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 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We have surveyed a population size of 6633315 from Diseases Surveillance Points (DSP) system in Gansu province for the last eleven years. The annual birth rate was 18.20% with an annual standard mortality rate 545.80/10(5). The annual standard mortality for male and female were 607.53/10(5) and 483.29/10(5) respectively. The major causes of death were Respiratory system diseases, Cardiovascular diseases, Neoplasms, Injuries, Digestive system diseases, Pediatric diseases, Infectious diseases in sequence. In eleven years, there seemed to be a rising trend in the mortalities of following diseases as: Cerebrovascular diseases, Ischemic heart diseases, Rheumatic fever and heart disease, Lung Cancer, Liver Cancer, Cancer of the Esophagus, Intestinal cancer, Cervical cancer, Injury, Congenital abnomalities, to different degrees. However, an obvious descending trend on the morbidity and mortality of infectious diseases was moticed. The average life expectancy was 71.05 years in DSP, with male 69.57 years, and female 72.72 years. Diseases with higher PYLL were Injuries, Neoplasms, Respiratory system diseases and the like. Data suggested not only the prevention andcontrol of infectious diseases, but also the surveillance of injuries and the prevention and control of chronic diseases should be strengthened.
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PMID:[Analysis on the health status of residents from Diseases Surveillance Points in Gansu Province]. 872 58

The causes of death and associated risk factors are compared in young and old diabetic patients attending a retinopathy clinic. Mortality in those diagnosed under and over the age of 30 years is also examined in order to compare insulin-dependent with non-insulin-dependent patients. A defined cohort attending the Hammersmith Hospital Retinopathy Clinic was followed for an average of 11 years. Main outcome measures were standardized mortality ratios (SMRs) in different age/sex groups and relative hazard rates (RHRs) for possible risk factors related to mortality. The patients were divided into those aged under and over the age of 60 years at attendance at the clinic. The RHRs were smaller in the elderly for plasma urea [1.015 versus 1.107 (p < 0.01)]. Attenuation of risk was also suggested for systolic blood pressure (RHR of 1.005 in the elderly versus 1.015 in the younger patients) and for the effects of smoking [RHR of 1.17 (elderly patients) and 1.35 (younger patients)]. In those diagnosed under the age of 30 years, there were very high SMRs for renal disease, cerebrovascular disease (men only), ischemic heart disease, other heart disease, and respiratory disease (men only), but increased SMRs were also demonstrated in those diagnosed over the age of 30 years. The risk factors associated with poor survival were similar for those diagnosed over and under the age of 30 years: poor diabetic control, high systolic and diastolic blood pressure, and increased plasma urea. In conclusion, there was no evidence that blood sugar control or diastolic blood pressure were less important in older age groups. Plasma urea, systolic pressure, and being on insulin were less useful as predictors of mortality in the elderly, but were still important in patients diagnosed over the age of 30 years.
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PMID:Causes of death and risk factors in young and old diabetic patients referred to a retinopathy clinic. 880 66

