Mortality and causes of death in patients with hemophilia, 1992-2001: a prospective cohort study.

BACKGROUND: Clotting factor products have been safe for HIV since 1985, and for hepatitis C since 1992. Few studies have reported on mortality in the total population of hemophilia patients after the period of risk of viral infection transmission. OBJECTIVES: We studied the mortality, causes of death, and life expectancy of hemophilia patients between 1992 and 2001. We compared these findings with those of previous cohorts, together spanning the periods before, during, and after the use of potentially contaminated clotting products. PATIENTS AND METHODS: We performed a prospective cohort study among 967 patients with hemophilia A and B. Death rates, overall and cause-specific, were compared with national mortality figures for males adjusted for age and calendar period as standardized mortality ratio (SMRs). RESULTS: Between 1992 and 2001, 94 (9.7%) patients had died and two patients were lost to follow-up (0.2%). Mortality was 2.3-times higher in hemophilia patients than in the general male population (SMR 2.3 95% confidence interval 1.9-2.8). In patients with severe hemophilia, life expectancy decreased from 63 (1972-1985) to 59 years (1992-2001). Exclusion of virus-related deaths resulted in a life expectancy at birth of 72 years. CONCLUSIONS: AIDS was the main cause of death (26%) and 22% of deaths were because of hepatitis C. In patients not affected by viral infections, there still appeared to be a trend toward a moderately increased mortality compared with the Dutch male population. Thus, mortality of patients with hemophilia is still increased; this is largely because of the consequences of viral infections.     

住院糖尿病患者死亡原因分析——附530例报告

目的：分析住院糖尿病患者死亡原因及特点,为本地区糖尿病的临床流行病学研究提供初步资料。方法：总结分析1998—2007年中山大学附属第一医院住院糖尿病死亡病例的病历资料。结果：10年间住院糖尿病患者死亡530例,占住院总死亡人数的12．5％,病死率为3．0％;死因依次为心血管病27．2％、感染21．8％、肿瘤15．4％、脑血管病12．5％、肾病6．6％;死于心脑血管病者占39．7％;死于糖尿病急症、糖尿病肾病者分别占1．7％、5．0％。结论：心脑血管疾病是住院糖尿病患者的主要死亡原因,感染、肿瘤作为糖尿病死亡的重要原因应受到重视。     

Epidemiology and Mortality of New-Onset Diabetes After Dialysis: Taiwan national cohort study

OBJECTIVE

We examined the predictors and risks associated with pre-existing versus new-onset diabetes mellitus (DM) after initiation of chronic dialysis therapy in end-stage renal disease (ESRD) patients.

RESEARCH DESIGN AND METHODS

In the Taiwan National Health Insurance Research Database, we examined records of ESRD patients who initiated dialysis between 1999 and 2005. Patients were followed until death, transplant, dialysis withdrawal, or 31 December 2008. Predictors of new-onset DM and mortality were calculated using Cox models.

RESULTS

A total of 51,487 incident dialysis patients were examined in this study, including 25,321 patients with pre-existing DM, 3,346 with new-onset DM, and 22,820 without DM at any time. Patients’ age (mean ± SD) was 61.8 ± 11.5, 61.6 ± 13.7, and 56.5 ± 16.6 years in pre-existing, new-onset DM, and without DM groups, respectively. The cumulative incidence rate of new-onset DM was 4% at 1 year and 21% at 9 years. Dialysis modality was not a risk factor for new-onset DM (peritoneal dialysis to hemodialysis hazard ratio [HR] of new-onset DM, 0.94 [95% CI 0.83–1.06]). Pre-existing DM was associated with 80% higher death risk (HR 1.81 [95% CI 1.75–1.87]), whereas the new-onset DM was associated with 10% increased death risk (HR 1.10 [95% CI 1.03–1.17]).

