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Reducing Mortality (reducing + mortality)
Selected AbstractsEffect of an In-Home Occupational and Physical Therapy Intervention on Reducing Mortality in Functionally Vulnerable Older People: Preliminary FindingsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2006Laura N. Gitlin PhD OBJECTIVES: To evaluate the effect of a multicomponent intervention on mortality and the role of control-oriented strategy use as the change mechanism. DESIGN: Two-group randomized design with survivorship followed for 14 months. Participants were randomized to intervention or a no-treatment control group. SETTING: Urban, community-living older people. PARTICIPANTS: Three hundred nineteen people aged 70 and older with functional difficulties. INTERVENTION: Occupational therapy and physical therapy sessions involving home modifications, problem solving, and training in energy conservation, safe performance, balance, muscle strength, and fall recovery techniques. MEASUREMENTS: Survival time was number of days between baseline interview and date of death or final interview if date unknown. Control-oriented strategy use was measured using eight items. RESULTS: Intervention participants exhibited a 1% rate of mortality, compared with a 10% rate for no-treatment control participants (P=.003, 95% confidence interval=2.4,15.04%). At baseline, those who subsequently died had more days hospitalized and lower control-oriented strategy use 6 months before study enrollment than survivors. No intervention participants with previous days hospitalized (n=31) died, whereas 21% of control group counterparts did (n=35; P=.001). Although intervention participants with low and high baseline control strategy use had lower mortality risk than control participants, mortality risk was lower for intervention participants with low strategy use at baseline (P=.007). CONCLUSION: An occupational and physical therapy intervention to ameliorate functional difficulties may reduce mortality risk in community-dwelling older people overall and benefit those most compromised. Instruction in control-oriented strategies may account for the intervention's protective effects on survivorship. [source] Management and Recovery Options for Ural River Beluga SturgeonCONSERVATION BIOLOGY, Issue 3 2010PHAEDRA DOUKAKIS caviar; CITES; criadero; Mar Caspio; puntos de referencia; sobrepesca Abstract:,Management of declining fisheries of anadromous species sometimes relies heavily on supplementation of populations with captive breeding, despite evidence that captive breeding can have negative consequences and may not address the root cause of decline. The beluga sturgeon (Huso huso), a species threatened by the market for black caviar and reductions in habitat quality, is managed through harvest control and hatchery supplementation, with an emphasis on the latter. We used yield per recruit and elasticity analyses to evaluate the population status and current levels of fishing and to identify the life-history stages that are the best targets for conservation of beluga of the Ural River. Harvest rates in recent years were four to five times higher than rates that would sustain population abundance. Sustainable rates of fishing mortality are similar to those for other long-lived marine species such as sharks and mammals. Yield per recruit, which is maximized if fish are first harvested at age 31 years, would be greatly enhanced by raising minimum size limits or reducing illegal take of subadults. Improving the survival of subadult and adult females would increase population productivity by 10 times that achieved by improving fecundity and survival from egg to age 1 year (i.e., hatchery supplementation). These results suggest that reducing mortality of subadults and adult wild fish is a more effective conservation strategy than hatchery supplementation. Because genetics is not factored into hatchery management practices, supplementation may even reduce the viability of the beluga sturgeon. Resumen:,El manejo de pesquerías de peces anádromos en declinación a veces depende estrechamente de la suplementación de poblaciones mediante la reproducción en cautiverio, no obstante la evidencia de que la reproducción en cautiverio puede tener consecuencias negativas y no abordar la causa principal de la declinación. El esturión beluga (Huso huso), una especie amenazada por el mercado de caviar negro y por reducciones en la calidad del hábitat, es manejado mediante el control de la cosecha y suplementación de poblaciones, con énfasis en esta. Utilizamos análisis de producción por recluta y de elasticidad para evaluar el estatus de la población y los niveles de pesca actuales y para identificar las etapas de la historia de vida que son los mejores blancos para la conservación del beluga en el Río Ural. Las tasas de cosecha en años recientes fueron cuatro a cinco veces mayores que las tasas que sustentarían la abundancia de la población. Las tasas sustentables de mortalidad por pesca son similares a las de otras especies marinas longevas como tiburones y mamíferos. La producción por recluta, que es maximizada si los peces son cosechados a la edad de 31 años, podría incrementar significativamente elevando los límites de talla mínima o reduciendo la captura ilegal de subadultos. La mejora de la supervivencia de hembras subadultas y adultas incrementaría la productividad de la población 10 veces más que la mejora obtenida incrementando la fecundidad y supervivencia de huevo a 1 año de edad (i. e., suplementación de poblaciones mediante reproducción en cautiverio). Estos resultados sugieren que la reducción de la mortalidad de peces silvestres subadultos y adultos es una mejor estrategia de conservación que la suplementación. Debido a que la genética no es considerada en las prácticas