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Death Rate (death + rate)
Selected AbstractsDeath rates from ecstasy (MDMA, MDA) and polydrug use in England and Wales 1996,2002HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 7 2003F. Schifano Abstract The present study reports on all deaths related to taking ecstasy (alone, or in a polydrug combination) occurring in England and Wales in the time frame August 1996,April 2002. Data presented here are based on all information recorded in the National Programme on Substance Abuse Deaths (np-SAD) database. The np-SAD regularly receives all information on drug related deaths in addicts and non addicts from coroners. A total of 202 ecstasy-related fatalities occurred in the chosen time-frame, showing a steady increase in the number of deaths each year. The ratio male:female was 4:1 and 3 of 4 victims were younger than 29. In 17% of cases ecstasy was the sole drug implicated in death and in the remaining cases a number of other drugs (mostly alcohol, cocaine, amphetamines and opiates) have been found. According to toxicology results, MDMA accounted for 86% of cases and MDA for 13% of cases; single deaths were associated with MDEA and PMA. This is the largest sample of ecstasy related deaths so far; possible explanations are given for the observed steady increase in ecstasy-related deaths and a tentative ,rationale' for this polypharmacy combination is then proposed. Copyright © 2003 John Wiley & Sons, Ltd. [source] Trends in suicide from drug overdose in the elderly in England and Wales, 1993,1999INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2002Rajen Shah Abstract Background Drug overdose is a common method of suicide in the elderly. Hence, an understanding of current trends in epidemiology of these deaths is important when considering measures to decrease suicide rates. Methods Analysis of the Office for National Statistics (ONS) database of deaths from overdose and poisoning. Suicide and undetermined deaths from drug overdose between 1993,1999 in the over 65 year olds were studied. Socio-demographic data from the four drug groups most commonly used in overdose were extracted, and age and sex specific mortality rates calculated. Enumeration districts were ranked into five quintiles based on their Carstairs scores, and death rates in each quintile for men and women calculated. Results There were 1864 deaths from drug overdose during the study period. Suicide and undetermined death rates from drug overdose remained stable between 1993,1999. Drugs most commonly used in overdose were (in order) paracetamol (and related compounds), benzodiazepines, antidepressants, and opiates. Women comprised 62% of deaths. Death rates increased with age, with highest rates in men over 75 (37.7 deaths per million). Benzodiazepines showed the most marked increase with age. Co-proxamol comprised 32% of deaths from paracetamol compounds, and 95% of antidepressant deaths were due to tricyclic antidepressants. There was no association in women between Carstairs area deprivation and suicide rates; in men rates were highest in the most deprived areas. Conclusion Suicides in the over 65 year olds may be decreased by changes in prescription practice. Paracetamol, co-proxamol, tricyclic antidepressants and benzodiazepines should be prescribed with caution to the elderly with depression or at high risk of depression. Copyright © 2002 John Wiley & Sons, Ltd. [source] Biases affecting the proportional reporting ratio (PRR) in spontaneous reports pharmacovigilance databases: the example of sertindolePHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2003Nicholas Moore Abstract Background Automated measures of reporting disproportionality in databases of spontaneous reports of adverse drug reactions are an emerging tool to identify drug-related alerts. Sertindole, a new atypical neuroleptic known to prolong the QT interval, was suspended in November 1998 because the proportion of reports of fatal reactions suggesting arrhythmia among all reports with sertindole was almost ten times higher than that for other atypical neuroleptics in the UK. This excess risk was not predicted in preclinical data and had not been found in premarketing trials. Method Reporting patterns over time were analysed. Prescription Event Monitoring (PEM) studies and a large retrospective cohort allowed for the comparison of actual death rates with atypical neuroleptics, and to assess which proportion of the deaths that occurred were reported. Results There were indications of possible skewing of reporting related to notoriety, surveillance and market size effects. Death rates in PEM studies were essentially similar between sertindole and other neuroleptics. Cardiac deaths had been two to three times more often reported than other causes of death. Conclusion Proportional reporting ratios indicate differential reporting of possible reactions, not necessarily differential occurrence. There was no indication of an actual increase of risk of all causes or cardiac deaths during sertindole treatment, but only an increased risk of its being reported. The suspension of sertindole was rescinded by Committee on Proprietary Medicinal Products (CPMP) in October 2001. Copyright © 2003 John Wiley & Sons, Ltd. [source] Liver and Intestine Transplantation in the United States 1998,2007AMERICAN JOURNAL OF TRANSPLANTATION, Issue 4p2 2009C. L. Berg Liver transplantation numbers in the United States remained constant from 2004 to 2007, while the number of waiting list candidates has trended down. In 2007, the waiting list was at its smallest since 1999, with adults ,50 years representing the majority of candidates. Noncholestatic cirrhosis was most commonly diagnosed. Most age groups had decreased waiting list death rates; however, children <1 year had the highest death rate. Use of liver allografts from donation after cardiac death (DCD) donors increased in 2007. Model for end-stage liver disease (MELD)/pediatric model for end-stage liver disease (PELD) scores have changed very little since 2002, with MELD/PELD <15 accounting for 75% of the waiting list. Over the same period, the number of transplants for MELD/PELD <15 decreased from 16.4% to 9.8%. Hepatocellular carcinoma exceptions increased slightly. The intestine transplantation waiting list