Avoidable Cause Of Death Research Articles

Expanding Our Understanding of Age-Related Mortality After Gastric Bypass Surgery.

Young adults are generally thought to be the least risky operative candidates for elective surgery, whereas older individualsmaybe considered too risky. In this issueof JAMASurgery, Davidson et al1 challenge these notions for patients undergoing gastric bypass surgery. At least 1 recent study2 inpatientsundergoingbariatric surgery has identified older age as a risk factor for poor outcome. These data combined with the belief that older patients may die before any health benefitsofweight loss surgeryare realized have led to physician reluctance to offer bariatric surgery to this population. However,Davidsonet al1 report ahazard ratio of only0.34, indicating a 66% reduction inmortality for the 65through 74year-old patientswhohave undergone gastric bypass surgery comparedwith their obese counterpartswhohavenot undergone gastric bypass surgery. This finding is a powerful argument for keeping bariatric surgery in the armamentarium for treating obesity in older individuals. These results should be interpreted with some caution, however. Bariatric surgeons exclude high-risk patients from surgery, which represents the major flaw in this study. The group not undergoing surgery had no such exclusion criteria and in all likelihood was not comparable in terms of disease burden and severity to the group undergoing surgery. Thus, the study by Davidson et al1 may be biased in favor of the patientsundergoingsurgery.That said, themagnitudeof thebeneficial effect of gastric bypass surgery onmortality is so stark that it is hard to solely attribute the authors’ findings to a selection bias alone. In addition,Davidsonet al1 found that theobese individuals not undergoing gastric bypass surgery had a faster increase in mortality as they aged compared with those undergoing the surgery. This finding indicates that patients should resist theurge to enjoy excess food intakewhile young, thinking that theyhavebariatric surgery tobail themoutwhen they areold.Obesepatientsmaybecomeprohibitively risky for surgery—or die—before the bariatric surgeon can intervene. Paradoxically, the data from the study by Davidson et al1 did not reveal improved outcome in patients younger than 35 years. The authors attribute this finding to the fact that young womenwere at a 3-fold increased risk of death from external causes (eg, unintentional or undetermined injuries or poisonings),whichappears tohaveoffset theprotectiveeffectsof surgery. A previous study3 reported on the increased incidence of external causes of death after bariatric surgery. The current study suggests that youngwomen in particular are a vulnerable population who may need additional preoperative preparation and postoperative follow-up to limit potentially avoidable causes of death. In conclusion, the study by Davidson et al1 suggests that mortality is drastically reduced for obese patients who undergo gastric bypass surgery across a broad age range. However, one should be judicious in the workup, selection, and postoperative support of both young and old patients before offering this powerful tool for treating obesity.

Secular trends in infant mortality by age-group and avoidable components in the State of São Paulo, 1996–2012

ObjectiveTo describe trends and composition of infant mortality rate in the State of São Paulo, from 1996 to 2012. MethodsAn ecological study was conducted, based on official secondary data of births and infant deaths of residents in São Paulo, from 1996 to 2012. The infant mortality rate was calculated by the direct method and was analyzed by graphs and polynomial regression models for age groups (early neonatal, late neonatal and post-neonatal) and for groups of avoidable causes of death. ResultsThe mortality rate in the State of São Paulo tended to fall, ranging from 22.5 to 11.5 per thousand live births. Half of the infant deaths occurred in the early neonatal group. The proportion of avoidable infant deaths varied from 76.0 to 68.7%. The deaths which were avoidable by adequate attention to women during pregnancy and childbirth and newborn care accounted for 54% of infant deaths throughout the period. ConclusionsThe mortality rate levels are still far from those in developed countries, which highlight the need to prioritize access and quality of healthcare services during pregnancy, childbirth and newborn care, especially in the first week of life, aiming at achieving standards of infant mortality similar to those of developed societies.