CONCLUSIONS

Whereas dialysis modality does not appear to associate with new-onset DM, both pre-existing and new-onset DM are related to higher long-term mortality in maintenance dialysis patients.The increasing prevalence of diabetes mellitus (DM) is a global health issue in the obese and aging (1). Chronic kidney disease is an important complication of DM. Diabetic nephropathy, the leading cause of end-stage renal disease (ESRD) (2), accounts for ∼40% of patients on maintenance dialysis (3).Many studies (2,4) report an association between pre-existing DM at the initiation of dialysis and a poor outcome in ESRD patients undergoing dialysis. However, few published studies have focused on postdialysis new-onset DM (4–7). Glucose is one of the contents of hemodialysates (8) and peritoneal dialysates (9). Peritoneal dialysis (PD) patients, who received 24-h continuous high-glucose–concentration peritoneal dialysates, can develop hyperglycemia and transient hyperinsulinism (10). Woodward et al. (6), examining the U.S. Renal Data System, showed the incidence of new-onset DM to be ∼6% per year in dialysis patients. In Asia, Chinese patients in Hong Kong have been observed to have a high prevalence of hyperglycemia with a daily exchange of 1.5% glucose dialysate (7). Some epidemiological studies of glycemic load in relation to incident DM report inconsistent results. For example, although high intake of foods with high glycemic load has been found to increase the risk of type 2 DM in Chinese (11), Mosdøl et al. (12) did not find such an association in the Whitehall II study. Nevertheless, one meta-analysis of prospective cohort studies enrolling 13 trials concluded that there was a positive association between glycemic load and type 2 DM (13). Pure glucose has the highest glycemic index, but few long-term follow-up studies have investigated the glucose load and the risk of DM, especially in patients with ESRD. In addition, it has been demonstrated that increased plasma glucose levels are an independent risk factor for mortality among dialysis patients, even a minor degree of hyperglycemia (7). It has also been reported that the cumulative advanced atherosclerotic change in DM could be responsible for the increased further cardiovascular mortality thereafter.The worldwide number of ESRD patients undergoing dialysis has grown significantly in recent decades. The incidence and prevalence rates of ESRD are high in Taiwan (14). However, studies on new-onset DM are scarce, especially studies with epidemiological data from a national cohort of Asians with ESRD on maintenance dialysis. Therefore, this study investigates whether there is an association between dialysis modality and new-onset DM and whether new-onset DM is a risk factor for long-term mortality. To find out, we used a large dataset from the Taiwan National Health Insurance Research Database (NHIRD) from 1999 to 2008 to evaluate the epidemiology, incidence, and mortality of new-onset DM in ESRD patients undergoing dialysis.     

1981-2014年江苏省昆山市全死因死亡率趋势分析

目的 探究江苏省昆山市1981-2014年全死因死亡率、平均期望寿命时间趋势及主要死因构成,为卫生部门循证决策提供依据。方法 历年全死因死亡病例来源于全死因监测,计算分性别的全死因死亡率和平均期望寿命,使用2000年全国人口普查年龄构成为标准计算年龄标化死亡率;使用年度变化百分比（APC）评价各个指标在年份之间变化趋势。结果 男女合计人群中全死因年龄标化死亡率由1981年的726.26/10万下降到2014年的258.40/10万（APC=-3.33%,95%CI:-3.54%~-3.12%）;男性人群中由1981年的830.16/10万下降到2014年的289.30/10万（APC=-3.44%,95%CI:-3.68%~-3.20%）;女性人群中由1981年的654.63/10万下降到2014年的226.40/10万（APC=-3.38%,95%CI:-3.60%~-3.16%）。男女合计人群平均期望寿命由1981年的69.67岁上升到2014年的82.26岁（APC=0.57%,95%CI:0.53%~0.61%）。恶性肿瘤（30.33%）、脑血管病（17.22%）、心血管病（9.09%）、呼吸系统疾病（15.30%）及损伤和中毒（8.08%）是当前影响居民死亡的主要原因。结论 昆山市1981-2014年全死因死亡率逐渐下降,平均期望寿命逐步提升,但恶性肿瘤、循环与呼吸系统疾病以及损伤与中毒仍是当前影响居民健康的主要原因。     

