Regional Unit Research Articles

Characteristics and regulatory mechanisms of net ecosystem CO2 exchange at the water-air interface in coastal aquaculture ponds

Coastal aquaculture ponds represented a biogeochemical hotspot in the global carbon cycle. However, there was a limited understanding of their dynamics. In this study, the eddy covariance (EC) technique was applied to quantify the net ecosystem CO2 exchange (NEE) over coastal aquaculture ponds in the Liaohe River estuary in northern China during 2020, aiming to investigate and quantify the carbon exchange characteristics of this region. The results showed that (a) a predominant “U” shaped diurnal NEE pattern throughout the year. During the sea cucumber monoculture phase, the ponds exhibited a consistent daytime carbon sink and nighttime carbon source pattern. In contrast, during the shrimp and sea cucumber polyculture phase, the ponds mostly remained in a net carbon sink state. (b) NEE was negatively correlated with photosynthetically active radiation (PAR), air temperature (Tair), and wind speed (WS), while showing a positive correlation with atmospheric pressure (AP). (c) Overall, the entire study area (complex underlying surfaces) functioned as a carbon sink in 2020, with a total net carbon sequestration of 281.533 g C·m−2. This was approximately four times greater than the restored wetlands that naturally formed from decommissioned coastal aquaculture ponds. Adjusting for surface heterogeneity revealed that the complex surfaces led to a 34.28 % underestimation of the aquaculture region's unit area carbon sequestration capacity. This study was crucial for assessing the carbon cycling and sequestration functions of coastal aquaculture pond ecosystems and provided a scientific basis for related ecological restoration projects.

PENGARUH KOMPETENSI DAN DISIPLIN KERJA TERHADAP KINERJA PEGAWAI PADA SATUAN KERJA PELAKSANAAN JALAN NASIONAL WILAYAH III PROVINSI JAWA TIMUR

This research is carried out in order to know: (1) the impact of competence on employee performance in the National Road Implementation Work Unitof Region III East Java Province, (2) the impact of work discipline on performance employees in the National Road Implementation Work Unit Region III East Java Province, and (3) The Simultaneous Impact of Work Discipline Competence and Competence on the performance of employees of the Region III National Road Implementation Work Unit East Java Province. 
 The population of this study consisted of employees of the National Road Implementation Task Force Region III East Java Province which amounted to 125 people. Data be obtained using a questionnaire that has been tested for validity and reliability. The data analysis method used is multiple regression. 
 The results of this study provide data that: (1) Competence has a positive effect on the performance of employees of the National Road Implementation Task Force Region III East Java; (2) Work discipline significantly affects employee performance in employees of the National Road Implementation Task Force Region III East Java Province (3) There is a simultaneous influence of ability and work discipline on the performance of employees of the National Road Implementation Task Force Region III East Java Province

Testing a social network approach to promote HIV self-testing and linkage to care among fishermen at Lake Victoria: study protocol for the Owete cluster randomized controlled trial

