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PubMed1978

Validation of the CALSPAN gross-motion-simulation code with actually occurring injury patterns in aircraft accidents.

Digital simulation of aircraft-accident kinematics has heretofore been used almost exclusively as a design tool to explore structural load limits, precalculate decelerative forces at various cabin stations, and describe the effect of protective devices in the crash environment. In an effort to determine the value of digital computer simulation of fatal aircraft accidents, a fatality involving an ejection-system failure (out-of-envelope ejection) was modeled, and the injuries actually incurred were compared to those predicted; good agreement was found. The simulation of fatal aircraft accidents is advantageous because of a well-defined endpoint (death), lack of therapeutic intervention, and a static anatomic situation that can be minutely investigated. Such simulation techniques are a useful tool in the study of experimental trauma.

Accidents, Aviation↗

PubMed1983

[Risk classification of patients with acute myocardial infarct using two-dimensional echocardiography].

30 patients with acute myocardial infarction were examined by means of two-dimensional echocardiography, clinically classified according to Killip and the requisite CK peak level was determined. An echocardiographic score system was used to quantify the wall movement disturbances. The patients were subdivided into 3 groups according to clinical course during hospitalization (average 4 weeks) and these data correlated to Killip classification, CK peak level and echocardiographic score system determined on admission: Group 1 (9 patients with uncomplicated myocardial infarction), group 2 (11 patients with complicated posterior wall infarction), group 3 (10 patients with complicated anterior wall infarction). Cardiogenic shock, left ventricular pump failure, life-threatening arrhythmias and death were defined as complications. Mean value difference of the scores between group 1 and group 2 were significant (alpha less than 1%) and between group 1 and group 3 very significant (alpha less than 0.1%). With respect to CK, a significant difference existed between group 1 and group 2 and also between group 1 and group 3 (alpha less than 5%). Killip classification was specific, but very insensitive (64%). The echocardiographic score system is suitable for the prediction of in hospital course after myocardial infarction, and is superior to CK peak level determination.

Adult↗

PubMed1983

Mortality from traumatic injuries. A case-control study using data from the National Hospital Discharge Survey.

This study examines a large number of demographic, hospital, patient volume, and medical factors that may influence in-hospital mortality due to trauma. The authors use data from the 1977 and 1978 National Hospital Discharge Survey to assemble a case-control data set of severe injuries (n = 336). Cases are defined as "deaths from trauma," and control subjects are "injured survivors." Control subjects are frequency-matched to cases on the basis of overall severity, site of the most severe anatomic injury, and age. The analysis estimates the relative risk of mortality associated with different levels of the risk factors by the odds ratio. The unadjusted results indicate a significant impact of the following variables: sex (with males at higher risk), average severity of hospital case mix, number of severe trauma patients treated at a hospital (with high-volume hospitals at increased risk), ischemic heart disease and other forms of heart disease, malignant neoplasms, influenza and pneumonia, and emergency tracheotomy or tracheostomy. After adjustment using multiple logistic regression, the single significant risk factor is the presence of ischemic heart disease and other forms of heart disease. The implication of this finding is that hospitals exhibit little difference in mortality from severe trauma after adjustment for patient mix characteristics. Possible explanations for this result are tendered.

Adult↗

PubMed1982

Further predictive indices of clinical severity of measles.

Predictive indices for the outcome of measles were sought from a clinical and immunological study. A poor outcome was defined as death or persistence of bronchopulmonary disease 6 weeks after onset. The 47 Black children studied were well nourished and lymphopenic (absolute lymphocyte count less than 2 000/mm3) in the first 2 days of the exanthem. The latter feature has previously been shown to carry a poor prognosis. Eight of the children recovered fully, 5 died and 34 had residual lung changes at 6 weeks. Other factors which could be related to prognosis in this group of children already at risk of severe disease were more extensive pneumonia and normal or minimally reduced serum complement C3 levels early in the course of the disease. A less than twofold rise in haemagglutinin-inhibiting antibody titre was also associated with a poor prognosis.

Humans↗

PubMed1995

Reliability and predictive value of the National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database nomenclature and grading system for cellular rejection of liver allografts.