Maternal mortality, as a largely avoidable cause of death and reduction in maternal mortality has been a top priority in Brazil, despite massive program efforts to avert maternal deaths, the maternal mortality ratio (MMR) in Brazil is still high especially in the poor area. Estimates of maternal mortality rates in Brazil are affected by underreporting of deaths, especially in less

Maternal mortality, as a largely avoidable cause of death and reduction in maternal mortality has been a top priority in Brazil, despite massive program efforts to avert maternal deaths, the maternal mortality ratio (MMR) in Brazil is still high especially in the poor area. Estimates of maternal mortality rates in Brazil are affected by underreporting of deaths, especially in less developed areas of the country where maternal mortality tends to be higher, and the absence of specific information indicating maternal death in reported deaths of women of reproductive age The objective of this study is to identify the true number of maternal deaths. We use data obtained from Ministry of Health information systems from the 2000 and 2012 Brazil Maternal Mortality Surveys to measure change in the maternal mortality ratio (MMR) and to measure changes in factors potentially related to such change. We estimate the changes in risk of maternal death between the two surveys using Poisson regression.

The Impact of Avoidable Mortality on the Life Expectancy in Bulgarian Population

Mortality due to avoidable causes of death is one of the most often used quality and efficiency indicators for the health care system and the policies of prevention of morbidity and mortality by causes of death due to behavioural or environmental factors. The objective of the article is to study the impact of avoidable mortality including amenable and preventable mortality on the life expectancy in Bulgaria during the period 2005-2012. The classification of avoidable mortality, proposed by the Office for National Statistics of the United Kingdom in 2011, is used. The methods of decomposing the change in two life expectancies by age and the change in two life expectancies by age according to the causes of death by E. Andreev and E. Arriaga are applied to measure the impact on the change in life expectancy. The main results of the study show that during the period 2005-2012 along with the decrease in the total mortality, also the avoidable mortality has dropped – from 34. 72% to 29. 12% of the mortality due to all causes of death. The avoidable causes’ of death contribution to life expectancy increase is by 1. 20 years and it is considerably greater than those of the other causes. Mortality due to amenable and preventable causes of death is also decreasing. Greater is the effect of the amenable causes of death on the life expectancy increase.

The Impact of Avoidable Mortality on the Life Expectancy in Bulgarian Population

Mortality due to avoidable causes of death is one of the most often used quality and efficiency indicators for the health care system and the policies of prevention of morbidity and mortality by causes of death due to behavioural or environmental factors. The objective of the article is to study the impact of avoidable mortality including amenable and preventable mortality on the life expectancy in Bulgaria during the period 2005-2012. The classification of avoidable mortality, proposed by the Office for National Statistics of the United Kingdom in 2011, is used. The methods of decomposing the change in two life expectancies by age and the change in two life expectancies by age according to the causes of death by E. Andreev and E. Arriaga are applied to measure the impact on the change in life expectancy. The main results of the study show that during the period 2005-2012 along with the decrease in the total mortality, also the avoidable mortality has dropped – from 34. 72% to 29. 12% of the mortality due to all causes of death. The avoidable causes’ of death contribution to life expectancy increase is by 1. 20 years and it is considerably greater than those of the other causes. Mortality due to amenable and preventable causes of death is also decreasing. Greater is the effect of the amenable causes of death on the life expectancy increase.

Tendência secular da mortalidade infantil, componentes etários e evitabilidade no Estado de São Paulo – 1996 a 2012

ObjectiveTo describe trends and composition of infant mortality rate in the State of São Paulo, from 1996 to 2012. MethodsAn ecological study was conducted, based on official secondary data of births and infant deaths of residents in São Paulo, from 1996 to 2012. The infant mortality rate was calculated by the direct method and was analyzed by graphs and polynomial regression models for age groups (early neonatal, late neonatal and post‐neonatal) and for groups of avoidable causes of death. ResultsThe mortality rate in the State of São Paulo tended to fall, ranging from 22.5 to 11.5 per thousand live births. Half of the infant deaths occurred in the early neonatal group. The proportion of avoidable infant deaths varied from 76.0 to 68.7%. The deaths which were avoidable by adequate attention to women during pregnancy and childbirth and newborn care accounted for 54% of infant deaths throughout the period. ConclusionsThe mortality rate levels are still far from those in developed countries, which highlight the need to prioritize access and quality of healthcare services during pregnancy, childbirth and newborn care, especially in the first week of life, aiming at achieving standards of infant mortality similar to those of developed societies.

