The contribution of diabetes to early deaths from ischemic heart disease: US gender and racial comparisons.

We evaluated the contribution of diabetes mellitus to premature ischemic heart disease mortality among US race- and gender-specific groups in 1986. Among persons aged 45 to 64 years, we examined ischemic heart disease death rates (corrected for underreporting of diabetes on death certificates) by diabetes status and calculated the population attributable risk due to diabetes for each group. Diabetes increased the ischemic heart disease death rate by 9 to 10 times for women but by only 2 to 3 times for men. Racial differences in ischemic heart disease mortality attributable to diabetes were greater for women (Blacks = 39%; Whites = 27%) than for men (Blacks = 19%; Whites = 14%). These discrepancies in the contribution of diabetes to ischemic heart disease mortality warrant further study.     

Heart disease and hospital deaths: an empirical study.

This study examines the effects of selected characteristics of hospitals and physicians on the mortality rates of heart patients who survive their first day in the hospital. Separate multivariate regression analyses are conducted for three groups: (1) patients who undergo a direct heart revascularization or coronary artery bypass graft (CABG) operation; (2) patients who undergo a cardiac catheterization and do not undergo a CABG operation; and (3) patients with a principal diagnosis of acute myocardial infarction (AMI) who do not undergo surgery. The number of patients in each group treated by specific physicians, and the number treated in specific hospitals, measure provider experience with similar patients. Other hypothesized determinants of in-hospital mortality include: (1) patient severity of illness, age, sex, and the presence of comorbidities; (2) hospital ownership, size, location, teaching status, resources expended, and the presence of a coronary care unit; and (3) board certification status of the attending physician or surgeon who operated. Empirical results show that presence of a coronary care unit decreases the chance that CABG patients will die in the hospital but is not significant for other heart patients included in this study. Patients with atherosclerosis who receive a CABG or a cardiac catheterization procedure are more likely to survive in hospitals with high volumes of these procedures. However, hospital volume of AMI admissions was not a factor in survival; AMI patients are more likely to survive when their attending physicians treat high volumes of AMI patients. Also, AMI patients whose physicians are board certified in family practice or in internal medicine are less likely to die compared to AMI patients with physicians not board certified. Similarly, AMI patients hospitalized in teaching facilities are less likely to die compared to AMI patients in hospitals not affiliated with a medical school.     

The time course of weather-related deaths.

We carried out time-series analysis in 12 U.S. cities to estimate both the acute effects and the lagged influence of weather on total daily deaths. We fit generalized additive Poisson regressions for each city using nonparametric smooth functions to control for long time trend and barometric pressure. We also controlled for day of the week. We estimated the effect and the lag structure of both temperature and humidity on the basis of a distributed lag model. In cold cities, both high and low temperatures were associated with increased deaths. In general, the effect of cold temperatures persisted for days, whereas the effect of high temperatures was restricted to the day of the death or the immediately preceding day and was twice as large as the cold effect. The hot temperature effect appears to be primarily harvesting. In hot cities, neither hot nor cold temperatures had much effect on deaths. The magnitude of the effect of hot temperature varied with central air conditioning use and the variance of summertime temperatures. We saw no clear pattern for humidity effect. These dissimilarities indicate that analysis of the impact of any climatic change should take into account regional weather differences and harvesting.     

The underregistration of neonatal deaths: Georgia 1974--77.

We reviewed the neonatal outcome of 3,369 infants who weighed less than or equal to 1500 grams and who were born in Georgia during the years 1974--76. We matched 1,465 of these infants with a death certificate registered in the State's Vital Records. Upon review of the hospital records of the remaining infants, we identified 453 infants that died during the neonatal period without a death certificate being registered. Subsequently, we compared the hospital death registries for 1977 in Georgia and death certificates registered in Vital Records during 1977. We identified an additional 236 infants who died without a death certificate being registered. Forty per cent of these infants weighed greater than 1500 grams. Two major procedural errors regarding the filing of death certificates in Georgia at the local level contributed to this 21 per cent underregistratioon of neonatal deaths in 1974--77. The underregistration occurred disproportionately for rural areas, for unmarried mothers, and for Black infants. The reason for underregistration included failure of hospitals and morticians to file death certificates with the county registrars.     

Lay beliefs about the preventability of major health conditions.

Beliefs about the extent to which health problems can be prevented reflect an understanding that preventive measures can reduce adverse health events and the level of control individuals perceive that they hold over the factors that affect their health. A population survey of 1659 people conducted in 1995 in south western Sydney, Australia, found that only child drownings, tooth decay, skin cancer, and burns and scalds were considered all or mostly preventable by more than 50% of the sample. The majority of respondents did not believe that heart attacks, cervical cancer, high blood pressure, serious road injury, lung cancer and asthma deaths were all or mostly preventable. Logistic regression analysis showed that people born in an English speaking country, those with more than 10 years of education and men were significantly more likely to recognize a number of key conditions as highly preventable. The findings suggest that, in spite of the range of prevention efforts in Australia to date, these are not matched by strong beliefs within the community that prevention is possible. Communication of the opportunities and methods for prevention needs to be improved, particularly among certain population groups. The findings also indicate a need to examine social and environmental factors which are potentially reducing confidence, and subsequently and adoption of preventive behaviours.     

