Changes In Mean Age Research Articles

Years of Potential Life Lost and Mean Age of Adults Experiencing Nontraumatic, Out-of-Hospital Cardiac Arrests - Chicago, 2014-2021.

Approximately 1,000 out-of-hospital cardiac arrests (OHCAs) are assessed by emergency medical services in the United States every day, and approximately 90% of patients do not survive, leading to substantial years of potential life lost (YPLL). Chicago emergency medical services data were used to assess changes in mean age and YPLL from nontraumatic OHCA in adults in biennial cycles during 2014-2021. Among 21,070 reported nontraumatic OHCAs during 2014-2021, approximately 60% occurred among men and 57% among non-Hispanic Black or African American (Black) persons. YPLL increased from 52,044 during 2014-2015 to 88,788 during 2020-2021 (p = 0.002) and mean age decreased from 64.7 years during 2014-2015, to 62.7 years during 2020-2021. Decrease in mean age occurred among both men (p<0.001) and women (p = 0.002) and was largest among Black men. Mean age decreased among patients without presumed cardiac etiology from 56.3 to 52.5 years (p<0.001) and among patients with nonshockable rhythm from 65.5 to 62.7 years (p<0.001). Further study is needed to assess whether similar trends are occurring elsewhere, and to understand the mechanisms that underlie these trends in Chicago because these mechanisms could help guide prevention efforts. Increased public awareness of the risk of cardiac arrest and knowledge of how to intervene as a bystander could help decrease associated mortality.

Rapid changes in age structure, mortality, and escapement accompanied stock recovery of the estuarine Red Drum population of Texas

AbstractObjectiveWe analyzed a fishery‐independent catch time series in the context of predicted historical age structure of Red Drum Sciaenops ocellatus for the years 1980–2019. This time series roughly coincided with closure of the commercial fishery in Texas (in 1981) and federal waters (in 1987). Changes in size and age were used to estimate changes in mortality and offshore escapement.MethodsOtoliths collected from Red Drum between 1997 and 2015 in Texas were used to create seasonal length‐at‐age growth functions, which were then used to estimate ages (based on total length) of all Red Drum encountered in fishery‐independent gill‐net samples collected by the Texas Parks and Wildlife Department during 1980–2019 (total n = 311,150). Temporal changes in observed body size and overall catch were used to predict annualized changes in mean age, mortality, and offshore escapement of the estuarine population.ResultThe initial 14‐year period (1980–1993) was characterized by rapid increases in mean catch per hour and mean total length (mm) in fishery‐independent samples, followed by relative stability for the remainder of the time series. There was a 55% increase in estimated mean age of Red Drum when comparing 1980 (mean age = 0.84 year) to 2019 (1.30 years). There were also rapid and significant declines in total mortality (Z; estimated via catch curves) and increases in offshore escapement (estimated indirectly from mortality) in the initial recovery period.ConclusionThe current estuarine population of Red Drum in Texas is significantly larger and older than it was at the onset of fishery management measures, and offshore escapement is annually well above the current target level of 30% set by the federal fisheries management plan. These findings suggest that regulations put into effect starting in the 1980s have succeeded in recovering the estuarine Red Drum population in Texas.

Trends and determinants of tobacco use initiation in India: analysis of two rounds of the Global Adult Tobacco Survey

ObjectivesEarly initiation of tobacco use can lead to lifelong addiction and increases tobacco-attributable morbidity and mortality. This study assesses trends in tobacco use initiation and factors associated with tobacco use...

Age, a Key Factor in the Performance of Doubles Badminton Players: Analysis of the Evolution of Age from 1994 to 2020