Study of pharmacotherapy role in smoking cessation giving an insight into the frequency of smoking among Zagazig University Hospitals’ staff in 2013

Background“Smoking is the main avoidable cause of death around the world”. It’s prevalence is about one billion smokers in the global adult population. “The most cost effective and well-documented methods for smoking cessation are professional advice combined with the nicotine replacement therapy”. So the main aim of hospital staff must be to give advices about smoking cessation and the ways to it. The aim of this work was to study the pharmacotherapy role in smoking cessation giving an insight into the frequency of smoking among Zagazig University Hospitals’ staff in 2013. Subjects and methodsThis epidemiological, observational and prospective study was carried out at Zagazig University Hospitals from the period January 2013 to December 2013. Subjects150 of those current smokers agreed to answer the study questionnaire and share in this study. The included subjects were 144 males and 6 females with a mean age of 39.48±11.95years. MethodsThe studied subjects were subjected to the following: (1) personal history including: smoking history and family history, (2) routine investigations and (3) plain X-ray. The studied subjects (150) were divided into 2 groups according to their agreement for taking pharmacotherapy: group I: included 111 subjects treated by behavioral therapy alone for 3months. Group II: included 39 subjects treated by behavioral therapy plus pharmacotherapy (Bupropion SR tablet) for 3months. ResultsA statistically highly significant percentage of subjects who did previous trial of quitting was found in group II than that in group I. Also, there was a statistically highly significant percentage of subjects who are less nicotine dependent in group II than that in group I, but the reverse was present in highly nicotine dependent subjects according to Fagerstrom score. The final outcome of quitting trial with a successful cessation rate was 48%, while the failed cessation rate was 52% and there was a statistically significant higher successful rate in group II (69.3%) than that in group I (40.5%). As regards occupation, the physicians had statistically highly significant higher levels of successful rate than para-medicals who had high levels of failed cessation rate. A statistically highly significant increase in the percentage of other smoker family member was found in failed cessation group than that in successful cessation one. Regarding Fagerstrom score, there were statistically significant increases in percentage of subjects who were less nicotine dependent in successful cessation group than that in failed cessation one and also in percentage of subjects who were highly nicotine dependent in failed cessation group than that in successful one. Conclusion(1) Programs promoting smoking cessation including behavioral therapy in addition to the complementary role of pharmacotherapy (Bubropion SR) enhanced the chance of success in smoking cessation. (2) This pilot study (regarding the number of the studied individuals) pointed to the smoking dilemma in a locality where smoking behavior should be brought to a minimum especially among physicians.

More than just numbers: Suicide rates and the economic cycle in Portugal (1910–2013)

Suicides are a major concern for public health first and foremost because they are an avoidable cause of death. Moreover, they can be an indicator of self-reported emotional satisfaction and a good marker of overall well-being.In this study we examine how different economic and social aspects affected Portuguese suicide rates for more than one hundred years (1910–2013). We place this exercise in the specific historical context of the XX and early XXI century in Portugal, emphasizing the role of economic recessions and expansions. Controlling for aspects like wars, health care availability, political instability, and demographic changes, we find a strong association between a decline in the growth rate of real output and an increase in suicide rates for the whole population. In this regard, while male suicide rates are non-negligibly influenced by economic downturns, female suicide rates are in general more responsive to a more open political and economic environment. Our results are robust if we consider the mid-term cyclical relationship.Our findings advocate that, during recessions, public health responses should be seen as a crucial component of suicide prevention.

Years of Life Lost (YLL) in Colombia 1998-2011: Overall and Avoidable Causes of Death Analysis.

