Morality Rate Research Articles

Mathematical Modeling for Scrub Typhus and Its Implications for Disease Control.

BackgroundThe incidence rate of scrub typhus has been increasing in the Republic of Korea. Previous studies have suggested that this trend may have resulted from the effects of climate change on the transmission dynamics among vectors and hosts, but a clear explanation of the process is still lacking. In this study, we applied mathematical models to explore the potential factors that influence the epidemiology of tsutsugamushi disease.MethodsWe developed mathematical models of ordinary differential equations including human, rodent and mite groups. Two models, including simple and complex models, were developed, and all parameters employed in the models were adopted from previous articles that represent epidemiological situations in the Republic of Korea.ResultsThe simulation results showed that the force of infection at the equilibrium state under the simple model was 0.236 (per 100,000 person-months), and that in the complex model was 26.796 (per 100,000 person-months). Sensitivity analyses indicated that the most influential parameters were rodent and mite populations and contact rate between them for the simple model, and trans-ovarian transmission for the complex model. In both models, contact rate between humans and mites is more influential than morality rate of rodent and mite group.ConclusionThe results indicate that the effect of controlling either rodents or mites could be limited, and reducing the contact rate between humans and mites is more practical and effective strategy. However, the current level of control would be insufficient relative to the growing mite population.

B-type Natriuretic Peptide and Other Risk Factors for Predicting Postoperative Atrial Fibrillation after Thoracic Surgery.

Postoperative atrial fibrillation (POAF) is associated with increased morality rate, prolonged hospitalization, and reduced long-term survival after surgery. Thus, prediction of POAF is important to assess surgical risk and provide prophylaxis. It was a prospective study of 207 consecutive patients who underwent a routine preoperative laboratory testing before thoracic surgery from October 2016 to May 2017. Comprehensive data were collected. Then stepwise multivariate logistic regression analysis was adopted to identify significant risk factors associated with POAF from various variables. As results, three variables as follows: male gender, open thoracotomy, and B-type natriuretic peptide (BNP) exceeding 59 pg/mL were considered as independent risk factors associated with POAF (p < 0.05). In patients undergoing noncardiac thoracic surgery, we found that an elevated preoperative BNP level (with the level of 59 pg/mL as a cutoff), male gender, and open-chest surgeries were significant risk factors for POAF. The identification of patients who are prone to develop POAF will provide prevention strategies to reduce this complication.

Surgical treatment of localized brainstem gliomas in children with multimodality techniques

Objective To discuss the effect of microsurgical treatment for children's focal brainstem gliomas with the assistance of neurophysiological monitoring and multimodal neuronavigation technology. Methods A retrospective analysis was conducted on 42 cases of focal brainstem glioma that were admitted to Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University from January 2012 to December 2016. During surgery, MRI and DTI (diffusion tensor imaging) data were transferred to the neuronavigator for three-dimensional reconstruction. Tumor resection was performed with the assistance of intraoperative neuronavigation and neuroelectrophysiological monitoring. 19 patients underwent radiotherapy and/or chemotherapy following tumor resection. Results Among all 42 patients, gross total resection was achieved in 38 (90.5%) cases and partial resection in 4 (9.5%) cases. Major postoperative complications included edema of brain stem (n=3, 7.1%), respiratory disorder (n=1, 2.4%) and injury of posterior cranial nerves (n=4, 9.5%) and were relieved following treatment. There was no perioperative death. The follow-up period varied from 6 to 48 months with an average of 34.0±10.1 months. At the last follow-up study, the average Karnofsky performance score was 90.0±9.2 which was significantly higher (P<0.01) than that before surgery (60.0±16.9). During the follow-up, 4 cases showed tumor progression and included 3 deaths. The total survival rate was 92.9% (39/42). Conclusions Microsurgery should be considered for children of focal brainstem gliomas with clear indications. DTI multimodal navigation and intraoperative electrophysiological monitoring could help improve the excision degree of the glioma, reduce surgical trauma and decrease the rates of disability and morality. Key words: Brain stem neoplasms; Glioma; Child; Microsurgery; Neuronavigation; Diffusion tensor imaging; Neurophysiology monitoring; Focal

Epidemiologic characteristics and outcomes of major trauma patients requiring prolonged mechanical ventilation.

