PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Mortality--standards”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed1983

Perinatal mortality: standardizing for birthweight is biased.

Standardization is often used to compare perinatal mortality between populations with different birthweight distributions. Unfortunately, the relationship between perinatal mortality and birthweight seldom satisfies one prerequisite for standardization. Furthermore, standardizing for birthweight is biased against populations with heavier birthweights. For example, the standardized perinatal mortality rate of the heavier of two populations is biased upwards by 15 to 25% when the difference in mean birthweight between those populations is 150 g. As a result, the use of standardization may confuse the interpretation of differences in perinatal mortality.

Birth Weight↗
PubMed1986

Perinatal mortality standards: construction and use of a health care performance indicator.

Perinatal mortality rates are an important index of the performance of perinatal health care services, but comparisons are confounded by variations in the prior risk status of the clienteles of different districts and different maternity units. A method of allowing for these differences has been devised. It is based jointly upon the exclusion of certain classes of birth, and on indirect standardisation for birthweight and a number of modifying factors. The method is described, tested, demonstrated, and proposed for more general use.

Birth Weight↗
PubMed1991

A comparison of PMRs and SMRs as estimators of occupational mortality.

Standardized mortality ratios (SMRs) for occupational diseases are confounded by health differences between industrial and general populations. In 109 industrial cohorts largely free of work-related mortality, these selection effects were sizable for both malignant and nonmalignant outcomes. All-cancer SMRs were considerably less than 1.0 for many cohorts, and lung cancer was subject to almost as much selection-derived confounding as nonmalignant disease. Standardized proportional mortality ratios (PMRs) (approximated by relative SMRs (RSMRs] were less confounded than SMRs in estimating occupational risk. PMRs appeared to overestimate cancer mortality on average by 6%, while SMRs underestimated by 13%. PMRs underestimated nonmalignant respiratory disease by 16 percent but SMRs underestimated by 39 percent. The sources of confounding, in addition to selection on health status at hire, most likely include social class. SMRs, in the absence of internal population comparisons, would fail to detect both malignant and nonmalignant work-related mortality in many industrial cohorts.

Bias↗
PubMed1999

Cancer incidence and mortality in a cohort of chloroprene workers from Armenia.

We evaluated the risk of cancer among 1897 men and 417 women exposed to chloroprene (2-chloro-1,3-butadiene, CP) at a production plant in Yerevan, Armenia, between 1940 and 1988. The cohort was followed up for cancer incidence for the years 1979-1990 and for cancer mortality for 1979-1988. In the cohort, incidence and mortality from all cancers were below expectation, but increased incidence (standardized incidence ratio 3.27, 95% confidence interval [CI] 1.47-7.27), and mortality (standardized mortality ratio 3.39, 95% CI 1.09-10.5) from liver cancer were noticed. A dose-response relationship was suggested between liver cancer and indices of CP exposure, such as duration of employment, duration of high CP exposure and cumulative exposure to CP. The risk of other neoplasms was not increased.

Armenia↗
PubMed1998

Mortality of a police cohort: 1950-1990.

This study presents findings from an updated retrospective cohort mortality study of male police officers from January 1, 1950 to December 31, 1990 (n = 2,593; 58,474 person-years; 98% follow-up). Significantly higher than expected mortality rates were found for all cause mortality (Standardized mortality ratio [SMR] = 110; 95% confidence interval [95% CI] = 1.04-1.17), all malignant neoplasms (SMR = 125; 95% CI = 1.10-1.41), cancer of the esophagus (SMR = 213; 95% CI = 1.01-3.91), cancer of the colon (SMR = 187; 95% CI = 1.29-2.59), cancer of the kidney (SMR = 2.08, 95% CI = 100-3.82), Hodgkin's disease (SMR = 313; 95% CI = 1.01-7.29), cirrhosis of the liver (SMR = 150; 95% CI = 1.00-2.16), and suicide (SMR = 153; 95% CI = 1.00-2.24). All accidents were significantly lower (SMR = 53; 95% CI = 0.34-0.79). Mortality by years of police service showed higher than expected rates for (1) all malignant neoplasms in the 1- to 9-years-of-service group; (2) all causes, bladder cancer, leukemia, and arteriosclerotic heart disease in the 10 to 19-year group; and (3) colon cancer and cirrhosis of the liver in the over 30 years of service group. Hypotheses for findings are discussed.