Pathologists participating in the National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplant Database (LTD) created a histopathological grading system for acute liver allograft rejection, and tested it first for inter- and intra-rater reliability among a group of five pathologists experienced in liver and transplantation pathology. Specimens from post-transplantation biopsies from 48 patients with rejection, hepatitis, or other diagnosis(es) were reviewed. There was moderate to good (kappa = 0.40 to 0.55) inter-rater and good (kappa = 0.55 to 0.58) intrarater agreement for the diagnosis and exact grading of mild, moderate, or severe acute rejection, which improved when a short clinical history was provided. Thus, the scheme was reproducible, and few of the disagreements among the pathologists would have affected treatment decisions. Secondly, the ability of the grading system to predict an unfavorable short- or long-term outcome from the initial histopathological diagnosis of cellular rejection was tested on groups of 168 and 133 patients, respectively, from the three LTD clinical centers, who were followed up for at least 6 months after the first onset of rejection. This analysis showed that a higher histopathological grade of acute rejection on first biopsy diagnosis was significantly associated (P < or = .006) with both an unfavorable short-term outcome, defined by failure of the episode to resolve within 21 days or the need for aggressive immunosuppressive treatment, and a long-term outcome defined by death or retransplantation from rejection within 6 months of onset. Lastly, an analysis was performed to determine whether subjective rejection grading by the pathologist or certain "objective" histopathological features identified by logistic regression modeling were more accurate in predicting an unfavorable outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Databases, Factual↗

PubMed1995

Unstable angina: clinical practice guidelines for diagnosis and management. Agency for Health Care Policy and Research.

Unstable angina is one of the most common reasons for hospital admission in the United States and causes substantial morbidity and mortality. Diagnosis of unstable angina is complicated by the dynamic range of presentations, which can vary between atypical chest pain and acute myocardial infarction. Overcautious management can result in unnecessary hospital admission, whereas inappropriate conservative strategies can cause cardiac injury and death. To define treatment strategies for these patients, the US Agency for Health Care Policy and Research in March 1994 published guidelines on the diagnosis and management of unstable angina. The emphasis is on diagnosis or exclusion of coronary artery disease, establishment of the patient's risk for adverse outcome, and triage to the most appropriate treatment regimen. The guidelines emphasize the use of aspirin, heparin sodium, nitroglycerin, and beta-blockers as the core therapy. Appropriate strategies are reviewed, starting with intensive medical management and ending with patient care after discharge. Many physicians will probably modify their approach to the diagnosis and treatment of unstable angina on the basis of these new guidelines.

Angina, Unstable↗

PubMed1995

[Piperacilline/tazobactam combination+amikacin versus ceftazidime+amikacin in patients with neutropenia and fever. An open multicenter study. Groupe d'étude des Aplasies Fébriles].

OBJECTIVES: To evaluate the toxicity and effectiveness of piperacillin+tazobactam and amikacin compared with a reference treatment with ceftazidime and amikacin given as first line therapy in neutropenic patients with fever. METHODS: A multicentric randomized trial was conducted in 222 adults who had fever (38 degrees C for > 3 h) during a period of aplasia (white cell count < 0.5.10(9)/l for 22.9 +/- 10.4 days) induced by chemotherapy for acute leukaemia (68.1%) or by bone marrow autograft for lymphoma, myeloma or solid tumour (30.3%). 109 patients were assigned to the piperacillin (12 g/d)/tazobactam (1.5 g/d)+amikacin group and 113 to the ceftazidime (3 g/d)+amikacin group. Evaluation criteria were the frequency of apyrexia after a 72-hour antibiotic regimen and major infectious events defined as death due to infection and severe infections causing a delay in the chemotherapy protocol. RESULTS: Data obtained in 188 patients who fulfilled all the protocol criteria were evaluated. The episode of fever was controlled better with the piperacillin/tazobactam+amikacin combination (apyrexia achieved in 60.6% of the patients vs 44.7% in the ceftazidime+amikacin group, p = 0.028) and there were fewer superinfections (23% vs 41% respectively, p < 0.008). Tolerance was similar in the two groups. In vitro, 56% of the strains resistant to piperacillin and isolated prior to treatment were sensitive to the piperacillin/tazobactam combination. Among the strains isolated (41 Gram-, 61 Gram+), 72% were sensitive to ceftazidime and 84% were sensitive to the piperacillin/tazobactam combination. There were 16 deaths due to infection (8.5%) with no difference according to antibiotic regimen. There was no difference in toxicity. CONCLUSION: Tolerance was similar in the two groups. A combined regimen of piperacillin/tazobactam can be proposed as first line treatment for neutropenic patients with fever.