The epidemiologic characteristics and outcomes of severe trauma patients requiring prolonged mechanical ventilation (PMV) remain unclear. This retrospective study aims to investigate the outcomes of PMV in this specific group. All patients with major trauma admitted to the respiratory care center (RCC) requiring PMV (duration ≥21 days between January 2014 and December 2016) were enrolled. A total of 36343 trauma patients visited our emergency department for management, and 1388 (3.82%) were admitted to the intensive care unit (ICU) after initial resuscitation. After ICU management, 93 major trauma patients required PMV, and were then transferred to the RCC. Their mean age of these 93 patients was 68.6 ± 18.3 years and 65 patients (70.0%) were older than 65 years. Head/neck trauma (n = 78, 83.9%) were the most common injury, followed by thoracic trauma (n = 30, 32.2%), and extremity trauma (n = 29, 31.2%). Their median injury severity score was 25 (interquartile range [IQR] 16–27). The median length of hospital stay was 50 days (IQR, 39–62). Six patients died of ventilator-associated pneumonia for an in-hospital morality rate of 6.5%. In addition, 11 PMV patients became mechanical ventilator-dependent and were transferred to the respiratory care ward for further long-term care. In conclusion, <0.3% of trauma patients required PMV, and their in-hospital mortality rate was only 6.5%. Ventilator-associated pneumonia was the main cause of death and nosocomial infections were common in patients with long-term mechanical ventilator dependence.

Brain responses to social norms: Meta-analyses of fMRI studies.

Social norms have a critical role in everyday decision-making, as frequent interaction with others regulates our behavior. Neuroimaging studies show that social-based and fairness-related decision-making activates an inconsistent set of areas, which sometimes includes the anterior insula, anterior cingulate cortex, and others lateral prefrontal cortices. Social-based decision-making is complex and variability in findings may be driven by socio-cognitive activities related to social norms. To distinguish among social-cognitive activities related to social norms, we identified 36 eligible articles in the functional magnetic resonance imaging (fMRI) literature, which we separate into two categories (a) social norm representation and (b) norm violations. The majority of original articles (>60%) used tasks associated with fairness norms and decision-making, such as ultimatum game, dictator game, or prisoner's dilemma; the rest used tasks associated to violation of moral norms, such as scenarios and sentences of moral depravity ratings. Using quantitative meta-analyses, we report common and distinct brain areas that show concordance as a function of category. Specifically, concordance in ventromedial prefrontal regions is distinct to social norm representation processing, whereas concordance in right insula, dorsolateral prefrontal, and dorsal cingulate cortices is distinct to norm violation processing. We propose a neurocognitive model of social norms for healthy adults, which could help guide future research in social norm compliance and mechanisms of its enforcement.

Rapid identification of pathogens responsible for necrotizing fasciitis on an integrated microfluidic system

Necrotic fasciitis (NF) is a particularly aggressive and serious infection of the fascia that can penetrate into the musculature and internal organs, resulting in death if not treated promptly. In this work, an integrated microfluidic system composed of micropumps, microvalves, and micromixers was used to automate the detection of pathogens associated with NF. The entire molecular diagnostic process, including bacteria isolation, lysis, nucleic acid amplification and optical detection steps, was enacted on this developed system. Mannose binding lectin coated magnetic beads were first used as probes to isolate all bacteria in a sample. In this work, polymerase chain reaction assays featuring primers specific to genes from each of four NF-causing bacteria (Vibrio vulnificus, Aeromonas hydrophila, and methicillin-sensitive and resistant Staphylococcus aureus) were used to rapidly and exclusively verify the presence of the respective bacterial strains, and the limits of detection were experimentally found to be 11, 1960, 14, and 11 400 colony forming units/reaction, respectively; all values reflect improvement over ones reported in literature. This integrated microfluidic chip may then be valuable in expediting diagnosis and optimizing treatment options for those with NF; such diagnostic improvements could ideally diminish the need for amputation and even reduce the morality rate associated with this life-threatening illness.

