Classification differences and maternal mortality: a European study. MOMS Group. MOthers' Mortality and Severe morbidity. (57/10952)

OBJECTIVES: To compare the ways maternal deaths are classified in national statistical offices in Europe and to evaluate the ways classification affects published rates. METHODS: Data on pregnancy-associated deaths were collected in 13 European countries. Cases were classified by a European panel of experts into obstetric or non-obstetric causes. An ICD-9 code (International Classification of Diseases) was attributed to each case. These were compared to the codes given in each country. Correction indices were calculated, giving new estimates of maternal mortality rates. SUBJECTS: There were sufficient data to complete reclassification of 359 or 82% of the 437 cases for which data were collected. RESULTS: Compared with the statistical offices, the European panel attributed more deaths to obstetric causes. The overall number of deaths attributed to obstetric causes increased from 229 to 260. This change was substantial in three countries (P < 0.05) where statistical offices appeared to attribute fewer deaths to obstetric causes. In the other countries, no differences were detected. According to official published data, the aggregated maternal mortality rate for participating countries was 7.7 per 100,000 live births, but it increased to 8.7 after classification by the European panel (P < 0.001). CONCLUSION: The classification of pregnancy-associated deaths differs between European countries. These differences in coding contribute to variations in the reported numbers of maternal deaths and consequently affect maternal mortality rates. Differences in classification of death must be taken into account when comparing maternal mortality rates, as well as differences in obstetric care, underreporting of maternal deaths and other factors such as the age distribution of mothers.  (+info)

Estimation of injecting drug users in the City of Edinburgh, Scotland, and number infected with human immunodeficiency virus. (58/10952)

OBJECTIVES: To estimate (1) the number of current and former injecting drug users (IDU) infected with human immunodeficiency virus (HIV) alive in Edinburgh, and (2) the total number of current injectors in the city. METHODS: The number of infected IDU was estimated using a local register of HIV infections with correction for incompleteness of the register. The number of injectors was estimated by two independent methods, one based on the HIV register, the other by log-linear modelling of four lists of IDU interviewed in a city-wide survey, and/or attending drug treatment agencies and family doctors because of drug use. MAIN OUTCOME MEASURES: Estimates for the period 1992-1994 of number of IDU infected with HIV, total number of IDU, and prevalence of injecting. RESULTS: The HIV register indicated that 371 infected drug users who had ever injected were alive and resident in Edinburgh. In all, 95% of infected survey respondents appeared in the register, leading to a corrected estimate of 472 infected ever injectors. From this the number of IDU currently injecting (i.e. in the previous 6 months) was estimated to be 1770 (95% CI: 1340-2240), and the prevalence of injecting as 8.0 (95% CI: 4.8-10.8) per 1000 Edinburgh residents aged 15-59 years. Log-linear modelling gave an estimate of 2070 (95% CI: 1360-2800) current injectors. CONCLUSIONS: The number of HIV-infected IDU in Edinburgh was estimated to be twice that in the larger nearby city of Glasgow, where a higher proportion of young adults currently injected drugs. Knowledge of the high prevalence of HIV in Edinburgh IDU (19.3%), the prescribing of oral substitutes, and counselling by doctors and drug workers are perceived reasons for the reduction in the prevalence of injecting which has occurred in Edinburgh in recent years. Such measures need to be continued to encourage further reduction of injecting.  (+info)

Ethnic differences in incidence of stroke: prospective study with stroke register. (59/10952)