ObjectiveEstimate the Years of Life Lost (YLL) for overall and avoidable causes of death (CoD) in Colombia for the period 1998-2011.MethodsFrom the reported deaths to the Colombian mortality database during 1998-2011, we classified deaths from avoidable causes. With the reference life table of the Global Burden of Disease (GBD) 2010 study, we estimated the overall YLL and YLL due to avoidable causes. Calculations were performed with the difference between life expectancy and the age of death. Results are reported by group of cause of death, events, sex, year and department. Comparative analysis between number of deaths and YLL was carried out.ResultsA total of 83,856,080 YLL were calculated in Colombia during period 1998-2011, 75.9% of them due to avoidable CoD. The year 2000 reported the highest number of missed YLL by both overall and avoidable CoD. The departments with the highest YLL rates were Caquetá, Guaviare, Arauca, Meta, and Risaralda. In men, intentional injuries and cardiovascular and circulatory diseases had the higher losses, while in women YLL were mainly due to cardiovascular and circulatory diseases.ConclusionsThe public health priorities should focus on preventing the loss of YLL due to premature death and differentiated interventions by sex.

Prévalence du tabagisme dans l’enseignement moyen et secondaire dans le Département de Dakar, Sénégal

Tobacco smoke is a global health problem, and the largest avoidable cause of death in the world. The objective of our study was to determine the prevalence of tobacco smoking in schools in Dakar area (Senegal). This descriptive and analytical cross-sectional study was performed from September2011 to June2012 in 27 schools of the Dakar area. We questioned 1654students over a 9-month school period. The mean age was 15±2.5years (range 11-22). The sample included 848boys (51.3%), therefore a sex ratio of 1.05. There were 68smokers (4.1%) and 60 ex-smokers (3.6%). The mean age of the smokers was 16.9±2.2years (range 11-22) with a male preponderance of 70.6% (n=48). Smoking in family members was the initiating factor most frequently reported by smokers (25%). The average age of ex-smokers was 16.4±2years. Fear of parents' reactions was the most frequently invoked reason for stopping smoking (41.7%). This study confirms the reality of smoking among school children in Senegal and highlights the urgency of the installation of a prevention policy near the young people.

Social differences in avoidable mortality between small areas of 15 European cities: an ecological study

BackgroundHealth and inequalities in health among inhabitants of European cities are of major importance for European public health and there is great interest in how different health care systems in Europe perform in the reduction of health inequalities. However, evidence on the spatial distribution of cause-specific mortality across neighbourhoods of European cities is scarce. This study presents maps of avoidable mortality in European cities and analyses differences in avoidable mortality between neighbourhoods with different levels of deprivation.MethodsWe determined the level of mortality from 14 avoidable causes of death for each neighbourhood of 15 large cities in different European regions. To address the problems associated with Standardised Mortality Ratios for small areas we smooth them using the Bayesian model proposed by Besag, York and Mollié. Ecological regression analysis was used to assess the association between social deprivation and mortality.ResultsMortality from avoidable causes of death is higher in deprived neighbourhoods and mortality rate ratios between areas with different levels of deprivation differ between gender and cities. In most cases rate ratios are lower among women. While Eastern and Southern European cities show higher levels of avoidable mortality, the association of mortality with social deprivation tends to be higher in Northern and lower in Southern Europe.ConclusionsThere are marked differences in the level of avoidable mortality between neighbourhoods of European cities and the level of avoidable mortality is associated with social deprivation. There is no systematic difference in the magnitude of this association between European cities or regions. Spatial patterns of avoidable mortality across small city areas can point to possible local problems and specific strategies to reduce health inequality which is important for the development of urban areas and the well-being of their inhabitants.