The Impact of Comorbidities on the Outcome of Tuberculous Patient in Respiratory Intensive Care Unit

Aim of the work: there are limited data regarding active pulmonary tuberculosis (APTB) patients requiring ICU admission.This study aimed to determine the mortality rate and risk factors associated with TB patients with comorbidities requiring respiratory intensive care unit (RICU) admission. Patients and methods: a combined retrospective-prospective study was conducted from November 2014 to October 2016 and from November 2016 to April 2017 on adult patients with APTB admit to the RICU of Abbassia Chest Hospital for a period of more than 24 h. Demographic, clinical and therapeutics characteristics as well as outcome (RICU morality) were obtained from the medical records. Results: in this study a total of 43 patients were considered (median age 45 years for non survived patients and 36 years for survived patients). The RICU morality rate was 81.4%. Respiratory failure was the most common cause of admission to RICU 37,2% (16 patient). Mechanical ventilation (MV) was needed in 69.8% of patients (30 patients). Death rate in the diabetic patients was14.29%, in patients with renal disease it was 20% , in case of HIVit was 17.14% and in case of malignancy it was 8.57%.There was highly significant mortality rate accompanying LCF and the ratio was 31.43%,in case of respiratory failure type II it was 94.28% and in mechanical ventilation it was 80%. Non survived patients had high significant APACHE SCORE 21.4±6.2 and the main cause of death was mainly ventilatory 80%(28 patients). Conclusion: the present study showed a very high mortality rate among TB patients with comorbidities requiring respiratory intensive care unit (RICU) admission and identified associated co morbidities, risk factors and a predictor of RICU mortality.

Effect of low-to-moderate-dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A(H1N1)pdm09 viral pneumonia.

BackgroundThe effect of corticosteroids on influenza A(H1N1)pdm09 viral pneumonia patients remains controversial, and the impact of dosage has never been studied.MethodsUsing data of hospitalized adolescent and adult patients with influenza A(H1N1)pdm09 viral pneumonia, prospectively collected from 407 hospitals in mainland China, the effects of low‐to‐moderate‐dose (25‐150 mg d−1) and high‐dose (>150 mg d−1) corticosteroids on 30‐day mortality, 60‐day mortality, and nosocomial infection were assessed with multivariate Cox regression and propensity score‐matched case–control analysis.ResultsIn total, 2141 patients (median age: 34 years; morality rate: 15.9%) were included. Among them, 1160 (54.2%) had PaO2/FiO2<300 mm Hg on admission, and 1055 (49.3%) received corticosteroids therapy. Corticosteroids, without consideration of dose, did not influence either 30‐day or 60‐day mortality. Further analysis revealed that, as compared with the no‐corticosteroid group, low‐to‐moderate‐dose corticosteroids were related to reduced 30‐day mortality (adjusted hazard ratio [aHR] 0.64 [95% CI 0.43‐0.96, P=.033]). In the subgroup analysis among patients with PaO2/FiO2<300 mm Hg, low‐to‐moderate‐dose corticosteroid treatment significantly reduced both 30‐day mortality (aHR 0.49 [95% CI 0.32‐0.77]) and 60‐day mortality (aHR 0.51 [95% CI 0.33‐0.78]), while high‐dose corticosteroid therapy yielded no difference. For patients with PaO2/FiO2 ≥300 mm Hg, corticosteroids (irrespective of dose) showed no benefit and even increased 60‐day mortality (aHR 3.02 [95% CI 1.06‐8.58]). Results were similar in the propensity model analysis.ConclusionsLow‐to‐moderate‐dose corticosteroids might reduce mortality of influenza A(H1N1)pdm09 viral pneumonia patients with PaO2/FiO2<300 mm Hg. Mild patients with PaO2/FiO2 ≥300 mm Hg could not benefit from corticosteroid therapy.