Adult↗
PubMed1996

Manipulation of the size and clone of an intra-abdominal abscess in rats.

A rat grading model of chronic sepsis was developed by inoculation of a small (0.8 ml) or a large (1.5 ml) fecal pellet consisting of sterile rat feces, agar and a known number and strain of bacteria. A uniform spherical abscess containing Escherichia coli and Bacteroides fragilis was formed in 100% of the animals that survived the initial peritonitis stage. The effects of a large biclonal abscess were compared with those of a small abscess and of a sham operation. The peritonitis stage with high mortality was followed by an abscess stage. In rats with a large abscess, net body weight did not increase and there was 16% mortality during the abscess stage. On the 7th day, severe hepatic energy deficiency and lactic acidosis occurred in the septic liver with B. fragilis bacteremia. Rats with small abscesses showed mild metabolic disturbances with no mortality. Standardization of rat models with chronic graded septic abscess is possible by controlling the size of the fecal pellet and the species and number of inoculated bacteria.

Abdomen↗
PubMed1999

Plasmapheresis as an adjunct treatment in toxic epidermal necrolysis.

BACKGROUND: Toxic epidermal necrolysis (TEN) is a severe, progressive disease characterized by the sudden onset of skin necrosis. It is frequently associated with systemic involvement and has a high rate of morbidity and mortality. Standard therapy includes meticulous wound care, fluid replacement, and nutritional support in an intensive care setting. OBJECTIVE: We evaluated the outcomes of patients treated in a burn unit for TEN over a 9-year period and compared the outcomes of a subset of patients treated with plasmapheresis with those managed by conventional means. METHODS: The records of 16 patients with a diagnosis of TEN obtained from a computerized database were reviewed. Parameters recorded included extent of body surface area involvement and number of mucous membranes involved at admission, complications such as sepsis or need for mechanical ventilation, length of stay, and disposition. RESULTS: Sixteen patients were included in this study. Ten were treated with conventional support measures alone. Six were treated with plasmapheresis. The average age was 42.4 years; the male/female ratio was 1:2.2. Sulfamethoxazole/trimethoprim was implicated in causation in 6 patients. The average extent of involvement on admission in all patients was 51.5% total body surface area. The average length of stay in all patients was 14.8 days. Eight patients (50%) were discharged home, 4 (25%) were discharged to a rehabilitation facility, and 4 (25%) died (2 of sepsis, 2 of cardiopulmonary arrest). None of the plasmapheresis-treated patients died. CONCLUSION: Plasmapheresis is a safe intervention in extremely ill TEN patients and may reduce the mortality in this severe disease. Prospective studies are needed to further define its usefulness.

Adolescent↗
PubMed1996

Acute blood loss.

Acute blood loss is a common, but often challenging, problem facing emergency physicians. Inadequate or delay in treatment can lead to morbidity or mortality. Standard classifications to quantify blood loss, as well as vital signs alone, are inadequate for guiding therapy. Mechanism of injury, base deficit and blood lactate, central venous oxygen saturation, and oxygen transport parameters should all play a role in deciding the need for further diagnostic studies and resuscitation. Extreme care must be taken to evaluate and resuscitate those with decreased physiologic reserve adequately, such as the elderly. Once bleeding has been identified, expeditious control of bleeding should be accomplished, either operatively or angiographically. Care must be individualized, but adherence to these general guidelines will improve outcome.

Adult↗
PubMed1996

Nutritional issues in cancer management.

The objective of this article was to investigate the relationship between nutrition and cancer, as it relates to the initiation, promotion, and treatment of tumor growth. English-language studies published in the last 25 years were retrieved using MEDLINE, bibliographies, and consultation with experts. MEDLINE search terms included "cancer", "malnutrition," and "nutritional support." In vitro and in vivo controlled studies addressing the impact of nutritional factors on cancer prevention and treatment were selected. Approximately 30% of cancers in the Western countries are diet-related. The presence of malignancy affects patients' nutritional status negatively, leading to increased morbidity and mortality. Standard nutritional support (both enteral and parenteral) is not always effective in significantly improving outcome in malnourished cancer patients, due to characteristic changes in host metabolism. Preliminary studies suggest that newer nutritional-pharmacologic agents may be beneficial in counteracting the derangement of host metabolism, and consequently in ameliorating cancer patients' nutritional status and outcome of malnourishment. This review suggests that dietary manipulations and nutritional-pharmacologic therapy might be highly effective adjuncts in controlling the symptoms of patients with neoplastic disease.