OBJECTIVE: To identify ethnic differences in the incidence of first ever stroke. DESIGN: A prospective community stroke register (1995-6) with multiple notification sources. Pathological classification of stroke in all cases was based on brain imaging or necropsy data. Rates were standardised to European and world populations and adjusted for age, sex, and social class in multivariate analysis. SETTING: A multi-ethnic population of 234 533 in south London, of whom 21% are black. RESULTS: 612 strokes were registered. The crude annual incidence rate was 1.3 strokes per 1000 population per year (95% confidence interval 1.20 to 1.41) and 1.25 per 1000 population per year (1.15 to 1.35) age adjusted to the standard European population. Incidence rates adjusted for age and sex were significantly higher in black compared with white people (P<0.0001), with an incidence rate ratio of 2.21 (1.77 to 2.76). In multivariable analysis increasing age (P<0.0001), male sex (P<0.003), black ethnic group (P<0.0001), and lower social class (P<0.0001) in people aged 35-64 were independently associated with an increased incidence of stroke. CONCLUSIONS: Incidence rates of stroke are higher in the black population; this is not explained by confounders such as social class, age, and sex. Ethnic differences in genetic, physiological, and behavioural risk factors for stroke require further elucidation to aid development of effective strategies for stroke prevention in multi-ethnic communities.  (+info)

Genetic effects on weight change and food intake in Swedish adult twins. (60/10952)

BACKGROUND: Obesity is influenced by genetic and environmental factors. Additionally, synergistic effects of genes and environments may be important in the development of obesity. OBJECTIVE: The aim of this study was to test for genetic effects on food consumption frequency, food preferences, and their interaction with subsequent weight gain. DESIGN: Complete data on the frequencies of consumption of 11 foods typical of the Swedish diet were available for 98 monozygotic and 176 dizygotic twin pairs aged 25-59 y who are part of the Swedish Twin Registry. The data were collected in 1973 as part of a questionnaire study. Body mass index was measured in 1973 and again in 1984. RESULTS: There was some evidence that genetic effects influenced the frequency of intake of some foods. Similarity among monozygotic twins exceeded that among dizygotic twins for intake of flour and grain products and fruit in men and women, intake of milk in men, and intake of vegetables and rice in women, suggesting that genes influence preferences for these foods. Analyses conducted for twins reared together and apart also suggested greater monozygotic than dizygotic correlations, but cross-twin, cross-trait correlations were all insignificant, suggesting that the genes that affect consumption frequencies are not responsible for mediating the relation between the frequency of intake and weight change. CONCLUSIONS: Genetic effects and the frequency of intake are independently related to change in body mass index. However, there was no suggestion of differential genetic effects on weight gain that were dependent on the consumption frequency of the foods studied.  (+info)

How much better can we predict dialysis patient survival using clinical data? (61/10952)

OBJECTIVE: To use three approaches to compare dialysis survival prediction based on variables included in the Standardized Mortality Ratio (SMR) with prediction based on a clinically enriched set of variables. DATA SOURCE: The United States Renal Data System Case Mix Severity data set containing demographic, clinical, functional, nutritional, and treatment details about a random sample of 4,797 adult dialysis patients from 291 treatment units, incident to dialysis in 1986 and 1987. STUDY DESIGN: This observational study uses baseline patient characteristics in two proportional hazards survival models: the BASE model incorporates age, race, sex, and cause of end-stage renal disease (ESRD); the FULL model includes these and additional clinical information. We compare each model's performance using (1) the c-index, (2) observed median survival in strata of predicted risk, and (3) predicted survival for patients with different characteristics. PRINCIPAL FINDINGS: The FULL model's c-index (0.709, 0.708-0.711) is significantly higher than that of the BASE model (0.675, 0.675-0.676), indicating better discrimination. Second, the sickest patients identified by the FULL model were in fact sicker than those identified as sickest by the BASE model, with observed median survival of 451 days versus 524. Third, survival predictions for sickest patients using the FULL model are one-third shorter than those based on the BASE model. CONCLUSIONS: The model with more detailed clinical information predicted survival better than the BASE model. Clinical characteristics enable more accurate predictions, particularly for the sickest patients. Thus, clinical characteristics should be considered when making quality assessments for dialysis patients.  (+info)

Improved survival and reduction in local failure rates after preoperative radiotherapy: evidence for the generalizability of the results of Swedish Rectal Cancer Trial. (62/10952)