Outcome of patients with interstitial lung diseases admitted to the Respiratory Intensive Care Unit

IntroductionClinicians may face unique challenges while managing critically ill patients with interstitial lung diseases (ILD) admitted to respiratory intensive care units (RICUs).ObjectivesThe aim of the present study was to determine the outcome of ILD patients admitted to RICU as regards mortality rate and risk factors associated with mortality.Patients and methodsNinety-one patients with ILD admitted to RICU were prospectively recruited. We analyzed demographic data, pulmonary function test results, arterial blood gas values, therapeutic strategies, mechanical ventilation (MV) use, RICU and hospital duration, and mortality rates.ResultsThe RICU morality rate was 9.9%. Presence of hemophilia, renal impairment, low-diffusion lung capacity for carbon monoxide, and low arterial oxygen saturation were significantly more frequent among nonsurvivor compared with survivor patients. All nonsurvivor patients had pulmonary hypertension compared with 69% of the survivors, but without a significant difference. Fifteen percent of our patients received invasive MV. There were no significant differences between nonsurvivors and survivors as regards need for MV and duration of MV. Whereas patients with a positive history of previous MV had a significant survival time that was less than those with a negative history of previous MV. The duration of hospital and RICU stay were significantly longer in the survivors group compared with the nonsurvivors group (12.65±9.06 vs. 5.55±4.12 and 10.51±7.51 vs. 4.88±2.31, respectively).ConclusionOur study population showed very low RICU morality rate when compared with previous studies. Nonsurvivors had a shorter hospital and RICU stay, positive history of previous MV, lower diffusion lung capacity for carbon monoxide, and lower arterial oxygen saturation.

Health implications of inorganic phosphate additives in food products: a systematic review

Background: Evidence based data identifies phosphate additives in food products as a public health concern, especially in the progression of chronic kidney disease (CKD). However, there is limited public awareness of the risks associated with phosphate additives. This study focuses on a systematic review of findings on health implications of phosphate additives, with the aim of strengthening public health knowledge, insight, understanding and prevention of exposure to phosphate toxicity and chronic diseases.Methods: Studies with primary data on phosphate additives were identified using keyword electronic database search in PubMed and BMC. To meet the review criteria, articles needed to (1) be published in English (2) focus on phosphate additives (3) address the potential health risks associated with phosphate additives (4) identify existing health problems caused by phosphate additives (5) published between 2005 to 2017 to provide a more dynamic review and (6) hold a strong research evidence that confirms the associated risks of phosphate additives.Results: Findings from reviewed literature suggest a link between high phosphate content in food products and chronic renal failure, cardiovascular complications, accelerated aging process, allergic reactions and increased morality rate. The need to regulate the use of phosphates additives in food products and strengthen public health education is essential to minimise high exposure to phosphate additives.Conclusions: Further research, proper food labelling, strict regulation of unhealthy food additives, nutrition education and sensitisation of consumers are required to minimise exposure to phosphate additives and susceptibility to chronic diseases.

Reducing premature mortality from non-communicable diseases.

Cardiovascular disease and other non-communicable diseases, such as diabetes, cancer and chronic respiratory disease, are a leading cause of premature death and disability worldwide. This article emphasises the importance of prevention in reducing death and disability from preventable non-communicable diseases, especially for individuals with established risk factors for these diseases. It reviews global initiatives to reduce morality rates from these diseases, identifies opportunities for nurses and other healthcare professionals to discuss risk factors with patients, and provides practical suggestions on how to provide advice on healthy lifestyles and enable behaviour change.