Use of varenicline for smoking cessation in UK primary care: an association rule mining analysis

BackgroundAssociation rule mining (ARM) is a structured data mining method used to discover numerically important and often unexpected associations between variables in a dataset without being hypothesis driven. Although widely applied in business, ARM has been little used in public health. Smoking is the largest avoidable cause of death and health inequalities in the UK, and varenicline is one of the most effective treatments to help smokers quit. We used ARM methods to identify the comorbidity characteristics of patients who typically do not receive varenicline for smoking cessation in UK primary care to identify numerically important groups in which varenicline is not being used. MethodsFrom the Health Improvement Network primary care database we obtained data on demographic and lifestyle characteristics, medical diagnoses based on Quality and Outcomes Framework disease indicators, and prescription of varenicline in all current smokers aged at least 16 years in 2011. ARM identifies rules of the form A→B, where A and B are disjoined sets of items such that B is likely to occur when A occurs. We therefore identified rules for sets of characteristics (A) of patients who did and did not receive a prescription for varenicline during 2011 (B). All (A) sets were required to contain a minimum of 500 patients, and we ordered rules according to their confidence, which is the probability of B given A. Findings were compared with traditional risk factor analysis of predictors of receiving a varenicline prescription by logistic regression. Ethics approval was granted from the EPIC Scientific Review Committee. Findings477 620 smokers were included in the analysis, of whom 19 316 (4%) were prescribed varenicline. Patients in the top ten rules for receiving varenicline were all heavy smokers, without obesity, excessive alcohol intake, hypertension, anxiety, depression, or psychotic disorders. Rates of receiving varenicline in these groups were at least 13·3%, which is much higher than in the general smoking population (4%). Patients in the initial top ten rules for not receiving varenicline were lighter smokers without comorbidity; however, of smokers with at least one comorbidity, those not prescribed varenicline were typically older (aged >60 years), non-heavy smokers without chronic obstructive pulmonary disease, but with a psychotic disorder or dementia; in these groups, fewer than 0·7% of patients were prescribed varenicline. Logistic regression also identified these characteristics, but did not provide the context of numerical importance. InterpretationARM analysis shows that varenicline is systematically underused in people with severe mental health problems, a group in whom smoking prevalence is extremely high and has changed very little over recent years. Although use of varenicline is subject to caution in these groups, the risk of continued smoking is likely to far exceed any risk arising from varenicline use. ARM has thus identified an important area of under-access of one of the most effective smoking cessation treatments. FundingThe authors are members of the UK Centre for Tobacco and Alcohol Studies, and the study is funded by the centre.

Causes of death in a cohort treated for opioid dependence between 1985 and 2005

To examine changes in causes of death in a cohort treated for opioid dependence, across time and age; quantify years of potential life lost (YPLL); and identify avoidable causes of death. People in New South Wales (NSW) who registered for opioid substitution therapy (OST), 1985-2005, were linked to a register of all deaths in Australia. NSW, Australia. Crude mortality rates (CMRs), age-sex-standardized mortality rates (ASSRs) and standardized mortality ratios (SMRs) across time, sex and age. Years of potential life lost (YPLL) were calculated with reference to Australian life tables and by calculating years lost before the age of 65 years. There were 43 789 people in the cohort, with 412 216 person-years of follow-up. The proportion of the cohort aged 40+ years increased from 1% in 1985 to 39% in 2005. Accidental opioid overdoses, suicides, transport accidents and violent deaths declined with age; deaths from cardiovascular disease, liver disease and cancer increased. Among men, 89% of deaths were potentially avoidable; among women, 86% of deaths were avoidable. There were an estimated 160 555 YPLL in the cohort, an average of 44 YPLL per decedent and an average of 29 YPLL before age 65 years. Among a cohort of opioid-dependent people in New South Wales, 1985-2005, almost nine in 10 deaths in the cohort were avoidable. There is huge scope to improve mortality among opioid-dependent people.