BackgroundNearly 50% of men living with HIV in many countries are unaware of their HIV status; men also have lower uptake of HIV treatment and pre-exposure prophylaxis (PrEP). In SSA, highly mobile men such as those working in fishing communities alongside Lake Victoria have low uptake of HIV testing and low rates of linkage to HIV treatment and PrEP, despite increasing availability of these services. HIV self-testing (HIVST) kits hold promise for overcoming barriers to HIV testing and linkage to services for HIV-positive and HIV-negative men. We describe here a protocol for an HIV status-neutral, social network-based approach to promote HIV testing, linkage to care and prevention, and better health outcomes, including adherence, in fishermen around Lake Victoria.MethodsUtilizing beach management unit (BMU) registries of fishermen operating in three Lake Victoria fishing communities in Siaya County, Kenya, we completed a census and social network mapping to identify close social networks of men. Network clusters identified by a socially-central lead (“promotor”) and selected to ensure maximal separation between treatment and control will be randomized. Promotors in both arms will receive basic HIV training; intervention promotors are further trained in HIVST to distribute kits to their cluster, while control promotors will distribute to their cluster vouchers for free HIVST at nearby clinics. We will test whether these promoters can enhance linkage to ART and PrEP after self-testing, thereby addressing a key limitation of HIVST. We will also measure 6- and 12-month viral load in those living with HIV and PrEP adherence among those without HIV via urine tenofovir levels as objective markers of adherence.DiscussionThis study has the potential to improve HIV health and promote HIV prevention among a hard to reach, at-risk, and highly mobile population of men in Western Kenya—a critical population in Kenya’s HIV prevention and treatment program. Further, if successful, this innovative social networks-based model could be scaled at the regional level to address HIV prevention and care among similarly at-risk populations of men in eastern Africa and inland fisheries settings across the continent.Trial registrationSelf-Test Strategies and Linkage Incentives to Improve ART and PrEP Uptake in Men, registered on February 26, 2021, registration #NCT04772469.

Modelling Human Brucellosis Based on Infection Rate and Vaccination Coverage of Sheep and Goats.

In this study, the vaccination coverage, serological sampling and infection rate of sheep and goats were evaluated as predictors for the modeling of human brucellosis in Greece. The human brucellosis disease frequency per local regional unit (RU) varied significantly (RR90) among consecutive years. The notification rate was higher (p < 0.001) in the RUs with implementation of vaccination in sheep and goats (vaccination zone—VZ) with a median of 1.4 (IQR 0.0–3.1) compared with the RUs of the eradication zone (EZ) with a median of 0.0 (IQR 0.0–0.0). In VZ, the increased frequency of human cases was associated with delayed vaccine administration (estimate: 0.14 (0.04; 0.29), p = 0.03) and higher vaccination coverage of the animals (estimate: −0.349 (−0.72; −0.07), p < 0.01). However, the flock sampling rate was highly heterogenous among RUs (IQR 10.56–52.93), and inconsistent within RUs throughout the period of the study 2013–2017 (p = 0.001), limiting the reliable estimation of the infection rate in livestock and the design of an integrated One Health model for human disease.

Combined assessment of tuberculosis case notification rate and infection control at health facilities of Dale districts, Sidama Zone, Southern Ethiopia.

BackgroundMycobacterium tuberculosis (TB) is the deadliest disease that claims millions of deaths globally. Ethiopia is among the countries heavily hit by the disaster. Despite the effective directly observed treatment and TB infection control (TBIC) measures provided by the world health organization (WHO), the rate of new cases increased daily throughout the country. Healthcare workers (HCWs) are at highest risk serving without having the necessary facility in place while overcrowding of patients exacerbated TB transmission. The study aimed to assess TBIC implementation and analyze case notification rate (CNR) of smear-positive pulmonary TB in the selected health facilities at Dale district, Sidama Zone, Southern Ethiopia.MethodsSeven health care facilities have been visited in the study area and smear-positive pulmonary TB notification rate was determined retrospectively during the years 2012 to 2014. Data on smear positive test results and demographic characteristics were collected from the TB unit registries. A structured questionnaire, facility survey, and observation checklists were used to assess the presence of TBIC plans at the health care facilities.ResultsThe overall case notification rate of smear-positive pulmonary tuberculosis was 5.3% among all 7696 TB suspected patients. The odds of being diagnosed with smear-positive TB were 24% more in males than in females (adj OR = 1.24, 95% CI: (1.22, 1.55). Moreover, in the study area, only 28% of the facilities have been practiced TB infection control and 71% of the facilities assigned a focal person for the TBIC plan. The implementation of environmental control measures in the facilities was ranged between 16–83%. N95 particulate respirators were found only in 14% of the facilities.ConclusionTB CNR in Dale district was low. Moreover, implementations of TBIC in Dale district health facilities were poor when the survey was done. Hence, urgent measures should be taken to reverse the burden of TB.