Abstract P6-09-50: Impact of young age on recurrence and mortality after surgery in breast cancer: 15 years active surveillance

Abstract Introduction:Substantial efforts have been made to find factors associated with breast cancer (BC) recurrence and mortality after BC treatment. So far TNM stage, ER, PR, and HER2 status are considered as the major predictive markers of BC recurrence and used for treatment decision. However, most of these factors were evaluated independent from other important confounders such as age, stage, and various anti-cancer treatments because they were mostly derived from clinical trials. In Korea, up to 50% of BC patients are premenopausal women, it is not clear how age at diagnosis affect the progression and outcomes of the disease considering all known prognostic factors including TNM stage, ER, PR, and HER2 status. We aim to evaluate the impact of young age on recurrence and mortality after surgery among Korean women with BC. Methods: This is a retrospective cohort study conducted using the data from BC registry from 2000 to 2016 at Samsung Medical Cancer, Seoul, Korea. Patients who received curative BC surgery and who had histologically-confirmed invasive BC between 2000 to 2011 were included in the study. Patients who second primary cancer or double primary cancer were excluded. Information local, regional, or distant recurrence and death until May 2016 was collected using electronic medical records and National Health Statistics. Cumulative incidence rates of distant recurrence and morality at 3-years, 5-years and 10-years were calculated using a competing-risk model. Cox proportional hazards analysis were conducted with 3 different models to take into account for potential confounding factors including age, body mass index (BMI), stage and subtype at breast cancer diagnosis, chemotherapy, radiotherapy and hormone therapy. Results:There were 7360 BC patients with curative BC surgery between 2000 and 2011, and the average follow up duration was 75.4 months. The mean age at diagnosis was 48.4 years old (Standard deviation (SD)=±10), and 6.2% (n=459) was diagnosed younger than 35. Of total, 13.3% were stage III BC and 73.4% of patients had hormone receptor positive BC. The cumulative incidence (95%CI) of recurrence at 3, 5, and 10 years was 4.4% (3.9-4.9), 7.5% (6.8-8.2), and 14.8% (12.9-16.7) respectively. The incidence of mortality at 3, 5, and 10 years was 1.8% (1.5-2.1), 3.8% (3.3-4.3), and 10.2% (9.1-11.5) respectively. Patients who were diagnosed BC under 35 years of age had 2.14 (95% confidence interval (CI):1.74-3.10) and 1.62 (95% CI:1.02-2.56) times higher risk of distant recurrence and mortality compared to patients whose age at diagnosis were between 50 to 60 after adjusting all well-known prognostic factors including stage, subtype, and BMI at diagnosis, chemotherapy, radiotherapy and hormone therapy. Conclusions: Young age at diagnosis (&amp;lt;35) was the most significant predictor on BC recurrence and mortality independently from BC stage and subtype. Further study is warranted to explain biologic background for the differences in outcomes in young women with BC. Citation Format: Kim J-Y, Cho J, Kim H, Kang D, Jung HA, Lee S-H, Bae S, Yu JH, Lee SK, Kim SW, Lee JE, Nam SJ, Ahn JS, Im Y-H, Guallar E, Park YH. Impact of young age on recurrence and mortality after surgery in breast cancer: 15 years active surveillance [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-50.

The influence of prosocial behaviors on evaluations of morality and warmth

This study examined the influence of prosocial behaviors on evaluations of morality and warmth. There were four patterns of interaction: positive reciprocity (with both cost and benefit), only-cost (with cost but without benefit), negative reciprocity (without either cost or benefit), and only-benefit (with benefit but without cost). Three-hundred-fourteen undergraduate students participated in this study. The participants read an example of interaction and evaluated the actors’ morality and warmth. Results of one-way ANOVA showed that the ratings of morality and warmth differed significantly between the conditions. There was no significant difference of perceived morality between only-cost and positive reciprocity. In contrast, warmth was evaluated higher in only-cost than in positive reciprocity. This suggests that people evaluated morality and warmth differently depending on whether the prosocial behavior was obligatory or optional.

Pulmonary Nocardiosis: A Clinical Analysis of 30 Cases.

