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PubMed1984

Cerebral palsy and perinatal deaths in geographically defined populations with different perinatal services.

The number of perinatal deaths and of children with cerebral palsy among 23,039 total births between 1973 and 1978 in one Swedish county were examined by comparing two populations which differed by the presence or absence of a neonatal ward (special care baby unit) in the maternity hospital for the district. No support was found for the assumption that lower perinatal mortality in the region without a neonatal ward would be at the cost of an increased number with cerebral palsy. Between the two three-year periods there was a highly significant decrease in perinatal mortality in the sample without a neonatal ward. When perinatal deaths and cerebral palsy were considered together the decline remained highly significant. The corresponding change in the sample with a neonatal ward was smaller and non-significant.

Ataxia↗
PubMed1985

Early neonatal deaths in geographically defined populations with different organization of medical care.

A comparison of early neonatal deaths was performed in fourteen Swedish referral districts over six years (1973-1978). Two populations of newborn infants were compared: those born of mothers resident in referral districts of general hospitals with specialized obstetric service but without own neonatal wards; and those born of mothers living in districts of central hospitals with specialized obstetric and neonatal care in the same hospital. The early neonatal death rates of these two populations did not differ significantly. However, a tendency was observed indicating a lower mortality in the former group, necessitating further analysis.

Female↗
PubMed1979

Partial death as a defining characteristic of a subculture.

This paper presents a discussion of the idea of "partial death" as it relates to the subculture of the beats or hypsters, especially in San Francisco, from about 1948 to 1964, with special emphasis on the works of Kerouac and Ginsberg and a study by Rigney and Smith.

Attitude to Death↗
PubMed1995

Notochord degeneration in chick embryo: a particular case of developmental cell death?

To define the type of cell death occurring in notochordal tissue, the cytological features of degenerating notochord were studied by transmission electron-microscope in thirty chick embryos from the 20th hour to the 15th incubation day. During the first two days the notochordal cells show nuclei with large nucleoli and cytoplasm with yolk granules, lipid droplets, phagolysosomes and deposits of glycogen. From the 3rd to the 5th incubation day, besides the peculiar vacuolization, disaggregation of the endoplasmic reticulum, transformation of the mitochondrial morphology, and disintegration of the cell membrane are detectable. Nuclei are normal up to advanced stages of cytoplasmic degeneration. On the 6th day a large number of cells are dying and, later on, the tissue disintegrates at the level of the vertebral bodies. Cell death in the notochord does not seem to be classifiable as one of the types of developmental cell death described in literature: the comparison with similar cytological features referred by pathologists as a consequence of metabolic damage, suggests that the degeneration of the notochord may be related to its morphological isolation and thus to trophic deprivation.

Animals↗
PubMed2004

Dementia: the leading predictor of death in a defined elderly population: the Cache County Study.

OBJECTIVE: To examine the relative risk and population attributable risk (PAR) of death with dementia of varying type and severity and other risk factors in a population of exceptional longevity. METHODS: Deaths were monitored over 5 years using vital statistics records and newspaper obituaries in 355 individuals with prevalent dementia and 4,328 without in Cache County, UT. Mean age was 83.3 (SD 7.0) years with dementia and 73.7 (SD 6.8) years without. History of coronary artery disease, hypertension, diabetes, and other life-shortening illness was ascertained from interviews. RESULTS: Death certificates implicated dementia as an important cause of death, but other data suggested a stronger association. Adjusted Cox relative hazard and PAR of death were higher with dementia than with any other illness studied. Relative hazard of death with dementia was highest at ages 65 to 74, but the high prevalence of dementia after age 85 resulted in 27% PAR among the oldest old. Mortality increased substantially with severity of dementia. Alzheimer disease shortened survival time most dramatically in younger participants, but vascular dementia posed a greater mortality risk among the oldest old. CONCLUSION: In this population, dementia was the strongest predictor of mortality, with a risk two to three times those of other life-shortening illnesses.

Aged↗
PubMed1994

A sex comparison of rates of new AIDS-defining disease and death in 2554 AIDS cases. AIDS in Europe Study Group.

