General Mortality Research Articles

Mortality and causes of death of traumatic spinal cord injury in Finland.

Prospective cohort study. To study the mortality rates of TSCI patients compared to matched controls and to examine possible TSCI-related mortality risk factors and causes of death. Oulu and Tampere University Hospital, Finland. All consecutive patients with a new TSCI were included in a prospective study (n = 344, 2012-16). All patients were followed until death or the end of 2019. Patients were compared to a control group formed by randomly choosing gender, age, municipality, and calendar time-matched controls (5 controls/TSCI patient). Standardized mortality ratios (SMR) were calculated using general population mortality rates. Mortality information was extracted from the Statistics of Finland (Helsinki, Finland). TSCI patients had an increased mortality (SMR = 2.9) compared with the Finnish population. During the observation period, 26% of TSCI patients and 12% of the matched controls died. Of the TSCI patient deaths, 51% occurred within the first two years postinjury. Increased age, severity of TSCI (as per International SCI Core Data Set) and fall were related to mortality (p < 0.05). The two most common etiologies of death were: circulatory (30%), and pulmonary diseases (28%). Pneumonia was the single most frequent disease leading to death among TSCI patients. During the first years after injury, the mortality of the patients with TSCI is double compared to the controls. Most deaths occur within two years postinjury. Elderly patients with more severe fall-related injury have the highest mortality risk. Circulatory diseases and pulmonary diseases, especially pneumonia, are the foremost causes of death after TSCI.

Krankenhaussterblichkeit bei Patienten mit und ohne Demenz

Background: Studies reported a higher in-hospital mortality in patients living with dementia (PlwD) with limited evidence across age groups, clinical departments and admission diagnoses. Study aim was to compare the in-hospital mortality rate of PlwD with non-demented controls across groups, clinical departments and admission diagnoses. Methods: This case-control study included patients aged ≥ 60 years hospitalized in one of 36 German hospitals between January 2019 and July 2023. PlwD were matched to non-demented controls. The associations between dementia and in-hospital mortality across groups were assessed using univariable logistic regression analyses. Results: 29,203patients with and 29,203 without dementia were included (mean age: 84 years, 60% female). PlwD had a significantly higher in-hospital mortality rate than non-dementia controls. The excess mortality rate was highest in the youngest age group (60–70 years), decreased with age, and became non-significant in the oldest age group (≥ 90 years). Significant differences were found for digestive system, cardiovascular and cerebrovascular disorders, endocrine, nutritional and metabolic diseases, and pneumonia, as well as for internal medicine and gastroenterology departments. Conclusion: The excess mortality rate was highest in younger age groups, where the general mortality and complication rate is relatively low in the general population. Appropriate approaches are needed.

Overcoming barriers in implementing healthy school nutrition policies: insights from Ukraine

Abstract The general mortality rate from NCDs in Ukraine exceeds that in European Union countries, (Yurochko et al., 2023) exacerbated by the ongoing war. Healthy nutrition plays a pivotal role in enhancing the overall quality of life and curbing the prevalence of non-communicable diseases (NCDs). Despite its significance, ensuring healthy eating habits, particularly during the early stages of life at the period of setting lifelong habits (Jackson et al., 2020; Riley et al., 2018), remains a challenge. Besides, school-based settings represent an ideal environment for effective intervention because they offer a shared common physical, academic, and social space (Tapia-Fonllem et al., 2020). Through a series of semi-structured interviews with key stakeholders, this study identifies barriers and facilitators to policy implementation, with a focus on educational institutions. Qualitative analysis reveals barriers such as inadequate human resources, funding constraints, resistance from the food industry, and ineffective communication strategies at the family level. Moreover, there exists a disjointed understanding of nutrition standards. However, collaborative efforts with civil society, empowerment of nursing roles, strategic utilization of grants and fundraising, engagement with the food industry, and the adoption of a family-oriented approach emerge as crucial enablers for successful policy implementation. These findings offer theoretical foundations for fostering healthier nutrition environments within schools. This research serves as a roadmap for policymakers and educators striving to create sustainable and effective strategies for promoting healthy eating among early school-age children in Ukraine and beyond. Study finds human resource shortages, funding constraints, and food industry resistance as major barriers to school nutrition policy. Recommendations include collaborative approaches, nurse involvement, and aligned standards for effective school nutrition policy. Key messages • Healthy nutrition plays a pivotal role in enhancing the overall quality of life and curbing the prevalence of non-communicable diseases. • Through a series of semi-structured interviews with key stakeholders, this study identifies barriers and facilitators to policy implementation, with a focus on educational institutions.