Objective Pulmonary nocardiosis frequently develops as an opportunistic infection in patients with malignant tumor and is treated with steroids. This study was performed to clarify the clinical features of pulmonary nocardiosis in Japan. Methods The patients definitively diagnosed with pulmonary nocardiosis at our hospital between January 1995 and December 2015 were retrospectively investigated. Results Nineteen men and 11 women (30 in total) were diagnosed with pulmonary nocardiosis. Almost all patients were complicated by a non-pulmonary underlying disease, such as malignant tumor or collagen vascular disease, or pulmonary disease, such as chronic obstructive pulmonary disease or interstitial pneumonia, and 13 patients (43.3%) were treated with steroids or immunosuppressors. Gram staining was performed in 29 patients, and a characteristic Gram-positive rod was detected in 28 patients (96.6%). Thirty-one strains of Nocardia were isolated and identified. Seven strains of Nocardia farcinica were isolated as the most frequent species, followed by Nocardia nova isolated from 6 patients. Seventeen patients died, giving a crude morality rate of 56.7% and a 1-year survival rate of 55.4%. The 1-year survival rates in the groups with and without immunosuppressant agents were 41.7% and 59.7%, respectively, showing that the outcome of those receiving immunosuppressants tended to be poorer than those not receiving them. Conclusion Pulmonary nocardiosis developed as an opportunistic infection in most cases. The outcome was relatively poor, with a 1-year survival rate of 55.4%, and it was particularly poor in patients treated with immunosuppressant agents. Pulmonary nocardiosis should always be considered in patients presenting with an opportunistic respiratory infection, and an early diagnosis requires sample collection and Gram staining.

Melanoma Perception in People of Color: A Targeted Educational Intervention.

Although melanoma is more common in non-Hispanic Whites, ethnic minorities face a greater risk of melanoma-related mortality, which may be partially attributed to presentation at atypical sites and a lack of awareness. Our objective was to assess the effectiveness of a melanoma educational intervention targeted towards people of color. Participants received one of two scripted melanoma educational interventions in the summer of 2015. They completed surveys before the intervention, immediately post-intervention, and 2months post-intervention. Dermatology clinic at an academic hospital. A consecutive sample of 100 participants who self-identified as African American, Asian, or Hispanic were recruited following their dermatology visit. In total, 70 participants completed the 2-month follow-up questionnaire. The comparison intervention group received an educational intervention using a conventional pamphlet on the 'ABCDEs' (Asymmetry, Borders, Color, Diameter, Evolution) of melanoma. The targeted intervention group received a modified pamphlet that included a skin of color section, the nomenclature "melanoma skin cancer", and an image of an individual performing a skin self-examination with the help of a friend. Melanoma knowledge, perceived risk for developing melanoma, and skin self-examination practices were assessed through self-reported questionnaires. Among the 100 participants, 78% self-identified as African American, 11% as Asian, and 11% as Hispanic. Both groups experienced a similar increase in melanoma knowledge that was retained at 2months. Perceived personal risk for developing melanoma increased more in the targeted intervention group immediately post-intervention (p=0.015), but this difference no longer existed between the groups at the 2-month follow-up. The targeted intervention group also demonstrated a greater increase in skin self-examinations (p=0.048) and knowledge of warning signs to look for when examining the skin (p=0.002) at the 2-month follow-up. The educational intervention targeted towards people of color resulted in increased skin self-examinations. Educational material that is relevant to ethnic minorities may better promote early detection and help to decrease the disparity in melanoma-related morality rates. Clinicaltrials.gov registration number NCT02437305.