This paper reports the mortality experience from 1948 to 1989 of 2,504 maintenance employees who had a minimum of one year of employment in jobs with potential exposure to asbestos at a Texas refinery and petrochemical plant. For the purposes of this study, "potential exposure" is equated with those jobs or crafts having the greatest direct potential proximity to, or which worked directly with, asbestos-containing materials, especially asbestos-containing thermal insulation. Approximately one-half of the study population had 10 years or longer potential exposure, and 80% had their first potential exposure before 1970. The total population exhibited significantly lower mortality for all causes, the standardized mortality ratio (SMR = 77); and for all cancer (SMR = 85), as compared to residents in the surrounding communities. Statistically significant deficits in mortality were also observed in a number of noncancerous diseases such as heart disease (SMR = 78; 95% CI = 69-88), nonmalignant respiratory disease (SMR = 70; 95% CI = 50-95), and cirrhosis of the liver (SMR = 44; 95% CI = 22-79). Mortality among employees who had 20 years or longer since their first potential exposure was also examined; the pattern of mortality was similar to that exhibited by the total cohort, with a slight increase in the SMR for most of the causes. The only statistically significant excess of mortality found was a fourfold increase in mesothelioma (5 observed and 1.2 expected deaths) the SMR was 428 (95% CI = 139-996) for the total cohort and was 469 (95% CI = 152-1093) for those who had 20 years or more since first potential exposure. In contrast to asbestos industry worker studies, mortality for lung cancer was substantially lower than the general population (SMR = 81; 95% CI = 63-103). The observed number of deaths for cancer of the larynx was virtually the same as expected (3 observed vs. 2.8 expected). This study also showed decreased mortality for cancers of gastrointestinal organs such as the esophagus (SMR = 78), stomach (SMR = 63), large intestine (SMR = 91), rectum (SMR = 55), or pancreas (SMR = 90)--cancers that have been reported to be elevated in studies of various industry workers directly exposed to asbestos.
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PMID:Mortality among maintenance employees potentially exposed to asbestos in a refinery and petrochemical plant. 880 46

Results from a prospective mortality surveillance of 3803 refinery and petrochemical workers at a Shell Oil Company facility in Louisiana are presented. This report includes employees who worked more than 6 months before January 1, 1994 and pensioners who were alive as of January 1, 1973. Vital status was ascertained through 1993. Regardless of the comparison population used to calculate expected numbers (United States, Louisiana, or the surrounding tri-parish area), significantly fewer deaths were observed for all causes combined, all malignant neoplasms, heart disease, nonmalignant respiratory disease, and cirrhosis of the liver among male employees after 10 or more years' latency. With the United States as comparison, the all causes combined standardized mortality ratio (SMR) was 0.72 (95% confidence interval [CI] = 0.65 to 0.79), and the SMR for all cancer was 0.75 (95% CI = 0.61 to 0.92). The brain cancer rate for this group was nonsignificantly increased, with five observed deaths and three expected deaths, whereas mortality from leukemia was consistently lower than expected. The overall favorable mortality experienced by employees at this refinery and chemical plant is probably a result of a combination of factors, such as the healthy worker effect, relatively low risks related to the workplace, and the beneficial effects of continuing employment.
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PMID:A mortality study of oil refinery and petrochemical employees. 917 90

A comprehensive survey of late effects (physical, social and reproductive) following treatment at a single institution for early stage Hodgkin's disease (HD) was performed. A total of 611 patients with stage I and II HD treated between 1973 and 1984 were reviewed; 460 were alive and were mailed a self-reported questionnaire. A total of 363 (79%) replies were received. Twenty patients died of second malignancy, 14 of heart disease and nine from respiratory disease. There were 37 cases of second malignancy [relative risk (RR) 2.2, absolute excess risk (AR) 35.8]. The 15-year incidence of heart disease was 11% and there were nine myocardial infarction deaths (RR 1.55, AR 5.4). Twenty-eight (8%) respondents stated that their career had been greatly interfered with, 53 (14.5%) perceived financial loss. Sexual activity was disrupted in 25.8%. In total, 56 men had fathered 112 pregnancies. Of 171 women, 40.3% became pregnant, resulting in 92 live births. A total of 43 men and 16 women had sought medical advice with regard to infertility.
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PMID:Late effects of treatment for early-stage Hodgkin's disease. 957 37

