Mortality by cause of death and marital status in Spain

A number of studies have shown an association between maritalstatus and mortality, with most of them finding a lower mortalityin married as compared to unmarried persons. The purpose ofthis study is to show the differences in mortality from theleading causes of death by marital status among men and womenin Spain. An analysis was made of persons aged 25 years andolder who died in Spain during 1991. The mortality differencesby marital status and sex were analysed for all the deaths andfor the most frequent causes of death, using the ratios of age-adjusteddeath rates calculated from Poisson log—linear models.For both men and women, mortality was always higher in singleand widowed persons than in married persons, except for a non-statisticallysignificant mortality from diabetes mellitus and cirrhosis ofthe liver in single women. Divorced and separated men had ahigher mortality than married men for all the causes of deathtaken together; the mortality among divorced and separated women,on the other hand, was lower than in married women. Divorcedand separated men and women generally had a lower mortalitythan married persons for the different causes of death, exceptfor traffic accidents, suicide, cirrhosis of the liver and HIVinfection, where it was higher. The results obtained are similarto the findings of most studies in other countries, in whicha lower mortality has been observed in married persons as comparedto those who are widowed or single. However, the data showingthat divorced and separated persons have a lower mortality fromsome causes of death than married persons stand in contrastto most published studies. This work has shown that unmarriedpersons are not a homogeneous group, in that divorced and separatedpersons are very different from those who are single or widowed.     

Antibiotics for sore throats?

Although not explicit, recommendations in the new edition of Therapeutic Guidelines: Antibiotic¹ have taken a lurch towards an evidence basis. What does this mean, and what is the basis of the recommendation that antibiotics be used for sore throat in very limited circumstances?     

Relationship between the Duration of the Basal QRS Complex and Electrical Therapies for Ventricular Tachycardias among ICD Patients

Background: In implantable cardioverter‐defibrillators (ICD) patients, the duration of the basal QRS complex (QRSd) is not associated with a greater risk of developing ventricular tachyarrhythmias. QRSd could be inversely related to the effectiveness of antitachycardia pacing (ATP) because it may be associated with longer conduction times of the paced‐impulses and hence, with a greater propensity to require shocks to terminate ventricular tachycardias (VTs). Methods: We followed 216 ICD patients (pacing site: right ventricular apex; QRSd ≤ 100: 34%) for 21 ± 12 months. ICD programming was standardized. QRSd was determined on the electrocardiogram (50 mm/s) at device implantation. Results: Five hundred and fifty‐one VTs (cycle length: 329 ± 35 ms) occurred in 67 patients (36% had a QRSd ≤ 100 ms). ATP terminated 86% of VTs and 11% needed shocks. Mean ATP efficiency per patient was 83%. QRSd was significantly correlated with the probability of successful ATP (C‐coefficient: 0.66), the best cut‐off point being 100 (sensitivity and specificity of 91% and 49%). Patients with QRSd ≤ 100 had a higher ATP effectiveness (98% vs 75%; P = 0.003) and fewer VTs terminated by shocks (1% vs 23%; P = 0.003). By logistic regression, QRSd > 100 remained as an independent predictor of receiving shocks to terminate VTs (P = 0.01). According to Kaplan‐Meier analysis, the occurrence of VTs was similar regardless of the QRSd (30% vs 38%; P = 0.2), but the incidence of shock due to VTs was higher in patients with a QRSd > 100 (19% vs 7%; P = 0.01). Conclusion: Since QRSd is a negative and independent predictor of effective ATP, ICD patients with QRSd > 100 ms require shocks more frequently to terminate VTs. (PACE 2010; 596–604)