Vietnamese pre-schoolers’ tablet use and early childhood learning: an ecological investigation

ABSTRACT

As Vietnam’s economic growth and consumer demands continue to accelerate, more Vietnamese families are now able to acquire portable touchscreen devices such as iPads. Previous research has shown that the use of touchscreen devices can benefit pre-schoolers’ learning, especially within school and home settings. However, little is known about the broader sociocultural environment within which such technology adoption by families with pre-schoolers takes place, especially in the Global South. Guided by Bronfenbrenner’s ecology of human development, this research investigates the ecology of tablet use and early childhood learning by pre-schoolers in Vietnam through an ethnographic investigation of 42 mother-child dyads. We found that Vietnamese pre-schoolers’ tablet use for the purpose of early childhood learning was initiated, sustained or even enforced by their parents. Vietnamese mothers strongly regard tablets as learning tools that give their children a distinct edge in educational achievement. However, such enthusiastic appropriation of the tablets was not matched by the mothers’ concomitant understanding of the benefits and risks of touchscreen devices for children, nor the availability of social scaffolding structures for the parents.     

Long-term remission in diabetes mellitus diagnosed at an early age

The authors deal with the clinical picture of total remission in diabetes, among young patients (below 30 years). In their interpretation "complete remission" means total withdrawal of insulin treatment for at least 2 months. Out of 14 patients with complete remission, the classified 7 patients--by clinical and immunogenetical parameters--as noninsulin-dependent diabetes in the young (MODY-NIDDY). 1 diabetic patient belongs to the autoimmune-subgroup of IDDM. The remaining 6 patients could be classified as IDDM-s. However their clinical and immunogenetical parameters were rather atypical. In conclusion they raised the possibility that this subgroup is heterogenous with in IDDM.     

Living arrangements and external causes of deaths in early adulthood

PurposeThe mortality-lowering benefits of living in a union are well-known in the adult population, but the association between living arrangements and mortality among the young remains unclear. This study examines the association between current living arrangements and external causes of death in early adulthood, adjusting for factors such as parental socioeconomic position, current main activity, household income, and level of own education.MethodsThe study is based on annually updated longitudinal register data that include a representative 11% sample of the whole Finnish population with an over-sample of 80% of all deaths. We used mortality rates and Cox proportional hazards models to study deaths in young adults aged between 17 and 29 years of age, from 1995 to 2004.ResultsCompared with living in parental home with married parents, those living alone in late teens and early 20s had clearly higher risk of external mortality among both sexes. Young adults living in cohabiting- or one-parent families carried likewise a higher risk of death. Living with a partner was associated with lower mortality in early 20s, but especially in late 20s. The observed mortality differentials by living arrangements remained notable for the most part, even after adjustment for socioeconomic factors.ConclusionsStrong excess mortalities among those living alone, single parents, children of single and cohabiting parents, the nonemployed, the less educated, and the less earning highlight the importance of late adolescence and early adulthood as a critical period for emerging health inequalities.     

Causes of infant and early childhood deaths in Sierra Leone

Information about the causes of infant and early childhood (1-4 years) mortality was compiled from the vital registration system for the Western Area, records from the children's Hospital in Freetown and two demographic sample surveys conducted in various chiefdom headquarters towns around the country. The leading causes of infant mortality are tetanus, fevers, measles and diarrhoea. A breakdown of certified deaths in infancy showed that tetanus is quite important in the neonatal period accounting for as much as 68% of neonatal deaths. Measles and diarrhoea were the leading causes of death in the last 6 months of infancy. The leading causes of early childhood deaths were measles, diarrhoea and fevers. Nutritionally related diseases such as measles and diarrhoea were seen to account for up to 40% of all early childhood deaths. The major factors affecting these causes of death were childbirth and childcare practices in the case of tetanus and the nutritional status of the children in the case of measles and diarrhoea. The majority of deliveries were still being performed by Traditional Birth Attendants in very unhygienic surroundings which it was felt contributed significantly to the high incidence of neonatal tetanus. At the other childhood ages the poor nutritional status of the majority of children in Sierra Leone as shown by the results of the 1978 National Nutrition Survey was seen as the significant factor. The effects of the identified major causes of infant and early childhood mortality (tetanus, fevers, measles, and diarrhoea) can be largely diminished by effective intervention programmes such as oral rehydration therapy and the training of Traditional Birth Attendants.     

