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To estimate the impact of intravenous drug use (IVDU) on mortality in the general population of young adults in Rome, Italy, the Population Attributable Risk (PAR) was calculated for the overall and cause-specific mortality in the 15-34 years age group. Relative risks were derived from a previous historical cohort study on mortality among 4200 intravenous drug users (IVDUs) in Rome, in which increased mortality from cardiovascular, respiratory, and gastrointestinal diseases as well as from violence, overdose and AIDS had been observed. The prevalence of the risk factor (i.e. the proportion of IVDUs) in the general population was estimated using the 'multiplier formula' and 'capture-recapture' methods. The proportion of all deaths attributable to IVDU in the 15-34 age group in the Roman population was 16% and 9% in males and females, respectively. The cause-specific attributable proportions were 66% for endocarditis and 37% for cirrhosis in males, and 36% for endocarditis and pneumonia in females. These findings further document the relevant health consequences of IVDU on the general population of a large metropolitan area.
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PMID:The impact of intravenous drug use on mortality of young adults in Rome, Italy. 149 77

All 327 patients treated in Oslo City Hospital for blunt chest injuries during a period of three months were registered prospectively. 274 were treated outside hospital. Traffic accidents accounted for 10% of the total number of patients, but 40% of the hospitalized patients. Accidents in the home were most numerous, with many complications and admissions to hospital. 20% of the hospitalizations, were for injuries due to violence. The registration indicates more than 1,300 patients with chest injuries per year, of whom more than 40 are severely multitraumatized. The chest injury was serious in 21 patients, moderate in 306. 13.5% of the cases were complicated by pneumo-hemothorax and lung contusion, or by late complications such as pneumonia and atelectases. Seven patients (2.1%) died. These were old, physically disabled or multitraumatized. 100 patients had extrathoracic injuries, of whom 15 had intrathoracic injuries as well. In 227 patients with thoracic injuries only, the injuries were intrathoracic in six of them. The mortality in patients with chest wall injuries only was 0.7%, as compared with 20% in patients with intrathoracic injuries.
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PMID:[Blunt thoracic injuries in Oslo]. 204 52

The ventral tegmental area (VTA) is the major dopaminergic (DA) center responsible for the innervation of the prefrontal cortex, nucleus accumbens, and entorhinal region. These areas have been causally implicated in schizophrenia. Thus, the existence of brainstem pathology could explain many of the previously reported findings in schizophrenic (SC) patients. The authors focus on uncovering brainstem abnormalities in schizophrenia by studying the autopsied material of a patient having an early onset of symptomatology. The patient was evaluated at the age of 10 years for manneristic behavior, a speech disorder, and violence. Prominent auditory hallucinations became apparent years later. His mental status and ability for self-care steadily deteriorated until he succumbed to pneumonia at age 22. Microscopic examination of the brain showed central chromatolysis of neurons and mild gliosis in a restricted distribution of the brainstem and thalamus. Cell loss and cytoarchitectural disruption were evident in the frontal lobes, prepyriform cortex, and entorhinal region. The neuropathological changes were interpreted as a chronic derangement in the function of neurons of the rostral brainstem tegmental area and medial thalamus with secondary involvement of their terminal projection sites.
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PMID:Neuropathological findings in a suspected case of childhood schizophrenia. 213 91

Continuous economic development and evolving social systems have created unique challenges for school health personnel in Taiwan. Due in part to economic growth and an improving health care system, average life expectancy has increased markedly for males and females since 1950. Traditional leading causes of death such as pneumonia, tuberculosis, and gastroenteritis have been replaced by accidents, neoplasms, and cardiovascular diseases. Schoolchildren suffer from various disorders that include hepatitis B, dental caries, and health problems related to scholastic pressure such as myopia, anxiety, and depression. However, new problems such as violence, substance use, and teen-age pregnancy may develop in the future. In response to the challenge, an extensive school health program has emerged that emphasizes school health instruction, school health services, and a healthful school environment. Increased attention has focused on teacher preparation in health education, and a cooperative approach to school health promotion emphasizes school, community, and interagency cooperation. Prompted by the establishment in 1980 of the Graduate Institute of Health Education, National Taiwan Normal University, school-based research initiatives have increased dramatically. Eighteen recommendations for further improvement are offered.
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PMID:Taiwan, R.O.C.: perspectives in school health. 224 77

