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Increased Mortality Risk (increased + mortality_risk)
Selected AbstractsRisk factors for post-weaning mortality of Merino sheep in south-eastern AustraliaAUSTRALIAN VETERINARY JOURNAL, Issue 8 2009AJD Campbell Objective To measure associations between body weight, growth rate, sex, time of shearing and post-weaning mortality of Merino sheep. Design Uni- and multivariable survival analyses of sheep mortality during the first year after weaning, using records (n = 3657) from two field experiments conducted in Western Victoria from 1996 to 2003. Results Overall mortality was 14.3% (range 4.5,26.8%) and mean maximum mortality rate was 29 deaths/1000 weaners/month. Increased mortality risk was associated with decreases in fleece-free body weight and mean weaner growth rate, particularly at low weights and growth rates. Weaners in the lightest weaning weight quintile had a hazard ratio of 3.5, compared with the middle quintile. The hazard ratio for a 2-kg decrease in weaning weight was 1.2 to 1.7 for weaners lighter than 22 kg. The hazard ratio for a reduction in mean weaner growth rate in the first 5 months after weaning of 0.25 kg/month was 1.1 to 6.8 if mean growth rate was less than 1 kg/month, but did not differ significantly from 1 at greater growth rates. The hazard ratio for wether weaners was approximately 1.5 compared with ewe weaners. The hazard ratio for weaners shorn between December and May, compared with unshorn weaners, was 1.2 to 3.5, with the greatest risk difference associated with shearing in March (45 deaths/1000 weaners/month). Conclusion Improving the body weight and mean growth rate of weaner sheep is likely to reduce post-weaning mortality. Lightweight weaners in a flock should be managed separately from the main portion after weaning. In southern Australia, not shearing spring-born Merino weaners between December and May may assist in reducing overall post-weaning mortality. [source] Overdose deaths following previous non-fatal heroin overdose: Record linkage of ambulance attendance and death registry dataDRUG AND ALCOHOL REVIEW, Issue 4 2009MARK A. STOOVÉ Abstract Introduction and Aims. Experiencing previous non-fatal overdoses have been identified as a predictor of subsequent non-fatal overdoses; however, few studies have investigated the association between previous non-fatal overdose experiences and overdose mortality. We examined overdose mortality among injecting drug users who had previously been attended by an ambulance for a non-fatal heroin overdose. Design and Methods. Using a retrospective cohort design, we linked data on non-fatal heroin overdose cases obtained from ambulance attendance records in Melbourne, Australia over a 5-year period (2000,2005) with a national death register. Results. 4884 people who were attended by ambulance for a non-fatal heroin overdose were identified. One hundred and sixty-four overdose deaths occurred among this cohort, with an average overdose mortality rate of 1.20 per 100 person-years (95% CI, 1.03,1.40). Mortality rate decreased 10-fold after 2000 coinciding with widely reported declines in heroin availability. Being male, of older age (>35 years) and having been attended multiple times for previous non-fatal overdoses were associated with increased mortality risk. Discussion and Conclusions. As the first to show a direct association between non-fatal overdose and subsequent overdose mortality, this study has important implications for the prevention of overdose mortality. This study also shows the profound effect of macro-level heroin market dynamics on overdose mortality.[Stoové MA, Dietze PM, Jolley D. Overdose deaths following previous non-fatal heroin overdose: Record linkage of ambulance attendance and death registry data. Drug Alcohol Rev 2009;28:347,352] [source] Increased sibling mortality in children with fetal alcohol syndromeADDICTION BIOLOGY, Issue 2 2004Larry Burd We compared the rate of all-cause mortality in siblings of children diagnosed with fetal alcohol syndrome (FAS) with the siblings of matched controls. The siblings of children with FAS had increased mortality (11.4%) compared with matched controls (2.0%), a 530% increase in mortality. The age of death in case siblings deaths occurred later (between 1 day and 7 years) compared with the controls (1 day to 4 years) [odds ratio (OR),=,2.4 (0.4,-,15.6)]. Siblings of children with FAS had increased risk of death due to infectious illness [OR,=,13.7 (1.2,-,361)] and sudden infant death syndrome compared with controls [OR,=,10.2 (1.2,-,75.1)]. A diagnosis of FAS is an important risk marker for mortality in the siblings of the proband even if they do not have FAS. Maternal alcoholism appears to be a useful risk marker for increased mortality risk in diagnosed cases and their siblings. This has important implications in the management of family members of children with FAS. [source] Outcomes of eating disorders: A systematic review of the literature,INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 4 2007Nancy D. Berkman PhD Abstract Objective: The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center systematically reviewed evidence on factors associated with outcomes among individuals with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) and whether outcomes differed by sociodemographic characteristics. Method: We searched electronic databases including MEDLINE and reviewed studies published from 1980 to September, 2005, in all languages against a priori inclusion/exclusion criteria and