Adult↗

PubMed1994

Outcome of isolated pulmonary contusion in blunt trauma patients.

To determine outcome in young, healthy blunt trauma patients with isolated pulmonary contusion, and to identify factors associated with poor outcome, we reviewed 6012 consecutive adult (aged 16-49) blunt trauma admissions. Ninety-four (7.9%) presented with an isolated pulmonary contusion defined by chest radiograph and Injury Severity Score < 25; they compromise the study group. Poor outcome was defined as death, prolonged hospitalization (> 7 days), or a severe complication (pneumonia, empyema, atelectasis requiring bronchoscopy, or bronchopleural fistula). None of the 94 study patients died. Admission chest radiograph demonstrated no contusion in 34 patients (36%). Fifteen patients (16%) required intubation, but 13 were extubated within 48 hours. Forty-one patients (44%) required insertion of a chest tube, and 20 patients (21%) had a PaO2/FiO2 ratio of < 250 on admission. Post-injury atelectasis (n = 17), pneumothorax (n = 17), effusion (n = 8), pneumonia (n = 2), empyema (n = 1), and Staphylococcal bacteremia (n = 1) complicated hospitalizations. The following clinical factors were identified as predisposing to poor outcome by univariate analysis: 1) Pulmonary contusion on admission chest radiograph (P = 0.035); 2) Three or more rib fractures (P = 0.002); 3) chest tube insertion (P = 0.010) and drainage (P = 0.020); and 4) hypoxia on admission (PO2 < 70 torr [P = .021], PaO2/FiO2 < 250 [P < 0.001]). Only PaO2/FiO2 < 250 on admission was an independent predictor of poor outcome in a multivariate analysis (P = 0.040). Our conclusion was that isolated pulmonary contusion in young, healthy patients is not associated with mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Birth weight and early lung compliance as predictors of short-term outcome in premature infants with respiratory distress syndrome.

In addition to birth weight (BW), respiratory mechanics during the first week of life have been reported to predict outcome in ventilated newborn infants with respiratory distress syndrome (RDS). Most measuring techniques are invasive, requiring the placement of an oesophageal tube or balloon. In the present study the compliance (Crs) and resistance (Rrs) of the total respiratory system were measured without an oesophageal tube , using a commercially available system (PEDS; MAS Inc., Hatfield, Pa.) . The Crs and Rrs were determined once, within 24 hours of birth, in 28 preterm infants requiring mechanical ventilation for RDS. Variables such as gestational age (GA) and BW were also evaluated for their predictive role in outcome. Poor outcome was defined as death from respiratory failure or the development of bronchopulmonary dysplasia (BPD) at 28 days. All non-survivors died of refractory respiratory failure, at a median of age of 6 days. The median Crs of the 21 survivors was 0.5 ml/cm H2O and of the non-survivors 0.21 ml/cm H2O (P = 0.01). Crs below 0.45 ml/cm H2O predicted 15 of the 16 infants who either developed BPD or died (positive predictive value 100%; negative predictive value 92%; sensitivity 94%; specificity 100%). Nine survivors, who subsequently developed B PD, had a median Crs of 0.38 ml/cm H2O. Their Crs was significantly lowe r than that of the infants without evidence of BPD (Crs = 0.61 ml/cm H2O ) (P = 0.01). All of the 12 babies without BPD who survived had median C rs values above 0.45 ml/cm H2O. The median Rrs of the 9 infants with BPD (96 cm H2O/l/s) was also significantly higher than the Rrs value of the non-BPD group (59 cm H2O/l/s) (P = 0.05). When stepwise multiple logistic regression was applied to predict outcome, the only variable that could be entered at a 0.05 level of significance was BW. Uncorrected compliance entered the second step, but did not reach statistical significance. We conclude that in premature infants with RDS, BW is a strong predictor of outcome. Although determination of the Crs within the first 24 hours after birth did not add significance to this predictive model, it was nevertheless a useful parameter to determine respiratory morbidity and mortality.