The main objective of this research was to establish the evolution of badminton players’ ages in the modalities of men’s, women’s and mixed doubles in the top-100 of the World Ranking (WR) from 1994 to 2020. Data were obtained from the Badminton World Federation website (7200 entries: 3304 players) from 1994 to 2020. The highest-ranking position and the mean age of the top-100 WR badminton players were analyzed for each modality. In the men’s doubles (MD) and mixed doubles (XD) modalities, a progressive increase of mean age was observed from 1994 to 2020 (MD: 1994 = 23.91 ± 3.93 years vs. 2020 = 25.55 ± 4.40 years; p &lt; 0.001 and XD: 1994 = 24.06 ± 3.99 years vs. 2020 = 25.34 ± 4.77 years; p = 0.004). In contrast, the women’s doubles modality did not present any change in mean age from 1994 to 2020 (~24 years; p = 0.317). In addition, women’s doubles players reached their highest ranking at an earlier age (~23 years) than men’s and mixed doubles players (~25 years). In conclusion, as often happens in other sports, elite women badminton doubles players are younger and reach their peak performance at a younger age than their male counterparts. These data could help coaches, trainers and selectors to plan the sports career of their elite players.

Age patterns of HIV incidence in eastern and southern Africa: a modelling analysis of observational population-based cohort studies

SummaryBackgroundAs the HIV epidemic in sub-Saharan Africa matures, evidence about the age distribution of new HIV infections and how this distribution has changed over the epidemic is needed to guide HIV prevention. We aimed to assess trends in age-specific HIV incidence in six population-based cohort studies in eastern and southern Africa, reporting changes in mean age at infection, age distribution of new infections, and birth cohort cumulative incidence.MethodsWe used a Bayesian model to reconstruct age-specific HIV incidence from repeated observations of individuals' HIV serostatus and survival collected among population HIV cohorts in rural Malawi, South Africa, Tanzania, Uganda, and Zimbabwe, in a collaborative analysis of the ALPHA network. We modelled HIV incidence rates by age, time, and sex using smoothing splines functions. We estimated incidence trends separately by sex and study. We used estimated incidence and prevalence results for 2000–17, standardised to study population distribution, to estimate mean age at infection and proportion of new infections by age. We also estimated cumulative incidence (lifetime risk of infection) by birth cohort.FindingsAge-specific incidence declined at all ages, although the timing and pattern of decline varied by study. The mean age at infection was higher in men (cohort mean 27·8–34·6 years) than in women (24·8–29·6 years). Between 2000 and 2017, the mean age at infection per cohort increased slightly: 0·5 to 2·8 years among men and −0·2 to 2·5 years among women. Across studies, between 38% and 63% (cohort medians) of the infections in women were among those aged 15–24 years and between 30% and 63% of infections in men were in those aged 20–29 years. Lifetime risk of HIV declined for successive birth cohorts.InterpretationHIV incidence declined in all age groups and shifted slightly to older ages. Disproportionate new HIV infections occur among women aged 15–24 years and men aged 20–29 years, supporting focused prevention in these groups. However, 40–60% of infections were outside these ages, emphasising the importance of providing appropriate HIV prevention to adults of all ages.FundingBill & Melinda Gates Foundation.

Incidence, Characteristics, and Outcomes of Emergent Isolated Coronary Artery Bypass Grafting

Data on emergency coronary artery bypass surgery (CABG) are limited. We studied patients who underwent isolated CABG at Mayo Clinic between 1993 and 2019. Baseline characteristics and in-hospital outcomes of emergent CABG were described in consecutive eras (1993 to 2000, 2001 to 2010, and 2011 to 2019). Cumulative survival was estimated by the Kaplan Meier method for the overall group, and stratified by the indication of surgery. In the 14,455 isolated CABG included, 427 (2.95%) were emergent. The number of emergent CABG decreased from 222 to 150 and 55 in the consecutive study eras. There was a temporal increase in the prevalence of heart failure, but no change in mean age, and prevalence of hypertension, diabetes, renal failure, or atrial fibrillation. The proportion of patients with failed/complicated percutaneous coronary intervention decreased from 38.2% in 1993 to 2000 to 22.7% in 2001 to 2010 and 25.5% in 2011 to 2019 (p = 0.003). In 2011 to 2019, 100% of patient received an internal mammary graft compared with 75.6% in 1993 to 2000 (p < 0.001). Operative mortality was 8.7% overall (8.6% in 1993 to 2000, 10.0% in 2001 to 2010, and 5.5% in 2011 to 2019, p = 0.56). There were no differences in postoperative complications except for the incidence of renal failure and new dialysis which increased over time. Predicted 10-year survival was 57.0% and was not different according to CABG indication (p = 0.12). In conclusion, we documented a temporal decrease in the incidence of emergent CABG between 1993 and 2019, especially those performed due to complications of coronary interventions. Despite the higher prevalence of left ventricular dysfunction and the more complete revascularization in more recent years, in-hospital mortality did not increase.