focused on eating, psychiatric or psychological, or biomarker outcomes. Results: At followup, individuals with AN were more likely than comparisons to be depressed, have Asperger's syndrome and autism spectrum disorders, and suffer from anxiety disorders including obsessive-compulsive disorders. Mortality risk was significantly higher than what would be expected in the population and the risk of suicide was particularly pronounced. The only consistent factor across studies relating to worse BN outcomes was depression. A substantial proportion of individuals continue to suffer from eating disorders over time but BN was not associated with increased mortality risk. Data were insufficient to draw conclusions concerning factors associated with BED outcomes. Across disorders, little to no data were available to compare results based on sociodemographic characteristics. Conclusion: The strength of the bodies of literature was moderate for factors associated with AN and BN outcomes and weak for BED. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007 [source] Cognitive Impairment and Mortality in Older Primary Care PatientsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2001Timothy E. Stump MA OBJECTIVE: To assess the impact of cognitive impairment on mortality in older primary care patients after controlling for confounding effects of demographic and comorbid chronic conditions. DESIGN: Prospective cohort study. SETTING: Academic primary care group practice. PARTICIPANTS: Three thousand nine hundred and fifty-seven patients age 60 and older who completed the Short Portable Mental Status Questionnaire (SPMSQ) during routine office visits. MEASUREMENTS: Cognitive impairment measured at baseline using the SPMSQ, demographics, problem drinking, history of smoking, clinical data (including weight, cholesterol level, and serum albumin), and comorbid chronic conditions collected at baseline; survival time measured during the 5 to 7 years after baseline. RESULTS: Eight hundred and eighty-six patients (22.4%) died during the 5 to 7 years of follow-up. Cognitive impairment was categorized as having no impairment (84.3%), mild impairment (10.5%), and moderate-to-severe impairment (5.2%) based on SPMSQ score. Chi-square tests revealed that patients with moderate-to-severe impairment were significantly more likely to die compared with patients with mild impairment (40.8% vs 21.5%) and those with no impairment (40.8% vs 21.4%). No significant difference in crude mortality was found between patients with no impairment and those with mild impairment. After analyzing time to death using the Kaplan-Meier method, patients with moderate-to-severe cognitive impairment were at increased risk of death compared with those with no or mild impairment (Log-rank ,2 = 55.5; P < .0001). Even in multivariable analyses using Cox proportional hazards to control for confounding factors, compared with those with no impairment, moderately-to-severely impaired patients had an increased risk of death, with a hazard ratio (HR) of 1.70. Increased risk of death was also associated with older age (HR = 1.03 for each year), a history of smoking (HR = 1.48), having a serum albumin level <3.5 g/L (HR = 1.29), and weighing less than 90% of the ideal body weight (HR = 1.98). Outpatient diagnoses associated with increased mortality risk were diabetes mellitus, coronary artery disease, congestive heart failure, cerebrovascular disease, cancer, anemia, and chronic obstructive pulmonary disease (HR range 1.36,1.67). Factors protective of mortality risk included female gender (HR = 0.67) and black race (HR = 0.73). CONCLUSIONS: Moderate-to-severe cognitive impairment is associated with an increased risk of mortality, even after controlling for confounding effects of demographic and clinical characteristics. Mild cognitive impairment is not associated with mortality risk, but a longer follow-up period may be necessary to identify this risk if it exists. [source] Serum osmolality and outcome in intensive care unit patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2006B. Holtfreter Background:, The aim of the present study was to compare 16 routine clinical and laboratory parameters, acute physiologic and chronic health evaluation (APACHE) and sequential organ failure assessment (SOFA) score for their value in predicting mortality during hospital stay in patients admitted to a general intensive care unit (ICU). Methods:, A retrospective observational clinical study was carried out in a 15-bed ICU in a university hospital. Nine hundred and thirty-three consecutive patients with ICU stay > 24 h (36.2% surgical, 29.1% medical and 34.7% trauma) were observed. Blood sampling, patient surveillance and data collection were performed. The primary outcome was mortality in the hospital. We used receiver operating characteristic (ROC) analyses and logistic regression to compare the 16 relevant parameters, APACHE II and SOFA scores. Results:, Two hundred and thirty-three out of the 933 patients died (mortality 25.0%). One laboratory parameter, serum osmolality [area under the curve (AUC) 0.732] had a predictive value for mortality which lay between that of APACHE II (AUC 0.784) and SOFA (AUC 0.720) scores. When outcome prediction was restricted to long-term patients (ICU stay > 5 days), serum osmolality (AUC 0.711) performed better than either of the standard scores (APACHE AUC 0.655, SOFA AUC 0.636). Using logistic regression analysis, the association of clinical parameters, age and diagnosis group with mortality was determined. Conclusion:, Elevated