.H.T., J.E.O.)
| | | | | | | | - Karl Sporer
- Department of Emergency Medicine (K.S., C.Y.)
| | - Clement Yeh
- Department of Emergency Medicine (K.S., C.Y.).,San Francisco Fire Department, Emergency Medical Services Division, CA (C.Y.)
| | - Benjamin Colburn
- Department of Family Medicine, Oregon Health and Science University, Portland (B.C.)
| | - Nina M Clark
- School of Medicine (N.M.C.), University of California, San Francisco
| | - Rana Khan
- Weill Cornell Medical College, New York (R.K.)
| | - Amy P Hart
- Office of the Chief Medical Examiner, City and County of San Francisco, CA (A.P.H., E.M.)
| | - Ellen Moffatt
- Office of the Chief Medical Examiner, City and County of San Francisco, CA (A.P.H., E.M.)
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Ioacara S, Guja C, Ionescu-Tirgoviste C, Martin S, Tiu C, Fica S. Rates and Causes of Death among Adult Diabetes Patients in Romania. Endocr Res 2019; 44:81-86. [PMID: 30424683 DOI: 10.1080/07435800.2018.1546734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Aims: To study the age and sex-dependent mortality rates and causes of death in a large Romanian diabetes cohort as compared with the general population. Methods: All adult patients aged 20-64 years, receiving a free diabetes prescription in a major urban area during 2001-2008 were included and followed-up for death until December 31, 2011. Crude mortality rates and standardized mortality rate ratios (SMR) against general population (data from the National Institute of Statistics) were calculated. Years lost due to diabetes were computed assuming the general population mortality rates for ages below 20 and above 64 years. Results: During the 11 years study period, 49,328 diabetes patients (mean age at baseline 53.0 ± 8.8 years) contributed 297,370 person-years and 5,053 deaths. All cause mortality rates (per 1000 person years) increased with age and was 3.4 in 20-24 years age group and 25.7 in 60-64 year age group, while the corresponding SMR decreased from 6.0 to 1.5. Diabetes patients aged 20-24 years had a life expectancy of 48.6 years, which was 6.6 years less compared with the corresponding general population (55.2 years). The gap was 7.0 years in women and 5.8 years in men. Diabetes patients aged 20-24 years lost 196 minutes of life daily due to diabetes in women and 182 minutes in men. Conclusions: Mortality rates increased, while mortality rate ratios against general population decreased with age. Men had higher mortality rates, but women had higher mortality rate ratios in the gender analysis.
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Affiliation(s)
- Sorin Ioacara
- a Endocrinology and diabetes , "Carol Davila" University of Medicine and Pharmacy , Bucharest , Romania
- b Endocrinology and diabetes , "Elias" University Emergency Hospital , Bucharest , Romania
| | - Cristian Guja
- a Endocrinology and diabetes , "Carol Davila" University of Medicine and Pharmacy , Bucharest , Romania
- c Neurology , "N. Paulescu" National Institute of Diabetes, Nutrition and Metabolic Diseases , Bucharest , Romania
| | | | - Sorina Martin
- a Endocrinology and diabetes , "Carol Davila" University of Medicine and Pharmacy , Bucharest , Romania
- b Endocrinology and diabetes , "Elias" University Emergency Hospital , Bucharest , Romania
| | - Cristina Tiu
- a Endocrinology and diabetes , "Carol Davila" University of Medicine and Pharmacy , Bucharest , Romania
- d University Emergency Hospital , Bucharest , Romania
| | - Simona Fica
- a Endocrinology and diabetes , "Carol Davila" University of Medicine and Pharmacy , Bucharest , Romania
- b Endocrinology and diabetes , "Elias" University Emergency Hospital , Bucharest , Romania
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Ultra-processed food intake and mortality in the USA: results from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). Public Health Nutr 2019; 22:1777-1785. [PMID: 30789115 DOI: 10.1017/s1368980018003890] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the association between ultra-processed food intake and all-cause mortality and CVD mortality in a nationally representative sample of US adults. DESIGN Prospective analyses of reported frequency of ultra-processed food intake in 1988-1994 and all-cause mortality and CVD mortality through 2011. SETTING The Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994).ParticipantsAdults aged ≥20 years (n 11898). RESULTS Over a median follow-up of 19 years, individuals in the highest quartile of frequency of ultra-processed food intake (e.g. sugar-sweetened or artificially sweetened beverages, sweetened milk, sausage or other reconstructed meats, sweetened cereals, confectionery, desserts) had a 31% higher risk of all-cause mortality, after adjusting for demographic and socio-economic confounders and health behaviours (adjusted hazard ratio=1·31; 95% CI 1·09, 1·58; P-trend = 0·001). No association with CVD mortality was observed (P-trend=0·86). CONCLUSIONS Higher frequency of ultra-processed food intake was associated with higher risk of all-cause mortality in a representative sample of US adults. More longitudinal studies with dietary data reflecting the modern food supply are needed to confirm our results.
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Taylor CJ, Ordóñez-Mena JM, Roalfe AK, Lay-Flurrie S, Jones NR, Marshall T, Hobbs FDR. Trends in survival after a diagnosis of heart failure in the United Kingdom 2000-2017: population based cohort study. BMJ 2019; 364:l223. [PMID: 30760447 PMCID: PMC6372921 DOI: 10.1136/bmj.l223] [Citation(s) in RCA: 254] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To report reliable estimates of short term and long term survival rates for people with a diagnosis of heart failure and to assess trends over time by year of diagnosis, hospital admission, and socioeconomic group. DESIGN Population based cohort study. SETTING Primary care, United Kingdom. PARTICIPANTS Primary care data for 55 959 patients aged 45 and overwith a new diagnosis of heart failure and 278 679 age and sex matched controls in the Clinical Practice Research Datalink from 1 January 2000 to 31 December 2017 and linked to inpatient Hospital Episode Statistics and Office for National Statistics mortality data. MAIN OUTCOME MEASURES Survival rates at one, five, and 10 years and cause of death for people with and without heart failure; and temporal trends in survival by year of diagnosis, hospital admission, and socioeconomic group. RESULTS Overall, one, five, and 10 year survival rates increased by 6.6% (from 74.2% in 2000 to 80.8% in 2016), 7.2% (from 41.0% in 2000 to 48.2% in 2012), and 6.4% (from 19.8% in 2000 to 26.2% in 2007), respectively. There were 30 906 deaths in the heart failure group over the study period. Heart failure was listed on the death certificate in 13 093 (42.4%) of these patients, and in 2237 (7.2%) it was the primary cause of death. Improvement in survival was greater for patients not requiring admission to hospital around the time of diagnosis (median difference 2.4 years; 5.3 v 2.9 years, P<0.001). There was a deprivation gap in median survival of 0.5 years between people who were least deprived and those who were most deprived (4.6 v 4.1 years, P<0.001) [corrected]. CONCLUSIONS Survival after a diagnosis of heart failure has shown only modest improvement in the 21st century and lags behind other serious conditions, such as cancer. New strategies to achieve timely diagnosis and treatment initiation in primary care for all socioeconomic groups should be a priority for future research and policy.