Dynamic changes in hs-CRP and risk of all-cause mortality among middle-aged and elderly adults: findings from a nationwide prospective cohort and mendelian randomization

IntroductionThe general population experiences mortality rates that are related to high levels of high-sensitivity C-reactive protein (hs-CRP). We aim to assess the linkage of longitudinal trajectories in hs-CRP levels with all-cause mortality in Chinese participants.MethodsWe utilized data from the China Health and Retirement Longitudinal Study (CHARLS). The exposures were dynamic changes in the hs-CRP and cumulative hs-CRP from 2012 to 2015, and the outcome was all-cause mortality. All participants were categorized into four trajectories according to hs-CRP levels. Multivariable logistic regression analysis, adjusted for potential confounders, was employed to evaluate the relationship of different trajectories of hs-CRP with mortality risk. A two-sample Mendelian randomization (TSMR) method and SHapley Additive exPlanations (SHAP) for identifying determinants of mortality risk were also employed.ResultsThe study included 5,445 participants with 233 deaths observed, yielding a mortality proportion of 4.28%. Compared to individuals maintaining low, stable levels of hs-CRP (Class 1), individuals with sustained elevated levels of hs-CRP (Class 4), those experiencing a progressive rise in hs-CRP levels (Class 2), or those transitioning from elevated to reduced hs-CRP levels (Class 3) all faced a significantly heighted death risk, with adjusted Odds Ratios (ORs) ranging from 2.34 to 2.47 across models. Moreover, a non-linear relationship was found between them. Further TSMR analysis also supported these findings. SHAP showed that hs-CRP was the fifth most important determinant of mortality risk.ConclusionsOur study shows all-cause mortality increases with dynamic changes in hs-CRP levels among middle-aged and elderly adults in China, and cumulative hs-CRP shows an L-shaped relationship with all-cause mortality.

Risk of Suicide and Suicidality in Patients with Moderate to Severe Psoriasis: results from the British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR).

Psoriasis is associated with poor mental health and reduced quality of life. Although the high risk for depression in patients with psoriasis is well-established, their suicidality risk is uncertain. Previous studies provide contrasting results and have not included patients with clinically-confirmed severe disease. Our aim was to determine risk of suicide among patients with moderate to severe psoriasis compared with the general population, and investigate if psychiatric comorbidity or history of suicidality increases future suicidality risk in psoriasis. We further estimated the incidence of suicidal and self-injurious behaviours in patients. Analysis was performed using the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR). As controls, general population mortality and suicide data were used. There were 9 suicides in BADBIR. The incidence rate of suicide was 12.5 per 100,000 person-years (95% CI 6.53, 24.11) in BADBIR versus 11.0 per 100,000 person-years (95% CI 10.7, 11.3) in the general population in England and Wales. Among patients, psychiatric comorbidity or past suicidality was associated with higher risk for suicidal ideation, suicide attempts and self-injurious behaviours. Suicide rates among patients with moderate to severe psoriasis were not significantly higher compared with the general population. Suicide is a rare event and our results are limited by the uncertainty in the estimate reliability. However, considering the high depression prevalence in psoriasis, our findings support the need for prompt assessment of patients for psychiatric comorbidities and suicidality history. Further research is required on suicidal behaviours and the role of psoriasis severity.

Considering User Experience and Behavioral Approaches in the Design of mHealth Interventions for Atrial Fibrillation: Systematic Review.