decreased from 2006, with the majority of candidates being children <5 years old. Death rates improved, but remain unacceptably high. Policy changes have been implemented to improve allocation and recovery of intestine grafts to positively impact mortality. In addition to evaluating trends in liver and intestine transplantation, we review in depth, issues related to organ acceptance rates, DCD, living donor transplantation and MELD/PELD exceptions. [source] Health status differentials across rural and remote AustraliaAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 1 2009Andrew Phillips Abstract This paper describes mortality and disease patterns across five broad remoteness categories of Australia, with reference to the context in which those outcomes develop and are treated. Health and its outcomes become worse as remoteness increases. Some of this phenomenon reflects proportionally greater numbers of Aboriginal and Torres Strait Islander people in remote areas coupled with their poorer overall health outcomes; however, mortality for non-indigenous people is clearly higher outside compared with inside major cities. Migration of people seeking services likely reduces the size of interregional health disparity. Poorer health outcomes stem from worse risk factor profiles and average lower levels of income and of education, poorer physical and financial access to services, higher occupational and environmental risk, as well as factors unique to Aboriginal and Torres Strait Islander health. Little is known about the health benefits of living outside major cities. Diseases of the circulatory system and injuries account, respectively, for 40% and 18% of the excess mortality outside major cities. Death rates are declining over time in all (particularly remote) areas, but rates of death due to certain lung diseases in rural women are not, and rates of suicide have increased in remote areas. Ostensibly, prevalence of mental ill-health appears roughly similar in all remoteness areas. Dental health is poorer and disability is more prevalent outside major cities, as are a range of infectious diseases. Although pertinent, the effects on rural health of climate change and resource degradation generally have not been addressed in this paper. [source] CONSTANT EFFORT AND CONSTANT QUOTAFISHING POLICIES WITH CUT-OFFS IN A RANDOM ENVIRONMENTNATURAL RESOURCE MODELING, Issue 2 2001CARLOS A. BRAUMANN ABSTRACT. Consider a population subjected to constant effort or constant quota fishing with a generaldensity-dependence population growth function (because that function is poorly known). Consider environmental random fluctuations that either affect an intrinsic growth parameter or birth/death rates, thus resulting in two stochastic differential equations models. From previous results of ours, we obtain conditions for non-extinction and for existence of a population size stationary density. Constant quota (which always leads to extinction in random environments) and constant effort policies are studied; they are hard to implement for extreme population sizes. Introducing cut-offs circumvents these drawbacks. In a deterministic environment, for a wide range of values, cutting-off does not affect the steady-state yield. This is not so in a random environment and we will give expressions showing how steady-state average yield and population size distribution vary as functions of cut-off choices. We illustrate these general results with function plots for the particular case of logistic growth. [source] Towards an understanding of the high death rate among young people with diabetes in UkraineDIABETIC MEDICINE, Issue 1 2001M. Telishevka SUMMARY Aims Published rates of deaths attributed to diabetes mellitus among those aged under 50 have risen substantially in several former Soviet republics since the late 1980s. The reasons for this increase, and the situation facing patients with diabetes in these countries are poorly understood. The aim of this study was to describe the circumstances leading up to the death of individuals dying under the age of 50 years with mention of diabetes on their death certificate. Methods Interviews with surviving relatives or neighbours, combining elements of verbal autopsy and confidential enquiry. For those who had lived in the city of Lviv a random sample was taken. For those in rural areas a purposive sample was used to ensure coverage of more and less remote areas. Results Key informants were identified and agreed to be interviewed for 64 individuals out of a possible 79 with insulin-treated diabetes identified from their death certificates. The main immediate causes of death were renal failure (69%), ischaemic heart disease (9%), ketoacidosis (6%) and hypoglycaemia (3%). Over a third of men, but no women, were reported to have been heavy drinkers. Informants described many difficulties in obtaining regular supplies of insulin and related supplies since 1990. Although insulin is officially available free of charge, most had retained supplies for use in an emergency. More than half had, at some time, purchased supplies. The large number of deaths from renal failure reflects the effective absence of renal replacement therapy for patients with diabetes. Conclusions Individuals with diabetes in Ukraine face profound challenges involving access to necessary care. Their needs require significantly more attention from policy makers. [source] Mortality among opiate users: opioid maintenance therapy, age and causes of deathADDICTION, Issue 8 2009Thomas Clausen ABSTRACT Aims This study investigates how age of opioid users is related to causes of death prior to, during and after opioid maintenance treatment (OMT), and estimates risks of death from various causes in relation to age. Design, setting and participants Data on all opiate dependents in Norway (1997,2003) who applied for and were accepted for OMT (n = 3789) were cross-linked with the Norwegian death register. The total observation time was 10 934 person-years. Findings A total of 213 deaths was recorded. Of these, 73% were subject to autopsy, and causes of death were known for 208 cases: the overall death rate was 1.9%. Deaths were due to drug overdose (54%), somatic (32%) and traumatic causes (14%). Overdose deaths among all age groups were reduced during OMT but age had a