de manejo en los criaderos, la suplementación incluso puede reducir la viabilidad del esturión beluga. [source] Report from the Rockefellar Foundation Sponsored International Workshop on reducing mortality and improving quality of life in long-term survivors of Hodgkin's disease: July 9,16, 2003, Bellagio, ItalyEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 2005Peter Mauch Abstract:, A workshop, sponsored by the Rockefellar Foundation, was held between 9 to 16 July, 2003 to devise strategies to reduce mortality and improve quality of life of long-term survivors of Hodgkin's disease. Participants were selected for their clinical and research background on late effects after Hodgkin's disease therapy. Experts from both developed and developing nations were represented in the workshop, and efforts were made to ensure that the proposed strategies would be globally applicable whenever possible. The types of late complications, magnitude of the problem, contributing risk factors, methodology to assess the risk, and challenges faced by developing countries were presented. The main areas of late effects of Hodgkin's disease discussed were as follows: second malignancy, cardiac disease, infection, pulmonary dysfunction, endocrine abnormalities, and quality of life. This report summarizes the findings of the workshop, recommendations, and proposed research priorities in each of the above areas. [source] Genomics and Cardiovascular DiseaseJOURNAL OF NURSING SCHOLARSHIP, Issue 4 2005Lorraine Frazier Purpose: To describe genetic knowledge and discovery in the area of cardiovascular disease (CVD) and to discuss how these new advances will influence the clinical care of affected people. Organizing Framework: A selective review of the literature is presented on the disease mechanism of both the Mendelian and multifactorial genetic cardiovascular conditions. A case study approach is used to illustrate how the genetic paradigm affects the healthcare experience of a family affected with familial hypertrophic cardiomyopathy. Findings: The current state of CVD treatment remains complex. An understanding of genomic concepts and a genome-based approach is necessary to determine: (a) the risk of CVD susceptibility beyond traditional risk factors; (b) early detection of illness; (c) response to treatment; and (d) molecular taxonomy of the disease. Conclusions: The results of genetic research, education, and teaching will lead to a new understanding of genes and pathways, resulting in powerful new therapeutic approaches to CVD. The challenge is to translate genetic discoveries into clinical practice that ultimately leads to preventing CVD and reducing mortality. [source] Mutations in two global regulators lower individual mortality in Escherichia coliMOLECULAR MICROBIOLOGY, Issue 1 2008Fanette Fontaine Summary There has been considerable investigation into the survival of bacterial cells under stress conditions, but little is known about the causes of mortality in the absence of exogenous stress. That there is a basal frequency of cell death in such populations may reflect that it is either impossible to avoid all lethal events, or alternatively, that it is too costly. Here, through a genetic screen in the model organism Escherichia coli, we identify two mutants with lower frequencies of mortality: rssB and fliA. Intriguingly, these two genes both affect the levels of different sigma factors within the cell. The rssB mutant displays enhanced resistance to multiple external stresses, possibly indicating that the cell gains its increased vitality through elevated resistance to spontaneous, endogenous stresses. The loss of fliA does not result in elevated stress resistance; rather, its survival is apparently due to a decreased physical stress linked to the insertion of the flagellum through the membrane and energy saved through the loss of the motor proteins. The identification of these two mutants implies that reducing mortality is not impossible; rather, due to its cost, it is subject to trade-offs with other traits that contribute to the competitive success of the organism. [source] Noninvasive ventilation in the pediatric intensive care unit for children with acute respiratory failure,,PEDIATRIC PULMONOLOGY, Issue 6 2003W. Gerald Teague MD Abstract Noninvasive ventilation, a novel treatment to increase alveolar ventilation, is accomplished with either subatmospheric or positive pressure administered via an external interface. In adults with acute respiratory failure, noninvasive positive pressure ventilation (NPPV) is superior to standard therapy in preventing intubation and reducing mortality. The role of NPPV in pediatric-age patients with acute respiratory distress is not as well established. Early case reports showed that NPPV treatment does acutely improve both the clinical manifestations of respiratory distress and respiratory gas exchange in children with respiratory distress. However, it is not clear whether NPPV in this setting can prevent vs. delay endotracheal intubation. Other uses of NPPV in the pediatric intensive care unit include the treatment of upper airway obstruction, atelectasis, and exacerbations of neuromuscular disorders, and to facilitate weaning from invasive mechanical ventilation. Successful use of NPPV in young infants with respiratory distress is impeded by the lack of suitable size interfaces, and the response characteristics of commercially available bilevel ventilators. Despite these challenges, NPPV is a promising alternate to standard therapies in the treatment of acute respiratory distress in the pediatric-age patient. Pediatr Pulmonol. 