急诊患者死亡原因分析

目的 通过对急诊病人死亡原因进行分析,探讨医院急诊救治和业务培训的重点,以提高急危重病人的抢救成功率。方法回顾性分析2007年1～12月份本院急诊处理全部死亡病历82份。结果 院前死亡46例,占56.1％;经抢救无效24h内死亡36例,占43.9％。主要病因：严重创伤48例,急性中毒6例,溺水3例,心脑血管病17例,器官衰竭5例,工业事故3例。结论 ①急诊死亡者车祸为主;②男性多于女性;③青少年死亡病因以急性中毒、创伤为主;④中壮年死亡病因以心源性猝死为主;⑤加强群众的健康和安全意识教育,加强群众的一般性急救知识和技能的普及,建立、健全急救网络体系,是提高急诊病人的抢救成功率、降低死亡率的关键措施。     

Mortality and predictors of mortality in a cohort of Brazilian type 2 diabetic patients

OBJECTIVE: To investigate mortality rates and predictors of mortality in Brazilian type 2 diabetic patients. RESEARCH DESIGN AND METHODS: A prospective follow-up study was carried out with 471 type 2 diabetic outpatients. Primary end points were all-cause, diabetes-related, and cardiovascular deaths. Excess mortality in this cohort was evaluated by calculating standardized mortality ratios (SMRs) in relation to those of the Rio de Janeiro population. Predictors of mortality were assessed by Kaplan-Meier survival curves and by uni- and multivariate Cox survival analyses. RESULTS: During a median follow-up of 57 months (range 2-84 months), 121 (25.7%) patients died, 91 (75.2%) from diabetes-related causes and 44 (36.4%) from cardiovascular diseases. After adjusting for age and sex, the all-cause SMR was 3.36 (95% confidence interval [CI] 2.81-4.02) and the cardiovascular SMR was 3.28 (CI 2.44-4.41). In the Cox multivariate analysis, the predictors of mortality were older age, increased 24-h proteinuria, preexisting vascular disease, presence of frequent ventricular premature contractions and prolonged maximum heart rate-corrected QT interval on baseline electrocardiogram, and decreased serum HDL cholesterol. The use of beta-blockers was a protective factor. In Kaplan-Meier curves, these variables were capable of distinguishing subgroups of patients with significantly different prognoses. CONCLUSIONS: Brazilian type 2 diabetic patients had a more than threefold excess mortality than the general population, largely because of increased cardiovascular mortality risk. Several clinical, laboratory, and electrocardiographic predictors of mortality were identified that could possibly be modified to decrease the mortality burden of type 2 diabetes in Brazil.     

糖尿病住院患者70例死亡原因及其相关因素分析

目的了解糖尿病患者的死亡原因及相关因素。方法对1992年4月～2002年4月在安徽医科大学第一附属医院内分泌科住院并死亡的糖尿病患者70例临床资料进行回顾性分析,并与同期住院的糖尿病患者70例对照。结果糖尿病慢性并发症,尤其是心、脑血管并发症是糖尿病患者的主要死亡原因。死亡病例主要集中于病程10～20年者。在65岁以上的糖尿病患者中,心脑血管疾病以及感染性疾病在死因中的比例较高。糖化血红蛋白、高血压、脂代谢紊乱等是糖尿病患者死亡的危险因素。结论严格控制血糖、血压及血脂,减少慢性并发症是降低糖尿病死亡率的关键。     

Mortality in diabetic children

The American Journal of Digestive Diseases - 1. A review is presented of 214 cases of diabetes in children, under my care from 1920 to 1934, which period goes back two years into the pre-insulin...     

急诊外科创伤患者死亡原因分析

目的:急诊外科为各类创伤患者的首诊科室,探讨如何提高急诊外科抢救成功率,减少外伤死亡.方法:回顾性分析我院急诊外科34例死亡病例.结果:青壮年男性为急诊外科死亡高危人群,交通伤是急诊外科死亡第一致病病因.死亡主要原因是颅脑损伤和创伤失血性休克.结论:应加强院前急救与院内急诊外科的联系,进一步普及创伤现场急救的知识,急诊外科医师应掌握高级创伤生命支持(ATLS).创伤失血性休克患者入抢救室之时就应该是准备输血的开始.急诊外科危重患者的抢救必须争分夺秒.     