OBJECTIVE: The Swedish Rectal Cancer Trial (SRCT) demonstrated that a short-term regimen of high-dose preoperative radiotherapy (5 x 5 Gy) not only reduced the local recurrence rates but also improved the overall survival rate. This compelling evidence will have a significant impact on the primary treatment of rectal cancer. The authors' aim was to explore the representativeness of the study. SUMMARY BACKGROUND DATA: Until the SRCT was presented in 1997, no major trial had established that radiotherapy has a positive effect on the overall survival rate. METHODS: A review of all rectal cancer cases reported to the Swedish Cancer Registry during the same period that the SRCT accrued patients (1987 to 1990) was performed at 57 of 68 participating hospitals. At these 57 hospitals, there were 2366 patients with invasive rectal cancer, with 1664 of these patients fulfilling the criteria for inclusion in the SRCT. RESULTS: Fifty-two percent (866/1664) of eligible patients were included in the SRCT. The patients not included, of whom 8% (67/798) received adjuvant radiotherapy, had an overall 5-year survival rate of 48%, which was identical to the overall survival rate in the SRCT surgery-alone group (48%) but was inferior to the SRCT radiotherapy group (58%). The cancer-specific 5-year survival rates were 65% and 66% among the patients not included and the surgery-alone group, respectively. The local recurrence rates reached 27% in both groups. The results were still comparable when stratifying for curative surgery, tumor stage, and surgical procedure. CONCLUSIONS: The achieved inclusion level of 52% in a randomized multicenter trial is comparatively high. Because the population in the SRCT was representative, it was concluded that the study results are reliable.  (+info)

The influence of gender on incidence and outcome of patients with bladder cancer in Harlem. (63/10952)

Although African Americans have a lower incidence of bladder cancer, overall survival is worse compared with American whites. This phenomenon has been attributed to the higher incidence of advanced disease at diagnosis and poor follow-up. Fifty-nine cases of bladder cancer were identified through the Tumor Registry at Harlem Hospital and reviewed retrospectively. Complete data were obtained for 42 patients. The primary independent variables of interest were primary care utilization, comorbid conditions, social variables, and gender. The outcome variables of interest were stage of disease at presentation and death. The median age at diagnosis in this group was 73 years compared with 68 for bladder cancer patients in the United States. There was no statistically significant correlation between primary care utilization or severity of comorbidities, and clinical stage at presentation. Similarly, these variables did not influence the occurrence of death as an outcome. For women, the mean age at diagnosis was 74.2 years compared with 67.3 in men (P = .112). The ratio of male-to-female cases in this group was 1.3 to 1 compared with 2.7 to 1 for the general US population. Women had lower odds of being diagnosed with superficial disease (OR = 0.24, 95% CI, 0.06-0.94) and a higher incidence of a cancer-specific death (OR = 2.7, 95% CI). The poor outcome and high incidence of bladder cancer cases among women in Harlem is intriguing. Overall, primary care utilization, comorbidities, and other social factors did not seem to influence stage or death as an outcome. The significantly elevated prevalence of smoking among women in this community, increased age at diagnosis, and possible environmental influences may play a role.  (+info)

Increased incidence of prostate cancer in Nigerians. (64/10952)

An increased incidence of prostate cancer among African-American men (now the second most common cause of cancer death) has been attributed mainly to the introduction of screening techniques, which have enabled earlier diagnosis of patients. This study reviewed male cancer patients recorded in a Nigerian cancer registry to assess the current trends in prostate cancer in Nigeria. For comparison, data were broken into two groups: 1980-1988 and 1989-1996. Only the top 10 cancers occurring in both periods were considered initially in this report. For emphasis, an analysis of adult male cancers was done per decade since 1960. Results show that prostate cancer has become the number one cancer in Nigerian men and constitutes 11% of all male cancers. The median age of patients was 67.5 years (variance 5.6), and the mean age was 71.4 years (variance 14.3). These results indicate that despite the absence of screening programs in Nigeria, the number of prostate cancer cases has increased. The known risk factors probably contribute to a varying degree among Nigerians, who are generally of average build or in the low-normal range for body mass index. Moreover, the role of genetics cannot be underplayed. Given its biological characteristics, more cases of prostate cancer probably would be recorded among this population if screening were undertaken.  (+info)