We evaluated the diagnoses noted on the medical records of 275 patients admitted to Saga Medical College Hospital during the six-year period 1990-1995: 245 patients with cardiopulmonary arrest on arrival (CPAOA) and 30 patients with cardiopulmonary arrest occurring in the emergency room (CPAER). The most frequent cause of CPAOA was heart disease, and the next frequent cause was respiratory disease. In the CPAER patients, the most frequent cause was heart disease, while the next frequent was acute aortic dissection. There were discrepancies in the respective causes of cardiac arrest between the CPAOA and CPAER patients, which was probably due to difficulty in diagnosis in the emergency room. In the emergency room, the cardiopulmonary resuscitation is the first treatment to be performed for CPAOA, the examination for the cause of cardiac arrest is the next followed after the heart beating. However, the cause of cardiac arrest can not be diagnosed in the emergency room for the CPAOA patients without the successful resuscitation, because the examinations for the cause of cardiac arrest can not be performed for the patients without beating heart in the emergency room. Therefore, it is concluded that there exists a need to improve the training for finding out the abnormal death with the inspection and the medico-legal autopsy. It may be suggested that the training system of forensic medicine is ideal for clinical physician who can study the decision of the diseases ranging from toxicosis to acute cardiopulmonary arrest in both the emergency and the forensic medicine.
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PMID:[Difficulty to diagnose the cause of death in emergency room]. 989 39

Chronic obstructive pulmonary disease (COPD) affects over 16 million people in the United States and is a major cause of disability and death worldwide. Its prevalence and mortality are increasing disproportionately among the elderly, women, African-Americans, persons of lower socioeconomic status, and the populations of developing countries in which tobacco is aggressively marketed. In contrast to other major chronic diseases such as heart disease and cancer, medical treatments for COPD have not made decisive inroads into its morbidity or death rates over the last 20 years, resulting in continuing efforts to reduce disability in patients with established disease. Depression is a source of increased disability in COPD, and, as in other chronically ill patient populations, is often unrecognized and untreated in the primary and specialty care sectors. Nearly half of all patients experience some depressive symptoms and at least one-fifth have had one or more major depressive episodes, frequently of long duration. Evidence from randomized controlled trials supports the thesis that patients with mild depression improve with multidisciplinary rehabilitation, whereas patients with major depression may require specific pharmacotherapy to achieve significant improvement in mood disorder and day-to-day function. In addition to its impact on disability, depression may contribute indirectly to the etiology and progression of COPD through its relationship to addictive smoking. Mood disorder in adolescence and early adulthood contributes to early smoking and failure to quit, even after the onset of respiratory disease in later life. Patients with a history of major depression are more likely to fail in smoking cessation programs and to develop a major depressive episode when they do stop. This relationship calls for psychiatrically informed intervention models to improve long-term abstinence rates. The functional impairments associated with COPD are themselves potential promoters of depressive morbidity and chronicity, acting through complex causal pathways. Progressive hypoxia due to respiratory insufficiency leads to structural brain changes and neurocognitive deficits that impair day-to-day function and reduce adaptive potential; and oxygen therapy, as now practiced, offers minimal neurocognitive and mood benefits to most patients. Limited data from studies of experimental hypoxia in animals suggest that relatively mild lack of oxygen impairs the function and plasticity of critical neurotransmitter systems implicated in both cognition and mood, although current practice standards withhold oxygen therapy until late in the course of disease when the damaging effects of hypoxia on the brain have become well established. Neuropsychiatric approaches to the prevention, delay, and treatment of brain dysfunction should be a primary objective of research to improve patient outcomes. A comprehensive relational model that links pulmonary disease, hypoxia, neurocognitive impairment, and structural brain disease with depression provides a useful framework for the design of such studies. The near-term research agenda should include three components: (1) practical methods for improving physician and patient recognition of depression and neurocognitive impairment as targets for intervention; (2) additional trials of standard antidepressant treatment approaches for both major and minor depression; and (3) tests of the hypothesis that late-onset depression in patients with COPD is a marker for the presence of neurocognitive deficits and structural brain changes. The long-range research agenda must aim at preventive interventions designed to forestall brain deterioration. Controlled clinical trials of supplemental oxygen in patients with mild hypoxia and minimal cognitive deficits are needed to determine whether early treatment can reverse or moderate decline, reduce the incidence and chronicity of depression, and improve response to antidepressant treatment. Novel neuroprotective therapies such as antioxidant supplementation and modulation of monoaminergic neurotransmission, coupled with overall improvements in long-term respiratory disease management that minimize episodes of increased systemic oxidative stress, should be considered for multisite trials designed to define optimal treatment and prevention.
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PMID:Depression and Chronic Obstructive Pulmonary Disease: Treatment Trials. 1008 98