Atrial fibrillation (AF) is a leading chronic cardiac disease associated with an increased risk of stroke, cardiac complications, and general mortality. Mobile health (mHealth) interventions, including wearable devices and apps, can aid in the detection, screening, and management of AF to improve patient outcomes. The inclusion of approaches that consider user experiences and behavior in the design of health care interventions can increase the usability of mHealth interventions, and hence, hopefully, yield an increase in positive outcomes in the lives of users. This study aims to show how research has considered user experiences and behavioral approaches in designing mHealth interventions for AF detection, screening, and management; the phases of designing complex interventions from the UK Medical Research Council (MRC) were referenced: namely, identification, development, feasibility, evaluation, and implementation. Studies published until September 7, 2022, that examined user experiences and behavioral approaches associated with mHealth interventions in the context of AF were extracted from multiple databases. The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were used. A total of 2219 records were extracted, with only 55 records reporting on usability, user experiences, or behavioral approaches more widely for designing mHealth interventions in the context of AF. When mapping the studies onto the phases of the UK MRC's guidance for developing and evaluating complex interventions, the following was found: in the identification phase, there were significant differences between the needs of patients and health care workers. In the development phase, user perspectives guided the iterative development of apps, interfaces, and intervention protocols in 4 studies. Most studies (43/55, 78%) assessed the usability of interventions in the feasibility phase as an outcome, although the data collection tools were not designed together with users and stakeholders. Studies that examined the evaluation and implementation phase entailed reporting on challenges in user participation, acceptance, and workflows that could not be captured by studies in the previous phases. To realize the envisaged human behavior intended through treatment, review results highlight the scant inclusion of behavior change approaches for mHealth interventions across multiple levels of sociotechnical health care systems. While interventions at the level of the individual (micro) and the level of communities (meso) were found in the studies reviewed, no studies were found intervening at societal levels (macro). Studies also failed to consider the temporal variation of user goals and feedback in the design of long-term behavioral interventions. In this systematic review, we proposed 2 contributions: first, mapping studies to different phases of the MRC framework for developing and evaluating complex interventions, and second, mapping behavioral approaches to different levels of health care systems. Finally, we discuss the wider implications of our results in guiding future mHealth research.

Healthy nutrition – prevention of chronic non-communicable diseases. Overview of recommendations

The article provides an overview of the National Recommendations on healthy nutrition available in Europe, Asia (China), the USA and the Russian Federation, assesses the compliance of the presented guidelines with the principles of a healthy diet according to the recommendations of the World Health Organization, and analyzes their role in the prevention of the development of non-infectious diseases, including number of diseases of the cardiovascular system. A search of relevant literature for the review was conducted in PubMed (www.pubmed.gov) using English keywords (“national dietary guidelines”, “WHO diet”, “FBDG”, “dietary guidelines”, “cardiovascular factors”), the website of the National Project of the Russian Federation “Healthy Nutrition” (https://здоровое-питание.рф), eLIBRARY.RU (https://elibrary.ru/defaultx.asp) using keywords in Russian (“ESSE-RF”, “risk factors for non-infectious diseases”, “nutrition”). Publications published between 1995 and 2022 were considered. The review included the National Recommendations in force for 2023, as well as the results of cohort and multicenter studies, the purpose of which was to assess the impact of current recommendations on the development of traditional cardiovascular risk factors, associated clinical conditions (myocardial infarction, stroke, etc.), as well as the impact on general mortality. Publications with completely duplicate data and conclusions were excluded, and in case of partial overlap, both sources were indicated. As a result, a list was compiled of articles, newsletters, and links with up-to-date information on the National Guidelines.

The Impact of the Approach to Accounting for Age and Sex in Economic Models on Predicted Quality-Adjusted Life-Years.