OBJECTIVES: To compare the development rate of new AIDS-defining diseases between 566 women and 1988 men with AIDS who were infected with HIV via the same routes (mainly by sharing drug injecting equipment and heterosexual sex). DESIGN: Information on patient follow-up after AIDS diagnosis was obtained by retrospectively reviewing case notes. METHODS: The 2554 men and women were followed from the time of AIDS diagnosis as part of the multicentre AIDS in Europe study, which examined AIDS cases diagnosed at 52 centres in 17 European countries between 1979 and 1989. Incidence of AIDS-defining diseases and demographic variables were recorded for all patients and CD4 lymphocyte count at the time of AIDS diagnosis for approximately half the patients. RESULTS: Only toxoplasmosis and herpes simplex virus ulceration showed statistically significant differences in occurrence rate between women and men [relative risks (RR), 1.51 and 3.44; 95% confidence interval (CI), 1.51 1.09-2.08 and 3.44 1.92-6.23, respectively] which remained after adjusting for imbalances in other variables. For both diseases, the additional absolute rate in women was approximately three per 100 person-years at risk. Survival after AIDS diagnosis was also similar between the two sexes (RR, 0.96; 95% CI, 0.86-1.08). CONCLUSION: There appears to be little difference between women and men in the clinical course of AIDS.

AIDS-Related Opportunistic Infections↗
PubMed1990

Conflict in the parameters defining life and death in Missouri statutes.

Over the last twenty years, state legislatures have enacted statutes incorporating medically and legally established criteria to be utilized in the determination of death. Similarly consistent criteria for determining the onset of life have yet to be established. As a result, unacceptably conflicting statutory language defining life and the state's interest in that life exists. This conflict can be resolved by a functional approach that consistently applies criteria used to define the end of life to the beginning of life.

Abortion, Legal↗
PubMed2000

A new method for the simultaneous analysis of growth and death of immunophenotypically defined cells in culture.

BACKGROUND: Internal standards have been used in flow cytometry methods to enumerate lymphoid subsets and hemopoietic progenitor cells ex vivo. However, the currently available methods cannot be readily applied to the analysis of cultured cells because of the frequent occurrence of cell death during in vitro assays. METHODS: This paper reports a new method for the enumeration of both viable and nonviable cells in culture. Cells were counted with the aid of an internal reference standard of microbeads, and live versus dead cell discrimination was performed using 7-amino-actinomycin D which allows the double staining of surface antigens. RESULTS: The method is more precise, accurate and sensitive than either conventional light microscopy-based or automated cell counting. Additionally, it may be used to accurately measure the number of apoptotic cells in a culture. RESULTS: Through the enumeration of surviving cells it is demonstrated that, when applied to the study of mitogen-activated T lymphocytes, current flow cytometry techniques (which do not use internal standards) for the study of the viability and apoptosis overestimate the fraction of viable cells and underestimate both the fraction of dead and apoptotic cells. CONCLUSIONS: The new method overcomes these limitations and is of use in the in vitro study of cell growth and apoptosis.

Apoptosis↗
PubMed1997

[Medical certification of deaths by trauma in the Chilean health services].

BACKGROUND: Trauma in the third cause of death in Chile and the most important among youngsters. AIM: To analyze the certification of deaths by trauma, studying those deaths in which it is not known if they were accidental or self inflicted. MATERIAL AND METHODS: Deaths certified as caused by trauma, poisoning or violence during the period 1992-1994 are analyzed. Those in which their accidental or self inflicted nature was ignored were specially considered. RESULTS: During the study period, 26,886 f 225,796 deaths were certified as caused by trauma, poisoning or violence. In 41.7% of these deaths, no defined cause (accidental or self inflicted) was reported) was reported. In the Metropolitan region 65.3% of deaths by trauma were not defined. Ninety seven percent of certificates in this area were extended by pathologists or coroners. In all health services, there was a positive correlation between the percentage of ill defined deaths by trauma and the percentage of certifications by pathologists or coroners. CONCLUSIONS: The deficiency in certification of deaths by trauma is possibly due to administrative causes and precludes the study of deaths caused by accidents, violence or suicide in Chile and its comparison with other countries. An effort should be done to solve this problem.

Adolescent↗
PubMed2003

Death from drowning: defining a new challenge for child survival in Bangladesh.