Birth Weight↗

PubMed1996

[Incidence and course of acute coronary events in the population of Ghent from 1983 to 1990].

In the framework of the W.H.O.- MONICA project, a register for acute coronary events was established in the adult population aged 25-69 years of the city of Ghent. One of the objectives is to collect on an annual basis precise and valid information on the frequency of the disease. Fatal and non-fatal coronary events were monitored through the population-based register, using a standardized protocol and rigid diagnostic criteria. These criteria were evaluated by the research group on the basis of available information that was collected in collaboration with family doctors, hospital physicians, the city hall services and the district medical structure. Lethality was defined as deaths occurring within 28 days after initial symptoms. From 1993 to 1990, 2.626 events were registered. The age standardized annual event rates in men varied from 32.2 to 41.7/10.000; in women the corresponding values were 9.2 and 16.6/10.000. The attack rate declined over time at a rate of -13% over 5 years in men and -23% over 5 years in women. Attack rates of fatal coronary events declined even stronger. The incidence was calculated only in hospitalized cases in whom the antecedents of heart attacks were known in 93%. The age standardized annual incidence rates in hospitalized men varied from 15.5 to 22.4/10.000 and from 4.0 to 6.8/10.000 in hospitalized women. Over time no significant changes in incidence rates were observed. In both sexes there was a trend towards a decline in the incidence of fatal cases and towards an increase in the incidence of non-fatal cases. Lethality was dependent on age, sex and declined over time; the maximal case fatality rate was 57.9% and the minimal 42.3%. The lethality in hospitalized cases was 23.8% on average and declined significantly over time. In hospitalized cases with a first heart attack the lethality was 18.5%. All patients who entered the register from 1983 to 1985 for a non-fatal event (n = 465) were followed as to vital status until the end of 1991. The five years survival was 80.4 and 77.0% in respectively men and women. The long term prognosis was not different between sexes, strongly dependent on age and slightly different in the presence of antecedents of heart attacks. These results illustrate how precise and valid information on the frequency of acute coronary events can be collected through a population-based register. The results indicate high attack and incidence rates, a high case-fatality but favorable time trends from 1983 to 1990.

Acute Disease↗

PubMed1996

[Perioperative mortality in elderly patients undergoing general surgery].

OBJECTIVE: To determine wether the physical status (ASA category) and surgical conditions could predict mortality in elderly general surgery patients. PATIENTS AND METHODS: This was a prospective study of patients greater than or equal 85 years of age who underwent elective or emergency surgery under general anesthesia between January 1987 and December 1991. Hospital mortality was defined as death occurring before discharge. Logical regression analysis (Cox's modeling) was used to assess group survival. RESULTS: One hundred and nine patients undergoing 117 operations were enrolled. Major surgery was performed in 70%; 44% were removals of malignant tumors and 84% were under general anesthesia. Hospital deaths occurred in 10%; the only significant predictors were neoplastic disease and emergency status. Mortality was 43% one year after surgery; significant predictors of death were prior physical status, neoplasia and emergency status. CONCLUSIONS: Neoplastic disease, emergency status and poor physical condition are factors that predict mortality in patients 85 or older who undergo general surgery.

Aged↗

PubMed1994

The transport of neonates to an intensive care unit.

OBJECTIVE: To describe the mode of transport, the type of patient transferred and outcome as defined by death or discharge from hospital. DESIGN: A retrospective study was done of all neonates transferred from outside the designated drainage area of the hospital. SETTING: The study was done at the level 3 Neonatal Intensive Care Unit at Tygerberg Hospital for the period January-September 1992. PARTICIPANTS: From a total of 58 infants 52 were enrolled; they originated over a vast area of the western and northern Cape Province. MAIN OUTCOME MEASURES: Reasons for transfer, mode of transport and survival were measured. RESULTS: None of the infants died during transport. In total 11 (21%) of the 52 died. Categorising outcome according to transport method showed 100% survival of babies transported by fixed-wing aircraft, 94% survival if transport was by helicopter, and 70% survival if transported by ambulance. The non-survivors had a higher mean gestational age (P < 0.05) than the survivors and included 8 (73%) with asphyxia-related meconium aspiration syndrome. When the primary referral diagnosis was considered, 8 (27%) of 29 infants with respiratory failure of any cause, and 2 (28%) of those with neurological problems, died. All the infants transported because of a surgical emergency survived. CONCLUSION: These results show a high survival rate in transported infants, with the highest mortality in the asphyxia-related meconium aspiration syndrome and the infants transported by ambulance. The preponderance of infants with meconium aspiration syndrome might reflect the standard of perinatal care provided in the outlying regions of the western and northern Cape.