The method used to model general population mortality estimates in cohort models can make a meaningful difference in appraisals; particularly in scenarios involving potentially curative treatments where a prior National Institute for Health and Care Excellence (NICE) appraisal demonstrated that this assumption alone could make a difference of ~£10,000 to the incremental cost-effectiveness ratio. Our objective was to evaluate the impact of different methods for calculating general population mortality estimates on the predicted total quality-adjusted life expectancy (QALE) as well as absolute and proportional quality-adjusted life year (QALY) shortfall calculations. We employed three distinct methods for deriving general population mortality estimates: firstly, utilizing the population mean age at baseline; secondly, modelling the distribution of mean age at baseline by fitting a parametric distribution to patient-level data sourced from the Health Survey for England (HSE); and thirdly, modelling the empirical age distribution. Subsequently, we simulated patient age distributions to explore the effects of mean starting age and variance levels on the predicted QALE and applicable severity modifiers. Provided sample code in R and Visual Basic for Applications (VBA) facilitates the utilization of individual patient age and sex data to generate weighted average survival and health-related quality of life (utility) outputs. We observed differences of up to 10.4% (equivalent to a difference of 1.01 QALYs in quality-adjusted life-expectancy) between methods using the HSE dataset. In our simulation study, increasing variance in baseline age diminished the accuracy of predictions relying solely on mean age estimation. Differences of -0.30 to 2.24 QALYs were found at a standard deviation of 20%; commonly observed in trials. For potentially curative treatments this would represent a difference in economically justifiable price of -£4,500-+£33,600 at a cost-effectiveness threshold of £30,000 per QALY for a treatment with a 50% cure rate. For lower baseline ages, the population mean method tended to overestimate QALE, whereas for higher baseline ages, it tended to underestimate QALE compared with individual patient age-based approaches. The severity modifier assigned did not vary, however, apart from simulations with means at the extremes of the age distribution or with very high variance. Our analysis underscores the necessity of accounting for the distribution of mean age at baseline, as failure to do so can lead to inaccurate QALE estimates, thereby affecting calculations of incremental costs and QALYs in models, which base survival and quality of life predictions on general population expectations. We would recommend that patient age and sex distribution should be accounted for when incorporating general population mortality in economic models. Provided sufficient sample size, utilizing the observed empirical distribution for the expected population in clinical practice is likely to yield the most accurate results. However, in the absence of patient-level data, selecting a suitable parametric distribution is recommended.

Abstract C055: Hurricane floods and quality of life among gynecological cancer patients in Puerto Rico: A retrospective cohort study

Abstract INTRODUCTION. Previous studies show the devasting impacts of hurricanes on the health outcomes of cancer patients via treatment interruption. However, there is limited information on the impact of floods after the hurricanes on quality of life, within physical and mental domains, especially for island communities such as Puerto Rico which are at high-risk of these events. PURPOSE. In this study we aimed to assess the relationship between floods and quality of life of women diagnosed with gynecological cancers in Puerto Rico after the hurricane season of 2017. Methods. Women (n=271) with gynecological cancers recruited from a clinic-based sample in Puerto Rico were retrospectively interviewed between September 2019 and November 2020. After consenting, one-hour interviews were conducted over the phone to complete a comprehensive survey. This survey collected information on sociodemographic, clinical, lifestyles, and quality of life for all participants. Our primary outcome was quality of life experienced by participants considering the physical and mental domains 3 months after the occurrence of the hurricanes. Pearson’s Chi-square test and logistic regression models were performed using STATA. SUMMARY OF DATA. Participants were mostly 50 years old or older (78.8%), married (51.2%), employed or self-employed (30.4%), had low annual income (&amp;lt;$20,000; 66.9%) and were well educated (41.2% hold a bachelor’s degree). A third of the participants (31%) reported physical distress before hurricanes, compared to 46% post hurricane. In terms of the mental domain, only 25% of participants reported mental distress before the hurricanes, compared to 59% post hurricane (p &amp;lt;0.01). A slight difference in percentage was observed for the need of emotional and social support of the participants pre (92%) and post (93%) hurricane. Half of the participants (51.4%) experienced floods related to the hurricanes. On multivariable analysis adjusted by education, age, income, and history of gynecological cancers, we observed that participants who experienced flooding were more likely to report having physical (AOR, 1.88; 95% CI 1.08-3.25) and mental (AOR, 2.85; 95% CI 1.52-5.35) distress after the hurricanes in comparison to their counterparts. No statistically significant association was observed for other measures such as general health status or the need of emotional or social support. Conclusion. Floods significantly impacted the quality of life of gynecological cancer patients in Puerto Rico following hurricane seasons of 2017. These findings highlight the need to strengthen public infrastructure that will better protect the homes of inhabitants of Puerto Rico, especially cancer patients, when faced with hurricane disasters. Cancer patients already face many obstacles that make it difficult to cope with physical and mental distress, but flooding is a preventable risk that public infrastructure can alleviate. Further research is warranted to understand the duration of impact on quality of life and effects on overall general health, health outcomes, and mortality. Citation Format: Amarilis Bolanos, Sandra Garcia, Jeslie M. Ramos-Cartagena, Ana Patricia Ortiz, Nancy R. Cardona-Cordero. Hurricane floods and quality of life among gynecological cancer patients in Puerto Rico: A retrospective cohort study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C055.