serum osmolality at ICU admission is associated with an increased mortality risk in critically ill patients. Serum osmolality is cheaper and more rapid to determine than the scoring systems. However, further studies are needed to evaluate the predictive value of serum osmolality in different patient populations. [source] Plasma Antithrombin Activity as a Diagnostic and Prognostic Indicator in Dogs: A Retrospective Study of 149 DogsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 3 2010S. Kuzi Background: Antithrombin (AT) is the major inhibitor of coagulation. In people, hypoantithrombinemia is associated with hypercoagulability, thrombosis, and poor prognosis. Veterinary studies, however, have not demonstrated similar prognostic significance. Thus, AT activity (ATA) in dogs currently is interpreted based on human medicine guidelines. Hypothesis: ATA can serve as a prognostic marker in dogs, as has been shown in people. Objectives: (1) To describe the clinical and clinicopathologic findings, diagnoses, and outcome of dogs with decreased versus normal ATA, (2) to identify diseases and mechanisms associated with hypoantithrombinemia, and (3) to assess ATA as a prognostic indicator. Animals and Methods: Retrospective study of 149 dogs with ATA measurement during their disease course. Results: Hypoantithrombinemic dogs had a higher proportion of leukocytosis, hemostatic abnormalities, hypoalbuminemia, and hyperbilirubinemia versus dogs with normal ATA. Hypoantithrombinemia commonly was present in immune-mediated hemolytic anemia (IMHA), pancreatitis, hepatopathy, and neoplasia. It was associated with higher risk of mortality in the entire study population and for specific diseases (eg, IMHA, neoplasia). The odds ratio for mortality significantly and progressively increased when ATA was <60 and <30% (9.9, 14.7, respectively). A receiver operating characteristics analysis of ATA as a predictor of mortality showed an area under the curve of 0.7, and an optimal cutoff point of 60% yielded sensitivity and specificity of 58 and 85%, respectively. Conclusions and Clinical Importance: In dogs, ATA <60% indicates increased mortality risk, similarly to human patients, but ATA has limited value as a single discriminating factor in the outcome. [source] Immune function in hypopituitarism: time to reconsider?CLINICAL ENDOCRINOLOGY, Issue 4 2010Annice Mukherjee Summary Hypopituitarism is not currently considered as a potential cause of immune disruption in humans. Accumulating data from in vitro and animal models support a role for the pituitary gland in immune regulation. Furthermore, the increased mortality risk noted in patients with adult hypopituitarism remains poorly explained and immune dysfunction could conceivably contribute to this observation. In a recent issue of Clinical & Experimental Immunology, we presented new data relating to immune status in adults with treated, severe hypopituitarism. We observed humoral immune deficiency in a significant proportion, despite stable pituitary replacement, including growth hormone (GH). This was especially evident in those with low pretreatment IGF-I levels and appeared independent of anticonvulsant use or corticosteroid replacement. These observations require substantiation with future studies. In this short review, we summarize existing data relating to the effects of pituitary hormones on immune function and discuss potential clinical implications surrounding the hypothesis of immune dysregulation in severe hypopituitarism. [source] Increased death risk and altered cancer incidence pattern in patients with isolated or combined autoimmune primary adrenocortical insufficiencyCLINICAL ENDOCRINOLOGY, Issue 5 2008Sophie Bensing Summary Objectives, Primary adrenocortical insufficiency is mostly caused by an autoimmune destruction of the adrenal cortex. The disease may appear isolated or as a part of an autoimmune polyendocrine syndrome (APS). APS1 is a rare hereditary disorder with a broad spectrum of clinical manifestations. In APS2, primary adrenocortical insufficiency is often combined with autoimmune thyroid disease and/or type 1 diabetes. We analysed mortality and cancer incidence in primary adrenocortical insufficiency patients during 40 years. Data were compared with the general Swedish population. Design and patients, A population based cohort study including all patients with autoimmune primary adrenocortical insufficiency (3299) admitted to Swedish hospitals 1964,2004. Measurements, Mortality risk was calculated as the standardized mortality ratio (SMR) and cancer incidence as the standardized incidence ratio (SIR). Results, A more than 2-fold increased mortality risk was observed in both women (SMR 2·9, 95% CI 2·7,3·0) and men (SMR 2·5, 95% CI 2·3,2·7). Highest risks were observed in patients diagnosed in childhood. SMR was higher in APS1 patients (SMR 4·6, 95% CI 3·5,6·0) compared with patients with APS2 (SMR 2·1, 95% CI 1·9,2·4). Cancer incidence was increased (SIR 1·3, 95% CI 1·2,1·5). When tumours observed during the first year of follow-up were excluded, only the cancer risk among APS1 patients remained increased. Cause-specific cancer incidence analysis revealed significantly higher incidences of oral cancer, nonmelanoma skin cancer, and male genital system cancer among patients. Breast cancer incidence was lower than in the general population. Conclusions, Our study shows a reduced life expectancy and altered cancer incidence pattern in patients with autoimmune primary adrenocortical insufficiency. [source] | |||||||||||||