Cause of Death↗

PubMed1996

Metabolic and genetic analyses of apoptosis in potassium/serum-deprived rat cerebellar granule cells.

Cerebellar granule cells maintained in medium containing serum and 25 mM potassium undergo an apoptotic death within 96 hr when switched to serum-free medium with 5 mM potassium. Because large numbers of apparently homogeneous neurons can be obtained, this represents a potentially useful model of neuronal programmed cell death (PCD). Analysis of the time course and extent of death after removal of either serum or K+ alone demonstrated that a fast-dying (T(1/2) = 4 hr) population (20%) responded to serum deprivation, whereas a slow-dying (T(1/2) = 25 hr) population (80%) died in response to K+ deprivation. Taking advantage of the complete death after removing both K+ and serum, changes in metabolic events and mRNA levels were analyzed in this model. Glucose uptake, protein synthesis, and RNA synthesis fell to <35% of control by 9 hr after potassium/serum deprivation, a time when 85% of the cells were still viable. The pattern of the fall in these metabolic parameters was similar to that reported for trophic factor-deprived sympathetic neurons. Most mRNAs decreased markedly after K+/serum deprivation. Levels of c-jun mRNA increased fivefold in potassium/serum-deprived granule cells; c-jun is required for cell death of sympathetic neurons. mRNA levels of cyclin D1, c-myb, collagenase, and transin remained relatively constant in potassium/serum-deprived granule cells. These data demonstrate the existence of two populations of granule cells with respect to cell death and define common metabolic and genetic events involved in neuronal PCD.

Animals↗

PubMed1997

Effect of myocardial viability assessed by technetium-99m-sestamibi SPECT and fluorine-18-FDG PET on clinical outcome in coronary artery disease.

UNLABELLED: PET imaging of myocardial perfusion and metabolism identifies regional viability as well as patients at high risk for future cardiac events. This study evaluated a combined "hybrid" imaging approach using 99mTc-sestamibi SPECT and [18F]fluoro-2-deoxy-D-glucose (FDG) PET with regard to reversibility of regional dysfunction and to patient clinical outcome during a 2-yr follow-up. METHODS: In this study, 161 consecutive patients underwent baseline viability imaging. All had regional wall motion (RWM) abnormalities and 88% had a history of previous myocardial infarction. Regions were classified by semiquantitative analysis of sestamibi and FDG uptake as normal, mild match, mismatch or scar. For clinical outcome, patients were divided into three groups: predominantly scar tissue (Group A, n = 90), mild match (Group B, n = 26) and mismatch (Group C, n = 45). Treatment was performed with the knowledge of nuclear results. Cardiac events during follow-up were defined as death, myocardial infarction, unstable angina requiring revascularization, heart transplantation and survived resuscitation. RESULTS: Patients were followed for 29 +/- 6 mo. Revascularization rate was 30% in Group A, 81% in Group B and 80% in Group C, whereas the other patients were treated by medication. Only Group C demonstrated a significant reduction of cardiac events after revascularization, whereas, particularly in Group A, revascularization did not influence the frequency of events. Subjective assessment of angina pectoris and heart failure revealed more patients with improvement after revascularization as compared with conservative treatment. Of the 84 revascularized patients, 61 underwent follow-up angiography at 5 +/- 2 mo with RWM analysis using the centerline method. RWM improved only in mismatch regions from -2.2 +/- 1.0 s.d. to -1.0 +/- 1.4 s.d. (p < 0.01), whereas regions with a mild match or scar did not change. CONCLUSION: Nuclear imaging using 99mTc-sestamibi SPECT and [18F]FDG PET allows diagnosis of viability in regions with reduced perfusion and function with prognostic implications for functional outcome as well as for identification of patients who benefit most from revascularization.