Cachexia↗
PubMed1997

Review article: insurance risks for patients with ulcerative colitis or Crohn's disease.

Prospective population-based studies have allowed a re-evaluation of the risks of insuring patients with ulcerative colitis or Crohn's disease. Life expectancy, the risk of cancer and working capacity are very much better than previously recognised and are normal for many patients. Three population-based studies in ulcerative colitis have shown a mortality similar to or slightly less than the general population except in the first year after diagnosis, whilst two have shown a slightly higher mortality (standardized mortality ratio, SMR = 1.4), except for those with proctitis. In Crohn's disease, two population-based studies have also shown an increased mortality (SMR = 1.4), which is similar to that of unskilled manual labourers (SMR = 1.43) from all causes of death. Three other studies have shown no increase in overall mortality, except in the first 5 years after diagnosis, in those with proximal small intestinal disease and in some patients needing multiple operations. Insurance risks should be evaluated on an individual basis, after details of the extent and pattern of disease have been obtained. Although the 'standard life' in insurance terms differs from that of the general population, because people who seek life assurance are self-selected from a more affluent section of society, many patients can be identified who have a particularly good prognosis. These include patients with ulcerative proctitis, those with left-sided colitis in extended remission (> 12 months), and patients more than 30 years old with localized ileal or ileocaecal Crohn's disease that has responded to treatment. From the published data, it is difficult to justify increasing the insurance premium in such patients.

Activities of Daily Living↗
PubMedDate not supplied

Medulloblastoma: experience of a single institution.

BACKGROUND: The treatment of medulloblastoma has changed considerably during the last decades. Treatment differences between centers may affect a multicenter analysis. We analyzed data from patients of a single institution gathered over a long period of time. PATIENTS: Between 1968 and 1995, 60 patients with medulloblastoma were treated at the University of Munster. Thirty-six were male, 24-female. The ages ranged between 11 months and 32 years. METHODS: Data were retrospectively analyzed from files. Survival was estimated using the Kaplan Meier method and compared using the logranktest and multivariance analysis. RESULTS: The 5-year survival rate was 37%. This included an early mortality of 20% within the first two months, prior to 1980. Significant single, positive, prognostic factors included: no solid metastases (p = 0.001), age > 10 years (p < 0.002); total resection (p < 0.025); posterior fossa radiation with more than 50 Gy (p = 0.04); and intense chemotherapy (p = 0.02). Male patients did slightly worse (not significant). The three-year event-free survival rate of 16 patients treated after 1991 was 70%. CONCLUSION: The prognosis of medulloblastoma has clearly improved with the reduction of the perioperative mortality, standardized radiotherapy, and the introduction of intense chemotherapy.

Adolescent↗
PubMed1995

Cancer incidence and mortality among beta-naphthylamine and benzidine dye workers in Moscow.

BACKGROUND: Cancer incidence and mortality were evaluated among 4581 aniline dye production workers in Moscow. METHODS: A historical cohort was assembled and followed-up from 1 January 1975 to 31 December 1989. Moscow district oncologic dispensary registries furnished case ascertainment and employer records provided job exposure data. Expected cancers and deaths were calculated based on gender-, age-, and calendar time-specific incidence and mortality rates for the Moscow general population applied to the cohort's person-years of follow-up. Disease-specific standardized mortality and incidence values were derived from ratios of observed to expected cancers. RESULTS: Men experienced elevated total cancer mortality (standardized mortality ratio [SMR] = 125; 95% CI: 110-142) and urinary bladder cancer mortality (SMR = 279; 95% CI: 192-391), and increased all malignancy (standardized incidence ratio [SIR] = 142; 95% CI: 125-160), oesophageal (SIR = 203; 95% CI: 108-347), respiratory tract (SIR = 154; 95% CI: 120-194) and bladder (SIR = 394; 95% CI: 268-559) cancer incidence. Women had elevated oesophageal (SMR = 313; 95% CI: 124-664) and bladder (SMR = 311; 95% CI: 149-571) cancer mortality and elevated all malignancy (SIR = 124; 95% CI: 106-144), oesophageal (SIR = 348; 95% CI: 140-719), and bladder (SIR = 861; 95% CI: 458-8002) cancer incidence. Bladder cancer rate increased with employment duration and younger age first hired. Rate estimates were highest among beta-naphthylamine exposed workers but was also increased among workers with other chemical exposures. A cancer prevention and control effort that limited benzidine exposure to < or = 3 years was apparently unsuccessful as indicated by a significant excess of bladder cancer (SIR = 1773; 95% CI: 356-5180) among these workers. CONCLUSION: Relative rates of oesophageal, lung, and stomach cancer were also elevated among all workers, but did not increase with total years worked, age first hired, or year first hired, suggesting a non-occupational aetiology.