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Affiliation(s)
- Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Andrea K Roalfe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Sarah Lay-Flurrie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Nicholas R Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
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Lastrucci V, D’Arienzo S, Collini F, Lorini C, Zuppiroli A, Forni S, Bonaccorsi G, Gemmi F, Vannucci A. Diagnosis-related differences in the quality of end-of-life care: A comparison between cancer and non-cancer patients. PLoS One 2018; 13:e0204458. [PMID: 30252912 PMCID: PMC6155541 DOI: 10.1371/journal.pone.0204458] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/07/2018] [Indexed: 11/23/2022] Open
Abstract
Background Cancer, chronic heart failure (CHF), and chronic obstructive pulmonary disease (COPD) in the advanced stages have similar symptom burdens and survival rates. Despite these similarities, the majority of the attention directed to improving the quality of end-of-life (EOL) care has focused on cancer. Aim To assess the extent to which the quality of EOL care received by cancer, CHF, and COPD patients in the last month of life is diagnosis-sensitive. Methods This is a retrospective observational study based on administrative data. The study population includes all Tuscany region residents aged 18 years or older who died with a clinical history of cancer, CHF, or COPD. Decedents were categorized into two mutually exclusive diagnosis categories: cancer (CA) and cardiopulmonary failure (CPF). Several EOL care quality outcome measures were adopted. Multivariable generalized linear model for each outcome were performed. Results The sample included 30,217 decedents. CPF patients were about 1.5 times more likely than cancer patients to die in an acute care hospital (RR 1.59, 95% C.I.: 1.54–1.63). CPF patients were more likely to be hospitalized or admitted to the emergency department (RR 1.09, 95% C.I.: 1.07–1.10; RR 1.15, 95% C.I.: 1.13–1.18, respectively) and less likely to use hospice services (RR 0.08, 95% C.I.: 0.07–0.09) than cancer patients in the last month of life. CPF patients had a four- and two-fold higher risk of intensive care unit admission or of undergoing life-sustaining treatments, respectively, than cancer patients (RR 3.71, 95% C.I.: 3.40–4.04; RR 2.43, 95% C.I.: 2.27–2.60, respectively). Conclusion The study has highlighted the presence of significant differences in the quality of EOL care received in the last month of life by COPD and CHF compared with cancer patients. Further studies are needed to better elucidate the extent and the avoidability of these diagnosis-related differences in the quality of EOL care.
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Affiliation(s)
- Vieri Lastrucci
- Department of Health Science, University of Florence, Florence, Italy
- * E-mail:
| | | | | | - Chiara Lorini
- Department of Health Science, University of Florence, Florence, Italy
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Abstract
Proper completion of death certificates is of vital importance. This study assessed the accuracy of death certification at one major hospital in Riyadh, Saudi Arabia. We collected all certificates from 1997 to 2016 and scored them on the degree of accuracy. We found no errors of incompleteness or missed contributors to death. However, in all certificates (100%), cause of death was either incorrect or absent; 75% provided no cause of death. Further large-scale studies should be conducted in other hospitals to determine the exact prevalence of these serious errors.
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Affiliation(s)
- Khaldoon Aljerian
- a Forensic Medicine Unit, Department of Pathology, College of Medicine , King Saud University , Riyadh 12372 , Saudi Arabia
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Physical, Cognitive, and Psychosocial Characteristics Associated With Mortality in Chronic TBI Survivors: A National Institute on Disability, Independent Living, and Rehabilitation Research Traumatic Brain Injury Model Systems Study. J Head Trauma Rehabil 2018; 33:237-245. [DOI: 10.1097/htr.0000000000000365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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You C, Lin DKJ, Young SS. PM 2.5 and ozone, indicators of air quality, and acute deaths in California, 2004-2007. Regul Toxicol Pharmacol 2018; 96:190-196. [PMID: 29782888 DOI: 10.1016/j.yrtph.2018.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 05/05/2018] [Accepted: 05/17/2018] [Indexed: 10/16/2022]
Abstract
Since the London Great Smog of 1952 was estimated to have killed over 4000 people, scientists have studied the relationship between air quality and acute mortality. Currently, the association between air quality and acute deaths is usually taken as evidence for causality. As air quality has markedly improved since 1952, do contemporary datasets support this view? We use a large dataset, eight air basins in California for the years 2004-2007, to examine the possible association of ozone and PM2.5 with acute deaths after statistically removing seasonal and weather effects. Our analysis dataset is available on request. We conducted a regression-corrected, case-crossover analysis for all non-accidental deaths age 75 and older. We used stepwise regression to examine three causes of death. After seasonal and weather adjustments, there was essentially no predictive power of ozone or PM2.5 for acute deaths. The case-crossover analysis produced odds ratio very close to 1.000 (no effect). The very narrow confidence limits indicated good statistical power. We study recent air quality in both time-stratified, symmetric, bidirectional case-crossover and time series regression and both give consistent results. There is no statistically significant association between either ozone or PM2.5 and acute human mortality. In the absence of an association, causality is in question.
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Affiliation(s)
- Cheng You
- Pennsylvania State University, United States.
| | | | - S Stanley Young
- CGStat, 3401 Caldwell Drive, Raleigh, NC 27607, United States.