Angioplasty, Balloon, Coronary↗

PubMed1997

[Intracranial meningioma in the elderly. Postoperative mortality, morbidity and quality of life in a series of 39 patients over 70 years of age].

UNLABELLED: The aim of this study was to assess the current morbidity and mortality in patients over 70 operated for intracranial meningioma. PATIENTS AND METHOD: We report a series of 39 consecutive patients (mean age: 73 y) operated for an intracranial meningioma over a period of 5 years (1990-1994). According to the Karnofski scale (KS), preoperative neurological status was inferior or equal to 70 in 21 patients (53.8%) and superior or equal to 80 in 18 (46.2%). All patients were followed up in order to precisely assess their post-operative condition and a computed tomographic scan (CT scan) was performed during the second semester of 1995 (mean follow-up 29 months). RESULTS: Operative mortality and permanent morbidity were respectively 7.6% and 10.3%. In 77% of this series, the KS score checked at the last follow up was 80 to 100 (good outcome). Poor outcome was defined by death or a postoperative (KS < or = 70, the principal cause being an hemorrhagic infarction. Three factors were predictors of poor outcome: poor preoperative neurological condition (KS < or = 70) (p = 0.07), location of the tumor on the base (p = 0.007), and the duration of surgery > 3 hours (p = 0.06). The logistical regression analysis showed that these three factors were independent. Tumor recurrence occurred in 5 (12.8%) of 39 patients. CONCLUSION: Preoperative KS is a prognosis factor, but a poor preoperative condition is not in itself a sufficient condition contraindicating surgery. The rates of operative mortality of 7.6%, and permanent operative morbidity of 10.3% can be given to patients and their families.

Aged↗

PubMed1998

Pre-discharge outcomes of 22-27 weeks gestational age infants born at tertiary care centers in Connecticut implications for perinatal management.

There is a lack of regional data on survival and morbidity of extremely premature infants born and resuscitated at tertiary care centers. This study analyzes such data from three tertiary care perinatal centers in Connecticut and provides a paradigm for its use in developing guidelines for evidence-based ethical considerations in infants at the threshold of viability. Outcomes of inborn infants 22 to 27 weeks gestation (based on obstetric estimates) who were actively resuscitated at three regional perinatal tertiary-care centers (representing 80% of such infants from Connecticut) were studied retrospectively. Survival and cumulative major morbidities at discharge, stratified by gestational age, were analyzed. Of the 405 infants studied, 278 (69%) survived to discharge. There were no survivors beyond three days at 22 weeks gestational age. Unfavorable outcome defined as death or major morbidity (> or = grade 2 intraventricular hemorrhage, periventricular leukomalacia, > or = Stage 3 retinopathy of prematurity, necrotizing enterocolitis > or = Stage 2, and severe bronchopulmonary dysplasia at 36 weeks postmenstrual age.) was seen in > 85% of 23 and 24 weeks gestation infants. At 25 weeks approximately equal to 30% of infants were discharged without an unfavorable outcome. At 26 and 27 weeks gestation 43% and 61% respectively escaped unfavorable outcomes with > 85% rates of survival. Current regional data such as these would help in developing guidelines for the perinatal management of premature infants at the threshold of viability.

Chi-Square Distribution↗

PubMed2003

Reduced dietary salt for prevention of cardiovascular disease.