Meta‐analysis of clinical trials with early stopping: an investigation of potential bias

Clinical trials that stop early for benefit have a treatment difference that overestimates the true effect. The consequences of this fact have been extensively debated in the literature. Some researchers argue that early stopping, or truncation, is an important source of bias in treatment effect estimates, particularly when truncated studies are incorporated into meta‐analyses. Such claims are bound to lead some systematic reviewers to consider excluding truncated studies from evidence synthesis. We therefore investigated the implications of this strategy by examining the properties of sequentially monitored studies conditional on reaching the final analysis. As well as estimation bias, we studied information bias measured by the difference between standard measures of statistical information, such as sample size, and the actual information based on the conditional sampling distribution. We found that excluding truncated studies leads to underestimation of treatment effects and overestimation of information. Importantly, the information bias increases with the estimation bias, meaning that greater estimation bias is accompanied by greater overweighting in a meta‐analysis. Simulations of meta‐analyses confirmed that the bias from excluding truncated studies can be substantial. In contrast, when meta‐analyses included truncated studies, treatment effect estimates were essentially unbiased. Previous analyses comparing treatment effects in truncated and non‐truncated studies are shown not to be indicative of bias in truncated studies. We conclude that early stopping of clinical trials is not a substantive source of bias in meta‐analyses and recommend that all studies, both truncated and non‐truncated, be included in evidence synthesis. Copyright © 2013 John Wiley & Sons, Ltd.     

Unexplained differences between hospital and mortality data indicated mistakes in death certification: an investigation of 1,094 deaths in Sweden during 1995

ObjectiveMortality statistics are important for epidemiological research. We examine if discrepancies between death certificate (DC) and hospital discharge condition (HDC) indicate certification errors.Study Design and SettingFrom 39,872 hospital deaths in Sweden in 1995, we randomly selected 600 “cases,” where DC and HDC were incompatible, and 600 compatible “controls,” matched on sex, age, and underlying cause of death. We obtained case summaries for 1,094 (91%) of these. Using a structured protocol, we assessed the accuracy of DCs.ResultsRegression analysis indicated diagnostic group and “case” or “control” as the variables that most affected the accuracy. Malignant neoplasm “controls” had the highest accuracy (92%), and benign and unspecified tumor “cases,” the lowest (20%). For all diagnostic groups except one, compatible “controls” had better accuracy than incompatible “cases.” The exception, chronic obstructive lung disease, had low accuracy for both “cases” (54%) and “controls” (52%).ConclusionIncompatibility between DC and HDC indicates a greater risk of certification errors. For some diagnostic groups, however, DCs are often inaccurate even when DC and HDC are compatible. By requesting additional information on incompatible cases and all deaths in high-risk diagnostic groups, producers of mortality statistics could improve the accuracy of the statistics.     

Patients' knowledge of diabetes: an area for concern.

In order to comply with the regimens which give them the best chance of a healthy life, it is essential for diabetics to have a sound understanding of their illness and its treatment. We used a questionnaire to assess interest in and knowledge of diabetes in diabetic adults attending a district general hospital diabetic outpatient clinic over a three month period. Procedures and facilities for patient education were similar to those found in many district hospitals. The results show that many patients had only a poor understanding of their disorder and the treatment they were receiving. On the whole, insulin treated diabetics, who tend to have more time spent with them, were better informed than those treated with oral hypoglycaemic agents or with diet alone. This study demonstrates the difficulty of achieving an acceptable level of awareness and understanding in a diabetic population. Regular use of a simple questionnaire in the outpatient department and in the GP's surgery could be a useful method for identifying problem areas.     

早期糖尿病性膀胱病的无创尿动力学变化

目的 研究早期糖尿病性膀胱病(DCP)的无创尿动力学指标变化,为其早期诊断提供依据.方法 以糖尿病病程1年为限将85例2型糖尿病患者分为初诊糖尿病组(32例)和非初诊糖尿病组(53例),以30例非糖尿病者作为对照组,分别应用无创尿动力学方法进行最大尿流率、平均尿流率、初尿意膀胱容量及残尿量测定.结果 初诊糖尿病组中有残余尿者18例,残尿量(13.2±17.3)ml,最大尿流率(18.4±6.9)ml/s,平均尿流率(10.6±5.3)ml/s,DCP检出率56.2%(18/32).非初诊糖尿病组中有残余尿者38例,残尿量(19.3±18.4)ml,最大尿流率(14.7±6.6)ml/s,平均尿流率(9.5±4.7)ml/s,DCP检出率71.7%(38/53).对照组无残余尿,最大尿流率(25.7±5.9)ml/s,平均尿流率(18.0±4.9)ml/s.初诊糖尿病组及非初诊糖尿病组最大尿流率、平均尿流率均低于对照组(P<0.01),残尿量高于对照组(P<0.01).非初诊糖尿病组最大尿流率明显低于初诊糖尿病组(P<0.05).结论 糖尿病早期便可出现尿动力学改变,其中可能以最大尿流率降低为最敏感指标.应用新的无创尿动力学检测方法可早期诊断DCP并动态观察评价膀胱功能.