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Kim H, Caulfield LE, Rebholz CM. Healthy Plant-Based Diets Are Associated with Lower Risk of All-Cause Mortality in US Adults. J Nutr 2018; 148:624-631. [PMID: 29659968 PMCID: PMC6669955 DOI: 10.1093/jn/nxy019] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/18/2018] [Indexed: 12/11/2022] Open
Abstract
Background Plant-based diets, often referred to as vegetarian diets, are associated with health benefits. However, the association with mortality is less clear. Objective We investigated associations between plant-based diet indexes and all-cause and cardiovascular disease mortality in a nationally representative sample of US adults. Methods Analyses were based on 11,879 participants (20-80 y of age) from NHANES III (1988-1994) linked to data on all-cause and cardiovascular disease mortality through 2011. We constructed an overall plant-based diet index (PDI), which assigns positive scores for plant foods and negative scores for animal foods, on the basis of a food-frequency questionnaire administered at baseline. We also constructed a healthful PDI (hPDI), in which only healthy plant foods received positive scores, and a less-healthful (unhealthy) PDI (uPDI), in which only less-healthful plant foods received positive scores. Cox proportional hazards models were used to estimate the association between plant-based diet consumption in 1988-1994 and subsequent mortality. We tested for effect modification by sex. Results In the overall sample, PDI and uPDI were not associated with all-cause or cardiovascular disease mortality after controlling for demographic characteristics, socioeconomic factors, and health behaviors. However, among those with an hPDI score above the median, a 10-unit increase in hPDI was associated with a 5% lower risk in all-cause mortality in the overall study population (HR: 0.95; 95% CI: 0.91, 0.98) and among women (HR: 0.94; 95% CI: 0.88, 0.99), but not among men (HR: 0.95; 95% CI: 0.90, 1.01). There was no effect modification by sex (P-interaction > 0.10). Conclusions A nonlinear association between hPDI and all-cause mortality was observed. Healthy plant-based diet scores above the median were associated with a lower risk of all-cause mortality in US adults. Future research exploring the impact of quality of plant-based diets on long-term health outcomes is necessary.
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Affiliation(s)
- Hyunju Kim
- Center for Human Nutrition, Department of International Health
| | | | - Casey M Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Address correspondence to CMR (e-mail: )
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Objective structured clinical examination “Death Certificate” station – Computer-based versus conventional exam format. J Forensic Leg Med 2018; 55:33-38. [DOI: 10.1016/j.jflm.2018.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/29/2018] [Accepted: 02/08/2018] [Indexed: 11/19/2022]
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Gatov E, Kurdyak P, Sinyor M, Holder L, Schaffer A. Comparison of Vital Statistics Definitions of Suicide against a Coroner Reference Standard: A Population-Based Linkage Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:152-160. [PMID: 29056088 PMCID: PMC5846963 DOI: 10.1177/0706743717737033] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We sought to determine the utility of health administrative databases for population-based suicide surveillance, as these data are generally more accessible and more integrated with other data sources compared to coroners' records. METHOD In this retrospective validation study, we identified all coroner-confirmed suicides between 2003 and 2012 in Ontario residents aged 21 and over and linked this information to Statistics Canada's vital statistics data set. We examined the overlap between the underlying cause of death field and secondary causes of death using ICD-9 and ICD-10 codes for deliberate self-harm (i.e., suicide) and examined the sociodemographic and clinical characteristics of misclassified records. RESULTS Among 10,153 linked deaths, there was a very high degree of overlap between records coded as deliberate self-harm in the vital statistics data set and coroner-confirmed suicides using both ICD-9 and ICD-10 definitions (96.88% and 96.84% sensitivity, respectively). This alignment steadily increased throughout the study period (from 95.9% to 98.8%). Other vital statistics diagnoses in primary fields included uncategorised signs and symptoms. Vital statistics records that were misclassified did not differ from valid records in terms of sociodemographic characteristics but were more likely to have had an unspecified place of injury on the death certificate ( P < 0.001), more likely to have died at a health care facility ( P < 0.001), to have had an autopsy ( P = 0.002), and to have been admitted to a psychiatric hospital in the year preceding death ( P = 0.03). CONCLUSIONS A high degree of concordance between vital statistics and coroner classification of suicide deaths suggests that health administrative data can reliably be used to identify suicide deaths.
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Affiliation(s)
- Evgenia Gatov
- 1 Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Paul Kurdyak
- 1 Institute for Clinical Evaluative Sciences, Toronto, Ontario.,2 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario.,3 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Mark Sinyor
- 3 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,4 Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Laura Holder
- 1 Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Ayal Schaffer
- 3 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,4 Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario
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Posey BM, Neuilly MA. A fatal review: Exploring how children's deaths are reported in the United States. CHILD ABUSE & NEGLECT 2017; 72:433-445. [PMID: 28918234 DOI: 10.1016/j.chiabu.2017.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/09/2017] [Accepted: 09/07/2017] [Indexed: 06/07/2023]
Abstract
Child death reports are the leading data source used to orchestrate child fatality prevention policy. Therefore, the way in which child death is reported is crucial to how we sustain life. We sought to assess the systematic ways in which death is reported for children. Based on a qualitative analysis of medico-legal investigation reports collected from a medical examiner's office and a coroner's office, we examined several indicators of data completeness, quality, site organizational structure, and consistency. We found stark differences between the two sites, as well as issues regarding death diagnosis certainty, and a general lack in consistency in the reports' content, as well as procedures performed post-mortem. We conclude that there are some flaws in our death reporting system for child populations, which have the potential to hinder reliability and accuracy of these death reports, as well as thwart their overall usefulness in prevention policies.
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Affiliation(s)
- Brianne M Posey
- Washington State University, Department of Criminal Justice and Criminology, Washington State University, Johnson Tower 706, Pullman, WA 99164-4872, United States.
| | - Melanie-Angela Neuilly
- Washington State University, Department of Criminal Justice and Criminology, Washington State University, Johnson Tower 721, Pullman, WA 99164-4872, United States.
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Devinsky O, Friedman D, Cheng JY, Moffatt E, Kim A, Tseng ZH. Underestimation of sudden deaths among patients with seizures and epilepsy. Neurology 2017; 89:886-892. [PMID: 28768851 DOI: 10.1212/wnl.0000000000004292] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/28/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To determine the definite and potential frequency of seizures and epilepsy as a cause of death (COD) and how often this goes unrecognized. METHODS Prospective determination of seizures or epilepsy and final COD for individuals aged 18-90 years with out-of-hospital sudden cardiac deaths (SCDs) from the population-based San Francisco POST SCD Study. We compared prospective seizure or epilepsy diagnosis and final COD as adjudicated by a multidisciplinary committee (pathologists, electrophysiologists, and a vascular neurologist) vs retrospective adjudication by 2 epileptologists with expertise in seizure-related mortality. RESULTS Of 541 SCDs identified during the 37-month study period (mean age 62.8 years, 69% men), 525 (97%) were autopsied; 39/525 (7.4%) had seizures or epilepsy (mean age: 58 years, range: 27-92; 67% men), comprising 17% of 231 nonarrhythmic sudden deaths. The multidisciplinary team identified 15 cases of epilepsy, 6 sudden unexpected deaths in epilepsy (SUDEPs), and no deaths related to acute symptomatic seizures. The epileptologists identified 25 cases of epilepsy and 8 definite SUDEPs, 10 possible SUDEPs, and 5 potential cases of acute symptomatic seizures as a COD. CONCLUSIONS Among the 25 patients identified with epilepsy by the epileptologists, they found definite or possible SUDEP in 72% (18/25) vs 24% (6/25) by the multidisciplinary group (6/15 cases they identified with epilepsy). The epileptologists identified acute symptomatic seizures as a potential COD in 5/14 patients with alcohol-related seizures. Epilepsy is underdiagnosed among decedents. Among patients with seizures and epilepsy who die suddenly, seizures and SUDEP often go unrecognized as a potential or definite COD.