Seasonal Phenological Patterns and Flavivirus Vectorial Capacity of Medically Important Mosquito Species in a Wetland and an Urban Area of Attica, Greece.

Seasonal patterns of mosquito population density and their vectorial capacity constitute major elements to understand the epidemiology of mosquito-borne diseases. Using adult mosquito traps, we compared the population dynamics of major mosquito species (Culex pipiens, Aedes albopictus, Anopheles spp.) in an urban and a wetland rural area of Attica Greece. Pools of the captured Cx. pipiens were analyzed to determine infection rates of the West Nile virus (WNV) and the Usutu virus (USUV). The data provided were collected under the frame of the surveillance program carried out in two regional units (RUs) of the Attica region (East Attica and South Sector of Attica), during the period 2017–2018. The entomological surveillance of adult mosquitoes was performed on a weekly basis using a network of BG-sentinel traps (BGs), baited with CO2 and BG-Lure, in selected, fixed sampling sites. A total of 46,726 adult mosquitoes were collected, with larger variety and number of species in East Attica (n = 37,810), followed by the South Sector of Attica (n = 8916). The collected mosquitoes were morphologically identified to species level and evaluated for their public health importance. Collected Cx. pipiens adults were pooled and tested for West Nile virus (WNV) and Usutu virus (USUV) presence by implementation of a targeted molecular methodology (real-time PCR). A total of 366 mosquito pools were analyzed for WNV and USUV, respectively, and 38 (10.4%) positive samples were recorded for WNV, while no positive pool was detected for USUV. The majority of positive samples for WNV were detected in the East Attica region, followed by the South Sector of Attica, respectively. The findings of the current study highlight the WNV circulation in the region of Attica and the concomitant risk for the country, rendering mosquito surveillance actions and integrated mosquito management programs as imperative public health interventions.

The Entrepreneurial Environment in Greek Rural Areas: The Entrepreneur’s Viewpoint

The business environment that prevails in a region has a significant influence on the businesses operating in that geographical area. A strong business environment can enhance not only the growth and success of businesses, but also their retention and sustainable development in the area. The literature review shows that a small number of empirical studies have examined the business environment in rural areas. This research attempts to highlight the factors (road access, technology infrastructure, etc.) that make up the business environent in rural areas, as well as to clarify the degree of satisfaction that the entrepreneurs themselves derive from them. For the purposes of the survey, a questionnaire was filled in by 240 entrepreneurs from rural areas in the Regional Unit (RU) of Serres, in the northern part of Greece, who assessed their satisfaction with the business environment using a five-point Likert-type scale, through personal interviews. The principal component analysis identified six factors, which showed higher satisfaction among the categories of “infrastructure” and “social capital”.

Geography of hospital admissions for multiple sclerosis in Greece

BackgroundMultiple sclerosis (MS) is the 2nd most common, disability causing neurological disorder in young adults, known for its differences in prevalence according to geographical position. Data on MS epidemiology is lacking in Greece. In this study, we aimed to examine the pattern of MS related hospital admissions in Greece and analyze their spatial distribution. Data for hospital admissions due to MS was obtained from the Hellenic Statistical Authority (ELSTAT) database and they were available from 1999 to 2012. MethodsWe used the proportional hospitalization ratio (PHR) which was age and sex adjusted according to hospitalizations of Greek population, in order to calculate the ratio between hospitalizations in each regional unit (RU) and hospitalizations of national population. PHR was calculated for each RU, which is categorized as level 3 based on the Nomenclature of Territorial Units for Statistics (NUTS level 3). The classification of MS was based on International Classification of Diseases, Ninth Revision (ICD-9), code 340. Descriptive analysis was conducted to understand the epidemiological characteristics and time series analysis was used to investigate the trend of annual PHR's values during the study period. Global spatial autocorrelation analysis was conducted to assess spatial homogeneity of MS across the country. Moreover, local spatial autocorrelation analysis was performed using the LISA statistic to detect any potential clusters of similar values. Finally, multiple linear regression was conducted to examine correlations between PHR and latitude. ResultsOver the 14-year period the number of hospitalizations increased while the proportion of hospitalizations remained higher for females compared to males, as well as for the 25-44 year age group. RUs that appeared to be most affected included Evros with a sex- and age- adjusted PHR of 2.00 (95%CI: 1.89-2.10), Larisa with a PHR of 1.74 (95%CI: 1.67-1.81) and Chios with a PHR of 1.77 (95%CI: 1.60-1.95). The least affected RU was Arkadia with a PHR of 0.29 (95%CI: 0.24-0.36). ConclusionIn this study we present a rise in hospital admissions related to MS over a 14-year period, possibly indicating a parallel rise in incidence. A combinational analysis of the number of hospitalizations along with incidence studies could be further performed to be used to design public health interventions

