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PubMedDate not supplied

Where giving birth is a forecast of death: maternal mortality in four districts of Afghanistan, 1999-2002.

BACKGROUND: Maternal mortality in Afghanistan is uniformly identified as an issue of primary public-health importance. To guide the implementation of reproductive-health services, we examined the numbers, causes, and preventable factors for maternal deaths among women in four districts. METHODS: We did a retrospective cohort study of women of reproductive age (15-49 years) who died between March 21, 1999, and March 21, 2002, in four selected districts in four provinces: Kabul city, Kabul province (urban); Alisheng district, Laghman province (semirural); Maywand, Kandahar province (rural); and Ragh, Badakshan province (rural, most remote). Deaths among women of reproductive age were identified through a survey of all households in randomly selected villages and investigated through verbal-autopsy interviews of family members. FINDINGS: In a population of 90 816, 357 women of reproductive age died; 154 deaths were related to complications during pregnancy, childbirth, or the puerperal period. Most maternal deaths were caused by ante-partum haemorrhage, except in Ragh, where a greater proportion of women died of obstructed labour. All measures of maternal risk were high, especially in the more remote areas; the maternal mortality ratio (per 100,000 livebirths) was 418 (235-602) in Kabul, 774 (433-1115) in Alisheng, 2182 (1451-2913) in Maywand, and 6507 (5026-7988) in Ragh. In the two rural sites, no woman who died was assisted by a skilled birth attendant. INTERPRETATION: Maternal mortality in Afghanistan is high and becomes significantly greater with increasing remoteness. Deaths could be averted if complications were prevented through optimisation of general health status and if complications that occurred were treated to reduce their severity--efforts that require a multisectoral approach to increase availability and accessibility of health care.

Adolescent↗
PubMed2004

[Changes in mortality associated with traffic accidents in Andalusia from 1975 to 2001 and forecast for 2004].

OBJECTIVE: To describe the evolution of mortality due to traffic accidents in Andalusia between 1975 and 2001 and to predict the mortality rates for 2004. DESIGN: Ecological study with a population base. SETTING: Residents in Andalusia between 1975 and 2001. PARTICIPANTS: Deaths due to traffic accidents in Andalusia between 1975 and 2001. Main measurements and results. Mortality rates adjusted for age in men and women and in three groups: under-35s, from 35 to 64, and over 64. The evolution of rates over time was studied through trend analysis. Short-term predictions of the mortality rates were made. The adjusted rates for men fell from 21.20 per 100000 inhabitants in 2001 to 20.21 in 2001. The rate for women fell from 4.87 to 4.60 during the same period. The evolution of mortality was similar for both sexes. CONCLUSIONS: Traffic accident mortality evolved in an oscillating way, with an important fall in numbers starting in 1989. Mortality rates increased with age. The predictions formulated indicate that the stable trend starting in 1995 will remain the same in the coming years.

Accidents, Traffic↗
PubMed1992

Forecasting thrombosis of vascular access with Doppler color flow imaging.

A noninvasive technique, color Doppler flow imaging, was used to study the predictive value for future episodes of thrombosis in vascular access (polytetrafluoroethylene [PTFE] grafts and radial-cephalic fistulae) in a series of chronic hemodialysis patients. Patients with grafts were classified into three groups based on maximum constriction of the vascular access diameter: narrowing of greater than 50% (group I), narrowing of 30% to 50% (group II), and no narrowing or narrowing less than 30% (group III). More than half of the patients in group I suffered vascular access thrombosis within 6 months, while only 9% to 13% of patients in groups II and III had episodes of thrombosis during the same time interval. Decreased access volume flow (AVF) also correlated with episodes of thrombosis in these patients. No correlation could be demonstrated between recirculation and future thrombosis. No patient with a fistula had narrowing greater than 30% and none had vascular access thrombosis during the 6-month follow-up.

Arteriovenous Shunt, Surgical↗
PubMedDate not supplied

Simple tools for forecasts of population ageing in developed countries based on extrapolations of human mortality, fertility and migration.

Suitable assumptions for the Gompertz mortality law take into account the break in the time development observed recently by Wilmoth et al. They show how a drastic reduction in the birth rate and improved living conditions lead to a drastic increase in the fraction of old people in the population, and how immigration of half a percent of the population per year can mostly stop this increase.

Aging↗
PubMed1999

The use of a Bayesian forecasting model in the management of warfarin therapy after total hip arthroplasty.

This study was performed to compare the computer-based and physician-based management of warfarin therapy after total hip arthroplasty (THA). The computer-assisted and control groups of patients were placed on warfarin postoperatively and followed for a 1-month period. A significant difference (P<.05) was found between the mean number of days needed to reach therapeutic anticoagulation in the control group (4.7+/-3.0 days) and the experimental group (2.8+/-1.4 days) and the proportion of patients in each group who were discharged with a subtherapeutic international normalized ratio (INR) (INR <1.5). The computer-based management of warfarin therapy was more efficient than unaided physician-based management and therefore may lead to improved, cost-effective patient care by reducing length of hospital stay and complications attributable to nontherapeutic anticoagulation in THA patients.

Aged↗