61P - No change in mean age of diagnosis of breast cancer during 30 years from 1981 to 2011 in the north east of Iran, report of six thousand patients

Background: Patterns of breast cancer differ greatly between Asian and Western countries and this study aimed to evaluate the age at the time of diagnosis of breast cancer and it’s probably changes in distribution among patients during 30 years Methods: This cross-sectional study was conducted in Mashhad, Iran from 1981 until 2011. The data of 6274 breast cancer patients were obtained from case records. The duration of study was categorized into three periods: 1981-1990, 1991-2000 and 2001-2011. SPSS software was used for analyses. Results: Mean age at the time of diagnosis was 49.07 ± 12.07 years (male: 56.48 ± 14.14, female: 48.8 ±12.01, p < 0.001). Table presents the mean age of studied patients in each 10 years of study. ANOVA test showed that there was no statistically significant difference (P value= 0.1).Table: 61PDecadesFrequencyMean ageSDYoungestOldest1981-199046747.9712.04318882000-1991177149.0312.33820992001-2011394949.2211.9542098 Open table in a new tab The most frequent histologic type of breast cancer was ductal carcinoma 65.6% others in order were: NOS 19.6%, lobular 3.7%, medullary 2.8%, adenocarcinoma 2.8%, tubular and papillary 0.2%, and 5.1% of other types. Relative frequency of histologic types had significant differences among 3 intervals (p < 0.001), the frequency of adenocarcinoma was decreasing but ductal carcinoma was increasing during 3 decades. Mean age of ductal carcinoma, lobular, medullary and adenocarcinoma was 48.9±11.8, 50.6±12.4, 46.4±11.4, 50.2±11.9, respectively. Mean age had significant differences among these main histologic types (p = 0.002).98% of patients were urban and 2% were rural. The frequency of people living in urban areas increased significantly (p < 00.1) during these 30 years compared with rural areas. Conclusions: Breast cancer occurs in Iranian women at least one decade younger than in women in developed countries. We found no change in mean age of diagnosis of breast cancer during these 30 years from 1981 to 2011. Legal entity responsible for the study: Mashhad University of Medical Sciences Funding: Mashhad University of Medical Sciences Disclosure: All authors have declared no conflicts of interest.

Abstract 266: Trends in age distribution of breast cancer, in north east of Iran: Report of six thousand patients over 30 years

Abstract Aim: This study was aimed to evaluate the age at the time of diagnosis of breast cancer and it’s probably changes in distribution among patients during 30 years. Methods: This cross- sectional study was conducted in Mashhad, Iran from 1981 until 2011. The data of patients were obtained from case records. The duration of study was categorized into three periods: 1981-1990, 1991-2000 and 2001-2011. SPSS software was used for analyses. The difference was considered significant if P&amp;lt;0.05. Result: From 6274 breast cancer cases, 174 patients were male (2.5%) and the others 6100 were female (97.5%).Mean age at the time of diagnosis was 49.07 ± 12.07 years (male: 56.48 ± 14.14, female: 48.8 ±12.01). There was significant difference in age by sex (p &amp;lt;0.001). Table 1 presents the mean age of studied patients in each 10 years of study. ANOVA test showed that there was not statistical significant difference (P value= 0.1). DecadesFrequencyMean ageSDYoungestOldest1981-199046747.9712.04318882000-1991177149.0312.33820992001-2011394949.2211.9542098 The most histologic type of breast cancer was ductal carcinoma 65.6% others percent in order were: NOS 19.6%, lobular 3.7%, medullary 2.8%, adenocarcinoma 2.8%, tubular and papillary 0.2% and 5.1% of other types. Relative frequency of histologic types had significant differences among 3 intervals (p &amp;lt;0.001), the frequency of adenocarcinoma was decreasing but ductal carcinoma was increasing during 3 decades. Mean age of ductal carcinoma, lobular, medullary and adenocarcinoma was 48.9±11.8, 50.6±12.4, 46.4±11.4, 50.2±11.9, respectively. Mean age had significant differences among these main histologic types (p =0.002).98% of patients were urban and 2% were rural. Mean age of these 2 groups has statistical significant difference (P = 0.001) and is 10 years older in rural patients. Frequency of people who live in urban area was increased significantly (p&amp;lt;00.1) during these 30 years compare with rural area. Conclusion: breast cancer occurs in Iranian women at least one decade younger than women in developed countries we found no change in mean age of diagnosis of breast cancer during these 30 years from 1981 to 2011. . Note: This abstract was not presented at the meeting. Citation Format: Maryam Salehi, Soodabeh Shahidsales, Mehdi Seilaniantousi, Gholamhosein Noferesti, Mahta Salehi, Amirhossein mohammadian bajgiran. Trends in age distribution of breast cancer, in north east of Iran: Report of six thousand patients over 30 years [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 266. doi:10.1158/1538-7445.AM2017-266