Hospital in the air: Royal Flying Doctor Service retrievals and challenges before, during and after, Australia's COVID‐19 lockdown in 2020

Hospital in the air: Royal Flying Doctor Service retrievals and challenges before, during and after, Australia's <scp>COVID</scp>‐19 lockdown in 2020

Ultrafiltration isolation, structures and anti-tumor potentials of two arabinose- and galactose-rich pectins from leaves of Aralia elata

Two novel arabinose- and galactose-rich pectic polysaccharides, AELP-B5 (Mw, 4.25 × 104 g/mol) and B6 (Mw, 1.56 × 104 g/mol), were rapidly obtained from the leaves of Aralia elata (Miq.) Seem. with anion resin and sequenced ultrafiltration membrane columns. The structural backbone and branched chains of AELP-B5 and B6 were preliminarily elucidated by mild acid hydrolysis with HILIC-ESI−-MS/MS. The planar structures and spatial configurations were further identified using UPLC-QDa and GC–MS for compositions, Smith degradation and methylation analysis, FT-IR, NMR (1H/13C, DEPT, HSQC, HMBC, COSY, NOESY and TOCSY) and SEC-MALLS-RID. (1) AELP-B5 possessed →4GalA1→ as smooth regions (HG) and a repeating disaccharide moiety of →4GalA1→2Rha1→ as hairy regions (RG-I) with a 1:5 molar ratio, whereas AELP-B6 had a distinguishing 1:1 molar ratio between the HG and RG-I; (2) complex side chains were constituted of T-α-Araf, 1,3-α-Araf, 1,5-α-Araf, T-β-Galp, 1,3-β-Galp, 1,4-β-Galp, 1,6-β-Galp, 1,3,4-β-Galp and 1,3,4,6-β-Galp connected at C-4 of the rhamnosyl units in RG-I of AELP-B5 and B6; and (3) both possessed highly branched and compact coil conformations. The CCK-8 assay illustrated that AELP-B6 possessed higher cytotoxicity against HepG2 and HT-29 than that of AELP-B5. Surface plasmon resonance showed the binding affinity of AELP-B6 to galectin-3 (6.488 × 10−5 M) was about 10 times stronger than that of AELP-B5 (4.588 × 10−4 M). The above findings provide a molecular structure and bioactivity basis for future potential applications of AELP in the food and medical industries.

Management of Australian Patients with Severe Traumatic Brain Injury: Are Potentially Harmful Treatments Still Used?

