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PubMed1998

Pathophysiology of cerebral ischemia.

The purpose of this manuscript is to briefly review the pathophysiology of cerebral ischemia. Ischemic thresholds are well-defined in lower animals. The concept of the ischemic penumbra may include regions of brain around deeper regions of ischemia but has also been defined in terms of brain salvageable by reperfusion or by pharmacological therapies. The principal pathophysiological processes in cerebral ischemia are energy failure, loss of cell ion homeostasis, acidosis, increased intracellular calcium, excitotoxicity, and free radical-mediated toxicity. The underlying biochemical processes are similar regardless of the amount of brain that is made ischemic or the duration of ischemia. The relative contributions of each process are believed to vary significantly especially in relation to the level of cerebral blood flow. Neurons may die by necrosis or apoptosis. In the core of an infarct where blood flow is very low, the predominant process is energy failure and rapid necrotic cell death. Reperfusion of ischemic tissue produces an influx of inflammatory cells and of oxygen that can cause increases in oxygen-derived free radicals. Free radicals are also important in prolonged ischemia. There is interest in changes in gene expression after ischemia. Induction of heat shock proteins suggests that gene expression changes may protect neurons from death. Changes in gene expression also may initiate apoptosis or other detrimental processes. Although advances have been made, there are still no proven pharmacological therapies to rescue ischemic human neurons. Such therapies do appear to be on the horizon.

Animals↗
PubMed1985

Changing patterns of perinatal and infant mortality in Western Australia: implications for prevention.

Perinatal and infant mortality rates have fallen dramatically in the developed world this century. A review of perinatal and infant mortality in Western Australia from 1970 to 1981 was undertaken, to examine trends in birthweight-specific and cause-specific rates. The predominant causes of death are now congenital malformation, stillbirth of unknown cause, preterm birth and cot death. Perinatal and infant mortality rates are unlikely to be reduced substantially until the reasons for these four causes of death are elucidated.

Australia↗
PubMed2002

["Natural cause of death or not?" How do nursing home physicians act when in doubt of natural cause of death?].

The objective of the study was to explore if nursing home physicians act by law, when they doubt the natural cause of death. In May 1999, a questionnaire was sent to 153 nursing home physicians in the region of Utrecht and Nijmegen. They were asked if they consult the coroner when they have doubts about the natural cause of death. Eighty-six percent (104) returned the questionnaire. Thirty-two percent of the nursing home physicians always consult the coroner and 52% does so most of the time. Only 12% does not consult the coroner most of the time and 2% never does. The main reasons for not consulting the coroner were that nursing home physicians judge a death after a fall as an incident that fits in the descending lifeline of patients and that some nursing home physicians had bad experiences consulting the coroner. We conclude that this policy may lead to underregistration of unnatural deaths. Changing the definition or changing the law may reduce this problem. Education and information can also contribute to change in physician's attitudes.

Accidents↗
PubMed2001

Why Did Cancer Deaths Increase in Japan after the Introduction of the Tenth Version of the International Classification of Disease? : Assessment Based on a Population-Based Cancer Registry.

Considerable increase in cancer deaths has been observed since 1995, after when the tenth version of the international classification of disease (ICD) was introduced in Japan according with the revision of a death certificate form at the same time. We assessed the contributing factors for this unnatural fluctuation, using a population-based cancer registry data as a model. All deaths of the prefectural residents are collated with the cancer registry database in the registration process. For all Japanese deaths of Aichi Prefecture in 1994 (n=41,111) and in 1995 (n=42,944), the description of the death certificates were compared with the ICD classified as the cause of death. It was ascertained that 97-99% of cancer and 97-98% of non-cancer deaths classified by ICD were proper. Among those classified as cancer as the cause of death and stated as other than the direct cause of death (n=92 in 1994, n=428 in 1995), only 22% (1994) and 8% (1995) were considered to be classifiable to both cancer and non-cancer as the cause of death. Among those who were classified as non-cancer as the cause of death in spite of including cancer in the original statement (n=770 in 1994, n=638 in 1995), 24% (1994) 10% (1995) were considered to be non-cancer as the cause of death, and the rest were considered classifiable into both cancer and non-cancer. Even if all cancer deaths classifiable to non-cancer were classified as non-cancer deaths, change in the number of cancer deaths was inconsiderable in both years. Therefore, it is suggested that the increase of cancer deaths after introduction of the new ICD was caused not by the artifact such as change in selection rule of disease when classify the cause of death, but by the improvement of the description of death certificate by physicians as a result of revision of death certificate form.