General Population Mortality Adjustment in Survival Extrapolation of Cancer Trials: Exploring Plausibility and Implications for Cost-Effectiveness Analyses in HER2-Positive Breast Cancer in Sweden.

In economic evaluations of novel therapies, assessing lifetime effects based on trial data often necessitates survival extrapolation, with the choice of model affecting outcomes. The aim of this study was to assess accuracy and variability between alternative approaches to survival extrapolation. Data on HER2-positive breast cancer patients from the Swedish National Breast Cancer Register were used to fit standard parametric distribution (SPD) models and excess hazard (EH) models adjusting the survival projections based on general population mortality (GPM). Models were fitted using 6-y data for stage I and II, 4-y data for stage III, and 2-y data for stage IV cancer reflecting an early data cutoff while maintaining sufficient events for comparison of model estimates with actual long-term outcomes. We compared model projections of 15-y survival and restricted mean survival time (RMST) to 15-y registry data and explored the variability between models in extrapolations of long-term survival. Among 11,224 patients compared with the observed registry 15-y RMST estimates across the disease stages, EH cure models provided the most accurate estimates in patients with stage I to III cancer, whereas EH models without cure most closely matched survival in patients with stage IV cancer, in which cure assumption was less plausible. The Akaike information criterion-averaged model projections varied as follows: -8.2% to +5.3% for SPD models, -4.9% to +5.2% for the EH model without a cure assumption, and -19.3% to -0.2% for the EH model with a cure assumption. EH models significantly reduced between-model variance in the predicted RMSTs over a 50-y time horizon compared with SPD models. EH models may be considered as alternatives to SPD models to produce more accurate and plausible survival extrapolation that accounts for general population mortality. Excess hazard (EH) methods have been suggested as an approach to incorporate background mortality rates in economic evaluation using survival extrapolation.We highlight that EH models with or without a cure assumption can produce more accurate survival projections and significantly reduce between-model variability in comparison with standard parametric distribution models across cancer stages.EH models may be a preferred modeling method to reduce model uncertainty in health economic modeling since models that would otherwise have produced implausible extrapolations are constrained by the EH framework.Reduced uncertainty in economic evaluations will enhance the application of evidence-based health care decision making.

Long-term survival analysis of patients with primary Sjögren's syndrome in China: A multicenter retrospective cohort study.

This study aimed to evaluate the long-term survival, causes of death, and prognostic factors in Chinese patients with primary Sjögren syndrome (pSS). We included patients with pSS registered in the Chinese Rheumatism Data Centre between May 2016 and December 2021, and collected baseline clinical, laboratory, and treatment data. Survival and standard mortality rates were calculated using general population mortality data. Factors related to mortality were identified using Cox proportional hazards regression. Among the 8588 patients included, 274 died during a median follow-up of 4.0 years. The overall standardized mortality ratio was 1.61 (95% CI: 1.43-1.81). Overall survival rates were 98.2% at 5 years and 93.8% at 10 years. The predominant causes of death were comorbidities, including cardiovascular diseases, tumors, and infections, while the most frequent pSS-related causes of death were interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH). Male sex, older age, ILD, PAH, and high EULAR Sjögren's syndromedisease activity index (ESSDAI), thrombocytopenia, anemia, high immunoglobulin A (IgA) level, and glucocorticoid treatment independently increased the mortality risk, while using hydroxychloroquine was a protective factor. Mortality rates have significantly increased in Chinese patients with pSS. Comorbidities, rather than pSS-related organ damage, were the main causes of death. All-cause mortality was associated with male sex, older age, ILD, PAH, high ESSDAI, thrombocytopenia, anemia, high IgA level, and glucocorticoid treatment, whereas hydroxychloroquine use might improve the long-term survival.

Trends in educational inequalities in smoking-attributable mortality and their impact on changes in general mortality inequalities: evidence from England and Wales, Finland, and Italy (Turin)

BackgroundSocioeconomic mortality inequalities are persistent in Europe but have been changing over time. Smoking is a known contributor to inequality levels, but knowledge about its impact on time trends in...

Randomized Controlled Trial Based US Commercial Payor Cost-Effectiveness Analysis of Endoscopic Sleeve Gastroplasty Versus Lifestyle Modification Alone for Adults With Class I/II Obesity.