We have studied 97 patients with dementia who have been discharged from our hospital and 106 inpatients with dementia who have been admitted during last two years in our hospital. The diagnosis of dementia was done according to the criteria of DSM-III. Based on their clinical course, neurological signs, Hachinski's ischemic score and neuroradiological findings, we divided patients into 4 groups, [senile dementia of the Alzheimer type (SDAT), vascular dementia (VD), unclassified dementia and other dementias which includes dementia with Parkinson's disease or motor neuron disease, etc.]. Concerning 70 demented patients who died during hospitalization, the average age of onset and the duration of illness of SDAT were 80.5 years old and 4.6 years respectively and those of VD were 77.6 years old and 2.7 years respectively. The common causes of death were pneumonia (50%) and cardiac failure (24%). Recurrence of cerebral vascular accident (CVA) was also another frequent cause of death in VD. The most common behavioral problems causing admission in patients of SDAT were aimless wandering, nocturnal delirium, illusion and hallucination. In VD, nocturnal delirium, aimless wandering, violence and abnormal monologue were most common causes of admission. The important causes degrading ADL of inpatients were fracture, especially fracture of the hip joint, pneumonia, intestinal bleeding and CVA. Concerning the increase of the population of over 75 years old, it will be suggested that the care and treatment of demented patients in this age group will become a major social problem.
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PMID:[Clinical and epidemiological studies on inpatients with dementia]. 238 92

The first analysis of multiple cause-of-death data for Huntington's disease in the United States was performed, using data from the National Center for Health Statistics for the period 1971 and 1973 through 1978. The overall mortality rate was 2.27 per million population per year, approximately 80% higher than the corresponding rate for deaths in which Huntington's disease was listed as the underlying cause of death. Age-specific mortality rates peaked around age 60. Rates were similar for both sexes, and higher in whites than nonwhites. Age-adjusted rates were similar for United States whites and reported values from the Scandinavian countries. The leading causes of death were pneumonia and heart disease. Other common causes of death were nutritional deficiencies; mental disorders; cerebrovascular disorders; and accidents, poisonings, and violence. Suicide was rarely reported.
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PMID:Huntington's disease mortality in the United States. 296 5

Population increase, rural-to-urban migration, excessive population concentration side by side with scattered rural populations, and the economic crisis provide the primary framework for this analysis of health manpower in Mexico. The secondary frame of reference is the primary causes of mortality (in 1981): the leading cause, accidents and violence; the second, heart disease; the third, influenza and pneumonia; and the fourth, enteric diseases and diarrheas. Data are supplied on the number of new physicians graduating (this number rose from 2,493 in 1976 to 14,099 in 1983), and on the number of nurses (about 98,000, of which 40% are professionals). The growth pattern of the contingent of dentists is the same as that of physicians, namely, disproportionate and inefficient. The Federal Government is now trying to set up a National Health System that will fulfill the constitutional right of all Mexican citizens to health protection. On the basis of the disequilibrium apparent in every part of the health sector, the author recommends that educational and health institutions plan and coordinate the training of physicians so that the number of graduates may meet the country's needs, and the quality of their education may be improved.
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PMID:[Health manpower in Mexico]. 378 May 2

All 995 persons with Down's syndrome who died in the United States during 1976 and whose death certificates listed Down's syndrome as the underlying or a contributing cause of death were identified. This allowed the underlying causes of death of 793 affected persons to be analysed and compared to deaths in the whole US population for that year. Mortality ratios provided evidence that the excess risk of leukemia mortality continues into adulthood and that deaths from other hematopoietic malignancies also occur excessively among Down's syndrome adults. Congenital anomalies of all kinds in infancy and congenital defects of the heart in infancy and later were also excessive. Respiratory tract infections and pneumonia showed persistently high ratios. Diabetes was raised only at ages 24 to 34 years. Ischemic heart disease, non-hematopoietic cancers, accidents, suicides and violence were under-represented among the causes of death. Methodological limitations of proportional mortality analysis are discussed.
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PMID:Leukemia and other cancers, anomalies and infections as causes of death in Down's syndrome in the United States during 1976. 621 2