Factors associated with smoking cessation in Brazil

Tobacco has been identified as the drug with the highest addiction rate and the leading cause of avoidable deaths. The current study thus aimed to identify the determinants of smoking cessation in a Brazilian population sample based on data from the National Household Sample Survey for 2008. The study analyzed socioeconomic, residential, and health-related data as well as individual habits. Data analysis used Poisson regression. The following factors were associated with smoking cessation: age 45 years or older, higher income, medical consultation in the previous 12 months, private health plan, physical exercise, believing that smoking is bad for one's health and that cigarette smoke is harmful to passive smokers, and Internet access in the household. Subjects with heart conditions, diabetes, and cancer were also more prone to quit smoking.

Factors associated with smoking cessation in Brazil

Tobacco has been identified as the drug with the highest addiction rate and the leading cause of avoidable deaths. The current study thus aimed to identify the determinants of smoking cessation in a Brazilian population sample based on data from the National Household Sample Survey for 2008. The study analyzed socioeconomic, residential, and health-related data as well as individual habits. Data analysis used Poisson regression. The following factors were associated with smoking cessation: age 45 years or older, higher income, medical consultation in the previous 12 months, private health plan, physical exercise, believing that smoking is bad for one's health and that cigarette smoke is harmful to passive smokers, and Internet access in the household. Subjects with heart conditions, diabetes, and cancer were also more prone to quit smoking.

Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial

Venous thromboembolism is a common, potentially avoidable cause of death and morbidity in patients in hospital, including those with stroke. In surgical patients, intermittent pneumatic compression (IPC) reduces the risk of deep vein thrombosis (DVT), but no reliable evidence exists about its effectiveness in patients who have had a stroke. We assessed the effectiveness of IPC to reduce the risk of DVT in patients who have had a stroke. The CLOTS 3 trial is a multicentre parallel group randomised trial assessing IPC in immobile patients (ie, who cannot walk to the toilet without the help of another person) with acute stroke. We enrolled patients from day 0 to day 3 of admission and allocated them via a central randomisation system (ratio 1:1) to receive either IPC or no IPC. A technician who was masked to treatment allocation did a compression duplex ultrasound (CDU) of both legs at 7-10 days and, wherever practical, at 25-30 days after enrolment. Caregivers and patients were not masked to treatment assignment. Patients were followed up for 6 months to determine survival and later symptomatic venous thromboembolism. The primary outcome was a DVT in the proximal veins detected on a screening CDU or any symptomatic DVT in the proximal veins, confirmed on imaging, within 30 days of randomisation. Patients were analysed according to their treatment allocation. ISRCTN93529999. Between Dec 8, 2008, and Sept 6, 2012, 2876 patients were enrolled in 94 centres in the UK. The included patients were broadly representative of immobile stroke patients admitted to hospital and had a median age of 76 years (IQR 67-84). The primary outcome occurred in 122 (8·5%) of 1438 patients allocated IPC and 174 (12·1%) of 1438 patients allocated no IPC; an absolute reduction in risk of 3·6% (95% CI 1·4-5·8). Excluding the 323 patients who died before any primary outcome and 41 without any screening CDU, the adjusted OR for the comparison of 122 of 1267 patients vs 174 of 1245 patients was 0·65 (95% CI 0·51-0·84; p=0·001). Deaths in the treatment period occurred in 156 (11%) patients allocated IPC and 189 (13%) patients allocated no IPC died within the 30 days of treatment period (p=0·057); skin breaks on the legs were reported in 44 (3%) patients allocated IPC and in 20 (1%) patients allocated no IPC (p=0·002); falls with injury were reported in 33 (2%) patients in the IPC group and in 24 (2%) patients in the no-IPC group (p=0·221). IPC is an effective method of reducing the risk of DVT and possibly improving survival in a wide variety of patients who are immobile after stroke. National Institute of Health Research (NIHR) Health Technology Assessment (HTA) programme, UK; Chief Scientist Office of Scottish Government; Covidien (MA, USA).