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Affiliation(s)
- Orrin Devinsky
- From the Department of Neurology (O.D., D.F., J.Y.C.), Epilepsy Center, NYU School of Medicine; and Department of Pathology (E.M.), Department of Neurology (A.K.), and Electrophysiology and Arrhythmia Service (Z.H.T.), Department of Medicine, UCSF School of Medicine.
| | - Daniel Friedman
- From the Department of Neurology (O.D., D.F., J.Y.C.), Epilepsy Center, NYU School of Medicine; and Department of Pathology (E.M.), Department of Neurology (A.K.), and Electrophysiology and Arrhythmia Service (Z.H.T.), Department of Medicine, UCSF School of Medicine
| | - Jocelyn Y Cheng
- From the Department of Neurology (O.D., D.F., J.Y.C.), Epilepsy Center, NYU School of Medicine; and Department of Pathology (E.M.), Department of Neurology (A.K.), and Electrophysiology and Arrhythmia Service (Z.H.T.), Department of Medicine, UCSF School of Medicine
| | - Ellen Moffatt
- From the Department of Neurology (O.D., D.F., J.Y.C.), Epilepsy Center, NYU School of Medicine; and Department of Pathology (E.M.), Department of Neurology (A.K.), and Electrophysiology and Arrhythmia Service (Z.H.T.), Department of Medicine, UCSF School of Medicine
| | - Anthony Kim
- From the Department of Neurology (O.D., D.F., J.Y.C.), Epilepsy Center, NYU School of Medicine; and Department of Pathology (E.M.), Department of Neurology (A.K.), and Electrophysiology and Arrhythmia Service (Z.H.T.), Department of Medicine, UCSF School of Medicine
| | - Zian H Tseng
- From the Department of Neurology (O.D., D.F., J.Y.C.), Epilepsy Center, NYU School of Medicine; and Department of Pathology (E.M.), Department of Neurology (A.K.), and Electrophysiology and Arrhythmia Service (Z.H.T.), Department of Medicine, UCSF School of Medicine
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Establishment of two forensic medicine OSCE stations on the subject of external post-mortem examination. Int J Legal Med 2017. [DOI: 10.1007/s00414-017-1630-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Air quality and acute deaths in California, 2000-2012. Regul Toxicol Pharmacol 2017; 88:173-184. [PMID: 28619682 DOI: 10.1016/j.yrtph.2017.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 05/22/2017] [Accepted: 06/06/2017] [Indexed: 11/21/2022]
Abstract
Many studies have shown an association between air quality and acute deaths, and such associations are widely interpreted as causal. Several factors call causation and even association into question, for example multiple testing and multiple modeling, publication bias and confirmation bias. Many published studies are difficult or impossible to reproduce because of lack of access to confidential data sources. Here we make publically available a dataset containing daily air quality levels, PM2.5 and ozone, daily temperature levels, minimum and maximum and daily maximum relative humidity levels for the eight most populous California air basins, thirteen years, >2M deaths, over 37,000 exposure days. The data are analyzed using standard time series analysis, and a sensitivity analysis is computed varying model parameters, locations and years. Our analysis finds little evidence for association between air quality and acute deaths. These results are consistent with those for the widely cited NMMAPS dataset when the latter are restricted to California. The daily death variability was mostly explained by time of year or weather variables; Neither PM2.5 nor ozone added appreciably to the prediction of daily deaths. These results call into question the widespread belief that association between air quality and acute deaths is causal/near-universal.
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Basso C, Rizzo S, Thiene G. Key role of the post-mortem in sudden cardiac death. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Andrew TA, Duval JV. Confronting an Upsurge in Opiate Deaths with Limited Resources. Acad Forensic Pathol 2017; 7:7-18. [PMID: 31239952 DOI: 10.23907/2017.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/03/2017] [Indexed: 11/12/2022]
Abstract
The dramatic increase in drug-related deaths in the last decade has presented fiduciary and logistical difficulties to medicolegal jurisdictions of all types and sizes. New Hampshire, with a centralized state medical examiner system of death investigation, has been confronted with the task of investigating these drug-related deaths against the backdrop of statutory hurdles inhibiting a nimble response to the situation. This has led to a collaborative approach with law enforcement and the state Department of Justice in terms of triaging drug deaths to full autopsy versus external examination with toxicology testing. Preliminary data suggest that between 11 and 13% of suspected drug deaths have an alternative cause of death revealed by autopsy. Positive toxicological findings were documented in 97.5% of cases in which only an external examination was performed; however, some of these cases may have had undetected, significant internal findings that could have accounted for an alternative cause of death if an autopsy had been performed. While the case triage system described has temporarily addressed the acute problem, the issue of the medical examiner's appropriate role in the adequate evaluation of public health and safety remains extant. Furthermore, noncompliance with the National Association of Medical Examiners inspection and accreditation standards puts this agency, and others facing the same issues, at risk of losing full accreditation status until such resource issues are addressed by legislators and other stakeholders in the quality of medicolegal death investigation in the United States.