differential effect upon risk when out of treatment. Younger opioid users were at greater risk of overdose before entering treatment; older users were at greater risk after leaving treatment. Older OMT patients were at higher risk of both somatic and traumatic deaths, and deaths during OMT were most likely to be due to somatic causes. Conclusions The high rates of overdose prior to and after treatment emphasize the need to provide rapid access to OMT, to retain patients in treatment and to re-enrol patients. The high prevalence among older patients of deaths due to somatic causes has implications for screening, treatment and referral, and may also lead to increased treatment costs. [source] Unintentional drug overdose death trends in New Mexico, USA, 1990,2005: combinations of heroin, cocaine, prescription opioids and alcoholADDICTION, Issue 1 2008Nina G. Shah ABSTRACT Aims To determine the contribution of heroin, prescription opioids, cocaine and alcohol/drug combinations to the total overdose death rate and identify changes in drug overdose patterns among New Mexico subpopulations. Design We analyzed medical examiner data for all unintentional drug overdose deaths in New Mexico during 1990,2005. Age-adjusted drug overdose death rates were calculated by sex and race/ethnicity; we modeled overall drug overdose death adjusting for age and region. Findings The total unintentional drug overdose death rate in New Mexico increased from 5.6 per 100 000 in 1990 to 15.5 per 100 000 in 2005. Deaths caused by heroin, prescription opioids, cocaine and alcohol/drug combinations together ranged from 89% to 98% of the total. Heroin caused the most deaths during 1990,2005, with a notable rate increase in prescription opioid overdose death during 1998,2005 (58%). During 1990,2005, the 196% increase in single drug category overdose death was driven by prescription opioids alone and heroin alone; the 148% increase in multi-drug category overdose death was driven by heroin/alcohol and heroin/cocaine. Hispanic males had the highest overdose death rate, followed by white males, white females, Hispanic females and American Indians. The most common categories causing death were heroin alone and heroin/alcohol among Hispanic males, heroin/alcohol among American Indian males and prescription opioids alone among white males and all female subpopulations. Conclusions Interventions to prevent drug overdose death should be targeted according to use patterns among at-risk subpopulations. A comprehensive approach addressing both illicit and prescription drug users, and people who use these drugs concurrently, is needed to reduce overdose death. [source] Male drugs-related deaths in the fortnight after release from prison: Scotland, 1996,99ADDICTION, Issue 2 2003Sheila M. Bird ABSTRACT Aims, To assess if 15,35-year-old males released after 14 + days' imprisonment in Scotland, 1996,99, had a higher drugs-related death rate in 2 weeks after release than during subsequent 10 weeks; higher than expected death rate from other causes; and if drugs-related deaths in the first fortnight were three times as many as prison suicides. Design, Confidential linkage of ex-prisoner database against deaths. Setting, Scotland's male prisons and young offenders' institutions during July to December 1996,99; 19 486 index releases after 14+ days' incarceration. Measurements, Relative risk of drugs-related death in the first 2 weeks after release (34 deaths) versus subsequent 10 weeks (23). Other causes of death (21) relative to expectation. Drugs-related deaths in first 2 weeks after release relative to suicides in prison (12). Findings, Drugs-related mortality in 1996,99 was seven times higher (95% CI: 3.3,16.3) in the 2 weeks after release than at other times at liberty and 2.8 times higher than prison suicides (95% CI: 1.5,3.5) by males aged 15,35 years who had been incarcerated for 14+ days. We estimated one drugs-related death in the 2 weeks after release per 200 adult male injectors released from 14 + days' incarceration. Non-drugs-related deaths in the 12 weeks after release were 4.9 times (95% CI: 2.8,7.0) the 4.3 deaths expected. Conclusion, Investment in, and evaluation of, prison-based interventions is needed to reduce substantially recently released drugs-related deaths. [source] HOST LIFE SPAN AND THE EVOLUTION OF RESISTANCE CHARACTERISTICSEVOLUTION, Issue 1 2007Martin R. Miller There is a wide variety of resistance mechanisms that hosts may evolve in response to their parasites. These can be functionally classified as avoidance (lower probability of becoming infected), recovery (faster rate of clearance), tolerance (reduced death rate when infected), or acquired immunity. It is commonly thought that longer lived organisms should invest more in costly resistance. We show that due to epidemiological feedbacks the situation is often more complex. Using evolutionary theory we examine how the optimal investment in costly resistance varies with life span in a broad range of scenarios. In the absence of acquired immunity, longer lived populations do generally invest more in resistance. If hosts have acquired immunity, the optimal resistance may either increase or decrease with increasing life span. In addition, there may be evolutionary bistability with high and low investments in avoidance or tolerance. The optimal investment in the duration of acquired immunity always increases with life span, and due to bistability, shorter lived hosts may commonly not evolve any immunity. In contrast, the optimal investment in the probability of acquiring immunity initially increases and then decreases with life span. Our results have important implications for the evolution of invertebrate and vertebrate immunity, and for the evolution of acquired immunity itself. [source] Factors enabling home death of the elderly in an institution specializing in home medical care: Analysis of apprehension of the bereaved familyGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2 2008Akiko Akiyama Aim: To determine the factors enabling home death despite caregiver apprehension about home medical care. Methods: This study was an anonymous mailed survey of bereaved family members (the caregiver) of patients who died in a home medical care setting provided by an institution specializing in home medical care