The study focuses on children less than 5 years old and explores the epidemiological profile and correlates of drowning as a challenge to child survival in Bangladesh. Two data sources from Bangladesh, a cohort of 8,070 children followed for 2 years in a rural area and a nation-wide survey conducted in 1996-97 have been used. In addition, a systematic review of the literature has been conducted spanning the past two decades for analysis of drowning in children. Seventy drowning deaths were reported in the cohort and 726 deaths were reported in the national survey. Verbal autopsy and semi-structured interviews were conducted on all deaths. Drowning accounted for 43% of deaths in the cohort and 20% of deaths in 1-4-year-old children in the national survey. Most drowning deaths were in 12-23 month old children from falling into ditches and ponds. Communities provided valuable insights on possible interventions to reduce deaths due to drowning. Drowning is a newly recognized challenge for Bangladesh. Considerable research and programmatic work is required to understand the nature of the problem and develop appropriate interventions. This paper calls on aid agencies to create opportunities for drowning research and action in their work plans for the country.

Bangladesh↗
PubMed1999

Ill-defined and multiple causes on death certificates--a study of misclassification in mortality statistics.

Biases can distort, limit or inhibit the value of mortality data as an epidemiological re source. From 9500 deaths occurring in Naples (Italy during 1994, a random sample of 372 death certificates reporting ill-defined causes and multiple causes of death was extracted. The code for the underlying cause on the death certificate (assigned code) was compared with the cause reattributed with the aid of interview of the certifying physician or clinical records (modified code). The aim was to investigate the extent of misclassification of 'underlying cause' in deaths attributed to ill-defined and/or multiple causes and the shortcomings in the ICD-IX. Ill-defined underlying causes of death (7.0% of death certificates) were cardiovascular diseases, tumours with no specified site or nature, symptoms, signs, ill-defined conditions and senility. There was disagreement between the initially assigned code and the modified code in 53.8% of ill-defined underlying causes; discordance was high for the certificates filled in by the family physician. Multiple causes of death were observed in 23.6% of certificates; of these 59.2% concerned subjects aged 75 years and over at death. Diabetes was always listed in association with other pathologies but neoplasms and traumas were generally listed alone. Disagreement between codes occurred in 48 (54.5%) certificates indicating multiple causes. In 10 of them, death was established as due to a concurrence of causes. As regards ill-defined causes of death, the authors concluded that specific training on certifying procedures would be insufficient on their own; the physician should be made aware that certification is a fundamental requirement for building up epidemiological data. Evidence-based educational interventions are needed. As regards multiple causes of death, multicausal analysis may be indicated for deaths due to a concurrence of causes.

Age Factors↗
PubMed1989

[Criteria for brain death: cessation of cerebral circulation demonstrated by Doppler ultrasonography of the carotid arteries].

If human death is defined by brain death, its diagnosis needs medicolegal criteria based on clinical examination and EEG. However, this evaluation could be difficult because technical or physiological limitations might impair the interpretation, especially after barbiturates and/or hypothermia. Since brain death is characterized by an intracranial circulatory arrest, methods assessing this phenomenon are warranted. Among these methods, conventional or isotopic cerebral angiography appears the most promising, but it cannot be easily performed everywhere. Because superficial blood flow in arteries is now accurately measured by the pulsed Döppler technique, this prompted us to test the specificity and sensitivity of common carotid blood flow data for brain death diagnosis. Two series of age-matched patients (36 yrs in mean) were studied. Series 1 (n = 28) was used to define the discriminant parameters between 14 severe coma patients and 14 brain-dead patients diagnosed by the classical criteria. Then these parameters were prospectively tested in a blind manner on a second series of 28 patients suffering from severe coma. The parameters allowing us to classify patients as brain dead or not with a 100% specificity and sensitivity were: end diastolic blood flow (QED in ml/min), end diastolic blood flow velocity (VED), and cerebral metabolic index (CMI = QED x AV D 02). The most powerful discriminant parameter was QED, allowing a strictly non-invasive diagnosis of brain death.

Adult↗
PubMed2000

Determinants of unexplained antepartum fetal deaths.