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Affiliation(s)
| | - Jennie V Duval
- Office of Chief Medical Examiner, State of New Hampshire
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Huo L, Harding JL, Peeters A, Shaw JE, Magliano DJ. Life expectancy of type 1 diabetic patients during 1997-2010: a national Australian registry-based cohort study. Diabetologia 2016; 59:1177-85. [PMID: 26796634 DOI: 10.1007/s00125-015-3857-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/14/2015] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS There is limited information about the impact of type 1 diabetes on life expectancy in a contemporary population. We examined the life expectancy of type 1 diabetic patients and explored the contribution of mortality at different ages and of different causes of death to years of life lost (YLL) compared with the general population. METHODS We derived mortality rates of Australians with type 1 diabetes listed on the National Diabetes Services Scheme (NDSS) between 1997 and 2010 (n = 85,547) by linking the NDSS to the National Death Index. The Chiang method was used to estimate life expectancy and Arriaga's method was used to estimate the contributions of age-specific and cause-specific mortality to the YLL. RESULTS A total of 5,981 deaths were identified during the 902,136 person-years of follow up. Type 1 diabetic patients had an estimated life expectancy at birth of 68.6 years (95% CI 68.1, 69.1), which was 12.2 years (95% CI 11.8, 12.7) less than that in the general population. The improvement in life expectancy at birth in 2004-2010 compared with 1997-2003 was similar for both type 1 diabetic patients (men, 1.9 years [95% CI 0.4, 3.3]; women, 1.5 years [95% CI 0.0, 3.2]) and the general population (men, 2.2 years; women, 1.4 years). Deaths at age <60 years accounted for 60% of the YLL from type 1 diabetes for men and 45% for women. The major contribution to YLL was mortality from endocrine and metabolic disease at age 10-39 years (men, 39-59%; women, 35-50%) and from circulatory disease at age ≥40 years (men, 43-75%; women, 34-75%). CONCLUSIONS/INTERPRETATION Data from 1997 to 2010 showed that Australian type 1 diabetic patients had an estimated loss in life expectancy at birth of 12.2 years compared with the general population.
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Affiliation(s)
- Lili Huo
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
- Department of Endocrinology, Beijing Jishuitan Hospital, Beijing, China.
| | - Jessica L Harding
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anna Peeters
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jonathan E Shaw
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Dianna J Magliano
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Marmet S, Rehm J, Gmel G. The importance of age groups in estimates of alcohol-attributable mortality: impact on trends in Switzerland between 1997 and 2011. Addiction 2016; 111:255-62. [PMID: 26360121 DOI: 10.1111/add.13164] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/19/2015] [Accepted: 09/07/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Monitoring trends of alcohol-attributable mortality is an integral part of the global strategy to reduce the harmful use of alcohol. However, mortality estimates based on different age ranges come to different conclusions. This study examined the impact of including different age ranges in terms of directions of trends of alcohol-attributable mortality during 14 years in Switzerland. METHOD Alcohol-attributable mortality was estimated at four time-points between 1997 and 2011 using the Global Burden of Disease 2010 methodology. Estimates were obtained for two age groups: 15-64 years and the total adult population (15 years and older). RESULTS Alcohol-attributable mortality among 15-64-year-olds decreased [1997: 1334 deaths, confidence interval (CI) = 1237-1432; 2011: 1019 deaths, CI = 964-1073; trend per year odds ratio (OR) = 0.99, P < 0.001]. In contrast, alcohol-attributable mortality among those 65 and older increased in the same time-period (1997: 581 deaths, CI = -196 to 1357; 2011: 1664 deaths, CI = 957-2372; OR = 1.07, P< 0.001), resulting in an overall increase of alcohol-attributable mortality for 15+ year-olds (1997: 1915 deaths, CI = 1133-2697; 2011: 2683, CI = 1973-3393; OR = 1.02, P < 0.001). The main shift in trends was due to changes in the mixture (e.g. hypertension, ischaemic heart disease) of cardiovascular diseases over time among those 65+ years old. CONCLUSIONS Trends in alcohol-attributable mortality may yield qualitatively different results based on the upper age limit for deaths set for these estimates. Global trends of alcohol-attributable mortality between 1997 and 2011 were influenced heavily by changes in the mixture of deaths across cardiovascular diseases. Trends for alcohol-attributable mortality and cross-country comparisons should be reported separately for 15-64 and 65+ year-olds.
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Affiliation(s)
- Simon Marmet
- Research Institute, Addiction Switzerland, Lausanne, Switzerland
| | - Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Institute for Clinical Psychology and Psychotherapy, Technische Universität, Dresden, Germany.,Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,PAHO/WHO Collaborating Centre for Mental Health and Addiction, Toronto, Canada
| | - Gerhard Gmel
- Research Institute, Addiction Switzerland, Lausanne, Switzerland.,Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Alcohol Treatment Center, Centre hospitalier universitaire vaudois (CHUV), Lausanne, Switzerland.,University of the West of England, Frenchay Campus, Bristol, UK
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Global Epidemiology and Incidence of Cardiovascular Disease. CARDIOVASCULAR DISEASES 2016. [DOI: 10.1016/b978-0-12-803312-8.00004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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Drake SA, Harper S, Wolf DA. Medicolegal Death Investigation and Hospital Patient Safety and Quality Outcomes: A Naturally Synergistic Collaboration. JOURNAL OF FORENSIC NURSING 2016; 12:183-188. [PMID: 27782925 DOI: 10.1097/jfn.0000000000000128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The role of medicolegal death investigation (MLDI) systems in the assessment of violent deaths (e.g., gunshots, stab wounds, car crashes) is well known. However, the role of MLDI systems in informing healthcare agencies about potential patient safety and quality improvement activities is less understood and thus the main focus of this article. In this article we describes-one agency's initiatives to identify decedents whose circumstances or cause of death had potential relevance for patient safety and quality outcomes and to communicate those findings to acute care hospitals where the decedents were previously treated. We also describes the evaluation of this communication process and provide preliminary outcomes of these efforts.
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Affiliation(s)
- Stacy A Drake
- Author Affiliations: 1School of Nursing, The University of Texas Health Science Center at Houston; and 2Harris County Institute of Forensic Sciences
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Mieno MN, Tanaka N, Arai T, Kawahara T, Kuchiba A, Ishikawa S, Sawabe M. Accuracy of Death Certificates and Assessment of Factors for Misclassification of Underlying Cause of Death. J Epidemiol 2015; 26:191-8. [PMID: 26639750 PMCID: PMC4808686 DOI: 10.2188/jea.je20150010] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Cause of death (COD) information taken from death certificates is often inaccurate and incomplete. However, the accuracy of Underlying CODs (UCODs) recorded on death certificates has not been comprehensively described when multiple diseases are present. Methods A total of 450 consecutive autopsies performed at a geriatric hospital in Japan between February 2000 and August 2002 were studied. We evaluated the concordance rate, sensitivity, and specificity of major UCODs (cancer, heart disease, and pneumonia) reported on death certificates compared with a reference standard of pathologist assessment based on autopsy data and clinical records. Logistic regression analysis was performed to assess the effect of sex, age, comorbidity, and UCODs on misclassification. Results The concordance rate was relatively high for cancer (81%) but low for heart disease (55%) and pneumonia (9%). The overall concordance rate was 48%. Sex and comorbidity did not affect UCOD misclassification rates, which tended to increase with patient age, although the association with age was also not significant. The strongest factor for misclassification was UCODs (P < 0.0001). Sensitivity and specificity for cancer were very high (80% and 96%, respectively), but sensitivity for heart disease and pneumonia was 60% and 46%, respectively. Specificity for each UCOD was more than 85%. Conclusions Researchers should be aware of the accuracy of COD data from death certificates used as research resources, especially for cases of elderly patients with pneumonia.
