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Reproductive Health Jun 2018This paper reviews the very large discrepancies in pregnancy outcomes between high, low and middle-income countries and then presents the medical causes of maternal...
This paper reviews the very large discrepancies in pregnancy outcomes between high, low and middle-income countries and then presents the medical causes of maternal mortality, stillbirth and neonatal mortality in low-and middle-income countries. Next, we explore the medical interventions that were associated with the very rapid and very large declines in maternal, fetal and neonatal mortality rates in the last eight decades in high-income countries. The medical interventions likely to achieve similar declines in pregnancy-related mortality in low-income countries are considered. Finally, the quality of providers and the data to be collected necessary to achieve these reductions are discussed. It is emphasized that single interventions are unlikely to achieve important reductions in pregnancy-related mortality. Instead, improving the overall quality of pregnancy-related care across the health-care system will be necessary. The conditions that cause maternal mortality also cause stillbirths and neonatal deaths. Focusing on all three mortalities together is likely to have a larger impact than focusing on one of the mortalities alone.
Topics: Developing Countries; Female; Humans; Infant; Infant Mortality; Infant, Newborn; Maternal Mortality; Perinatal Death; Pregnancy; Pregnancy Outcome; Stillbirth
PubMed: 29945628
DOI: 10.1186/s12978-018-0524-5 -
European Journal of Orthopaedic Surgery... May 2016Bone density insufficiency is the main cause for significant musculoskeletal trauma in the elderly population following low-energy falls. Hip fractures, in particular,... (Review)
Review
Bone density insufficiency is the main cause for significant musculoskeletal trauma in the elderly population following low-energy falls. Hip fractures, in particular, represent an important public health concern taking into account the complicated needs of the patients due to their medical comorbidities as well as their rehabilitation and social demands. The annual cost for the care of these patients is estimated at around 2 billion pounds (£) in the UK and is ever growing. An increased early and late mortality rate is also recognised in these injuries together with significant adversities for the patients. Lately, in order to improve the outcomes of this special cohort of patients, fast-track care pathways and government initiatives have been implemented. It appears that these measures have contributed in a steady year-by-year reduction of the 30-day mortality rates. Whether we have currently reached a plateau or whether an ongoing reduction in mortality rates will continue to be observed is yet to be seen.
Topics: Aged; Aged, 80 and over; Critical Pathways; Hip Fractures; Humans; Mortality
PubMed: 26943870
DOI: 10.1007/s00590-016-1744-4 -
Interactive Cardiovascular and Thoracic... Dec 2012A best evidence topic was written according to a structured protocol. The question addressed was whether cardiopulmonary bypass can be used safely with satisfactory... (Review)
Review
A best evidence topic was written according to a structured protocol. The question addressed was whether cardiopulmonary bypass can be used safely with satisfactory maternal and foetal outcomes in pregnant patients undergoing cardiac surgery. A total of 679 papers were found using the reported searches of which 14 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Reported measures were maternal and foetal mortality and complications, mode of delivery, cardiopulmonary bypass and aortic cross-clamp times, perfusate flow rate and temperature and maternal NYHA functional class. The most recent of the best evidence studies, a retrospective observational study of 21 pregnant patients reported early and late maternal mortalities of 4.8 and 14.3%, respectively, and a foetal mortality of 14.3%. Median cardiopulmonary bypass and aortic cross-clamp times were 53 and 35 min, respectively, and the median bypass temperature was 37°C. Three larger retrospective reviews of the literature reported maternal mortality rates of 2.9-5.1% and foetal mortality rates of 19-29%. Mean cardiopulmonary bypass times ranged from 50.5 to 77.8 min. Another retrospective observational study reported maternal mortality of 13.3% and foetal mortality of 38.5%. Mean cardiopulmonary bypass and aortic cross-clamp times were 89.1 and 62.8 min, respectively, with a mean bypass temperature of 31.8°C. A retrospective case series reported no maternal mortality and one case of foetal mortality. Median cardiopulmonary bypass and aortic cross-clamp times were 101 and 88 min, respectively. Eight case reports described 10 patients undergoing cardiopulmonary bypass. There were no reports of maternal mortality and one report of foetal mortality. Mean cardiopulmonary bypass and aortic cross-clamp times were 105 and 50 min, respectively. We conclude that while the use of cardiopulmonary bypass during pregnancy poses a high risk for both the mother and the foetus, the use of high-flow, high-pressure, pulsatile, normothermic bypass and continuous foetal and uterine monitoring can allow cardiac surgery with the use of cardiopulmonary bypass to be performed with the greatest control of risk in the pregnant patient.