Comparaative study of Lipid profile and level of Antioxidant enzymes in cigarette smokers with non cigaretee smokers

Cigarette smoking is the serious health problems and most important avoidable cause of death in world. Worldwide more than 8 million people currently die each year from smoking half of them before of the age of 60. Every cigarette reduces the life span by about 5 minutes. Smoke contains oxidising agents and the oxidation reactions can produce free radicals. In turn, these radicals can start chain reactions that damage cells. In the present study 40 male subjects were divided into four different groups and their lipid profile have been estimated by various tests i.e. Cholesterol, Triglyceride, HDL-C, LDLC, VLDL-C. It was observed that in cigarette smokers HDL-C level decreased and cholesterol, triglyceride, LDL-C, VLDL-C level increased as compared to the control i.e. non- cigarette smokers. In case of MDA and Antioxidant enzymes test, the value of MDA increases and antioxidant enzymes decreases in cigarette smokers as compared to the control i.e. non- cigarette smokers. The variation in the level of lipid profile and antioxidant enzymes from normal values causes several diseases such as Lung cancer, other cancers, heart disease, and stroke and has numerous immediate health effects on the brain and on the respiratory, cardiovascular, gastrointestinal, immune systems.

Interventions for Tobacco Smoking

Around 19% of US adults smoke cigarettes, and smoking remains the leading avoidable cause of death in this country. Without treatment only ~5% of smokers who try to quit achieve long-term abstinence, but evidence-based cessation treatment increases this figure to 10% to 30%. The process of smoking cessation comprises different pragmatically defined phases, and these can help guide smoking treatment development and evaluation. This review evaluates the effectiveness of smoking interventions for smokers who are unwilling to make a quit attempt (motivation phase), who are willing to make a quit attempt (cessation phase), who have recently quit (maintenance phase), and who have recently relapsed (relapse recovery phase). Multiple effective treatments exist for some phases (cessation), but not others (relapse recovery). A chronic care approach to treating smoking requires effective interventions for every phase, especially interventions that exert complementary effects both within and across phases and that can be disseminated broadly and cost-effectively.

Women with Gynecologic Malignancies Have a Greater Incidence of Suicide than Women with Other Cancer Types

To evaluate risk of suicide of women with invasive gynecologic malignancies, the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (1973-2007) was queried. Suicide per 100,000 women with gynecologic malignancies was compared with that of women with other malignancies; suicide was 30% more likely in those with gynecologic malignancies. Most suicides occurred within 4 years of diagnosis. Better understanding of the descriptive epidemiology of suicide among women with gynecologic malignancies could lead to improved risk assessment, screening, and prevention of this potentially avoidable cause of death.

Deaths from symptomatically identifiable furious rabies in India: a nationally representative mortality survey.

BackgroundIt is estimated that India has more deaths from rabies than any other country. However, existing estimates are indirect and rely on non-representative studies.Methods and Principal FindingsWe examined rabies deaths in the ongoing Million Death Study (MDS), a representative survey of over 122,000 deaths in India that uses enhanced types of verbal autopsy. We estimated the age-specific mortality rates of symptomatically identifiable furious rabies and its geographic and demographic distributions. A total of 140 deaths in our sample were caused by rabies, suggesting that in 2005 there were 12,700 (99% CI 10,000 to 15,500) symptomatically identifiable furious rabies deaths in India. Most rabies deaths were in males (62%), in rural areas (91%), and in children below the age of 15 years (50%). The overall rabies mortality rate was 1.1 deaths per 100,000 population (99%CI 0.9 to 1.4). One third of the national rabies deaths were found in Uttar Pradesh (4,300) and nearly three quarters (8,900) were in 7 central and south-eastern states: Chhattisgarh, Uttar Pradesh, Odisha, Andhra Pradesh, Bihar, Assam, and Madhya Pradesh.Conclusions and SignificanceRabies remains an avoidable cause of death in India. As verbal autopsy is not likely to identify atypical or paralytic forms of rabies, our figure of 12,700 deaths due to classic and clinically identifiable furious rabies underestimates the total number of deaths due to this virus. The concentrated geographic distribution of rabies in India suggests that a significant reduction in the number of deaths or potentially even elimination of rabies deaths is possible.