2-Naphthylamine↗
PubMed1997

Has mortality in drug addicts increased? A comparison between two hospitalized cohorts in Stockholm.

BACKGROUND: Substance abusers are known to have a high mortality, but the mortality rate and cause of death pattern has varied between studies and over time. The aim of the study was to compare the mortality in two cohorts of hospitalized drug addicts in Stockholm County identified in 1971-1972 and 1980-1981, respectively. METHOD: Two cohorts consisting of all patients admitted for drug dependence in 1971-1972 and in 1980-1981, were selected from Stockholm County inpatient register. Both cohorts were followed for a mean time of 10 years with regard to mortality. Standardized mortality ratios (SMR) and Cox hazard regression models were computed. RESULTS: Mortality in the two cohorts did not differ significantly. However, differences were found between subgroups. Thus for addicts using opiates, the death rate was twice as high as that of central stimulant users. For those addicts mixing drugs, the death rate was 48% higher compared to the central stimulant users. Males and people over 34 years of age had a significantly higher death rate than females and younger people. Mortality in drug addicts, especially opiate addicts, remained very high, though stable, over the study period. Patients in the 1980-1981 cohort were at risk of HIV/ AIDS but this had not increased the excess mortality. CONCLUSIONS: There was no significant difference in overall mortality between the two cohorts and the causes of death patterns seemed quite stable over time.

Adolescent↗
PubMed1988

Coronary heart disease mortality in the Western Collaborative Group Study. Follow-up experience of 22 years.

In 1960-1961, 3,154 healthy, middle-aged men were entered into the Western Collaborative Group Study, a long-term study of coronary heart disease. A 22-year mortality follow-up of this cohort in 1982-1983 accounted for almost 99% of the cohort, and determined that 214 of the men had died of coronary heart disease. The risk of coronary heart disease mortality was studied for several variables measured at baseline, i.e., Type A/B behavior, systolic blood pressure, serum cholesterol level, cigarette smoking status, and age. Using a proportional hazards regression model, systolic blood pressure, serum cholesterol level, cigarette smoking status, and age were highly significant predictors (p less than 0.001) of 22-year coronary heart disease mortality. Type A/B behavior showed no association with 22-year coronary heart disease mortality (standardized relative hazard (SRH) = 0.98, 95% confidence interval (CI) = 0.85-1.12). Systolic blood pressure, serum cholesterol, and age showed relatively consistent positive associations with coronary heart disease mortality over four successive time intervals after the baseline examination. Cigarette smoking showed a significant positive association in the first and second intervals and a nonsignificant positive association in the third and fourth intervals. Type A/B behavior was positively but not significantly associated with coronary heart disease in the first and third intervals, significantly negatively associated (SRH = 0.70, 95% CI = 0.53-0.93) in the second interval and not associated in the fourth interval. The results confirm the importance of the traditional coronary heart disease risk factors, and raise a substantial question about the importance of Type A/B behavior as a risk factor for coronary heart disease mortality.

Adult↗
PubMed1990

Frequency of emergency department attendances as a predictor of mortality: nine-year follow-up of a population-based cohort.