Impact of UK NICE clinical guidelines 168 on referrals to a specialist academic leg ulcer service.

Background Leg ulcers are a common cause of morbidity and disability and result in significant health and social care expenditure. The UK National Institute for Health and Care Excellence (NICE) Clinical Guideline (CG)168, published in July 2013, sought to improve care of patients with leg ulcers, recommending that patients with a break in the skin below the knee that had not healed within two weeks be referred to a specialist vascular service for diagnosis and management. Aim Determine the impact of CG168 on referrals to a leg ulcer service. Methods Patients referred with leg ulceration during an 18-month period prior to CG168 (January 2012-June 2013) and an 18-month period commencing six months after (January 2014-June 2015) publication of CG168 were compared. Results There was a two-fold increase in referrals (181 patients, 220 legs vs. 385 patients, 453 legs) but no change in mean age, gender or median-duration of ulcer at referral (16.6 vs. 16.2 weeks). Mean-time from referral to specialist appointment increased (4.8 vs. 6 weeks, p = 0.0001), as did legs with superficial venous insufficiency (SVI) (36% vs. 44%, p = 0.05). There was a trend towards more SVI endovenous interventions (32% vs. 39%, p = 0.271) with an increase in endothermal (2 vs. 32 legs, p = 0.001) but no change in sclerotherapy (24 vs. 51 legs) treatments. In both groups, 62% legs had compression. There was a reduction in legs treated conservatively with simple dressings (26% vs. 15%, p = 0.0006). Conclusions Since CG168, there has been a considerable increase in leg ulcer referrals. However, patients are still not referred until ulceration has been present for many months. Although many ulcers are multi-factorial and the mainstay of treatment remains compression, there has been an increase in SVI endovenous intervention. Further efforts are required to persuade community practitioners to refer patients earlier, to educate patients and encourage further investment in chronically underfunded leg ulcer services.

A chemistry‐climate model study of past changes in the Brewer‐Dobson circulation

AbstractModel simulations indicate an acceleration of the Brewer‐Dobson circulation (BDC) in the past with a direct impact on the exchange of air masses between the troposphere and the stratosphere. However, most observational data sets do not confirm the model results. Bönisch et al. (2011) and Ray et al. (2010) indicate a strengthening of the BDC in its shallow branch and a weakening in its deep branch. In contrast, balloon‐borne measurements and Michelson Interferometer for Passive Atmospheric Sounding satellite observations show no significant acceleration of the BDC at Northern Hemisphere (NH) midlatitudes. In our study, the change of the BDC in the recent past is analyzed from simulations with the chemistry‐climate model ECHAM/MESSy Atmospheric Chemistry. As the sign of change considerably depends on the underlying forcings, namely, changes in concentrations of greenhouse gases (GHGs) and ozone‐depleting substances (ODSs), as well as their interactions, we separate their contributions by using sensitivity simulations. The changes in tropical upward mass flux indicate a strengthening of the BDC between 1960 and 2000 in NH winter season in the lower and a weakening in the upper stratosphere with a change in sign at 10 hPa. While the lower stratospheric increase of about 2%/decade is caused by equal contributions from rising GHGs and ODSs, rising ODS concentrations counteract the GHG effect in the middle and upper stratosphere with a total decrease of about 0.5%/decade. Changes in mean age of air show a decrease of about 0.13 yr/decade in the lower and middle stratosphere and a slight increase in the Arctic upper stratosphere and lower mesosphere, which is induced by interactions between the forcings.