Clinical trials have shown that intravenous albumin and decompressive craniectomy to treat early refractory intracranial hypertension can cause harm in patients with severe traumatic brain injury (TBI). The extent to which these treatments remain in use is unknown. We conducted a multi-center retrospective cohort study of adult patients with severe TBI admitted to five neurotrauma centers across Australia between April 2013 and March 2015. Patients were identified from local trauma and intensive care unit (ICU) registries and followed until hospital discharge. Main outcome measures were the administration of intravenous albumin, and decompressive craniectomy for intracranial hypertension. Analyses were predominantly descriptive. There were 303 patients with severe TBI, of whom a minority received albumin (6.9%) or underwent early decompressive craniectomy for treatment of refractory intracranial hypertension complicating diffuse TBI (2.3%). The median (intequartile range [IQR]) age was 35 (24, 58), and most injuries were caused by road traffic accidents (57.4%) or falls (25.1%). Overall, 34.3% of patients died while in the hospital and the remainder were discharged to rehabilitation (44.6%), other health care facilities (4.6%), or home (16.5%). There were no patient characteristics significantly associated with use of albumin or craniectomy. Intravenous albumin and craniectomy for treatment of intracranial hypertension were used infrequently in Australian neurotrauma centers, indicating alignment between best available evidence and practice.

The abdominal wall hernia in cirrhotic patients: a historical challenge

BackgroundThe incidence rate of abdominal wall hernia is 20–40% in cirrhotic patients. A surgical approach was originally performed only if complication signs and symptoms occurred. Several recent studies have demonstrated the usefulness of elective surgery. During recent decades, the indications for surgical timing have changed.MethodsCirrhotic patients with abdominal hernia who underwent surgical operation for abdominal wall hernia repair at the Policlinico “Paolo Giaccone” at Palermo University Hospital between January 2010 and September 2016 were identified in a prospective database, and the data collected were retrospectively reviewed; patients’ medical and surgical records were collected from charts and surgical and intensive care unit (ICU) registries. Postoperative morbidity was determined through the Clavien-Dindo classification. Cirrhosis severity was estimated by the Child-Pugh-Turcotte (CPT) score and MELD (model of end-stage liver disease) score. Postoperative mortality was considered up to 30 days after surgery. A follow-up period of at least 1 year was used to evaluate hernia recurrence.ResultsThe univariate and multivariate analyses demonstrated the unique independent risk factors for the development of postsurgical morbidity (emergency surgery (OR 6.42; p 0.023), CPT class C (OR 3.72; p 0.041), American Society of Anesthesiologists (ASA) score ≥ 3 (OR 4.72; p 0.012) and MELD ≥ 20 (OR 5.64; p 0.009)) and postsurgical mortality (emergency surgery (OR 10.32; p 0.021), CPT class C (OR 5.52; p 0.014), ASA score ≥ 3 (OR 8.65; p 0.018), MELD ≥ 20 (OR 2.15; p 0.02)).ConclusionsConcerning abdominal wall hernia repair in cirrhotic patients, the worst outcome is associated with emergency surgery and with uncontrolled disease. The correct timing of the surgical operation is elective surgery after ascites drainage and albumin/electrolyte serum level and coagulation alteration correction.

First four Oral Rabies Vaccination campaigns of the red foxes in Greece: Evaluating factors and assessment

Following the last animal rabies outbreak in Greece in 2012, Oral Rabies Vaccination (ORV) campaigns of red foxes (Vulpes vulpes) were conducted in order to halt the spread of the disease, as widely and effectively have also been implemented in other countries. The present study aims to report the main outcomes following the first Greek ORV campaigns during autumn 2013, 2014, 2015 and spring 2016, to assess their effectiveness and to investigate factors potentially related to their success. Blood samples, mandible bones and teeth, derived by 452 foxes, were tested for rabies antibody titration, animal age determination and tetracycline (TTC) detection. The laboratory results obtained were statistically analyzed. High seroprevalence and TTC detection rates were obtained following the autumn campaigns studied, while these rates were significantly reduced following the spring campaign. The year or the season of the vaccination campaign, the estimated age group of the animal and the geographical Regional Unit (RU), where the animal was hunted, were identified as important factors. On the contrary, no significance could be ascertained for TTC detection based on exclusively previous uptake, use of filter paper, blood sample type and quality, as well as sex of animal. Based on the monitoring results achieved, the first ORV campaigns conducted in the country can be generally considered to be satisfactory. No positives cases were detected since May 2014. Seasonal, geographical parameters and factors related to fox ecology may interfere with monitoring results and should be always considered when planning future ORV programs.