in Japan (home death rate, ,80%). We analyzed the relationships between caregiver apprehension about home medical care, overall satisfaction with home medical care and the place of death. Results: Higher caregiver apprehension about home medical care and lower overall satisfaction with home medical care were significantly associated with dying in a hospital. In addition, the home death group with apprehension about home medical care significantly rated higher overall satisfaction with home medical care than the hospital death group. Meanwhile, there was no difference in the overall satisfaction with home medical care between those with or without apprehension about home medical care in the home death group. Factors influencing overall satisfaction with home medical care in the home death group with apprehension about home medical care were: (i) being free from pain or symptoms (partial regression coefficient: 0.83); and (ii) fulfilled medical care service system (partial regression coefficient: 0.40). Conclusion: These results suggest that caregiver satisfaction with home medical care is an essential factor to enable home death of the patient despite the caregiver apprehension about home medical care. [source] Effectiveness of Supportive Educative Learning programme on the level of strain experienced by caregivers of stroke patients in ThailandHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2010R. Oupra RN MSc MNS PhD Abstract In Thailand, the crude death rate from stroke is 10.9/100 000 population and increasing. Unlike Western countries where community rehabilitation programmes have been established to provide services following the acute stage of stroke recovery, there is no stroke rehabilitation team in the community in Thailand. Therefore, family caregivers are the primary source for ongoing care and support. While family members accompany patients during their hospitalisation, they receive little information about how to assist their relatives, and as a result feel inadequately trained, poorly informed and dissatisfied with the support that is available after discharge. Family caregivers report that they suffer both physically and psychologically and find themselves overwhelmed with strain, experiencing burden and exhaustion. This study aimed to develop and implement a nurse-led Supportive Educative Learning programme for family caregivers (SELF) of stroke survivors in Thailand and to evaluate the effect of the SELF programme on family caregiver's strain and quality of life. This was a non-randomised comparative study with concurrent controls, using a two-group pre-test and post-test design. A total of 140 stroke survivors and 140 family caregivers were recruited; 70 patients/caregiver pair in each group. Caregivers of patients admitted to the intervention hospital following an acute stroke received the intervention, while caregivers of patients admitted to the comparison hospital received the usual care provided at the hospital. The data were collected prior to discharge of the patients and after 3 months. The family caregivers in the intervention group had a significantly better quality of life than the comparison group (GHQ-28 at discharge t = 2.82, d.f. = 138, P = 0.006; and at 3 months t = 6.80, d.f. = 135, P < 0.001) and they also reported less strain (Caregiver Strain Index at discharge t = 6.73, d.f. = 138, P < 0.001; and at 3 months t = 7.67, d.f. = 135, P < 0.001). This research demonstrated that providing education and support to the family caregiver of stroke survivors can reduce caregiver strain and enhance their quality of life. [source] Resource settings have a major influence on the outcome of maintenance hemodialysis patients in South IndiaHEMODIALYSIS INTERNATIONAL, Issue 2 2010ABRAHAM Georgi Abstract Chronic kidney disease is reaching epidemic proportions and the number of patients on renal replacement therapy (RRT) is increasing worldwide and also in developing countries. To meet the challenge of providing RRT, a few charity organizations provide hemodialysis units for underprivileged patients, as the private hospitals are unaffordable for the majority. There is a paucity of information on the outcome of dialysis in these patients. Here, we describe the outcome of hemodialysis patients comparing the middle- and upper-class income group with the lower class income group. A retrospective analysis was carried out in 558 CKD patients initiated on maintenance hemodialysis in two different dialysis facilities. Group A (n=247) included those who belonged to the lowermost socioeconomic status and were undergoing dialysis in two nonprofit, charity (TANKER)-run dialysis units, and Group B (n=311) was undergoing dialysis in a nonprofit hospital setting where no subsidy was given. Those patients of a low socioeconomic status, especially those who are diabetics, have a higher death rate (Group A-38.1%, Group B-4.2%) and loss to follow-up (Group A-25.9%, Group B-0.3%) compared with those who are in the middle- and high-income group. Higher EPO use and hence higher hemoglobin levels (Group A-6.4±1.2, Group B-8.9±1.5 P<0.001) were observed in those who were in the middle and the higher income group. Lower serum phosphorus level was observed in the low-socioeconomic group (Group A-4.7±1.5, Group B-5.5±1.9, P<0.001). Patients belonging to the middle and higher socioeconomic group undergo more transplantations compared with the lower socioeconomic group (Group A-2.4%, Group B-65.6%). [source] Implantable cardioverter defibrillator in maintenance hemodialysis patients with ventricular tachyarrhythmias: A single-center experienceHEMODIALYSIS INTERNATIONAL, Issue 1 2009Itaru ITO Abstract Patients with hemodialysis (HD) are at risk of death due to cardiac arrhythmias, worsening congestive heart failure (CHF), and noncardiac causes. This study reviews our experience with the use of implantable cardioverter defibrillators (ICDs) in patients with ventricular tachycardia who are under maintenance HD. We retrospectively reviewed 71 consecutive patients who underwent an ICD implantation in our hospital. There were 11 patients under maintenance HD and 60 patients without HD. The group of patients with HD (HD group) was compared with the patients without HD (control group). The mean follow-up period was 30±9 vs. 39±4 months in the