Topics: Adult; Aorta; Benchmarking; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Constriction; Evidence-Based Medicine; Female; Fetal Mortality; Gestational Age; Humans; Maternal Mortality; Patient Safety; Pregnancy; Pregnancy Complications, Cardiovascular; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Young Adult
PubMed: 22945848
DOI: 10.1093/icvts/ivs318 -
NCHS Data Brief Dec 2021This report presents final 2020 U.S. mortality data on deaths and death rates by demographic and medical characteristics. These data provide information on mortality...
This report presents final 2020 U.S. mortality data on deaths and death rates by demographic and medical characteristics. These data provide information on mortality patterns in U.S. residents by variables such as sex, age, race and Hispanic origin, and cause of death. Life expectancy estimates, age-adjusted death rates, age-specific death rates, 10 leading causes of death, and 10 leading causes of infant death were analyzed by comparing 2020 and 2019 final data (1).
Topics: Cause of Death; Humans; Infant; Infant Mortality; Life Expectancy; Mortality; Sex Distribution; United States
PubMed: 34978528
DOI: No ID Found -
Revista Da Associacao Medica Brasileira... Jan 2019
Topics: Cardiovascular Diseases; Cause of Death; Diabetes Mellitus, Type 2; Humans; Mortality, Premature
PubMed: 30758412
DOI: 10.1590/1806-9282.65.1.1 -
Asian Pacific Journal of Cancer... 2010Research papers and data concerning NPC epidemiology in China available worldwide were reviewed. It was found that although the results of three national all... (Review)
Review
Research papers and data concerning NPC epidemiology in China available worldwide were reviewed. It was found that although the results of three national all death-causes sampling surveys in China showed mortality rates in most sampling areas and all as overall to be declining continuously and remarkably, figures for 1987-2000 in some selected areas of China released by the World Health Organization were relatively stable, and the NPC incidence and mortality rates reported by Zhongshan and Sihui cities of Guangdong Province in China had shown ascending or stable trends, respectively. Differences with regard to change in NPC incidence and mortality rates over time may be caused by variation in the data quality from divergent sources, but the exact reasons clearly warrant further analysis.
Topics: China; Humans; Incidence; Mortality; Nasopharyngeal Neoplasms; Survival Rate
PubMed: 20593926
DOI: No ID Found -
European Journal of Cancer (Oxford,... Jul 2021Breast cancer mortality in European women has been falling for three decades. We analysed trends in mortality from breast cancer in Europe over the period 1980-2017 and...
BACKGROUND
Breast cancer mortality in European women has been falling for three decades. We analysed trends in mortality from breast cancer in Europe over the period 1980-2017 and predicted number of deaths and rates to 2025.
METHODS
We extracted death certification data for breast cancer in women for 35 European countries, between 1980 and 2017, from the World Health Organisation database. We computed the age-standardised (world standard population) mortality rates per 100,000 person-years, by country and calendar year. We obtained also predictions for 2025 using a joinpoint regression model and calculated the number of avoided deaths over the period 1994-2025.
RESULTS
The mortality rate declined from 15.0 in 2012 to 14.4 in 2017 per 100,000 women (-3.9%) for the European Union (EU)-27. This fall was greater in the EU-14 (-5.2%), whereas rates rose in the transitional countries during this period by 1.9%. Mortality rate predictions across Europe are expected to reach relatively uniform levels in 2025. During the studied period, favourable trends in mortality emerged in most countries, with the greatest decrease in Denmark, whereas Poland and Romania showed an upward trend. The largest predicted decrease in breast cancer mortality was estimated for the United Kingdom (12.2/100,000 women in 2025), leading to the estimated avoidance of 150,000 breast cancer deaths over the period 1994-2025 and 470,000 in the EU-27.