2003; 35:418,426. © 2003 Wiley-Liss, Inc. [source] Mortality in pediatric renal transplantation: A study of the French pediatric kidney databasePEDIATRIC TRANSPLANTATION, Issue 6 2009E. Allain-Launay Abstract:, Objective and Methods:, To assess patient survival in pediatric renal transplantation, we retrospectively reviewed 573 transplants in 553 patients, registered from 1995 to 2005. Results:, Mean age at transplantation was 9.9 years. Patient survival at 1, 5 and 10 years was respectively 99%, 97% and 96%. Death occurred at a median time of 2.6 years after transplantation. Long-term patient survival was significantly lower in recipients younger than 5 years old. Seventeen patients (3.1%) died. Two deaths occurred while under maintenance dialysis. Among the remaining patients, the two main causes of death were infections (33%) and malignancies (27%). Interestingly, initial disease-related complications were a major cause of death (34%). Conclusion:, A low mortality rate was observed, with the majority of deaths due to malignancies and infections, and with a notable participation of complications related to the initial disease. No impact of cardiovascular disease was noted with the given follow-up period. Improvements in managing immunosuppression may contribute to reducing mortality in pediatric renal transplantation. [source] Preclinical Studies with Adrenomedullin and Its Binding Protein as Cardiovascular Protective Agents for Hemorrhagic ShockCARDIOVASCULAR THERAPEUTICS, Issue 3-4 2006Rongqian Wu ABSTRACT Traumatic injury is a major, largely unrecognized public health problem in the US that cuts across race, gender, age, and economic boundaries. The resulting loss of productive life years exceeds that of any other disease, with societal costs of $469 billion annually. Most trauma deaths result either from insufficient tissue perfusion due to excessive blood loss, or the development of inflammation, infection, and vital organ damage following resuscitation. Clinical management of hemorrhagic shock relies on massive and rapid infusion of fluids to maintain blood pressure. However, the majority of victims with severe blood loss do not respond well to fluid restoration. The development of effective strategies for resuscitation of traumatic blood loss is therefore critically needed. We have recently discovered that the vascular responsiveness to a recently-discovered potent vasodilatory peptide, adrenomedullin (AM) is depressed after severe blood loss, which may be due to downregulation of a novel specific binding protein, AM binding protein-1 (AMBP-1). Using three different animal models of hemorrhage (controlled hemorrhage with large volume resuscitation, controlled hemorrhage with low volume resuscitation, and uncontrolled hemorrhage with minimum resuscitation), we have shown that cell and organ injury occurs after hemorrhage despite fluid resuscitation. Administration of AM/AMBP-1 significantly improves cardiac output, heart performance and tissue perfusion, attenuates hepatic and renal injury, decreases pro-inflammatory cytokines, prevents metabolic acidosis, and reduces hemorrhage-induced mortality. Thus, administration of AM/AMBP-1 appears to be a novel and useful approach for restoring cardiovascular responses, preventing organ injury, and reducing mortality after hemorrhagic shock. [source] Trends in childhood mortality from 1969 to 2004 in FinlandACTA PAEDIATRICA, Issue 8 2008Marjo Lantto Abstract Aim: The aim was to evaluate the trends in childhood mortality in Finland from 1969 to 2004. We especially wanted to find out whether the decline in mortality is continuous and whether there are still deaths that could be prevented. Methods: We analyzed mortality data obtained from the official cause of death statistics in Finland from 1969 to 2004. Annual mortality rates were calculated in proportion to those at risk of dying. Comparison of cause specific mortality rates was conducted for neonatal group and children aged 1 month to 15 years. Results: Annual neonatal mortality declined from 11.13, in 1969 to 2.46, in 2004. The leading causes of death were perinatal disorders and congenital malformations. Mortality among children aged 1 month to 15 years declined from 0.67, in 1969 to 0.23, in 2004, with accidents the leading cause of death, although congenital malformations, tumours and haematological diseases, and infectious diseases were significant causes as well. There was a notable peak in total mortality in 2004, as 44 Finnish children died in the Asian tsunami in December of that year. Conclusion: Childhood mortality in Finland has decreased significantly during recent decades. Prevention programmes should be directed towards reducing mortality from accidents by promoting traffic safety and ensuring a safer environment. Even though child mortality is very low in Finland at present, continued reductions can still be achieved. [source] The Late Open Infarct-related Artery Hypothesis: Evidence-based Medicine or Not?CLINICAL CARDIOLOGY, Issue 11 2007Martin Brueck M.D. Abstract Randomized clinical trials have clearly shown that early reperfusion of coronary arteries is the established treatment of myocardial infarction preserving left ventricular function and reducing mortality. However, late patency of the infarct-related artery is an independent predictor of survival leading to the late open-artery hypothesis. This concept implies restoration of antegrade blood flow of the infarct-related artery in patients with myocardial infarction to improve survival by mechanisms less time-dependent or even time-independent. Possible explanations for this benefit include improved left ventricular function and electrical stability by perfusion of hibernating myocardium, accelerated infarct healing and limitation of ventricular remodeling. This review focuses on the evidence of late recanalization of occluded infarct-related arteries in patients with coronary artery disease. Copyright © 2007 Wiley Periodicals, Inc. [source] | |||||||||||||