HD group vs. the control group, respectively. Among these patients, 6 in the HD group and 26 in the control group received appropriate ICD therapies. There was no difference in appropriate ICD therapy, time to the first therapy, and electrical storm between the 2 groups. In the HD group, 1 patient underwent surgical removal of the ICD system due to infective endocarditis. There were 5 deaths in the HD group (4 from CHF) and 8 deaths in the control group (4 from CHF). There were no sudden cardiac deaths or arrhythmic deaths in both groups of patients during the follow-up period. However, the overall death rate was significantly higher in the HD group (P<0.01). In HD patients, ICD therapy prevented arrhythmic death, but their rate of nonarrhythmic adverse outcomes was high. This risk-benefit association should be considered before implantation of the device. [source] Mortality differences among organisms causing septicemia in hemodialysis patientsHEMODIALYSIS INTERNATIONAL, Issue 1 2006Mark D. DANESE Abstract Septicemia is a serious problem in hemodialysis patients because it can lead to life-threatening complications and a persistently elevated risk of death. Most analyses have not examined whether there are differences in mortality risk among the organisms that cause these episodes of septicemia. This study was a retrospective cohort analysis of first septicemia hospitalizations during the first year of hemodialysis. Time to death (both in-hospital and within 12 weeks post-discharge) was compared among the different septicemia-causing organisms based on discharge diagnoses in Medicare billing data from 1996 to 2001. The effect of various complications on mortality risk was also evaluated. There were 22,130 septicemia hospitalizations identified. The most common organism identified was Staphylococcus aureus (27%), with no other organism having an incidence >10%. The overall unadjusted death rate from admission through 12 weeks of follow-up was 34%. During the first hospitalization, the death rate was 14%, and during the 12-week period after the hospitalization it was 20%. In adjusted analyses, S. aureus was associated with a 20% higher risk of death both during the in-hospital period and the 12-week post-discharge period, when compared with all other specified organisms. Hospitalizations complicated by meningitis, stroke, or endocarditis were also associated with increased risk of mortality, independent of the organism causing septicemia. Septicemia hospitalizations are associated with a high mortality rate,both during the initial hospitalization and after discharge. Meningitis, stroke, and endocarditis represent particularly serious complications. Overall, septicemia hospitalizations (especially for S. aureus) are serious events, and patients would benefit from better treatment and prevention. [source] Living donor liver transplantation for patients with fulminant hepatic failureHEPATOLOGY RESEARCH, Issue 2008Yasuhiko Hashikura The prognosis for patients with fulminant hepatic failure has improved since the introduction of liver transplantation. However, the death rate of patients awaiting liver transplantation is high, possibly because of the difficulty in obtaining grafts in a timely manner, given the relative shortage of cadaveric donors. Under these circumstances, living donor liver transplantation is an alternative therapeutic option for patients with fulminant hepatic failure. The present review provides recent updates on the clinical and therapeutic aspects of living donor liver transplantation for fulminant hepatic failure. [source] Burden of stroke in SingaporeINTERNATIONAL JOURNAL OF STROKE, Issue 1 2008N. Venketasubramanian Stroke is Singapore's fourth leading cause of death, with a crude death rate of 40·4/100 000 in 2006, a prevalence of 3·65% and an incidence of 1·8/1000, and is among the top 10 causes of hospitalization. Approximately one-quarter of strokes are hemorrhagic. Hospital care for acute stroke costs about US$5000. Subsidized healthcare is widely available for primary level and hospital care, as are rehabilitative services. A national stroke support group has been established. With our rapidly aging population, coupled with the high prevalence of stroke risk factors in the community, the burden of stroke is expected to increase dramatically in the years to come, posing challenges to the healthcare system and society. A national disease management plan incorporating high-quality clinical care coupled with research would be essential. [source] Prevalence of renal cell carcinoma: A nation-wide survey in Japan, 2002INTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2007Ken Marumo Objective: To investigate the incidence of renal cell carcinoma, classified by sex, age group and region in Japan, following a 5-year interval after a previous survey performed in 1997. Methods: The survey was conducted between the beginning of January 2002 and the end of December 2002. A total of 1288 institutions in all 47 prefectures throughout Japan were requested to register cases. Results: There were 7405 persons with renal cell carcinoma, consisting of 5063 males and 2342 females. Crude incidence rates were 8.2 and 3.6 per 100 000 population for men and women, respectively. Incidence rates in the Hokkaido region were highest followed by the Shikoku region. Conclusions: Despite incidence of renal cell carcinoma increasing to 7405 from the 6358 persons in 1997, statistical data reported by the Ministry of Health, Labor and Welfare indicate that rising age-adjusted death rate for this tumor reached a ceiling in the past decade. Early detection may have contributed to this current trend; however, further epidemiological research is required to fully elucidate this. [source] High-dose chemotherapy for male germ cell tumorINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2006ISAO HARA Abstract, Today, 20,30% of male patients with advanced germ cell tumor (GCT) do not have durable, complete remission in spite of cis -platinum (CDDP)-based chemotherapy. High-dose chemotherapy (HDCT) has been tried in CDDP refractory GCT patients. Initially HDCT was performed with autologous bone marrow transplantation in heavily treated patients. However, the clinical outcome was not good and the treatment-related death rate was not