Vacuum-Assisted Wound Closure with Mesh-Mediated Fascial Traction Achieves Better Outcomes than Vacuum-Assisted Wound Closure Alone: A Comparative Study

BackgroundOpen abdomen (OA) permits the application of damage control surgery principles when abdominal trauma, sepsis, severe acute peritonitis and abdominal compartmental syndrome (ACS) occur.MethodsNon-traumatic patients treated with OA between January 2010 and December 2015 were identified in a prospective database, and the data collected were retrospectively reviewed. Patients’ records were collected from charts and the surgical and intensive care unit (ICU) registries. The Acosta “modified” technique was used to achieve fascial closure in vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) patients. Sex, age, simplified acute physiology score II (SAPS II), abdominal compartmental syndrome (ACS), cardiovascular disease (CVD) and surgical technique performed were evaluated in a multivariate analysis for mortality and fascial closure prediction.ResultsNinety-six patients with a median age of 69 (40–78) years were included in the study. Sixty-nine patients (72%) underwent VAWCM. Forty-one patients (68%) achieved primary fascia closure: two patients (5%) were treated with VAWC (37 median days) versus 39 patients (95%) who were treated with VAWCM (10 median days) (p = 0.0003). Forty-eight patients underwent OA treatment due to ACS, and 24 patients (50%) survived compared to 36 patients (75%) from the “other reasons” group (p = 0.01). The ACS group required longer mechanical ventilator support (p = 0.006), length of stay in hospital (p = 0.005) and in ICU (p = 0.04) and had higher SAPS II scores (p = 0.0002).ConclusionsThe survival rate was 62%. ACS (p = 0.01), SAPS II (p = 0.004), sex (p = 0.01), pre-existing CVD (p = 0.0007) and surgical technique (VAWC vs VAWCM) (p = 0.0009) were determined to be predictors of mortality. Primary fascial closure was obtained in 68% of cases. VAWCM was found to grant higher survival and primary fascial closure rate.

Entomological Study of the Mosquito Fauna in the Regional Unit of Drama, Region of East Macedonia-Thrace, Greece (2015 to 2016).

This study reports the mosquito collections conducted from June to September of 2015 and 2016, in Regional Unit (R.U.) of Drama, East Macedonia-Thrace Region, in Northeastern Greece. A total of 923 specimens were examined based on their morphological characteristics and identified to the species level. Medically important taxa were recognized among the 15 mosquito species recorded belonging to seven genera. All data presented here comprise new distribution records due to lack of previous mosquito faunal surveys in the R.U. of Drama.

Perinatal Outcome in Pregnancies with Extreme Preterm Premature Rupture of Membranes ( Mid-Trimester PROM ) = الولادة المبتسرة الناتجة عن تمزق أغشية الجنيين المدقع قبل اكتمال ٢٦ أسبوعا من الحمل

Preterm premature rupture of membranes (PPROM) is defined as the rupture of fetal membranes before 37 weeks. Extreme PPROM occurs before 26 weeks' gestation and can result in perinatal morbidity and mortality. The aim of this study was to study the perinatal outcomes of mothers with extreme PPROM. A retrospective cohort study of 44 consecutive pregnant women, presenting with PPROM before 26 weeks' gestation, was conducted from January 2006 to December 2011 at Sultan Qaboos University Hospital, Oman. Maternal and neonatal information was collected from medical records, and delivery and neonatal unit registries. Women with PPROM presenting after 26 weeks' gestation, those with multiple gestations, or other types of preterm deliveries were excluded from the study. Of the 44 preterm infants admitted to the Neonatal Intensive Care Unit, 24 (55%) survived, 7 (16%) died within 24 hours of birth, 9 (20%) were miscarried, and 4 (9%) were stillbirths. Neonatal sepsis and pulmonary hypoplasia were the major causes of death. Neonatal complications among the surviving infants included prematurity in 11 (46%), respiratory distress syndrome in 19 (79%), sepsis in 12 (50%), and low birth weight in 11 (46%). The neonatal survival rate was significantly associated with the gestational age at delivery but not with the gestational age upon rupture of membranes. Extreme PPROM was associated with adverse perinatal outcomes. The results of this study will help obstetricians and neonatologists in counselling couples experiencing PPROM. Future studies of long-term neonatal morbidity should have larger sample sizes and include more hospitals.