Journal Article↗
PubMedDate not supplied

Experiences of patients and significant others with automatic implantable cardioverter defibrillators after discharge from the hospital.

Sudden cardiac death (SCD) is a leading cause of mortality in this country. The automatic implantable cardioverter defibrillator (AICD) is a technology which has proven successful in reducing the risk of SCD in patients who qualify for it. However, little is known about how individuals adjust to living with the device. This field study used a focus group technique to investigate the question "What are the experiences of patients and their significant others (S.O.) in the time since being discharged from the hospital with an AICD?" Fifteen AICD recipients and 14 S.O.s each attended one of three focus groups which were tape recorded. Data from the transcriptions were analyzed by a combination of content analysis and ethnographic summary. The major concerns of the patients were [Physiologic], the sensations of being shocked, medications, trouble sleeping, dizziness (accompanied by heat intolerance at times), physical awareness of the device; [Psychosocial], fear, including fear of death and preparation for death, changes in mental functioning, changes in lifestyle including clothing not fitting, loss of control, driving an automobile, and spousal overprotectiveness. The primary psychosocial concerns of the S.O.s were fears, including fear of death and preparation for death, family and role changes, being overprotective and driving an automobile. Mental changes and heat intolerance have not been addressed in the literature previously.

Adaptation, Psychological↗
PubMed2004

The association of 6-minute walk performance and outcomes in stable outpatients with heart failure.

BACKGROUND: We sought to evaluate the prognostic value of the 6-minute walk test in stable outpatients with heart failure. METHODS AND RESULTS: We examined the association of 6-minute walk test distance and outcomes among 541 patients enrolled in the Digitalis Investigation Group trial. Patients were grouped by total distance (< or =200 m, 201 m-300 m, 301 m-400 m, and >400 m) with median follow-up of 32 months. All-cause mortality for patients who walked < or =200 m was significantly higher than patients who walked >200 m (43.9% versus 23.3%, P<0.001), but mortality was comparable among patients who walked >200 m (201 m-300 m: 23.7%, 301 m-400 m: 25.2%, >400 m 19.8%, P for trend 0.45). Results were similar for death due to worsening heart failure (< or =200 m: 29.3%, 201 m-300 m: 7.6%, 301 m-400 m: 6.7%, >400 m: 6.1%, P for trend <0.001). In multivariable analysis, distance < or =200 m remained associated with increased mortality (< or =200 m: hazard ratio (HR) 1.47, 95% CI 0.96-2.27; >200 m: HR 1.00, Referent; P=0.07) and death due to worsening heart failure (< or =200 m: HR 2.89, 95% CI 1.54-5.41; >200 m: 1.00, Referent; P=0.001). CONCLUSIONS: The 6-minute walk test identifies patients who walk less than 200 m as being at markedly increased risk of death. Changing the 6-minute walk test to a time- and distance-based standard would improve the efficiency of the test while retaining the bulk of the prognostic information.

Aged↗
PubMed1991

Perinatal mortality statistics in Harare 1980-1989.

Perinatal and neonatal mortality rates, in the Greater Harare Maternity Unit, which showed a modest decline from 1980 to 1985, have rise dramatically since then. Half of the rise in neonatal mortality rate is due to increased numbers and an increased mortality rate in babies of birth weight less than 1001g. There is also an increase in the numbers of deaths of large babies. There is a strong case for a broad-based on-going enquiry into the reasons for such changes.