Stroke: Changing Risk Factor Profile and Unaltered Mean Age in a Developing Country. A Retrospective Study and Literature Review

Background: The rapid changes in the lifestyles of people in the developing countries such as India are known to increase the incidence of risk factors for stroke like hypertension (HTN), diabetes mellitus and dyslipidemia. Tobacco smoking and alcoholism are on the rise. Hence, stroke might occur in younger age groups when compared to the earlier generations. We compared data of age at stroke in India across a decade. Methods: Data from medical case records of 299 stroke patients from our tertiary referral Government General Hospital, Guntur, from January 2012 to December 2014 are collected and compared with previous studies of stroke in India. Results: The mean age at stroke was 55 (14) years with 32.3% women. The prevalence of smoking was 43%, HTN 46%, diabetes 17% and dyslipidemia 54.6%. A previous medical diagnosis of coronary artery disease was reported in 0.01% cases. When compared to previous studies, there was no significant change in mean age of stroke (p = 1.0). While smoking and dyslipidemias have increased, HTN and diabetes were more in earlier decades. Conclusions: The age at stroke has remained constant over the last 4 decades in India. The profile of risk factors for stroke has changed over the years.

Simulating water-quality trends in public-supply wells in transient flow systems.

Models need not be complex to be useful. An existing groundwater-flow model of Salt Lake Valley, Utah, was adapted for use with convolution-based advective particle tracking to explain broad spatial trends in dissolved solids. This model supports the hypothesis that water produced from wells is increasingly younger with higher proportions of surface sources as pumping changes in the basin over time. At individual wells, however, predicting specific water-quality changes remains challenging. The influence of pumping-induced transient groundwater flow on changes in mean age and source areas is significant. Mean age and source areas were mapped across the model domain to extend the results from observation wells to the entire aquifer to see where changes in concentrations of dissolved solids are expected to occur. The timing of these changes depends on accurate estimates of groundwater velocity. Calibration to tritium concentrations was used to estimate effective porosity and improve correlation between source area changes, age changes, and measured dissolved solids trends. Uncertainty in the model is due in part to spatial and temporal variations in tracer inputs, estimated tracer transport parameters, and in pumping stresses at sampling points. For tracers such as tritium, the presence of two-limbed input curves can be problematic because a single concentration can be associated with multiple disparate travel times. These shortcomings can be ameliorated by adding hydrologic and geologic detail to the model and by adding additional calibration data. However, the Salt Lake Valley model is useful even without such small-scale detail.

Effect of preeclampsia on insulin sensitivity

Objective:The objective of this study is to investigate whether preeclampsia is associated with exacerbation of insulin resistance.Materials and Methods:The study was conducted over a period of 7 months from November 2011 to May 2012, in a tertiary care hospital attached to a medical college. A total of 14 pregnant women in the third trimester with preeclampsia were recruited for this study and 14 well-matched normotensive women in the third trimester were taken as control. 15 g, 50% dextrose load was given intravenously and blood sampling was carried out for glucose and insulin levels up to 3 h afterward. Minimal model analysis of glucose and insulin levels was performed to arrive at results.Results:No significant changes in mean age, body mass index, gestation, serum lipid and progesterone, cortisol and androgen concentrations were recognized. No significant difference was found between the glucose decay curves and between the glucose clearance rate K, in the two groups (preeclamptic vs. normotensive: 2.1 ± 0.2 vs. 2.2 ± 0.3; P = 0.48). Therefore, there was a small but prolonged decrease in the insulin response of women with preeclampsia compared with women in the normotensive group.Conclusion:Preeclampsia per se is not a risk factor for development of insulin resistance.