Three-Month and Three-Year Survival Rates and Complications of Transthoracic Surgery in Patients with Esophageal Cancer at Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences

Background: Nowadays, esophageal cancer is among the most malignant cancers with high mortality and morbidity. Although reasonable progress in radiotherapy and chemotherapy has been made, still esophagectomy is the main treatment for the disease. Using esophagectomy induces a durable palliation and provides possible cure. Objectives: This study aimed to assess the three-month and three-year survival rates and complications of transthoracic surgery in patients with esophageal cancer. Methods: In a longitudinal case series study was performed in three years, 34 patients with esophagus cancer, operated using trans-thoracic approach were assessed for short- and long-term survival rates and complications. Results: Immediately after the surgery, anastomotic leakage was seen in 17.6% and vocal cord paresis in 26.6% of cases; in next days, the vocal cord paresis decreased to 11.8%. Hospital mortality rate was 20.6% and the rate of malignancy recurrence in long-term follow-up was 8.8%. Long-term morality rate was 39.0%. There was microscopic residue in 20.5% and macroscopic residue in 6.0% of the patients. Three-month and three-year survival rates were 76% and 61%, respectively. Conclusions: The achieved three-month and three-year survival rate were reasonable in comparison to other studies. Although the rate of vocal cord paresis after the surgery was about two times more than previous studies, most of the cases were temporary paresis and resolved in coming days.

Time Indices of Emergency Medical Services

Background: Almost 25% of the world population suffer from early death due to preventable events. Trauma and sudden cardiac death are known as common causes of death. The arrival time to help the patient is known as a very important factor in enhancing survival and reducing side effects. Objectives: The aim of the present study was to identify the factors relating to the efficacy of prehospital emergency service (timerelated performance). In addition, it was intended to describe time indices of prehospital services among patients who had internal medical and trauma related problems. Methods: In the present cross-sectional study, all the calls to the emergency medical service (EMS) were monitored. The reasons of these calls were internal medical problems and trauma (March 2009 to March 2013). The frequency of calls were derived from the information bank of EMS in Isfahan, Iran. Demographic features, type of events, time indices of EMS and the outcomes of registered patients were collected and the data were analyzed using descriptive and analytical statistics. Descriptive statistics included frequency, percentage, mean, median, and standard deviation and inferential statistics included t-test, ANOVA, multiple regression and chi-square test. Results: From a total of 299956 cases who had sought help, 61.9% were men. Also, 48.5% of the cases had internal medical and 51.5% had traumatic injuries. In 61.5% of the cases, the injured persons were transferred to the hospital and 3.2% of the cases resulted in death. The men had a morality rate of 1.6 more than women (P < 0.001). Response times were significantly higher than the standard of 8 minutes (P < 0.001). In 50.6% of the cases, the mean response time was less than 8 minutes. Conclusions: Considering the increasing trend of traumatic events, especially in active groups of society (age groups of less than 45), equipping and updating ambulances and providing the EMS personnel with better training can help the injured people in reducing aftermath consequences. On the other hand, increasing neurologic problems in these age groups is an alarm for health managers and health workers, so that they can improve public health through revising health guidelines. Increase in the response time in prehospital emergency missions is also an alarm for the managers who must revise the methods of conducting emergency missions

REPRODUCTIVE AND CHILD HEALTH SERVICES AND DEMOGRAPHIC CHANGE IN THE DISTRICTS OF UTTAR PRADESH, 2002-13.