Incidence of Type 1 diabetes in children in Cáceres, Spain, during 1988–1999

Aim: To determine the incidence of Type 1 diabetes in Cáceres in children less than 14 years of age. We tested for differences in incidence by age, sex and season at diagnosis. Methods: All Type 1 diabetes cases with onset <14 years of age between 1988 and 1999 were recorded retrospectively. Pediatric Unit registries provided the primary source of ascertainment. The secondary independent data source was based on the registries of local Diabetic Associations, diabetes camp records and guarantee cards of blood-glucose meters. We used the capture–recapture method for ascertainment. Results: During the 12-year period, 137 new cases of Type 1 diabetes were identified. Completeness of ascertainment was 99.2%. Average annual observed incidence was 16.8/100,000/year (95% C.I. 14.1–19.8). Age-standardised incidence (world population): 16.5/100,000/year (95% C.I. 13.9–19.6). Average annual incidence for 0–4, 5–9 and 10–13-year-old groups: 12.7/100,000 (95% C.I. 8.8–17.9), 18.2/100,000 (95% C.I. 13.7–23.8) and 19.1/100,000 (95% C.I. 14.2–25.1). The highest age-specific annual incidence rate was found in the 10–13-year age group. There was a seasonal onset pattern, with the highest incidence in autumn and winter. November was the month with the highest number of cases (22/137). Conclusion: Cáceres has a moderately high incidence of Type 1 diabetes in children less than 14 years of age, similar to that found in other more developed and densely populated regions of Spain, and in the range of other countries of northern Europe. These data do not support the hypothesis of a decrease in the incidence of the disease from north to south over Europe.

Testicular cancer mortality in Eastern Europe

A substantial delay in the decline of mortality from testicular cancer has been reported over the last few years. In the European Union (EU) testicular cancer rates at age 20 to 44 have fallen by 2 thirds between 1975–1979 and 1995–1997, from 1.5 to 0.5/100,000 men. However, in eastern European countries providing comparable data over time (i.e, Bulgaria, Czech Republic, Hungary, Poland, Romania and Slovakia), rates have only moderately declined and were still 1.3/100,000 men age 20 to 44 in 1995–1997. This corresponded to a few hundred excess avoidable deaths per year.1 Consequently, it is important to further monitor trends in testicular cancer mortality in the last few years. As in previous reports, we obtained official death certification figures from the WHO database, and recoded them according to the Ninth Revision of the International Classification of Diseases.2 We obtained estimates of the resident population from the same WHO database. Age-standardized rates were based on the world standard population. Figure 1 shows updated trends in mortality from testicular cancer in 4 broad geographic areas. In eastern Europe, a 16% fall in males was observed between 1995–1997 and 1998–1999, from 1.30 to 1.09/100,000. The fall was 14% in the EU, from 0.51 to 0.44/100,000. In contrast, a plateau was observed in the USA and Japan, with rates in the late 1990s of 0.47/100,000 and 0.38/100,000, respectively. Overall age-standardized rates in 1995–1997 and 1998–1999 were 0.31 and 0.27/100,000 in the EU, 0.75 and 0.65/100,000 in eastern Europe, 0.21 and 0.24/100,000 in the USA and 0.14 and 0.18/100,000 in Japan. Trends in age-adjusted (world population) death certification rates from testicular cancer in men aged 20–44 years. Eastern European countries represented are Bulgaria, Czech Republic, Hungary, Poland, Romania and Slovakia. There are 2 main messages in this updated analysis of trends in testicular cancer mortality. First, the levelling of the falls in rates over the last few years in the USA and Japan are confirmed by the most recent data, and testicular cancer mortality seems to have reached a plateau. Some fall is still observed in the EU, whose rates of 0.44/100,000, however, have now approached the low levels of the USA and Japan. Second, the fall registered since the early 1990s3 is persisting in eastern Europe, whose rates remain twice that of the EU and comparable to that registered in the EU in the early 1980s. In absolute terms, this corresponds to over 100 excess deaths in young men per year in the 6 countries considered. Testicular cancer, particularly seminomas and teratomas of young men, is a largely curable disease if adequate treatment is adopted.4 Thus, despite favorable trends over the last decade, there remains a substantial scope for improving testicular cancer management and treatment in eastern Europe. Fabio Levi*, Franca Lucchini*, Peter Boyle , Eva Negri , Carlo La Vecchia1* ?, * Cancer Epidemiology Unit and Cancer Registries of Vaud and Neuchâtel, Institut universitaire de médecine sociale et préventive, Lausanne, Switzerland, Division of Epidemiology and Biostatistics, European Institute of Oncology, Milano, Italy, Laboratory of Epidemiology, Istituto di Ricerche Farmacologiche ‘Mario Negri’, Milano, Italy, ? Istituto di Statistica Medica e Biometria, Università degli Studi di Milano, Milano, Italy.