Unraveling impact factors for future changes in the Brewer‐Dobson circulation

Climate models project an increase in the Brewer‐Dobson circulation (BDC) with increasing future greenhouse gas (GHG) concentrations. This study identifies the causes of future changes in the BDC from sensitivity simulations with the EMAC chemistry‐climate model, by changing the external forcings, like GHG concentrations, sea surface temperatures (SSTs) together with sea ice concentrations, and ozone‐depleting substances (ODS), separately. The particular influence of rising tropical SSTs is assessed. Contributions of different waves to changes in the residual circulation are calculated as well as changes in mean age of stratospheric air (AoA) to account for the effect of mixing processes. We find that in boreal winter the tropical upward mass flux increases by about 1%/dec in the upper and 2%/dec in the lower stratosphere until the end of the 21st century. Mean AoA decreases by up to 60 and 30 days/dec, respectively. Changes in transient planetary and synoptic waves account for the strengthening of the BDC in the lower stratosphere, whereas upper stratospheric changes are due to improved propagation properties for gravity waves in future climate. Regarding the external forcings, the radiative impact of rising GHG concentrations is detected to affect upper stratospheric layers only, whereas lower stratospheric signals are almost entirely due to rising SSTs. Changes in tropical SSTs influence not only the shallow but also the deep branch of the BDC as confirmed from both changes in residual circulation and mixing. Declining ODS will slightly counteract the BDC increase in the Southern Hemisphere.

Age at Maturity, Fork Length, and Sex Ratio of Upper Willamette River Hatchery Spring Chinook Salmon

AbstractWe used data from 17 brood years of coded‐wire‐tagged hatchery spring Chinook Salmon Oncorhynchus tshawytscha from the upper Willamette River to test for changes in mean age at maturity, fork length, and sex ratio. We found only limited evidence for any trend in age at maturity or sex ratio. However, Chinook Salmon sampled from tangle nets, recreational fisheries, spawning grounds, and hatcheries all presented trends of decline in mean fork length. Rates of change in fork length ranged from 0 to 5 mm per year in most sample collections, though fork length declined more rapidly for samples from tangle nets. We also observed a positive relationship between adult fork lengths and the median monthly Pacific Decadal Oscillation index in the year prior to juvenile liberation (the brood year). We suggest that future research should investigate the potential cause(s) for the decline in size of hatchery spring Chinook Salmon from the upper Willamette River, with attention to harvest, broad‐scale environmental conditions, and hatchery spawning and rearing practices.Received March 12, 2012; accepted December 11, 2012

HIV Counseling and Testing in an Urban Reproductive Primary Health Clinic in South Africa

This letter to the editor focuses on the gender differences for HIV counseling and testing in South Africa. It describes the profile of men and women testing positive for HIV at an urban reproductive health facility in Durban and explains the methods and results of the study.

P213 Longitudinal changes in the rate and mean age of incidence and prevalence of COPD in the UK, 2000–2009

IntroductionSince the NICE guidelines in 2004 and introduction of the Quality and Outcomes Framework (QOF) in 2004, the prevalence of COPD seen in general practice has increased (Smith 2008).1 We...