Endoscopic sleeve gastroplasty (ESG) is a minimally invasive day procedure that the MERIT randomized controlled trial (RCT) has demonstrated to be an effective and safe method of weight loss versus lifestyle modification alone. We sought to evaluate the cost-effectiveness of ESG from the perspective of a US commercial payer in a cohort of adults with class II and class I obesity with diabetes based on this RCT. We used a Markov modelling approach with BMI group health states and an absorbing death state. Baseline characteristics, utilities, BMI group transition probabilities, and adverse events (AEs) were informed by patient-level data from the MERIT RCT. Mortality was estimated by applying BMI-specific hazard ratios to US general population mortality rates. We used BMI-based health state utilities to reflect the impact of obesity comorbidities and applied disutilities due to ESG AEs. Costs included intervention costs, AE costs, and BMI-based annual direct healthcare costs to account for costs associated with obesity comorbidities. A willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY) was assumed. In our base-case analysis over a 5-year time horizon, ESG was cost-effective versus lifestyle modification alone with an incremental cost-effectiveness ratio of $23,432/QALY. ESG remained cost-effective in all sensitivity analyses we conducted and was dominant in analyses with longer time horizons. ESG is a cost-effective treatment option for people living with obesity and should be considered in commercial health plans as an additional treatment option for clinically eligible patients.

Life Table Prediction Using the Lee-Carter Model

&lt;span lang="EN-US"&gt;Mortality is the state where all signs of life permanently, which can occur at any time after a person is born. Mortality data can be presented in the form of table called a mortality table, which is a table that provides an overview of the life of a population group starting from births at the same time and life of a population group that starts from birth at the same time and slowly decreases due to death. In actuarial studies, this table has a role as one of the important factors to determine the amount of premium costs and premium reserves, especially life insurance. Therefore, it is necessary for continuity in conducting research related to mortality tables. This research aims to forecast the death rate and the probability of death of the population in the future using the Lee-Carter model, which is a mortality forecasting model that combines a demographic model with a time series model. This mortality model shows that the logarithm of mortality rate is the sum of the parameters of the average general mortality rate by age and the multiplication of the trend parameter of mortality rate changes by age with the mortality index parameter. Forecasting process begins with estimating the parameters of the average mortality rate and the trend of mortality rate changes influenced by the mortality index parameter using the singular value decomposition (SVD) method. After that, the mortality index mortality index is forecasted using the ARIMA model and the results of this forecast are then reinserted into the Lee-Carter model to obtain death rate prediction. Based on the results of the mortality rate prediction, it can then be the prediction of the probability of death for the mortality table. The result of this research is a mortality table that contains predictions of the probability of death of the Indonesian population for both male and female gender using the Lee-Carter model from the year 2022 2026. Based on these results, it is concluded that the value of the probability of death for each year increases with increasing age.&lt;/span&gt;

Sensitivity of Fire Indicators on Forest Inventory Plots Is Affected by Fire Severity and Time since Burning

Forest inventory data are useful for determining forest stand structure, growth, and change. Among the information collected on forest inventory plots by the USDA Forest Service Forest Inventory and Analysis Program, attributes characterizing various types of disturbance provide researchers a means of selecting plots specifically affected by disturbances, such as fire. We determine the performance of three of these attributes as indicators of recent fires on forest inventory plots of the United States by comparing them to independent records of wildland fire occurrence. The indicators are plot-level observations of fire effects on (1) general site appearance, (2) tree mortality, and (3) damage to live trees. Independent spatial layers of wildland fire perimeters provide an approach to test indicator performance and identify characteristics of fires that may affect detection. The sensitivities of indicators are generally higher in the West relative to the East. Detection rates exceed 90 percent for the Pacific Coast forests but seldom reach 80 percent in the East. Among the individual indicators, site appearance has higher identification rates than tree indicators for fires in the Pacific Coast, Great Plains, North, and South regions. Tree mortality is the most important single indicator for identifying Rocky Mountain fires. Tree damage is more important than tree mortality in the South; otherwise, the tree damage indicator is of relatively lower importance, particularly where high-severity fires are common, and tree survival is low. The rate of detection by the indicators is affected by the severity of the fire or the recency of the fire. The joint effect of severity and recency influence all three indicators for the Pacific Coast and Rocky Mountain fires, as well as the site appearance indicator in the South. Only a small proportion of fires are clearly missed by all three of the indicators.