Lateral impact motor vehicle collisions: significant cause of blunt traumatic rupture of the thoracic aorta.

This study was undertaken to determine the relationship between traumatic rupture of the thoracic aorta (TRA) and the direction of impact at the time of motor vehicle crash. Retrospective review of TRA patients from two different databases over a 4.5-year period (January 1, 1991 to June 30, 1995): (1) Ontario Coroner's Office records of motor vehicle deaths from Metropolitan Toronto, and (2) the trauma registries of Sunnybrook Health Science Centre and St. Michael's Hospital in Metropolitan Toronto. Ninety-seven patients (81 from the coroner's database and 16 from the adult trauma unit registries) sustained traumatic rupture of the thoracic aorta. Forty-eight cases (49.5%) were a result of lateral impact crashes. Twenty-eight drivers (22 ipsilateral and six contralateral) and 20 passengers (16 ipsilateral and four contralateral) sustained TRA from lateral impact crashes. Ninety-one TRAs (94%) occurred at the peri-isthmic region. Lateral impact crashes are a significant cause of TRA. Traumatic rupture of the aorta should be considered with a high index of suspicion after serious lateral impact crashes, just as physicians now consider patients at high risk of TRA after serious frontal impact crashes.

Decreasing mortality and morbidity rates after the institution of a statewide burn program.

During the late 1970s, a statewide system for burn treatment and prevention was developed in Maine; it was assumed that such a system would reduce mortality and morbidity rates. To examine the effect of this intervention and the validity of its underlying hypothesis, data for the period from 1973 to 1988 were collected from burn unit registries inside and outside of the state and from hospital discharge abstracts, death certificates, and published sources. In Maine, the annual number of deaths per million persons that resulted from fire- and burn-related injuries declined from 41 in the years 1973-1980 to 25 in the years 1981-1988, which is a significantly greater decrease than for the United States as a whole (p less than 0.001). This decrease could not be explained by changes in the age or urban and rural distribution of the population. The annual number of hospital admissions for treatment of burns (per million persons) in Maine decreased from 401 to 301 over the same period, and patients with more complicated burns were increasingly referred to more specialized centers within and outside of the state. Since a state system was instituted, hospital mortality rates, when grouped by age and burn area, were not significantly different from those reported by the most prominent burn unit in New England. The population-based methods of data collection and linkage that were developed for this investigation may be useful for other studies of injury epidemiology. A statewide burn program appears to have contributed to a reduction in mortality and morbidity rates, primarily through preventive efforts.