Trends in refractive surgery at an academic center: 2007-2009

BackgroundThe United States officially entered a recession in December 2007, and it officially exited the recession in December 2009, according to the National Bureau of Economic Research. Since the economy may affect not only the volume of excimer laser refractive surgery, but also the clinical characteristics of patients undergoing surgery, our goal was to compare the characteristics of patients completing excimer laser refractive surgery and the types of procedures performed in the summer quarter in 2007 and the same quarter in 2009 at an academic center. A secondary goal was to determine whether the volume of astigmatism- or presbyopia-correcting intraocular lenses (IOLs) has concurrently changed because like laser refractive surgery, these "premium" IOLs involve out-of-pocket costs for patients.MethodsRetrospective case series. Medical records were reviewed for all patients completing surgery at the Wilmer Laser Vision Center in the summer quarter of 2007 and the summer quarter of 2009. Outcome measures were the proportions of treated refractive errors, the proportion of photorefractive keratectomy (PRK) vs. laser-assisted in-situ keratomileusis (LASIK), and the mean age of patients in each quarter. Chi-square test was used to compare the proportions of treated refractive errors and the proportions of procedures; two-tailed t-test to compare the mean age of patients; and two-tailed z-test to compare proportions of grouped refractive errors in 2007 vs. 2009; alpha = 0.05 for all tests. Refractive errors were grouped by the spherical equivalent of the manifest refraction and were considered "low myopia" for 6 diopters (D) of myopia or less, "high myopia" for more than 6 D, and "hyperopia" for any hyperopia. Billing data were reviewed to obtain the volume of premium IOLs.ResultsVolume of laser refractive procedures decreased by at least 30%. The distribution of proportions of treated refractive errors did not change (p = 0.10). The proportion of high myopes, however, decreased (p = 0.05). The proportions of types of procedure changed, with an increase in the proportion of PRK between 2007 and 2009 (p = 0.02). The mean age of patients did not change [42.4 ± 14.4 (standard deviation) years in 2007 vs. 39.6 ± 14.5 years in 2009; p = 0.4]. Astigmatism-correcting IOL and presbyopia-correcting IOL volumes increased 15-fold and three-fold, respectively, between 2007 and 2009.ConclusionsVolume of excimer laser refractive surgery decreased by at least 30% between 2007 and 2009. No significant change in mean age or in the distribution of refractive error was seen, although the proportion of high myopes decreased between summer quarters of 2007 and 2009. PRK gained as a proportion of total cases. Premium IOL volume increased, but still comprised a very small proportion of total IOL volume.

Effect of delivery care user fee exemption policy on institutional maternal deaths in the central and volta regions of ghana.

To improve access to skilled attendance at delivery and thereby reduce maternal mortality, the Government of Ghana introduced a policy exempting all women attending health facilities from paying delivery care fees. To examine the effect of the exemption policy on delivery-related maternal mortality. Maternal deaths in 9 and 12 hospitals in the Central Region (CR) and the Volta Region (VR) respectively were analysed. The study covered a period of 11 and 12 months before and after the introduction of the policy between 2004 and 2006. Maternal deaths were identified by screening registers and clinical notes of all deaths in women aged 15-49 years in all units of the hospitals. These deaths were further screened for those related to delivery. The total births in the study period were also obtained in order to calculate maternal mortality ratios (MMR). A total of 1220 (78.8%) clinical notes of 1549 registered female deaths were retrieved. A total of 334 (21.6%) maternal deaths were identified. The delivery-related MMR decreased from 445 to 381 per 100,000 total births in the CR and from 648 to 391 per 100,000 total births in the VR following the implementation of the policy. The changes in the 2 regions were not statistically significant (p=0.458) and (p=0.052) respectively. No significant changes in mean age of delivery-related deaths, duration of admission and causes of deaths before and after the policy in both regions. The delivery-related institutional maternal mortality did not appear to have been significantly affected after about one year of implementation of the policy.

Trends in the management of vestibular schwannomas at Johns Hopkins 1997–2007

To assess trends in the management of unilateral vestibular schwannomas over an 11-year period and to identify disease- and provider-related influences. Retrospective chart review. Subjects presented to the Department of Otolaryngology-Head and Neck Surgery and the Department of Neurosurgery for management of unilateral vestibular schwannoma from 1997 through 2007, with at least two visits within the first year of presentation. The proportion of patients for whom initial management consisted of observation, surgical resection, or radiation therapy was determined, and the relative influence of study year, patient age, hearing status, and tumor size was analyzed. Over the study period there was an increase in the proportion of cases that were observed with follow-up scanning (10.5% to 28.0%) and recommended for radiation (0% to 4.0%), whereas the proportion of operated cases declined (89.5% to 68.0%). There were no changes in mean age or hearing status at diagnosis, but mean tumor size declined significantly. Compared to those undergoing surgery, patients choosing observation and radiation therapy were on average 11.7 and 4.5 years older, respectively. Tumors that were surgically removed were on average 11.6 mm larger than those that were observed. The increasing frequency over time of observation relative to surgery was significant even after controlling for age, hearing status, and tumor size. Among patients managed by our center, there has been a significant shift in management of vestibular schwannomas over the last decade, with increasing tendency towards observation. This trend implies changing provider philosophy and patient expectations.