Depression treatment and satisfaction in a multicultural sample of type 1 and type 2 diabetic patients

OBJECTIVE: To assess rates of depressive symptoms, depression treatment, and satisfaction in a multicultural sample of individuals with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS: This study was conducted with a cross-sectional community-based survey design. RESULTS: The sample (n = 221) was predominantly female (60.3%), had type 2 diabetes (75%), and was middle class with a mean (+/-SD) age of 54 +/- 12 years. A total of 53% were white. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD) (mean 16.4 +/- 11.3). Using conservative thresholds (CESD score > or =22), 25.3% of participants reported clinically significant depression. Rates of depression did not differ by ethnic group or diabetes type. The majority (76%) of depressed participants reported treatment (52% antidepressants, 63% mental health providers, 19% alternative healers, and 15% herbal remedies). African Americans were less likely to report any depression treatment, to receive antidepressant medications, or receive treatment from a mental health professional compared with whites. Participants with high depressive symptoms reported general satisfaction with depression treatment experiences. CONCLUSIONS: High rates of depressive symptoms were observed across ethnic groups, yet significant differences in use of depression treatment existed across ethnic groups. Those seeking depression treatment reported satisfaction with a variety of depression treatment modalities. Increased depression screening and treatment may be beneficial for ethnically diverse patients with type 1 and type 2 diabetes.     

Association of doctor specialty with diabetic patient risk of hospitalization due to diabetic ketoacidosis: a national population‐based study in Taiwan

Objectives Diabetic ketoacidosis (DKA) is a life‐threatening complication of diabetes mellitus, and its risks can be largely reduced by adequate and high‐quality ambulatory diabetic care. The aim of this study is to assess the risk and frequency of developing DKA in relation to the specialty of doctors who provide diabetes cares. Methods In searching for possible episodes of hospitalization due to DKA (ICD‐9‐CM: 250.1), we used a prospective cohort design in which 500 867 diabetic patients identified in the 1997 National Health Insurance (NHI) ambulatory care data set of Taiwan were linked to the 1997–2006 NHI inpatient claims data. The study subjects were categorized into four groups according to doctor specialty. A logistic regression model was used to assess the risk and frequency of DKA admission in relation to doctor's specialty. Results Compared with the patients routinely cared by endocrinologists, those not consistently cared by endocrinologists had significantly increased odds ratios (ORs) of DKA admission, ranging between 1.51 and 2.12. Moreover, the adjusted OR of the higher DKA admission frequency (≥0.133 times/person‐year) for the patients not regularly cared by endocrinologists was also significantly increased, between 4.45 and 6.93. Conclusions Doctor specialty significantly influenced the risk and frequency of DKA admission in diabetes patients in Taiwan. Local health care administrators and policy makers should therefore consider promoting the quality of diabetes care provided by non‐endocrinologists.     

糖尿病患者便秘原因分析及护理管理研究进展

文章归纳了自主神经病变、药物、饮食、日常活动及患者的年龄和心理等导致糖尿病患者发生便秘的危险因素,并提出护理管理措施,包括通过控制血糖、减轻药物副反应、合理膳食、腹部按摩、适当运动、排便训练、心理健康指导等,以有效降低糖尿病患者便秘的发生率,提升患者的生活质量。     

肝移植术前等待患者的死亡原因分析

目的 调查分析住院等待肝移植患者的死亡原因,为加强肝移植术前等待患者的管理提供方向和依据.方法 回顾性分析我院2003年1月-2007年6月住院等待肝移植手术期间死亡的63例患者等待时间、治疗过程和死亡原因.结果 63例患者的平均住院等待时间为(32.53±17.21)d,重症加强治疗病房(ICU)住院时间为(12.75±9.77)d.等待期间上消化道出血、意识障碍、感染的发生率分别为47.62%、39.68%和74.60%.主要死因感染性休克和感染性多器官功能衰竭(MOF)以及曲张静脉破裂出血的病死率分别为39.68%和26.98%.血液净化治疗对肝性脑病治疗有效.结论 当前肝移植术前等待住院患者的主要死亡原因是感染和致命性上消化道出血.