ignorable. Therefore, earlier introduction of HDCT with peripheral blood stem cell transplantation was preferable as it renders HDCT more effective and less toxic, and multicycle HDCT is feasible. The durable free rate of recent HDCT for refractory GCT patients is 32,65%. HDCT is also performed as first line chemotherapy for poor prognosis GCT patients. Induction chemotherapy followed by multicycles of HDCT was tried. The durable free rate of recent HDCT as first line chemotherapy is 43,73%. Although previous reports suggest the superiority of HDCT, one recent randomized controlled trial (RCT) failed to show an improvement with one cycle of HDCT followed by three cycles of standard-dose chemotherapy (SDCT) compared with four cycles of SDCT. Ongoing RCT comparing multicycles of HDCT with SDCT for poor prognostic GCT patients will clarify the role of HDCT. Recently, new regimens of HDCT containing paclitaxel have been devised. In this review, the history, current status and future of HDCT for advanced or refractory GCT will be discussed. [source] Leptodora kindti and Flexible Foraging Behaviour of Fish , Factors behind the Delayed Biomass Peak of Cladocerans in Lake HiidenvesiINTERNATIONAL REVIEW OF HYDROBIOLOGY, Issue 1 2003Laura Uusitalo Abstract In the eutrophic L. Hiidenvesi, the spring biomass maximum of cladoceran zooplankton is missing and the highest biomass takes place in July,August. The factors behind the delayed biomass peak were studied in four different basins of the lake with concomitant data on cladocerans assemblages, density of the predatory cladoceran Leptodora kindti and food composition of fish. In all the basins, the abundance of Leptodora peaked in June, being highest (up to 800 ind. m,3) in the two most shallow basins (max depth < 4 m). The duration of the high population density was short and in July-August Leptodora density stayed below 200 ind. m,3, although the water temperature was still favourable. The collapse of the Leptodora population coincided with the change in the feeding habits of fish. In early summer, fish predation was targeted mainly on copepods and zoobenthos, while in high summer Leptodora was one of the main preys of perch, white bream and bleak. The biomass of herbivorous cladocerans was below 10 ,g C l,1 in June, and climbed to a maximum in August in the two most shallow basins (34 and 76 ,g C l,1), in July in the deepest basin (27 ,g C l,1), and in September in the intermediate basin (55 ,g C l,1). In the two most shallow basins, the death rate of the dominating cladoceran, Daphnia cristata, closely followed the food consumption rate by the Leptodora population. In the deeper basins, the agreement was not so close, smelts (Osmerus eperlanus) and chaoborids being important predators of herbivores. The duration of the period of high Leptodora density thus depended on the predation pressure by fish, while the increased fish predation on Leptodora in July,August allowed the elevation of the biomass of herbivorous cladocerans. [source] Constructing life-tables for the invasive maize pest Diabrotica virgifera virgifera (Col.; Chrysomelidae) in EuropeJOURNAL OF APPLIED ENTOMOLOGY, Issue 4 2006S. Toepfer Abstract:, The western corn rootworm (Diabrotica virgifera virgifera LeConte, Col.; Chrysomelidae) is an alien invasive species in Europe. It is a univoltine species with eggs that overwinter in the soil and larvae that hatch in spring. Three larval instars feed on maize roots, which can cause plant lodging and yield loss of economic importance. Adults emerge between mid-June and early August and can reduce yields through intensive silk feeding. In order to provide a thorough understanding of the population dynamics of this invasive pest species in the invaded European region, complete age specific life-tables were constructed in two maize fields in southern Hungary assessing the significance of natural mortality factors acting on D. v. virgifera populations. This information provides a rational basis for devising sustainable integrated pest management programmes, in particular, by enabling the identification of vulnerable pest age intervals for the timely application of various management tools. The life-table for D. v. virgifera in Europe resulted in a total mortality of about 99% from the egg stage in the autumn to the emergence of adult females in the following year (KTotal = 2.48), which is comparable with North America. The highest reduction of D. v. virgifera numbers resulted from the mortality in first instar larvae (94% marginal death rate) and from the unrealized fecundity (80%). However, only the variation in mortality between years can change the generational mortality and thus influence population growth. High variation in the marginal death rate between fields and years was found in the second and third instar larval stages, and in the overwintering egg stage. These mortality factors therefore have the potential to cause changes in the total generational mortality. Furthermore, the life-table suggested that a high fecundity could compensate for a high generational mortality and would lead to population increase. [source] To Replace or Not to Replace: A Systematic Approach to Respond to Device AdvisoriesJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2009Ph.D., SILVIA G. PRIORI M.D. Aim: The decision of whether and when to replace a device in response to an "advisory" letter requires careful consideration, because device replacement carries related risks and is influenced by the clinical characteristics of the patient. Methods and Results: The risk/benefit of device replacement depends on four parameters: expected annual sudden cardiac death rate; residual device life; difference in failure rate between the device listed on the advisory letter and the replacement device; and the replacement procedure mortality risk. Using these four factors, we have developed an equation that provides the "number needed to replace" (NNR) to save one life. Per our model, patients implanted with a device with a failure rate approaching 1% and a probability of requiring device intervention ,25% per year,in particular, pacemaker-dependent patients,have an NNR <250. Pacemaker-dependent patients, with devices having three or more years longevity, but with device failure rates ,0.5%, have an NNR <100. Patients