OBJECTIVE: To assess fetal, maternal, and pregnancy-related determinants of unexplained antepartum fetal death. METHODS: We conducted a hospital-based cohort study of 84,294 births weighing 500 g or more from 1961-1974 and 1978-1996. Unexplained fetal deaths were defined as fetal deaths occurring before labor without evidence of significant fetal, maternal, or placental pathology. RESULTS: One hundred ninety-six unexplained antepartum fetal deaths accounted for 27.2% of 721 total fetal deaths. Two thirds of the unexplained fetal deaths occurred after 35 weeks' gestation. The following factors were independently associated with unexplained fetal death: maternal prepregnancy weight greater than 68 kg (adjusted odds ratio [OR] 2.9; 95% confidence interval [CI] 1.85, 4.68), birth weight ratio (defined as ratio of birth weight to mean weight for gestational age) between 0.75 and 0.85 (OR 2.77; 95% CI 1.48, 5.18) or over 1.15 (OR 2.36; 95% CI 1.26, 4.44), fewer than four antenatal visits in women whose fetuses died at 37 weeks or later (OR 2.21; 95% CI 1.08, 4.52), primiparity (OR 1.74; 95% CI 1.26, 2.40), parity of three or more (OR 2.01; 95% CI 1.26, 3.20), low socioeconomic status (OR 1.59; 95% CI 1.14, 2.22), cord loops (OR 1.75; 95% CI 1.04, 2.97) and, for the 1978-1996 period only, maternal age 40 years or more (OR 3.69; 95% CI 1.28, 10.58). Trimester of first antenatal visit, low maternal weight, postdate pregnancy, fetal-to-placental weight ratio, fetal sex, previous fetal death, previous abortion, cigarette smoking, and alcohol use were not significantly associated with unexplained fetal death. CONCLUSION: In this study, we identified several factors associated with an increased risk of unexplained fetal death.

Adult↗
PubMed2004

Unexplained antepartum fetal deaths: what are the determinants?

OBJECTIVE: The objective was to assess fetal, antenatal, and pregnancy determinants of unexplained antepartum fetal death. METHODS: This is a hospital-based cohort study of 34,394 births weighing 500 g or more from January 1995 to December 2002. Unexplained fetal deaths were defined as fetal deaths occurring before labor, without evidence of significant fetal, maternal or placental pathology. RESULTS: Ninety-eight unexplained antepartum fetal deaths accounted for 27.2% of 360 total fetal deaths. Two-thirds of these deaths occurred after 36 weeks' gestation. The following factors are independently associated with unexplained fetal deaths: primiparity (OR 1.74; 95% CI 1.21, 2.86); parity of five or more (OR 1.19; 95% CI 1.26, 3.26); low socioeconomic status (OR 1.22; 95% CI 1.14, 2.86); maternal age 40 years or more (OR 3.62; 95% CI 1.22, 4.52); maternal age of 18 years or less (OR 1.79; 95% CI 0.82, 2.89); maternal prepregnancy weight greater than 70 kg (OR 2.20; 95% CI 1.85, 3.68); fewer than three antenatal visits in women whose fetuses died at 31 weeks or more (OR 1.11; 95% CI 1.08, 2.48); birth weight ratio (defined as ratio of birth weight to mean birth weight for gestational age) between 0.85 and 0.94 (OR 1.77; 95% CI 1.28, 4.18) or over 1.45 (OR 2.92; 95% CI 1.75, 3.21); trimester of first antenatal visit. Previous fetal death, previous abortion, cigarette smoking, fetal sex, low maternal weight, fetal-to-placenta weight, and post date pregnancy were not significantly associated with unexplained fetal deaths. CONCLUSION: Several factors were identified that are associated with an increased risk of unexplained fetal deaths.

Birth Weight↗
PubMed2006

Opioid analgesics and rates of fatal drug poisoning in the United States.

OBJECTIVE: To determine whether the variability in rate of sale of prescription opioid analgesics is related to the variability in rates of drug poisoning mortality among states in the United States in 2002. METHODS: Drug poisoning deaths were defined as unintentional deaths or those of undetermined intent whose underlying cause was coded to "narcotics" (X42) or "other and unspecified" drugs (X44) in the National Vital Statistics System. Per capita sales of ten opioid analgesics from the Drug Enforcement Administration and combined sales in morphine equivalents were correlated with drug poisoning mortality rates by state using multivariate linear regression. Regression coefficients between mortality rates and sales rates were adjusted for race (percent white, percent black) and age (percent aged 24 years or younger, and percent aged 65 years and older). RESULTS: There was over a ten-fold variability in sales of some opioid analgesics. Combined sales ranged 3.7-fold, from 218 mg per person in South Dakota to 798 mg per person in Maine. Drug poisoning mortality varied 7.9-fold, from 1.6/100,000 in Iowa to 12.4/100,000 in New Mexico. Drug poisoning mortality correlated most strongly with non-OxyContin oxycodone (r=0.73, p<0.0001), total oxycodone (r=0.68, p<0.0001), and total methadone (r=0.66, p<0.0001) in the multivariate analysis. A scatterplot demonstrated a linear relationship between total opioid analgesic sales and drug poisoning mortality. CONCLUSIONS: The extent of opioid analgesics use varies widely in the United States. Variation in the availability of opioid analgesics is related to the spatial distribution of drug poisoning mortality by state.

