Reduction of Mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by Combined Treatment with Clofibrate and Nicotinic Acid

Consecutive survivors of a myocardial infarction from the Southern Hospital, below 70 years of age, were randomized into a Control group (n=276) and a Treatment group (n=279). The latter was openly prescribed the combination of clofibrate and nicotinic acid for serum lipid lowering. Each patient should remain in the study for 5 years and be seen regularly every 4 months at a special IHD outpatient clinic within the hospital. The concentration of serum cholesterol and triglyceride was lowered by 13% and 19%, respectively, in the Treatment group compared to the Control group. Total mortality was 82 cases in the Control group and 61 in the Treatment group, a 26% reduction (p<0.05). For patients above 60 years of age in the Treatment group the reduction in mortality was 28% (p<0.05). IHD mortality was reduced by 36% (p<0.01)in the Treatment group compared to the Control group. The beneficial effect of the serum lipid lowering treatment was related to the serum triglyceride concentration in two ways. First, it only occurred in patients with a triglyceride level >1.5 mmol/l (n=216). Secondly, it was most pronounced in the 44% of the treated patients who had a lowering of the serum triglyceride concentration by 30% or more, and in this subgroup the reduction of IHD mortality was 60% (p<0.01). For serum cholesterol there were no such relations. The difference between serum triglycerides and cholesterol concerning these relations to the treatment outcome may be due to the fact that hypertriglyceridaemia was the most common hyperlipidaemia among our patients, occurring in 50%, while hypercholesterolaemia only occurred in 13 %. Caution should be exercised in the interpretation of the results as the trial was not blind. However, the fact that the decrease in IHD deaths was directly related to the degree of serum triglyceride lowering indicates that it was the drug effect on serum lipids that was reponsible for the beneficial effect of the treatment.     

A cohort mortality study among cobalt and sodium workers in an electrochemical plant

We have studied the mortality between 1950 and 1980 of a cohort of 1,143 workers in an electrochemical plant producing cobalt and sodium. The mortality of the whole cohort is significantly lower than in the French population for all causes of death (SMR = 0.77), and especially for deaths from circulatory system diseases (SMR = 0.59). However, among cobalt production workers, there is a relative over-mortality, especially from lung cancers (SMR = 4.66, 4 cases). The relationship between cobalt production and lung cancer mortality was supported by a case-control study nested in the cohort study. The authenticity of the occupational origin of this risk could not be established due to the low number of cases and because the role of tobacco consumption could not be taken into account. Other studies should be carried out in plants producing or using cobalt.     

加强保健措施 降低孕产妇死亡率的试点研究

经调查河南省七县1988～04～1989～03孕产妇死亡率为136.1/10万,高于全国平均水平(94.7/10万)。从七县中选择了死亡率偏高的三个县(147.9/10万)为样本.进行厂降低农村孕产妇死亡率保健措施的研究。自1990年4月1日～1992年3月31日。在三县采取了以下保健措施:①加强基层妇幼卫生建设,特别是中心乡卫生院的建设,②整顿和完善三级保健网;③建全孕产妇系统管理制度,高危妊娠筛查,转化和转诊制度,④配备必要设备,建立联合小产院,实行定点接生。两年内孕产妇死亡率,由1989年的147.9/10万下降到67.7/10万,下降幅度为54.44%,最高达72.1%。此工作为实现2000年孕产妇死亡率下降一半的规划目标提供了依据。     

顽固性室性早搏的射频消融治疗

目的 :通过对 2 3例顽固性室性早搏 (简称室早 )的射频消融分析 ,探讨室早的心电图特点、消融方法及效果 .方法 :男性 16例 ,女性 7例 ,均为频发、药物难治、症状明显的顽固性单形性室早患者 ,年龄(4 4 4± 9 6 )岁 .采用起搏标测和激动顺序标测 ,前者以起搏时与室早QRS波形态完全相同点为消融靶点 ,后者以早搏时最早心室激动点为消融靶点 .2 3例中 17例室早起源于右室 ,4例起源于左室 .消融即刻成功率86 9% ,累积放电 (930 4± 72 5 )s,成功者行动态心电图检查记录消融前后室早数为 (5 6 71± 2 4 36 )次 / 2 4h和 (39± 5 2 )次 / 2 4h (P <0 0 1) .随访 (2 3 2± 12 3)月 ,未服任何抗心律失常药 ,无 1例复发及并发症发生 .结论 :射频消融可有效而安全地消除单形性室早 ,采用粗标激动顺序、精标起搏图形 ,多点、长时间、高功率放电可提高成功率 ,降低复发率 ,可作为症状严重、药物无效或不能耐受患者的治疗选择     