with arrhythmic risk ,2.5% per year and those with devices having failure rates <0.1% have a high NNR and stand more risk to be harmed than benefited from device replacement. Conclusions: Pacemaker-dependent patients and those with high arrhythmic risk (,25% annually) when having "advisory" devices with high failure rate (,1%) have an NNR <250 and, hence, could be considered for device replacement. Conversely, patients with arrhythmic risk ,2.5% per year and those with devices having failure rates ,0.1% have a high NNR or even risk of "harm" from device replacement. In all the intermediate cases, the NNR will quantify the benefit/risk ratio of replacement, thus helping physicians and patients decide on the preferred approach. The NNR methodology proposed here is also applicable to advisory notices issued to leads, but the high morbidity associated with lead replacement will generally rule out interventions to replace leads. [source] Phytanic Acid Accumulation Is Associated with Conduction Delay and Sudden Cardiac Death in Sterol Carrier Protein-2/Sterol Carrier Protein-x Deficient MiceJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 11 2004GEROLD MÖNNIG M.D. Introduction: The sterol carrier protein-2 gene encodes two functionally distinct proteins: sterol carrier protein-2 (SCP2, a peroxisomal lipid carrier) and sterol carrier protein-x (SCPx, a peroxisomal thiolase known as peroxisomal thiolase-2), which is involved in peroxisomal metabolism of bile acids and branched-chain fatty acids. We show in this study that mice deficient in SCP2 and SCPx (SCP2null) develop a cardiac phenotype leading to a high sudden cardiac death rate if mice are maintained on diets enriched for phytol (a metabolic precursor of branched-chain fatty acids). Methods and Results: In 210 surface and 305 telemetric ECGs recorded in wild-type (C57BL/6; wt; n = 40) and SCP2 null mice (n = 40), no difference was observed at baseline. However, on diet, cycle lengths were prolonged in SCP2 null mice (262.9 ± 190 vs 146.3 ± 43 msec), AV conduction was prolonged (58.3 ± 17 vs 42.6 ± 4 ms), and QRS complexes were wider (19.1 ± 5 vs 14.0 ± 4 ms). In 11 gene-targeted Langendorff-perfused hearts isolated from SCP2 null mice after dietary challenge, complete AV blocks (n = 5/11) or impaired AV conduction (Wenckebach point 132 ± 27 vs 92 ± 10 msec; P < 0.05) could be confirmed. Monophasic action potentials were not different between the two genotypes. Left ventricular function studied by echocardiography was similar in both strains. Phytanic acid but not pristanic acid accumulated in the phospholipid fraction of myocardial membranes isolated from SCP2 null mice. Conclusion: Accumulation of phytanic acid in myocardial phospholipid membranes is associated with bradycardia and impaired AV nodal and intraventricular impulse conduction, which could provide an explanation for sudden cardiac death in this model. [source] Prenatal diagnosis of fetal intra-abdominal umbilical vein varix: Report of 2 casesJOURNAL OF CLINICAL ULTRASOUND, Issue 1 2008pek MD Abstract Fetal intra-abdominal umbilical vein varix (FIUVV) is a focal aneurysmal dilatation of the umbilical vein. Its clinical importance has not yet been clearly established, but it has been reported to be associated with increased fetal death rate (in nearly 44% of cases) and chromosomal abnormalities (in 12% of cases). We report 2 cases of FIUVV diagnosed via sonography in the third trimester. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2008 [source] Temperature affects longevity and age-related locomotor and cognitive decay in the short-lived fish Nothobranchius furzeriAGING CELL, Issue 3 2006Dario R. Valenzano Summary Temperature variations are known to modulate aging and life-history traits in poikilotherms as different as worms, flies and fish. In invertebrates, temperature affects lifespan by modulating the slope of age-dependent acceleration in death rate, which is thought to reflect the rate of age-related damage accumulation. Here, we studied the effects of temperature on aging kinetics, aging-related behavioural deficits, and age-associated histological markers of senescence in the short-lived fish Nothobranchius furzeri. This species shows a maximum captive lifespan of only 3 months, which is tied with acceleration in growth and expression of aging biomarkers. These biological peculiarities make it a very convenient animal model for testing the effects of experimental manipulations on life-history traits in vertebrates. Here, we show that (i) lowering temperature from 25 °C to 22 °C increases both median and maximum lifespan; (ii) life extension is due to reduction in the slope of the age-dependent acceleration in death rate; (iii) lowering temperature from 25 °C to 22 °C retards the onset of age-related locomotor and learning deficits; and (iv) lowering temperature from 25 °C to 22 °C reduces the accumulation of the age-related marker lipofuscin. We conclude that lowering water temperature is a simple experimental manipulation which retards the rate of age-related damage accumulation in this short-lived species. [source] Hepatitis C virus infection in a Japanese leprosy sanatorium for the past 67 yearsJOURNAL OF MEDICAL VIROLOGY, Issue 4 2010Kazuya Shiogama Abstract Oku-Komyo-En is one of the national leprosy sanatoria, located on a small island in Setouchi city, Okayama prefecture of Japan since 1938. Since autopsies were carried out routinely on almost all patients who had died in the sanatorium up to 1980, approximately 1,000 formalin-fixed autopsy tissue samples were available for analysis. When these samples were reviewed, the pathological data indicated a sharp rise in the death rate caused by cirrhosis of the liver and hepatocellular carcinoma (HCC) since 1960 and 1970, respectively. Hepatitis C virus (HCV) infection is a common cause of HCC in Japan. The presence of HCV RNA was demonstrated in paraffin sections prepared from the autopsied liver tissue fixed in formalin for a prolonged period of time, by employing nested RT-PCR using type-specific primers. The data showed that HCV RNA was detectable in samples of the liver archived as early as 1940, representing the liver tissues kept in formalin for up to 67 years. HCV genotypes 1b and 2a were found by RT-PCR at 85.7% and 14.3%, respectively, in patients with leprosy. J. Med. Virol. 