The mortality experience of an isolated Indian population in the Sioux Lookout Zone of northwestern Ontario from 1972 through 1981 is reviewed and compared with that of the Canadian population. Standardized mortality ratios for major categories of causes computed showed excessive risks in most conditions. Notable exceptions included circulatory diseases and neoplasms. Injuries and poisonings accounted for more than one-third of deaths. The proportionate mortality and age-specific mortality rates were considerably higher in all age groups in the Sioux Lookout Zone than in the whole of Canada. Excessive risks were found in almost all categories of accidental and violent deaths except motor vehicle accidents and accidental falls. Local conditions that contributed to the pattern observed are discussed. More than 90 percent of deaths from accidents and violence occurred before the medical care system was involved, highlighting the need for primary preventive strategies in reducing mortality due to these causes. While the infant mortality rate declined, pneumonia, gastroenteritis, and meningitis still accounted for 28 percent of infant deaths in the decade. Even with sudden infant death syndrome excluded, about 25 percent of infant deaths still occurred at home. Some features of the pattern of mortality reported here are also observed in other North American Indian groups undergoing the stresses of social change.
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PMID:Mortality pattern of isolated Indians in northwestern Ontario: a 10-year review. 641 32

Recently, with the increase in elderly population, we have had more opportunities to administer neuroleptics to elderly patients for hallucinatory delusional state, delirium, psychomotor excitement, wandering etc. However, little is known about the characteristics of the neuroleptic malignant syndrome (NMS) in elderly patients, which is the most serious side effect of neuroleptics. In this paper, we present the clinical course of five NMS patients in the presenium and senium. Case 1 was 72-year-old male who was diagnosed as having dementia of Alzheimer's type (with late onset). He showed nocturnal wandering, insomnia, and irritability. Tiapride 60 mg per day had been administered previously. Just after the addition of oxypertine 10 mg per day, NMS occurred, and he died of pneumonia a week later. Case 2 was 75-year-old male who was diagnosed as having vascular dementia. He showed insomnia, hyperactivity and wandering. He had been given levomepromazine (LPZ) 10 mg per day over a long period of time. At first, he had daily episodic fever, however, serum CPK levels did not increase at that time. A month later, all the symptoms of NMS appeared and then the patient's condition suddenly deteriorated and he died three days later. Case 3 was a 64-year-old male who was diagnosed as having dementia of Alzheimer's type (with early onset). He showed insomnia, irritability and violence. Tiapride 50-125 mg per day was administered along with oxypertine 50-115 mg per day. Almost two months later, NMS occurred. He had daily episodic fever at first, extrapyramidal symptoms and autonomic instabilities gradually increased. Soon after symptoms of NMS were completed. In this case, NMS seemed to be induced by bacterial pneumonia after long term administration of LPZ 5 mg per day. Case 4 was a 75-year-old female who was diagnosed as having dementia of Alzheimer's type (with late onset). She showed hallucinatory delusional state. Although she had autonomic instabilities just after adminstration of haloperidol 1-2 mg per day, NMS itself occurred after discontinuing the neuroleptic. Case 5 was a 61-year-old female who was diagnosed as having schizophrenia at the age of forty. She was given various neuroleptics over a period of time. The neuroimaging in SPECT showed her cerebral cortex was generally hypoactive. She had a tendency to have autonomic instabilities after the administration of relatively high potential neuroleptics. Risperidone 3-6 mg per day was administered, and almost a month later, autonomic instabilities increased and she was diagnosed as having NMS. All the patients would be able to have brain dysfunction, which suggested that such patients may be liable to NMS. In our patients, NMS occurred after the additional administration of oxypertine 10 mg per day or after long time administration of LPZ 5 mg per day. It was suggested that NMS could occur after the administration of low dose and relatively low potential neuroleptics in elderly patients. Our 3 of 5 patients showed the delayed type of NMS, which might be relatively more frequent in senior and presenior patients than in younger patients. In case 3, NMS was induced by the somatic disease (bacterial pneumonia), however in other cases, NMS was not always induced by somatic disease. Our 4 of 5 patients experienced some of the symptoms of NMS--episodic fever, extrapyramidal symptoms and autonomic instabilities--before the onset of NMS. Such symptoms may be "pre-steps" to NMS. Once NMS occurred, the patient's systemic condition tended to deteriorate acutely. Due to the fact that our 2 of 5 patients died, it was suggested that the prognosis of the NMS patients in presenium and senium tends to be much worse. It is important to find the "pre-steps" to NMS and treat them as soon as possible for better prognosis.
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PMID:[A study of neuroleptic malignant syndrome in the presenium and senium]. 974 53


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