BACKGROUND: Restricting sodium intake in elevated blood pressure over short periods of time reduces blood pressure. Long term effects (on mortality, morbidity or blood pressure) of advice to reduce salt in patients with elevated or normal blood pressure are unclear. OBJECTIVES: To assess in adults the long term effects (mortality, cardiovascular events, blood pressure, quality of life, weight, urinary sodium excretion, other nutrients and use of anti-hypertensive medications) of advice to restrict dietary sodium using all relevant randomised controlled trials. SEARCH STRATEGY: The Cochrane Library, MEDLINE, EMBASE, bibliographies of included studies and related systematic reviews were searched for unconfounded randomised trials in healthy adults aiming to reduce sodium intake over at least 6 months. Attempts were made to trace unpublished or missed studies and authors of all included trials were contacted. There were no language restrictions. SELECTION CRITERIA: Inclusion decisions were independently duplicated and based on the following criteria: 1) randomisation was adequate; 2) there was a usual or control diet group; 3) the intervention aimed to reduce sodium intake; 4) the intervention was not multifactorial; 5) the participants were not children, acutely ill, pregnant or institutionalised; 6) follow-up was at least 26 weeks; 7) data on any of the outcomes of interest were available. DATA COLLECTION AND ANALYSIS: Decisions on validity and data extraction were made independently by two reviewers, disagreements were resolved by discussion or if necessary by a third reviewer. Random effects meta-analysis, sub-grouping, sensitivity analysis and meta-regression were performed. MAIN RESULTS: Three trials in normotensives (n=2326), five in untreated hypertensives (n=387) and three in treated hypertensives (n=801) were included, with follow up from six months to seven years. The large, high quality (and therefore most informative) studies used intensive behavioural interventions. Deaths and cardiovascular events were inconsistently defined and reported; only 17 deaths equally distributed between intervention and control groups occurred. Systolic and diastolic blood pressures were reduced at 13 to 60 months in those given low sodium advice as compared with controls (systolic by 1.1 mm Hg, 95% CI 1.8 to 0.4, diastolic by 0.6 mm hg, 95% CI 1.5 to -0.3), as was urinary 24 hour sodium excretion (by 35.5 mmol/ 24 hours, 95% CI 47.2 to 23.9). Degree of reduction in sodium intake and change in blood pressure were not related. People on anti-hypertensive medications were able to stop their medication more often on a reduced sodium diet as compared with controls, while maintaining similar blood pressure control. REVIEWER'S CONCLUSIONS: Intensive interventions, unsuited to primary care or population prevention programmes, provide only minimal reductions in blood pressure during long-term trials. Further evaluations to assess effects on morbidity and mortality outcomes are needed for populations as a whole and for patients with elevated blood pressure. Evidence from a large and small trial showed that a low sodium diet helps in maintenance of lower blood pressure following withdrawal of antihypertensives. If this is confirmed, with no increase in cardiovascular events, then targeting of comprehensive dietary and behavioural programmes in patients with elevated blood pressure requiring drug treatment would be justified.

Antihypertensive Agents↗

PubMed1983

The nature of life and the nature of death.

Life is defined as a "condition" that distinguishes animals and plants from inorganic materials and dead organisms. Life is comprised of processes and is a maintained state. The most sophisticated form of life is man and our though focuses upon the nature of the life and death of man. Man demonstrates three lives or aspects of life: Life of the body--the physical, life of the mind and life of the spirit. Physical life is basic existence; the mind contributes effectiveness and scope; the spiritual entity contributes maximum living. Physiology: The existence of life physical is demonstrated by the presence of functions. Living tissues and organisms exhibit: Irritability: the ability to be excited or detect stimuli and to respond thereto; Growth and reproduction: this consists of the power of multiplication and duplication, regeneration and differentiation; Adaptability: permitting both change and maintenance of balances (homeostasis); and finally and most characteristic of all is Metabolism: the transformation of energy and the use of materials. These properties, however, can be retained for a while by tissues after death of the organism so there is another mystery of life which we understand only in part. Life consists of structure and processes operating under integrative control. This integrative power is the secret we do not understand--we know it confers all the life properties, the continuous flow of processes related to the organism's need for survival. Death is failure not so much of process but of integrative drive and coordination--but, of course, structure and process can fail too, destroying integrated activity. The total organism is under integrative control by brain and mind, the autonomic nervous system and by the neuroendocrine-endocrine complex, all acting in unison. These physical processes contribute to the existence of the life of the mind and spirit and are in turn powerfully affected by intellect and morale. However, we do not understand the driving force which converts inorganic matter, organizes it and then propels it into life. Life seems to be only a continuation of a heritage--life creating life. Philosophy: The life of the mind requires acquisition of knowledge, curiosity, cultivation of the power to reason, use of thought and contemplation, all under discipline. True life of the mind may not exist and may cease to be even though physical existence may be present. Somewhat the same can be said of the life of the spirit; it also is not automatically genetically granted in completed form.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