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Affiliation(s)
- Makiko Naka Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University
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Hwa HL, Pan CH, Shu GM, Chang CH, Lee TT, Lee JCI. Child homicide victims in forensic autopsy in Taiwan: A 10-year retrospective study. Forensic Sci Int 2015; 257:413-419. [PMID: 26562789 DOI: 10.1016/j.forsciint.2015.10.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/06/2015] [Accepted: 10/19/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Child homicides are critical medico-legal issues worldwide. Data on the characteristics of these cases in Asia are limited. This study aimed to describe the characteristics of child homicides in Taiwan. METHODS A retrospective analysis of forensic autopsy records of child homicide victims (aged 0-17 years) in Taiwan, during a 10-year period between 2001 and 2010, was carried out. The age, sex, relationship with the perpetrator(s), injury patterns of the victims, and causes of death were analyzed. RESULTS In all, 193 child homicide autopsies were identified. There were 38 (19.7%), 82 (42.5%), 25 (13.0%), and 48 (24.9%) homicide victims aged under 1, 1-5, 6-12, and 13-17 years, respectively. One-hundred boys (mean age: 8.4±7.0) and 93 girls (mean age: 3.7±4.3) were included. A female predominance was noted among the victims aged 0-5. Blunt force (53.4%) was the most frequent method of injury, followed by suffocation/strangulation (20.2%) and sharp force (13.0%). Bruise (64.8%) and brain injury (45.1%) were the most common types of injuries. The cranium (62.2%) and face (60.6%) were the most frequently injured body regions. The distribution of fatal injuries varied among victims in different age groups. Neurogenic shock, asphyxia, and hemorrhagic shocks were most common in victims aged 0-5, 6-12, and 13-17, respectively. The most frequent causes of death included blunt force head injury (40.4%), suffocation/strangulation (20.2%), and sharp force lung trauma (7.3%). The type of offenders, injury methods, types of injuries, distribution of injuries, mechanism of death, and causes of death were significantly different among victims of different age groups. Eighteen (9.33%) victims displayed no external evidence of trauma. CONCLUSIONS The patterns of injuries, mechanism of death, and causes of death were different among victims of different age groups. A female predominance was noted among the victims aged 0-5. Complete forensic autopsy is necessary to identify child homicide. This report will help forensic examiners and forensic pathologists recognize the signs of child homicide and serve as a working basis for these professionals.
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Affiliation(s)
- Hsiao-Lin Hwa
- Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, No. 1, Sec. 1, Jen Ai Rd., Taipei, Taiwan 100, ROC; National Taiwan University, Children and Family Research Center, Leader of Division, No. 1, Sec. 4, Roosevelt Rd., Taipei, Taiwan 106, ROC
| | - Chih-Hsin Pan
- Institute of Forensic Medicine, Ministry of Justice, No. 123, Min'an St., Zhonghe Dist., New Taipei City, Taiwan 235, ROC
| | - Guang-Ming Shu
- Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, No. 1, Sec. 1, Jen Ai Rd., Taipei, Taiwan 100, ROC
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, Taiwan 100, ROC
| | - Tsui-Ting Lee
- Institute of Forensic Medicine, Ministry of Justice, No. 123, Min'an St., Zhonghe Dist., New Taipei City, Taiwan 235, ROC
| | - James Chun-I Lee
- Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, No. 1, Sec. 1, Jen Ai Rd., Taipei, Taiwan 100, ROC.
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Baggett TP, Chang Y, Porneala BC, Bharel M, Singer DE, Rigotti NA. Disparities in Cancer Incidence, Stage, and Mortality at Boston Health Care for the Homeless Program. Am J Prev Med 2015; 49:694-702. [PMID: 26143955 PMCID: PMC4615271 DOI: 10.1016/j.amepre.2015.03.038] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 03/23/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Homeless people have a high burden of cancer risk factors and suboptimal rates of cancer screening, but the epidemiology of cancer has not been well described in this population. We assessed cancer incidence, stage, and mortality in homeless adults relative to general population standards. METHODS We cross-linked a cohort of 28,033 adults seen at Boston Health Care for the Homeless Program in 2003-2008 to Massachusetts cancer registry and vital registry records. We calculated age-standardized cancer incidence and mortality ratios (SIRs and SMRs). We examined tobacco use among incident cases and estimated smoking-attributable fractions. Trend tests were used to compare cancer stage distributions with those in Massachusetts adults. Analyses were conducted in 2012-2015. RESULTS During 90,450 person-years of observation, there were 361 incident cancers (SIR=1.13, 95% CI=1.02, 1.25) and 168 cancer deaths (SMR=1.88, 95% CI=1.61, 2.19) among men, and 98 incident cancers (SIR=0.93, 95% CI=0.76, 1.14) and 38 cancer deaths (SMR=1.61, 95% CI=1.14, 2.20) among women. For both sexes, bronchus and lung cancer was the leading type of incident cancer and cancer death, exceeding Massachusetts estimates more than twofold. Oropharyngeal and liver cancer cases and deaths occurred in excess among men, whereas cervical cancer cases and deaths occurred in excess among women. About one third of incident cancers were smoking-attributable. Colorectal, female breast, and oropharyngeal cancers were diagnosed at more-advanced stages than in Massachusetts adults. CONCLUSIONS Efforts to reduce cancer disparities in homeless people should include addressing tobacco use and enhancing participation in evidence-based screening.
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Affiliation(s)
- Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Boston Health Care for the Homeless Program, Boston, Massachusetts.