This study examined the effect of reproductive and child health (RCH) services on fertility and child mortality in the districts of Uttar Pradesh. It specifically measured the effect of antenatal care, medical assistance at birth, child immunization and use of modern methods of contraception on Total Fertility Rate (TFR), Infant Mortality Rate (IMR) and Under-five Morality Rate (U5MR) before and after the National Rural Health Mission (NRHM) period. Data from the 2002-04 District Level Household Survey (DLHS-2), 2012-13 Annual Health Survey (AHS) and the 2001 and 2011 Censuses of India were used. The TFR and U5MR were estimated from the Census of India with district as the unit of analysis. Descriptive statistics, composite indices, random- and fixed-effects models and difference-in-difference models were used to understand the effect of RCH services on the reduction in TFR, IMR and the U5MR. The results suggest large inter-district variations in the coverage of RCH services in the state. During the post-NRHM period, improvement was highest in safe delivery followed by immunization coverage and antenatal care and least for contraceptive use in most districts. The relative ranking of districts has not changed much over time. In 2002-04, the RCH Index was highest in Lucknow (0.442) followed by Ballia and least in Kaushambi (0.115). By 2012-13, it was highest in Jhansi (0.741) and lowest in Shrawasti (0.241). The districts of Kaushambi, Unnao, Mahoba, Banda and Hardoi performed better in the RCH Index over time, while Ballia, Gautam Buddha Nagar, Kanpur Nagar, Pratapgarh and Sonbhadra remained poor. The RCH service coverage and demographic outcomes were poor in seven districts, particularly those in eastern and western Uttar Pradesh. The regression analyses suggest that the RCH Index exerts greater influence on the reduction in IMR and U5MR, while female literacy exerts greater influence on the reduction in TFR. The results of the hybrid model suggest that a 10% change in RCH Index would lead to a 3 point decline in IMR, and a 10% increase in female literacy would lead to a 0.2 point decline in TFR. The study suggests continuing investment in female education and RCH services with a greater focus on poor-performing districts to realize demographic and health targets.

Utilization of Inpatient Care for Pancreatic Cancer on the Rise in the U.S: A Nationwide Perspective

Introduction: Patients with pancreatic cancer are increasingly undergoing aggressive treatment, often delivered in inpatient care setting. Given the paucity of population based data on the trend of utilization of inpatient care in patients with pancreatic cancer, we analyzed the data in patients hospitalized with principal discharge diagnosis of pancreatic cancer. Methods: With the use of the Nationwide Inpatient Sample from 2000 through 2011, we identified annual trends in age-sex-race pancreatic cancer related hospitalizations using International Classification of Diseases (ICD-9), 9th Revision, Clinical Modification code 157.0 - 157.9 as the principal discharge diagnosis.Figure 1Figure 2Figure 3Results: An estimated 422,675 hospitalizations with the primary discharge diagnosis of pancreatic cancer were identified in the US from the beginning of calendar year 2000- 2011. The majority of the patients identified with pancreatic cancer were in the age group of 65-79 years (42 %) with an overall increase in incidence from 8% to 10 % which was statistically significant with a p < 0.001. There was no statistical significant difference between males and females. Approximately 60% of the population was white with an overall increase in incidence from 7% to 11% which was also statistically significant with a p-value < 0.001. Conclusion: The total number of hospitalizations secondary to pancreatic cancer appears to be increasing throughout the last decade. This shift is likely due to increasing use of more aggressive treatment modalities, delivered in inpatient setting and may have led to improved outcomes, as reflected by the decreasing morality rate over the last decade. A strategy based on effective shifting of some of this inpatient care to ambulatory setting may result in improved cost-efficiency.

Sex matters: Examination of disgust and morality judgments of transgressions committed by homosexuals and heterosexuals

Although homosexuality can evoke disgust, the extent to which disgust influences judgments about transgressions committed by homosexuals remains unclear. To address this knowledge gap, participants high (HHD) and low (LHD) in homosexual disgust provided disgust and immorality ratings of offenses committed by homosexuals or heterosexuals. The present study also examined the extent to which judgments about violations of social mores by homosexuals or heterosexuals differed as a function of the purity of the violation. Consistent with predictions, HHD participants had significantly higher disgust and immorality ratings than LHD participants for violations committed by homosexuals. However, the two groups did not differ in ratings of violations committed by heterosexuals. The findings also revealed that the difference between violations committed by homosexuals and heterosexuals in disgust was greater when the violation did not contain impurity versus when impurity was present. However, this pattern of findings was not observed for differences in ratings of immorality. Lastly, pathogen, but not sexual or moral disgust mediated the association between moral purity and ratings of violations committed by homosexuals. This mediated effect was not observed for ratings of violations committed by heterosexuals. The implications of these findings for better understating moral perceptions of homosexuality are discussed.