82:556,561, 2010. © 2010 Wiley-Liss, Inc. [source] Intermittent hypoxia during sleep induces reactive gliosis and limited neuronal death in rats: implications for sleep apneaJOURNAL OF NEUROCHEMISTRY, Issue 4 2010Rolando Xavier Aviles-Reyes J. Neurochem. (2010) 112, 854,869. Abstract Sleep apnea (SA) can be effectively managed in humans but it is recognized that when left untreated, SA causes long-lasting changes in neuronal circuitry in the brain. Recent neuroimaging studies gave suggested that these neuronal changes are also present even in patients successfully treated for the acute effects of SA. The cellular mechanisms that account for these changes are not certain but animal models of intermittent hypoxia (IH) during sleep have shown neuronal death and impairment in learning and memory. Reactive gliosis has a drastic effect on neuronal survival and circuitry and in this study we examined the neuro-glial response in brain areas affected by SA. Glial and neuronal alterations were analyzed after 1, 3, 5 and 10 days of exposure to IH (8 h/day during the sleep phase, cycles of 6 min each, 10,21% O2) and observed significant astroglial hyperplasia and hypertrophy in parietal brain cortex and hippocampus by studying gliofibrillary acidic protein, Vimentin, S100B and proliferating cell nuclear antigen expression. In addition, altered morphology, reduced dendrite branching and caspase activation were observed in the CA-1 hippocampal and cortical (layers IV,V) pyramidal neurons at short exposure times (1,3 days). Surprisingly, longer exposure to IH reduced the neuronal death rate and increased neuronal branching in the presence of persistent reactive gliosis. Up-regulation of hypoxia inducible factor 1 alpha (HIF-1,) and mdr-1, a HIF-1, target gene, were observed and increased expression of receptor for advanced end glycated products and its binding partner S100B were also noted. Our results show that a low number of hypoxic cycles induce reactive gliosis and neuronal death whereas continuous exposure to IH cycles reduced the rate of neuronal death and induced neuronal branching on surviving neurons. We hypothesize that HIF-1, and S100B glial factor may improve neuronal survival under hypoxic conditions and propose that the death/survival/re-growth process observed here may underlie brain circuitry changes in humans with SA. [source] Risk factors for venous thrombosis in medical inpatients: validation of a thrombosis risk scoreJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 12 2004N. A. Zakai Summary.,Background/objectives:,The occurrence of and risk factors for venous thrombosis (VT) complicating hospital admission in unselected medical inpatients have not been widely studied. Patients and methods:,In a 400-bed teaching hospital we identified all cases of VT complicating hospital admission between September 2000 and September 2002 using discharge codes and chart review. Controls were randomly selected adult inpatients frequency matched to cases for medical service. Results:,The incidence of VT complicating hospital admission was 7.6 per 1000 admissions. On average, VT was diagnosed on the fifth hospital day. The median age of the 65 cases and 123 controls was 68 years and 45% were men. Cases had a 4-fold higher death rate than controls [95% confidence interval (CI) 1.9, 8.8]. At admission, trauma within 3 months, leg edema, pneumonia, platelet count > 350 × 103 mm,3 and certain cancers were associated with risk of VT. Age, body mass index, and acute myocardial infarction were not associated with VT risk. One of three published VT risk models was able to risk stratify patients and was associated with a 2.6-fold increased risk of VT (95% CI 1.3, 5.5). Use of VT prophylaxis did not differ in cases and controls; prophylaxis was used <,1/3 of hospital days in 52% of patients. Conclusions:,VT was common among medical inpatients. Of the risk factors identified, elevated platelet count has not been previously reported. Only one of three published risk scores was associated with risk of inpatient VT. Future study should improve upon risk prediction models for in-hospital VT among medical patients. [source] Prophylactic strategies for hepatitis B patients undergoing liver transplant: A cost-effectiveness analysisLIVER TRANSPLANTATION, Issue 5 2006Yock Young Dan Hepatitis B immunoglobulin with lamivudine prophylaxis (LAM/HBIG) is effective in preventing Hepatitis B (HBV) recurrence posttransplant but is expensive and inconvenient. Lamivudine-resistant HBV, which has limited the usefulness of lamivudine monoprophylaxis in transplant, can now be effectively controlled with adefovir dipivoxil. We performed a cost-effectiveness analysis on the strategies of lamivudine prophylaxis with adefovir rescue(LAM/ADV) compared to combination LAM/intravenous fixed high-dose HBIG prophylaxis(LAM/ivHBIG) or LAM/intramuscular HBIG prophylaxis(LAM/imHBIG). Markov modeling was performed with analysis from societal perspective. Probability rates were derived from systematic review of the literature and cost taken from MEDICARE database. Outcome measures were incremental cost-effectiveness ratio(ICER) and cost to prevent each HBV recurrence and death. Analysis was performed at 5 years posttransplant as well as at end of life expectancy (15 years). Combination LAM/ivHBIG cost an additional USD562,000 at 15 years, while LAM/imHBIG cost an additional USD139,000 per patient compared to LAM/ADV. Although there is an estimated increase in recurrence of 53% with LAM/ADV and 7.6% increased mortality at the end of life expectancy (15 years), the ICER of LAM/ivHBIG over LAM/ADV treatment is USD760,000 per quality-adjusted life-years and for LAM/imHBIG, USD188,000. Cost-effectiveness is most sensitive to cost of HBIG. Lamivudine prophylaxis with adefovir dipivoxil salvage offers the more cost-effective option for HBV patients undergoing liver transplant but with higher recurrence and death rate using a model that favors LAM/HBIG. Lowering the cost of HBIG maintenance will improve cost-effectiveness of LAM/HBIG strategy. In conclusion, a tailored approach based on individual risks will optimize the cost-benefit of HBV transplant prophylaxis. Liver Transpl 12:736,746, 2006. © 2006 AASLD. [source] | ||||||||||||||||||||||||||||||||||||||||