Birth Rate↗
PubMed1990

[Topics in clinical thanatology. Autopathothanatobiographies, -diaries, -epistulographies in comparison with Angloamerican clinical thanatologic experiences].

Extensive results of thanatologic sciences since the first decades of 20. century and multivarious practical knowledge in clinical thanatology are discussed--relating to the central problem of understanding different forms of "realisation of death". Possibilities of thanatologic information, forms of dialogue, communicative engagement and self-attitude in care-situations are critically conferred--this even in regard to mourning, grief and sorrow of the bereaved. The confrontation of thanatologic data in short-time illness until death to autopathothanatobiographic insights in long-time illness until death seems comparable in respect to relations between present clinical findings and anamnestic data. Awareness of approaching death seems not seldom due to "presentiment", averbal-communicative "preinformation" or impressions in face to progressive illness without successful therapy. Not only this is to think over in treatment and care, but also some new thanatologic experiences of the last years--for instance in respect to the question of timing, various circumstances and possible forms of informations and clearing up. Apart from individual forms of "living until death" there are certain pithy types in awareness, feeling, thinking, exposition or attitude. Some autobiographic, diaristic or epi-stulographic dates to long-time illness until death are characterized by striking limited possibilities of self-description and verbalization in situations of vital-existential distress. Silent suffering can be caused by loss of possibility in verbalization. Autothanatobiographic insights and experiences in thanatologic praxis in long-time illness until death lead to more differentiated insights than short-time illness until death--especially in respect of changing and contrary courses. Insight "evidences" of life continuities in the face of danger of death, changes in awareness of time, intensifications in intensities of perception, of feelings of the own life and changes in perception of the own ill organism, just as intensivation of partnership-relations ("synchronisation") can pass in the foreground. The last seems especially evident in special forms of "partnerautobiography" with alternating informations of the two. This illustrates the "two-sided aspect of death" death as a "dyadic event" (A. Toynbee), which is an important view relating to care of bereaved with changes in personal identity and awareness of time. Processes of dying and reactions of bereaved are integrated in complex anthropologic, psychologic, psychosociologic and psychosomatic factors. Certainly it is not possible such catastrophic incidents merely to interpret in psychoanalytic categories.

Attitude to Death↗
PubMed1989

Trends in perinatal and neonatal mortality and morbidity in India.

Although the infant mortality rate (IMR) has reduced by 50% during the past century, it compares poorly with the advanced countries and some developing countries. The observed fall in IMR has been mostly in post-neonatal mortality, with the result that neonatal deaths now account for over 60% of all infant deaths. The overall perinatal mortality rate (PMR) in India is still over 50 per 1000 and has shown virtually no decline during the past decade, However, PMR differs widely in different states, urban/rural areas, different hospitals and so on. PMR is seen to correlate better with social development than economic development of the representative community. The causes of perinatal deaths suggest poor health of mother and poor health facilities and are hence potentially preventable. Various studies have shown that PMR can be significantly reduced within a short span of time. The registration of vital statistics continue to be highly unsatisfactory especially in rural areas.

Cause of Death↗
PubMed1982

Infant, neonatal and perinatal mortality rates in Singapore.

Infant, neonatal and perinatal mortality rates are reliable indices of the health status and delivery of health care in a country. These rates have been declining in Singapore since World War II, and presently have become comparable to those of many developing countries. The pattern has also changed; postneonatal mortality has fallen markedly, resulting in neonatal mortality accounting for 75% of infant mortality, and first week mortality for 85% of neonatal mortality. Perinatal mortality rates have also declined over the years, due mainly to a decline in the first week mortality rates though a slight fall in stillbirth rates has also occurred. Further improvements can be expected in the perinatal and neonatal mortality rates. As neonatal intensive care improves, the prognosis of the very small and feeble infants will be brighter even though the efforts required might be very much greater. Such a challenge will prove to be very exciting and stimulating, and be an impetus to the raising of neonatal intensive care to a much higher level.

Female↗