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Bianca C Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Monica Bharel
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Massachusetts Department of Public Health, Boston, Massachusetts
| | - Daniel E Singer
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Nancy A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Bewtra M, Newcomb CW, Wu Q, Chen L, Xie F, Roy JA, Aarons CB, Osterman MT, Forde KA, Curtis JR, Lewis JD. Mortality associated with medical therapy versus elective colectomy in ulcerative colitis: a cohort study. Ann Intern Med 2015; 163:262-70. [PMID: 26168366 PMCID: PMC4925099 DOI: 10.7326/m14-0960] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Ulcerative colitis (UC) can be treated with surgery or medications. Patients often must choose between long-term immunosuppressant therapy or total colectomy. Whether one of these treatment approaches has a mortality benefit is uncertain. OBJECTIVE To determine whether patients with advanced UC treated with elective colectomy have improved survival compared with those treated with medical therapy. DESIGN Retrospective matched cohort study. SETTING Data from all 50 states for Medicaid beneficiaries (2000 to 2005), Medicare beneficiaries (2006 to 2011), and dual-eligible persons (2000 to 2011). PATIENTS 830 patients with UC pursuing elective colectomy and 7541 matched patients with UC pursuing medical therapy. MEASUREMENTS The primary outcome was time to death. Cox proportional hazards models were used to compare the survival of patients with advanced UC treated with elective colectomy or medical therapy. The models controlled for significant comorbid conditions through matched and adjusted analysis. RESULTS The mortality rates associated with elective surgery and medical therapy were 34 and 54 deaths per 1000 person-years, respectively. Elective colectomy was associated with improved survival compared with long-term medical therapy (adjusted hazard ratio [HR], 0.67 [95% CI, 0.52 to 0.87]), although this result did not remain statistically significant in all sensitivity analyses. Post hoc analysis by age group showed improved survival with surgery in patients aged 50 years or older with advanced UC (HR, 0.60 [CI, 0.45 to 0.79]; P = 0.032 for age-by-treatment interaction). LIMITATIONS Retrospective nonrandomized analysis is subject to residual confounding. The source cohort was derived from different databases throughout the study. Sensitivity and secondary analyses had reduced statistical power. CONCLUSION Elective colectomy seemed to be associated with improved survival relative to medical therapy among patients aged 50 years or older with advanced UC. PRIMARY FUNDING SOURCE National Institutes of Health and Agency for Healthcare Research and Quality.
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Affiliation(s)
- Meenakshi Bewtra
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Craig W. Newcomb
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Qufei Wu
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Lang Chen
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Fenglong Xie
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Jason A. Roy
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Cary B. Aarons
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark T. Osterman
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Kimberly A. Forde
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey R. Curtis
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - James D. Lewis
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
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Ceelen M, van der Werf C, Hendrix A, Naujocks T, Woonink F, de Vries P, van der Wal A, Das K. Sudden death victims <45 years: Agreement between cause of death established by the forensic physician and autopsy results. J Forensic Leg Med 2015; 34:62-6. [DOI: 10.1016/j.jflm.2015.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 05/08/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
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Baggett TP, Chang Y, Singer DE, Porneala BC, Gaeta JM, O'Connell JJ, Rigotti NA. Tobacco-, alcohol-, and drug-attributable deaths and their contribution to mortality disparities in a cohort of homeless adults in Boston. Am J Public Health 2015; 105:1189-97. [PMID: 25521869 PMCID: PMC4431083 DOI: 10.2105/ajph.2014.302248] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVES We quantified tobacco-, alcohol-, and drug-attributable deaths and their contribution to mortality disparities among homeless adults. METHODS We ascertained causes of death among 28 033 adults seen at the Boston Health Care for the Homeless Program in 2003 to 2008. We calculated population-attributable fractions to estimate the proportion of deaths attributable to tobacco, alcohol, or drug use. We compared attributable mortality rates with those for Massachusetts adults using rate ratios and differences. RESULTS Of 1302 deaths, 236 were tobacco-attributable, 215 were alcohol-attributable, and 286 were drug-attributable. Fifty-two percent of deaths were attributable to any of these substances. In comparison with Massachusetts adults, tobacco-attributable mortality rates were 3 to 5 times higher, alcohol-attributable mortality rates were 6 to 10 times higher, and drug-attributable mortality rates were 8 to 17 times higher. Disparities in substance-attributable deaths accounted for 57% of the all-cause mortality gap between the homeless cohort and Massachusetts adults. CONCLUSIONS In this clinic-based cohort of homeless adults, over half of all deaths were substance-attributable, but this did not fully explain the mortality disparity with the general population. Interventions should address both addiction and non-addiction sources of excess mortality.
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Affiliation(s)
- Travis P Baggett
- Travis P. Baggett and James J. O'Connell are with the Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, the Department of Medicine, Harvard Medical School, Boston, MA, and the Boston Health Care for the Homeless Program, Boston, MA. Bianca C. Porneala is with the Division of General Internal Medicine, Massachusetts General Hospital, Boston. Yuchiao Chang, Daniel E. Singer, and Nancy A. Rigotti are with the Division of General Internal Medicine, Massachusetts General Hospital, Boston, and the Department of Medicine, Harvard Medical School, Boston. Jessie M. Gaeta is with the Boston Health Care for the Homeless Program and the Section of General Internal Medicine, Department of Medicine, Boston University, School of Medicine, Boston, MA
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Rate of deaths due to child abuse and neglect in children 0-3 years of age in Germany. Int J Legal Med 2015; 129:1091-6. [PMID: 25631691 DOI: 10.1007/s00414-015-1144-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
Abstract
In recent years, increasing attention has been paid to the issue of (fatal) child abuse and neglect, largely due to the media attention garnered by some headline-grabbing cases. If media statements are to be believed, such cases may be an increasing phenomenon. With these published accounts in mind, publicly available statistics should be analysed with respect to the question of whether reliable statements can be formulated based on these figures. It is hypothesised that certain data, e.g., the Innocenti report published by UNICEF in 2003, may be based on unreliable data sources. For this reason, the generation of such data, and the reliability of the data itself, should also be discussed. Our focus was on publicly available German mortality and police crime statistics (Polizeiliche Kriminalstatistik). These data were classified with respect to child age, data origin, and cause of death (murder, culpable homicide, etc.). In our opinion, the available data could not be considered in formulating reliable scientific statements about fatal child abuse and neglect, given the lack of detail and the flawed nature of the basic data. Increasing the number of autopsies of children 0-3 years of age should be considered as a means to ensure the capture of valid, practical, and reliable data. This could bring about some enlightenment and assist in the development of preemptive strategies to decrease the incidence of (fatal) child abuse and neglect.