Heavy users of the services of emergency departments (EDs) have in previous studies been found to have psychological, social, economic and other difficulties besides their more or less acute medical problems. In order to establish whether mortality is associated with high ED use, a nine-year follow-up study was conducted of a 10 per cent population sample (n = 17,000), selected from the catchment area of Huddinge Hospital, Sweden. ED visits were found to predict nine-year mortality in the cohort. The group of individuals who had made four or more ED visits during a period of 15 months prior to follow-up (heavy ED users) had a two-fold excess mortality (95 per cent confidence interval (CI) = 1.9-2.1), those who had made one to three ED visits (moderate ED users) had a slightly elevated mortality (standardized mortality ratio SMR = 1.1, 95 per cent CI = 1.0-1.3), while the SMR of the non-users was 0.9 (95 per cent CI = 0.8-1.0). The three predominant causes of death in the cohort were diseases in the circulatory system, tumours and violent death. Heavy ED users had elevated mortality in all diagnoses, the most important excess mortality being from violent death, comprising suicide, probable suicide and alcohol/drug abuse, with an SMR of 6.3 (95 per cent CI = 6.0-6.7). The excess mortality from these causes of the heavy ED users accounted for more than one-third of their total excess mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1999

Inequalities in mortality and illness in Trent NHS Region.

BACKGROUND: The Department of Health is encouraging health authorities to improve health status by tackling health inequalities. We defined ward level spatial health variations in Trent National Health Service Region, England, investigated urban and rural inequalities, and examined the relationship with deprivation, to identify the extent of small area health inequalities and to establish whether a quantifiable difference exists between urban and rural health as affected by deprivation. METHOD: A small area ecological study design was adopted and ward level (n=591) standardized ratios were calculated (population aged <75, n=3,900,000) for specific causes of death and limiting long-term illness. A classification was devised to assess ward health inequalities according to an urban-rural dimension. Deprivation was measured using the Townsend Index and the relationship with mortality and illness was analysed using Pearson product moment correlation. RESULTS: Wide variations in mortality and illness were evident at ward level, being widest for accident mortality (standardized mortality range 0-508). Stroke mortality accounted for the largest proportion of wards with standardized mortality ratios over 125 (36.2 per cent). Relative deprivation correlated strongly with limiting long-term illness (r=0.82) and all-cause mortality (r=0.68) across Trent, and in both urban and rural environments. CONCLUSION: The study set health inequalities within a regional context for Trent as an initiative to coincide with the Government's proposed health strategy for the next few years. Wide health inequalities were evident in Trent and the association between deprivation and health was of a similar magnitude in urban and rural wards. This small area approach allows health authorities access to ward level information in order to inform key debate on tackling health inequalities and distributing resources in relation to need.

Adolescent↗
PubMed1997

Cancer mortality among man-made vitreous fiber production workers.

We have updated the follow-up of cancer mortality for a cohort study of man-made vitreous fiber production workers from Denmark, Finland, Norway, Sweden, United Kingdom, Germany, and Italy, from 1982 to 1990. In the mortality analysis, 22,002 production workers contributed 489,551 person-years, during which there were 4,521 deaths. Workers with less than 1 year of employment had an increased mortality [standardized mortality ratio (SMR) = 1.45; 95% confidence interval (CI) = 1.37-1.53]. Workers with 1 year or more of employment, contributing 65% of person-years, had an SMR of 1.05 (95% CI = 1.02-1.09). The SMR for lung cancer was 1.34 (95% CI = 1.08-1.63, 97 deaths) among rock/slag wool workers and 1.27 (95% CI = 1.07-1.50, 140 deaths) among glass wool workers. In the latter group, no increase was present when local mortality rates were used. Among rock/slag wool workers, the risk of lung cancer increased with time-since-first-employment and duration of employment. The trend in lung cancer mortality according to technologic phase at first employment was less marked than in the previous follow-up. We obtained similar results from a Poisson regression analysis limited to rock/slag wool workers. Five deaths from pleural mesothelioma were reported, which may not represent an excess. There was no apparent excess for other categories of neoplasm. Tobacco smoking and other factors linked to social class, as well as exposures in other industries, appear unlikely to explain the whole increase in lung cancer mortality among rock/slag wool workers. Limited data on other agents do not indicate an important role of asbestos, slag, or bitumen. These results are not sufficient to conclude that the increased lung cancer risk is the result of exposure to rock/slag wool; however, insofar as respirable fibers were an important component of the ambient pollution of the working environment, they may have contributed to the increased risk.

Aged↗