Analgesics, Opioid↗
PubMed2005

Antimicrobial drug resistance in salmonella-infected aortic aneurysms.

BACKGROUND: Salmonella infection of the aorta and adjacent arteries is rare, but life-threatening. There is an increasing number of infections caused by antimicrobial drug resistant Salmonella. This study sought to assess the association between antimicrobial drug resistance and clinical outcomes of patients with Salmonella-infected aortic aneurysm. METHODS: Data were collected by retrospective chart review. Between October 1995 and October 2004, 34 patients with Salmonella-infected aortic aneurysm were included. Aneurysm-related deaths were defined as hospital deaths and late deaths due to prosthetic graft infection. Analysis was performed using the chi2 test, Fisher's exact test, and Mann-Whitney test. RESULTS: Nineteen patients had a suprarenal and 15 patients had an infrarenal aortic infection. The most common responsible pathogen was group C Salmonella (47%). Ciprofloxacin-resistant Salmonella infection occurred since March 2001 and the rate increased from 0 per 15 in the years before March 2001 to 5 per 19 in the years after March 2001 (p = 0.005 by Fisher's exact test). Among the 26 patients who had combined medical and surgical therapy, 4 died in the hospital and 4 died of late prosthetic graft infection 3 to 6 months after operation, whereas 4 of the 8 who had medical therapy alone died of aneurysm rupture during hospitalization. The actuarial survival rates by the Kaplan-Meier method were 64% at 6 months, 61% at 1 year, and 56% at 5 years. The risk factors for aneurysm-related death were old age (78.5 +/- 9.7 years vs 63.5 +/- 11.4 years; p < 0.001) and ciprofloxacin-resistant Salmonella infection (4 of 5 vs 8 of 29; p = 0.042). CONCLUSIONS: There was an increased mortality associated with ciprofloxacin resistance in infected aortic aneurysms with Salmonella. With an increasing incidence of ciprofloxacin resistant Salmonella, third generation cephalosporin is the antibiotic of choice for Salmonella-infected aneurysm.

Adult↗
PubMed2000

Sudden death in patients after transcatheter device implantation for congenital heart disease.

To explore whether transcatheter intracardiac devices increase risk for sudden death, we analyzed patient and device-related variables with a case-control design. Sudden death was defined as unexpected death with abrupt onset and rapid deterioration. Cases included all patients known to have died suddenly after device closure at our institution, using 3 large databases. Controls (2:1), matched on year of procedure, were chosen randomly from the same databases. Data were obtained from medical record review. Of 777 patients who received implants between February 1989 and February 1999, 9 were known to have died suddenly (1.2%). In 27 cases and controls, diverse defects were occluded: atrial (n = 16), ventricular (n = 4), Fontan fenestration (n = 4), or other (n = 3). Cases were more likely to have had a history of serious arrhythmias (p = 0.008), severe valve regurgitation (p = 0.03), > or =1 cardiac surgery (p = 0.009), and multiple devices (p = 0.03). Cases were somewhat more likely to have pulmonary hypertension (p = 0.09), ventricular dysfunction (p = 0.09), and nonatrial septal defects (p = 0.10). Patients were less likely to have device arm fractures (p = 0.05). The following were not related to sudden death: age, weight, gender, low systemic cardiac index, end-diastolic pressure, major noncardiac disease, serious adverse events, maximum device size, malposition, and residual leak. This study suggests that sudden death was more likely to occur in device-implanted patients who had severe underlying cardiac disease and/or multiple devices. No other device-related variables were associated with sudden death.

Adult↗