Prevalence of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae and Associated Clinical Implications at the University Teaching Hospital of Kigali in Rwanda.

Extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae poses a global problem and complicates therapeutic choices. The paucity of data in resource-poor countries undermines the understanding of the problem's extent, and cases of antimicrobial treatment failure continue to accumulate. This study aimed to determine the prevalence and clinical implications of ESBL-producers at the University Teaching Hospital of Kigali in Rwanda. A 1-year cross-sectional retrospective study was conducted on Escherichia coli and Klebsiella pneumoniae isolated in blood and urine from January 1 to December 31, 2022. In total, 1,283 isolates were recorded. The results showed an overall prevalence of ESBL phenotypes at 300/1,283 (23.4%). Extended spectrum beta-lactamase-positive E. coli was more frequently detected than K. pneumoniae in both urine (20.6% versus 10.1%) and blood (8.8% versus 6.2%). These isolates were 100% resistant to amoxicillin-clavulanic acid, third-generation cephalosporins, piperacillin, sulbactam ampicillin, ampicillin, cefuroxime, and cefoxitin. The least resistance was observed to amikacin (18%), meropenem (10%), and polymyxin B (3%). Hospital stays ranging from 8 to 21 days were the most frequent, and the mortality rate was 10.3% in patients with ESBL cases, which was more than double the general hospital mortality rate in the same period. In conclusion, our findings indicate a high prevalence of ESBL phenotypes, high antibiotic resistance rates, prolonged hospital stays, and an increased mortality rate. These findings suggest the need for continued surveillance, planning appropriate interventions, and caution during empirical therapy.

Acute Renal Failure in the Pediatric Intensive Care Unit: Incidence and Its Effects on Clinical Outcomes

Background: Renal dysfunction is a prevalent complication among patients admitted to intensive care units (ICUs), significantly impacting patient outcomes. Objectives: This study focuses on assessing the incidence of acute renal failure (ARF) in pediatric patients hospitalized in ICUs, exploring its occurrence and associated effects on patient outcomes. Methods: A prospective observational study was conducted to examine the incidence of ARF in pediatric patients admitted to a tertiary pediatric hospital's intensive care unit (PICU) in Iran from September 2019 to August 2020. Patients who developed ARF during their ICU stay were included in the study. Clinical and laboratory data were systematically collected upon admission and on a daily basis thereafter. This data collection aimed to elucidate differences in etiology, disease severity, and clinical practices, and to ascertain their impact on patient outcomes. Results: Out of 1145 pediatric ICU admissions, 4.3% experienced acute renal failure during their hospitalization. Of the 49 affected patients, information was available for 46 individuals, constituting the final analysis cohort. The staging of renal failure was categorized as follows: Stage I (45.7%), Stage II (19.6%), and Stage III (34.8%). Acute tubular necrosis emerged as the predominant cause of acute kidney injury (60.8%). The mortality rate among these patients was notably high at 39.1%, compared to the general PICU mortality rate of 7.1% during the study period. Non-survivors exhibited a higher prevalence of antibiotic use, particularly aminoglycosides and antifungal drugs. Additionally, resuscitation procedures were more frequently documented among non-survivors. Conclusions: Approximately 4.3% of pediatric ICU patients develop acute renal failure, with half of the cases manifesting within the initial 24 hours of hospitalization. Acute tubular necrosis stands out as the primary cause of acute kidney injury. A substantial proportion of patients (39.1%) succumb to the condition, particularly those subjected to resuscitation efforts or prescribed multiple antibiotics and antifungal drugs during hospitalization.

Perfil metabólico, zootécnico e sanitário de bezerras Girolando concebidas por fertilização in vitro

ABSTRACT: This study determined the zootechnical, metabolic, and health performance of Girolando calves born with high or low birth weight, conceived through in vitro fertilization. The study was carried out on a commercial dairy farm located in Passos, Minas Gerais, Brazil. For this, a hundred Girolando calves were divided into two groups: The Control, which consisted of calves that were born weighing ≤ 35 kg; and high birth weight (HBW) calves, which were born weighing &gt; 35 kg. The calves were monitored for zootechnical parameters; epidemiological indices, for diseases such diarrhea and pneumonia; as well as serum concentrations of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, cholesterol, triglycerides, paraoxonase1, albumin, urea, and globulin. Calves from the HBW group had a higher general mortality rate, but no effects on the zootechnical performance or metabolism were observed. The results obtained allow us to conclude that Girolando calves generated by IVF and heavier at birth have a greater chance to present diseases such as omphalophlebitis, tympany, and bovine parasitic sadness, and have a higher rate of general mortality. Conversely, birth weight of the calves does not influence diarrhea or pneumonia, the zootechnical performance, or the metabolism.