床旁临时起搏器作为AMI的常备急救设备及其在基层医院推广应用研究

目的 床旁临时起搏器作为急性心肌梗死（AMI）的常备急救设备的价值及其在基层医院推广应用的可行性研究。方法 回顾性研究分析2001-2003年间不能床旁植入临时起搏器与2004-2005年能床旁植入临床起搏器抢救AMI的住院病死率、心衰、心源性休克、2mo后再次住院发生率。临时起搏器植入术安全性的指标比较。结果 不能床旁植入临时起搏器组的住院病死率为14．58％，心衰发生率为27．08％，心源性休克发生率为12．5％，2mo后再次住院发生率为16．67％。床旁植入临时起搏器组的住院病死率为3．57％，心衰发生率为7．14％，心源性休克发生率为3．57％，2mo后再次住院发生率为3．57％，两组相比p〈0．01有显著性差异。而起搏器植入的安全性指标：起搏器植入成功率为100％，脱位率为10．7％，并发症发生率为14.3％，住院病死率3．57％。结论 床旁临时起搏器抢救AMI住院病死率低，心衰发生率、心源性休克发生率及2mo后再次住院发生率低，应作为AMI抢救的常备急救设备，另外床旁临时起搏器植入是安全的、有效的，成功率高，操作不难，在基层医院（二甲医院）可推广应用。     

Improving emergency obstetric care in Mozambique: the story of Sofala.

OBJECTIVE: The 5-year project in the province of Sofala was designed to improve access, quality and utilization of emergency obstetric care (EmOC) by strengthening rural hospitals and health centers and ultimately the health system's capacity to respond to emergencies more quickly and effectively. METHODS: Implementation consisted of attention to infrastructure, human resource development, transportation and communication systems, and management. Specific management aspects that were targeted for improvement included: supportive supervision, logistics for supplies, equipment and drugs, record keeping, monitoring and evaluation, and quality improvement techniques such as maternal death audits. RESULTS: Access to EmOC improved with an increase in the number of fully functional EmOC facilities from 4 to 18. The number of women with obstetric complications who were admitted for treatment in participating facilities tripled, and the proportion of those women dying declined by half. CONCLUSIONS: Close collaboration and partnership with the provincial health directorate make the sustainability of many results likely while the replication of much of the Sofala model to other provinces is promising for the national strategy to reduce maternal mortality.     

Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with “No Indicated Risk,” United States, 1998–2001 Birth Cohorts

ABSTRACT: Background: The percentage of United States’ births delivered by cesarean section has increased rapidly in recent years, even for women considered to be at low risk for a cesarean section. The purpose of this paper is to examine infant and neonatal mortality risks associated with primary cesarean section compared with vaginal delivery for singleton full‐term (37–41 weeks’ gestation) women with no indicated medical risks or complications. Methods: National linked birth and infant death data for the 1998–2001 birth cohorts (5,762,037 live births and 11,897 infant deaths) were analyzed to assess the risk of infant and neonatal mortality for women with no indicated risk by method of delivery and cause of death. Multivariable logistic regression was used to model neonatal survival probabilities as a function of delivery method, and sociodemographic and medical risk factors. Results: Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62). The magnitude of this difference was reduced only moderately on statistical adjustment for demographic and medical factors, and when deaths due to congenital malformations and events with Apgar scores less than 4 were excluded. The cesarean/vaginal mortality differential was widespread, and not confined to a few causes of death. Conclusions: Understanding the causes of these differentials is important, given the rapid growth in the number of primary cesareans without a reported medical indication. (BIRTH 33:3 September 2006)     

Low molecular weight advanced glycation end products predict mortality in asymptomatic patients receiving chronic haemodialysis.