A study was done on geriatric residents from three institutions in Metro Manila namely La Verna I and II, a retirement home of Sisters of Franciscan Immaculate Concepcion; Hospicio de San Jose, a catholic welfare institution for the very young as well as for the very old; and Golden Acres, a government institution that takes care of indigent old/elderly people. A total of 176 geriatric residents were examined, majority are from Golden Acres with 121, followed by Hospicio de San Jose with 30 and lastly La Verna I and II with 25. In general, the oral health status of geriatric residents is very poor especially at Golden Acres and Hospicio de San Jose. Since all the resident sisters in La Verna I and II are highly educated, their oral health status is fair to good. The more prevalent medical problems the geriatric residents had are: Cataract (54); Hypertension/Cardiac Disorders (46); Rheumatoid Arthritis (30); Respiratory Diseases (29); Blood Diseases (28); Diabetes Mellitus (14); Skin Diseases (10); Impaired Hearing (13); Neurologic Problems (19); and Psychological Problems (2).
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PMID:Oral health status of institutionalized geriatric residents in Metro Manila. 1020 12

This study used the standard error of measurement (SEM) to evaluate intra-individual change on both the Chronic Respiratory Disease Questionnaire (CRQ) and the SF-36. After analyzing the reliability and validity of both instruments at baseline among 471 COPD outpatients, the SEM was compared to established minimal clinically important difference (MCID) standards for three CRQ dimensions. A value of one SEM closely approximated the MCID standards for all CRQ dimensions. This SEM-based criterion was then validated by cross-classifying the change status (improved, stable, or declined) of 393 follow-up outpatients using the one-SEM criterion and the MCID standard. Excellent agreement was achieved for all three CRQ dimensions. Although MCID standards have not been established for the SF-36, the one-SEM criterion was explored in these change scores. Among SF-36 scales demonstrating acceptable reliability and reasonable variance, the percent of individuals within each change category was consistent with those seen in the CRQ dimensions. These results replicate previous findings where a value of one SEM also closely approximated MCIDs for all dimensions of the Chronic Heart Disease Questionnaire among cardiovascular outpatients. The one-SEM criterion should be explored in other health-related quality of life instruments with established MCIDs.
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PMID:Further evidence supporting an SEM-based criterion for identifying meaningful intra-individual changes in health-related quality of life. 2716 75

This is a prospective cohort comparison study aiming to determine the mortality of patients with peripheral arterial occlusive disease (PAOD) and identify the risk factors affecting their survival. Data regarding demographic and biochemical risk factors, and lower limb disease severity classified by vascular laboratory criteria were collected prospectively from 665 consecutive patients presenting with symptoms of peripheral arterial occlusive disease. The effect of patient and disease risk factors on survival was analyzed by the life-table method and independent significant variables examined by a multivariate Cox regression model. The cumulative survival for all patients at 1, 3, and 5 years were 86.1, 71.2, and 55.8%, respectively, with a median survival of 72.2 months. Female sex, age, smoking, heart disease, renal disease, respiratory disease, stroke, critical ischemia, lowest anklebrachial index, no vascular reconstruction, and major amputation were associated with higher mortality. Lipid and biochemical variables were not significant determinants. Using multivariate Cox regression, age (>70), disease severity, anklebrachial index (<0.5), no vascular reconstruction, diabetes mellitus, and renal and cardiorespiratory diseases were identified as independent risk factors affecting patient survival. The survival of patients with PAOD is poor compared with the general population. Significant patient-related variables were largely coexisting diseases and advanced age, whereas the other risk factors for atherosclerosis are less influential. Disease severity may bear a direct relationship to mortality, and patients with critical ischemia have the worst prognosis. Early disease detection and timely vascular reconstruction may lead to an improvement in overall survival.
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PMID:Survival in patients with chronic lower extremity ischemia: a risk factor analysis. 1074 31


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