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101.
Background
Infant mortality rate (IMR) is regarded as an important indicator of population health. IMR rates vary substantially with the highest found in sub-Saharan Africa (SSA) compared to the lowest in Europe. Identifying spatial disparities in IMR and quantifying attributable risk factors is essential for policymakers when tailoring time-appropriate interventions at a global, regional, and country level.Methods
Data for 192 countries were extracted from the World Bank Development Indicator database for the period 1990–2011. Spatial clustering was used to identify significant higher-risk IMR countries. A robust ecological generalized linear negative binomial regression model was used to quantify risk factors and associated decomposition values (Shapley).Results
Significant reductions were observed in IMR for all of the World Health Organization regions for the period 1990–2011 except for SSA, which indicated a reversal of this trend in the 1990s due to HIV. Significant high-risk clustering of IMR is also indicated in SSA countries and parts of Asia. Maternal mortality (survival), lack of water and sanitation and female education were confirmed as prominent and high attributable risk factors for IMR. Distinct temporal changes in the attributability of these factors were observed, as well as significant heterogeneity with regards to the most attributable factor by region and country.Conclusions
Our study suggests that maternal mortality is the most prominent attributable risk factor for infant mortality, followed by lack of access to sanitation, lack of access to water, and lower female education. Variation exists across regions and countries with regards to the most attributable factor. Our study also suggests significant underestimation of IMR in regions known for poorer data quality. The results will aid policymakers in re-tailoring time-appropriate interventions to more effectively reduce IMR in line with Millennium Development Goal 4.102.
Yersinia enterocolitica is an important cause of acute gastrointestinal disease and post-infectious complications. In Germany, incidence of reported yersiniosis is relatively high compared with other countries of the European Union. Children aged <5 years are most frequently affected. The aim of our study was to identify risk factors for sporadic yersiniosis in Germany. A population-based case-control study was conducted in five federal states of Germany from April 2009 to June 2010. Cases exhibiting gastrointestinal symptoms were notified to the local health department with a Yersinia enterocolitica infection culture-confirmed from stool. Controls were selected from population registries and frequency-matched on age group and state of residency. Cases and controls received a questionnaire on possible risk factors by mail. Multivariable logistic regression modelling was used to identify risk factors and to calculate adjusted odds ratios (aORs). Population attributable fractions (PAFs) were estimated for exposures associated with yersiniosis. We analysed data on 571 case patients and 1798 controls. Consumption of raw minced pork, a dish frequently consumed even by young children in Germany, was the main risk factor for disease (aOR 4·7, 95% confidence interval (CI) 3·5-6·3, PAF 30%). This association varied by age group and, unexpectedly, was strongest for children aged <2 years (aOR 17·5, 95% CI 6·0-51·2). Other independent risk factors included recent preparation of minced pork in the household (aOR 1·4, 95% CI 1·1-1·9, PAF 21%), playing in a sandbox (aOR 1·7, 95% CI 1·3-2·4, PAF 17%), and contact with birds (aOR 1·7, 95% CI 1·1-2·6, PAF 4%). Prevention efforts should specifically target parents and caregivers of young children and focus on the high infection risk associated with consumption of raw minced pork. 相似文献
103.
E. Werber 《Journal of cancer research and clinical oncology》1933,39(1):305-307
Ohne ZusammenfassungMit 2 Textabbildungen. 相似文献
104.
Ohne ZusammenfassungÜber den Inhalt dieser Arbeit wurde am 23. X. 1931 in der Gesellschaft der Ärzte Wiens (Wiener klin. Wschr.1931, Nr 44) auszugsweise Mitteilung gemacht. 相似文献
105.