Coccidioidomycosis in Immunocompromised at a Non-Endemic Referral Center in Mexico.

The incidence and distribution of coccidioidomycosis are increasing. Information scarcity is evident in Mexico, particularly in non-endemic zones and specific populations. We compared the treatment and outcomes for patients with isolated pulmonary infections and those with disseminated coccidioidomycosis, including mortality rates within six weeks of diagnosis. Of 31 CM cases, 71% were male and 55% were disseminated. For 42% of patients, there was no evidence of having lived in or visited an endemic region. All patients had at least one comorbidity, and 58% had pharmacologic immunosuppressants. The general mortality rate was 30%; without differences between disseminated and localized disease. In our research, we describe a CM with a high frequency of disseminated disease without specific risk factors and non-significant mortality. Exposure to endemic regions was not found in a considerable number of subjects. We consider diverse reasons for why this may be, such as climate change or migration.

Analysis and projections of disease burden for different risk factors and sexes of ischemic stroke in young adults in China

To estimate the rate of death, and disability-adjusted life years (DALYs) and project the disease burden of ischemic stroke due to relevant risk factors in young adults age 20–49 years by sex in China. Data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were used. The age-standardized mortality (ASMR), age-standardized DALYs rate (ASDR), and estimated annual percentage changes (EAPC) were calculated to evaluate the temporal trends from 1990 to 2019. We also used the NORDPRED model to predict ASMR for ischemic stroke due to related risk factors in Chinese young adults over the next 10 years. From 1990 to 2019, the general age-standardized mortality [from 2.39 (1.97 to 2.99) in 1990 to 1.8 (1.41 to 2.18) in 2019, EAPC = − 1.23] and DALYs rates (from 171.7 (140.34 to 212.36) in 1990 to 144.4 (114.29 to 177.37) in 2019, EAPC = − 0.86) decreased for ischemic stroke in young adults in China. ASMR and ASDR decreased for all level 1 risk factors (including behavioral, environmental/occupational, and metabolic) from 1990 to 2019, with the slightest decrease for metabolic risks [ASMR from 1.86 (1.39 to 2.41) in 1990 to 1.53 (1.15 to 1.92) in 2019, ASDR from 133.68 (99.96 to 173.89) in 1990 to 123.54 (92.96 to 156.98) in 2019] and the largest decrease for environmental/occupational risks [ASMR from 1.57 (1.26 to 1.98) in 1990 to 1.03 (0.78 to 1.29) in 2019, ASDR from 110.91 (88.44 to 138.34) in 1990 to 80.03 (61.87 to 100.33) in 2019]. In general, high body-mass index, high red meat intake, and ambient particulate matter pollution contributed to the large increase in ASMR and ASDR between 1990 and 2019. Significant reductions in ASMR and ASDR were observed in low vegetables intake, household air pollution from solid fuels, lead exposure, and low fiber intake. In addition, there were sex differences in the ranking of ASMR attributable to risks in ischemic stroke. The disease burden of ischemic stroke attributable to relevant risk factors in young adults in China is greater and has a faster growth trend or a slower decline trend in males than in females (except for secondhand smoke). The apparent increasing trend of ASMR attributable to high fasting plasma glucose, high systolic blood pressure, high body-mass index, and high red meat intake was observed in males but not in females. The projected analysis showed an increasing trend in ASMR between 1990 and 2030 for all specific metabolic risks for males, but a decreasing trend for females. ASMR attributable to ambient particulate matter pollution showed an increasing trend from 1990 to 2030 for both males and females. The burden of ischemic stroke in young adults in China showed a downward trend from 1990 to 2019. Specific risk factors associated with the burden of ischemic stroke varied between the sexes. Corresponding measures need to be developed in China to reduce the disease burden of ischemic stroke among young adults.