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Sušnjara IMS, Gojanović MD, Vodopija D, Smoljanović A. Difficulties in recording mortality resulting from drug abuse. Cent Eur J Public Health 2015; 22:288-90. [PMID: 25622492 DOI: 10.21101/cejph.a3997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is considered, according to statements from different sources, that data on the number of deaths in the population of a certain country or region are accurate and correct, but determining causes of death is, for different reasons, often incorrect. There is, therefore,a justified doubt that there are more inaccurately registered drug abuse-related deaths in state registries. Hence, this paper tends to show the most frequent difficulties encountered when recording mortality resulting from drug abuse.
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Shen TC, Lin CL, Chen CH, Tu CY, Hsia TC, Shih CM, Hsu WH, Sung FC. Reply: Chronic obstructive pulmonary disease in rheumatoid arthritis. QJM 2014; 107:1055-6. [PMID: 25174052 DOI: 10.1093/qjmed/hcu179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T-C Shen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung 404, Taiwan Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chu Shang Show Chwan Hospital, Nantou 557, Taiwan Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung 404, Taiwan
| | - C-L Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan
| | - C-H Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung 404, Taiwan Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung 404, Taiwan
| | - C-Y Tu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung 404, Taiwan
| | - T-C Hsia
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung 404, Taiwan
| | - C-M Shih
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung 404, Taiwan
| | - W-H Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung 404, Taiwan
| | - F-C Sung
- Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung 404, Taiwan
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Gao W, Ho YK, Verne J, Gordon E, Higginson IJ. Geographical and temporal Understanding In place of Death in England (1984–2010): analysis of trends and associated factors to improve end-of-life Care (GUIDE_Care) – primary research. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundPlace of death (PoD) has been used as an outcome measure for end-of-life care. Analysis of variations in PoD can improve understanding about service users’ needs and thus better target health-care services.Objectives(1) To describe PoD in England by demographic, socioeconomic and temporal variables; (2) to determine how much of the variation in PoD can be explained by potential explanatory variables at the area level, and building on this to develop individual-level multivariable regression models; and (3) to evaluate factors associated with PoD and to construct risk assessment models to inform practice.MethodsA population-based study of all registered deaths between 1984 and 2010 in England (n = 13,154,705). The outcome was the PoD. Explanatory variables included age, gender, cause of death (CoD), marital status, year of death, whether or not the death was in a holiday period (Christmas, Easter, New Year), season of death, the location of usual residence and area-level deprivation. The proportion of explained variation in PoD was estimated using the weighted aggregate-level linear regression. Factors associated with PoD were investigated using generalised linear models. The risk assessment models were constructed using the 2006–9 data; the performance was evaluated using the 2010 data.ResultsHospital was the most common PoD in 2001–10 [overall 57.3%; range – cancer 46.1% to chronic obstructive pulmonary disease (COPD) 68.3%], followed by home [overall 19.0%; range – cerebrovascular disease (CBD) 6.7% to cardiovascular disease 27.4%] or care home (overall 17.2%; range – cancer 10.1% to neurological conditions 35.2%), depending on CoD. Over the period, the proportion of hospital deaths for people who died from non-cancer increased (57.1–61.2%) and care home deaths reduced (21.2% down to 20.0%); a reverse pattern was seen for those who died of cancer (hospital: reduced, 48.6–47.3%; care home: increased, 9.3–10.1%). Hospice deaths varied considerably by CoD (range – CBD 0.2% to cancer 17.1%), and increased slightly overall from 4.1% in 1993–2000 to 5.1% in 2001–10. Multivariable analysis found that hospital deaths for all causes combined were more likely for people aged 75+ years [proportion ratios (PRs) 0.863–0.962 vs. aged 25–54 years], those who lived in London (PRs 0.872–0.988 vs. North West), those who were divorced, single and widowed (PRs 0.992–1.001 vs. married), those who lived in more deprived areas (PRs 0.929–1.000 more deprived vs. less deprived) and those who died in autumn, winter or at New Year. We were able to develop risk assessment models but the areas under the receiver operating characteristic curve indicating poor predictive performance, ranging from 0.552 (COPD) to 0.637 (CBD).ConclusionsHospital remains the most common PoD, followed by home and care home. Hospices play an important role for people who died from cancer but little for other diseases. Place of death is strongly associated with the underlying CoD. The variation in PoD by region, age, marital status and area deprivation suggests that inequities exist, which services and clinical commissioning groups could seek to address.FundingThe National Institute for Health Services and Delivery Research programme.
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Affiliation(s)
- Wei Gao
- King’s College London, The School of Life Sciences and Medicine, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
| | - Yuen K Ho
- King’s College London, The School of Life Sciences and Medicine, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
| | - Julia Verne
- Knowledge & Intelligence (South West) and National End of Life Care Intelligence Network, Public Health England, Grosvenor House, Bristol, UK
| | - Emma Gordon
- Life Events and Population Sources Division, Office for National Statistics, Newport, Wales, UK
| | - Irene J Higginson
- King’s College London, The School of Life Sciences and Medicine, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
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Lott JP, Gross CP. Mortality from nonneoplastic skin disease in the United States. J Am Acad Dermatol 2014; 70:47-54.e1. [DOI: 10.1016/j.jaad.2013.09.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 09/24/2013] [Accepted: 09/25/2013] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW To review the literature with regard to mortality in patients with hypopituitarism with a focus on the role of growth hormone (GH) deficiency and therapy. RECENT FINDINGS Mortality is increased in hypopituitarism, particularly in female patients. In recent years mortality rates appear to be trending downwards towards that of the general population. Recent studies from retrospective or postmarketing surveillance studies have suggested that patients who receive GH therapy may not have increased mortality. Recent studies regarding mortality in paediatric patients treated with GH are conflicting and this area needs further study. SUMMARY There are several important limitations of available data regarding mortality in hypopituitarism and even more so in the impact of GH therapy, which need to be taken into account when interpreting the available data. The data regarding mortality in patients treated with GH as children is an area of much debate and will need further studies to clarify, given the conflicting reports in recent studies.
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Affiliation(s)
- Mark Sherlock
- Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham,
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Aggarwal B, Ellis SG, Lincoff AM, Kapadia SR, Cacchione J, Raymond RE, Cho L, Bajzer C, Nair R, Franco I, Simpfendorfer C, Tuzcu EM, Whitlow PL, Shishehbor MH. Cause of Death Within 30 Days of Percutaneous Coronary Intervention in an Era of Mandatory Outcome Reporting. J Am Coll Cardiol 2013; 62:409-15. [DOI: 10.1016/j.jacc.2013.03.071] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 02/15/2013] [Accepted: 03/05/2013] [Indexed: 11/24/2022]
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