BACKGROUND: Advanced glycation end products (AGEs) have biological properties that may contribute to the premature cardiovascular mortality of haemodialysis patients. This study examines the hypothesis that low molecular weight forms of fluorescent AGEs (LMW fluorescence) predict mortality in haemodialysis patients. METHODS: The LMW fluorescence was measured in 85 patients treated with chronic haemodialysis and prospectively followed for 4 years. The primary outcome of all-cause mortality was assessed using Cox proportional hazards regression model. RESULTS: At the end of the follow-up period 37 (44%) patients died. The median LMW fluorescence level was 24.2 arbitrary units (range: 10.6-148.1 AU) and the receiver operator characteristic (ROC) curve cut-off for mortality was 37.0 AU. The LMW fluorescence predicted death both as a binary variable at the ROC cut-off, and as a continuous log-transformed variable when adjusted for age, albumin and C-reactive protein (CRP). Adjusted for age, albumin and CRP, the hazard ratio for mortality was 3.05 (1.41-6.60, P = 0.005) for LMW fluorescence as a binary variable and 2.71 per log unit (1.37-5.38, P = 0.004) as a continuous log-transformed variable. CONCLUSION: The low molecular weight forms of AGEs predict mortality in patients receiving chronic haemodialysis, and may be important in the mechanisms leading to atherosclerosis and inflammation in such patients.     

Mortality and suicide rates of involuntarily committed patients

The mortality and suicide rates for involuntarily committed patients in Denmark are presented. Two cohorts of psychiatric patients committed to a mental hospital from January 1, 1971 to December 31, 1975 (8322 people) and January 1, 1981 to December 31, 1985 (5253 people) have been followed. The standard mortality rate (SMR) in relation to the total Danish population were 4.9 (4.5–5.4) and 5.2 (4.7–5.8), respectively, for the two cohorts, during the first year after involuntarily commitment to a mental hospital. During the same period, the SMR for suicide among the committed patients were 44.9 (37.1–53.9) and 30.9 (24.2–38.9), respectively. The crude suicide rates among the committed patients during the first year after the commitment were 14.3 and 14.0, respectively, per 1000 years, unchanged between the cohorts. Short length of stay in hospital (< 14 days), a nonpsychotic main diagnosis, male sex, and age 35 years or more were equally related to high risk of suicide in the 1971 cohort as evaluated to proportional hazard methods (Cox regression), and short length of stay and commitment on the danger indication provided the most information in relation to high suicidal risk in the 1981 cohort. Methodological problems and the reasons for the results are discussed.     

Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence. Part 1: short-term outcome

OBJECTIVE: An association between caseload and outcome has been reported for complex surgical procedures. We systematically reviewed recent literature to determine whether caseload and surgical speciality are associated with short-term outcome following colorectal cancer surgery. METHOD: We searched the MEDLINE and Cochrane Library databases for relevant publications starting in 1992. We selected hospital caseload and type, and surgeon's caseload, education and experience as variables of interest. Measures of outcome were postoperative morbidity, in-hospital and 30-day mortality, and for rectal cancer anastomotic leak. We stratified the 35 reviewed studies by tumor location: colonic cancer, rectal cancer, or colorectal cancer and described the studies individually. A meta-analysis was performed only when it was considered appropriate. RESULTS: For colonic cancer, postoperative morbidity was associated with surgeon's caseload and education. Postoperative mortality was strongly associated with hospital caseload (OR 0.64, 95% CI 0.55-0.73), and surgeon's caseload (OR 0.50, 95% CI 0.39-0.64). It was also influenced by surgeon's education and experience. For rectal cancer, we found no evidence of an association between the selected variables and short-term outcome, including frequency of anastomotic leak. For colorectal cancer, there was evidence for an association between postoperative morbidity and hospital caseload. CONCLUSION: Our review offers evidence for a positive association between high hospital caseload, surgeon's caseload, sub-speciality and experience and improved short-term outcome in colonic cancer surgery. We failed to find evidence of a relationship for rectal cancer surgery, possibly owing to methodological artifacts. No study reported an inverse relation.