BACKGROUND & AIMS: The majority of patients with celiac sprue experience diarrhea before diagnosis. There have been no studies of the prevalence or causes of chronic diarrhea in these patients after treatment with a gluten-free diet. METHODS: Seventy-eight patients with celiac sprue (59 women and 19 men) treated with a gluten-free diet for at least 12 months were surveyed about their bowel habits. Those with chronic diarrhea, defined as passage of loose stools three or more times per week for 6 months, underwent an extensive diagnostic evaluation to determine its cause. RESULTS: Sixty-two of the 78 patients (79%) experienced diarrhea before treatment, and 13 (17%) had chronic diarrhea (of lesser severity) after treatment. The causes of diarrhea in 11 patients consenting to this study were microscopic colitis, steatorrhea secondary to exocrine pancreatic insufficiency, dietary lactose or fructose malabsorption, anal sphincter dysfunction causing fecal incontinence, and the irritable bowel syndrome. Only 1 patient had antigliadin antibodies detected in serum or small intestinal villous atrophy. CONCLUSIONS: After treatment of celiac sprue with a gluten-free diet, chronic diarrhea persists in a substantial percentage of patients. Although ongoing gluten ingestion is one possible cause, other causes may be more frequent. Therefore, diagnostic investigation of diarrhea in celiac sprue after treatment seems warranted. (Gastroenterology 1997 Jun;112(6):1830-8) 相似文献
106.
Enhanced transcription factor DNA binding and gene expression induced by arsenite or arsenate in renal slices 总被引:1,自引:4,他引:1
Although the kidney represents a target for the accumulation and toxicity
of arsenic, little is known about the molecular targets of arsenic in this
organ. Therefore, these studies were designed to examine the molecular
impact of arsenite [As(III)] and arsenate [As(V)] at low (nanomolar)
concentrations. Precision-cut rabbit renal cortical slices were challenged
with As(III) or As(V) for up to 8 h. Neither form of the metal induced
overt cytotoxicity as assessed by intracellular K+ levels over this time
period at concentrations from 0.01-10 microM. In addition, no alterations
in the expression of Hsp 60, 70, or 90 were observed. However, induction of
heme oxygenase-1 (Hsp 32) was seen following a 4-h challenge with As(III),
but not with As(V). As(III) and As(V) induced DNA binding of AP-1 at 2- and
4-h exposure; following a 6-h exposure there was no difference. Although no
alteration in the DNA binding activity of ATF-2 was induced by As(III) or
As(V), both forms enhanced the DNA binding activity of Elk-1. Enhanced DNA
binding activity of AP-1 and Elk-1 correlated with increased gene
expression of c-fos, but not c-jun, at 2 h. c-myc gene expression was also
induced by As(III) and As(V), albeit at a later time point (6 h). These
results suggest that acute arsenic challenge, by either As(III) or As(V),
is associated with discrete alterations in the activity of signaling
pathways and gene expression in renal tissue.
相似文献
107.
108.
A 39-year-old old Jewish woman of Algerian origin developed a rapidly progressive neurocognitive disorder characterized by asymmetric rigidity, spasticity with bilateral Babinski's sign, bradykinesia, altered speech that progressed to mutism, and severe bradyphrenia. She partially responded to levodopa. The family history revealed 4 affected first-degree relatives (3 had already died). Genetic studies carried out in the proband and her living affected sister showed a P301S mutation in chromosome 17. 相似文献
109.
110.
Thrombolytic therapy with tissue plasminogen activator or streptokinase induces transient thrombin activity 总被引:7,自引:0,他引:7
We have determined the plasma level of fibrinopeptide A as a specific index of thrombin activity during the infusion of a thrombolytic agent in patients with acute myocardial infarction. Peripheral venous plasma levels of fibrinopeptide A increased following the initiation of thrombolytic therapy from 2.7 nmol/L to a peak of 13.0 nmol/L at 30 minutes with streptokinase and from 1.1 nmol/L to a peak of 10.7 nmol/L at 90 minutes with tissue plasminogen activator. The amount of fibrinogen converted to fibrin I was determined by integration of the plasma level of fibrinopeptide A over time. The amount of fibrin I formed over the five-hour period from the start of drug infusion was approximately 10 mg/dL in response to either streptokinase or recombinant tissue plasminogen activator. We conclude that activation of coagulation occurs in response to thrombolytic therapy despite heparin administration. This thrombin action, though transient, would be sufficient to cause rethrombosis if localized and incompletely opposed by fibrinolytic activity. 相似文献