CONCLUSIONS
Favourable trends in breast cancer mortality were observed in most European countries, and they will continue to fall in the coming years. Less favourable patterns were still observed among the transitional countries than other European areas.
Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Databases, Factual; Europe; Female; Forecasting; History, 20th Century; History, 21st Century; Humans; Middle Aged; Mortality; Young Adult
PubMed: 34062485
DOI: 10.1016/j.ejca.2021.04.026 -
CMAJ : Canadian Medical Association... Feb 2016Data on resting heart rate and risk of all-cause and cardiovascular mortality are inconsistent; the magnitude of associations between resting heart rate and risk of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Data on resting heart rate and risk of all-cause and cardiovascular mortality are inconsistent; the magnitude of associations between resting heart rate and risk of all-cause and cardiovascular mortality varies across studies. We performed a meta-analysis of prospective cohort studies to quantitatively evaluate the associations in the general population.
METHODS
We searched PubMed, Embase and MEDLINE from inception to Jan. 1, 2015. We used a random-effects model to combine study-specific relative risks and 95% confidence intervals (CIs). We used restricted cubic spline functions to assess the dose-response relation.
RESULTS
A total of 46 studies were included in the meta-analysis, involving 1 246 203 patients and 78 349 deaths for all-cause mortality, and 848 320 patients and 25 800 deaths for cardiovascular mortality. The relative risk with 10 beats/min increment of resting heart rate was 1.09 (95% CI 1.07-1.12) for all-cause mortality and 1.08 (95% CI 1.06-1.10) for cardiovascular mortality. Compared with the lowest category, patients with a resting heart rate of 60-80 beats/min had a relative risk of 1.12 (95% CI 1.07-1.17) for all-cause mortality and 1.08 (95% CI 0.99-1.17) for cardiovascular mortality, and those with a resting heart rate of greater than 80 beats/min had a relative risk of 1.45 (95% CI 1.34-1.57) for all-cause mortality and 1.33 (95% CI 1.19-1.47) for cardiovascular mortality. Overall, the results did not differ after adjustment for traditional risk factors for cardiovascular disease. Compared with 45 beats/min, the risk of all-cause mortality increased significantly with increasing resting heart rate in a linear relation, but a significantly increased risk of cardiovascular mortality was observed at 90 beats/min. Substantial heterogeneity and publication bias were detected.
INTERPRETATION
Higher resting heart rate was independently associated with increased risks of all-cause and cardiovascular mortality. This indicates that resting heart rate is a predictor of all-cause and cardiovascular mortality in the general population.
Topics: Cardiovascular Diseases; Cause of Death; Heart Rate; Humans; Mortality; Risk Factors
PubMed: 26598376
DOI: 10.1503/cmaj.150535 -
Frontiers in Public Health 2023Under-five mortality rate (U5MR) and maternal mortality rate (MMR) are important indicators for evaluating the quality of perinatal health and child health services in a...
INTRODUCTION
Under-five mortality rate (U5MR) and maternal mortality rate (MMR) are important indicators for evaluating the quality of perinatal health and child health services in a country or region, and are research priorities for promoting maternal and infant safety and maternal and child health. This paper aimed to analysis and predict the trends of U5MR and MMR in China, to explore the impact of social health services and economic factors on U5MR and MMR, and to provide a basis for relevant departments to formulate relevant policies and measures.
METHODS
The JoinPoint regression model was established to conduct time trend analysis and describe the trend of neonatal mortality rate (NMR), infant mortality rate (IMR), U5MR and MMR in China from 1991 to 2020. The linear mixed effect model was used to assess the fixed effects of maternal health care services and socioeconomic factors on U5MR and MMR were explored, with year as a random effect to minimize the effect of collinearity. Auto regressive integrated moving average models (ARIMA) were built to predict U5MR and MMR from 2021 to 2025.
RESULTS
The NMR, IMR, U5MR and MMR from 1991 to 2020 in China among national, urban and rural areas showed continuous downward trends. The NMR, IMR, U5MR and MMR were significantly negatively correlated with gross domestic product (GDP), the proportion of the total health expenditure (THE) to GDP, system management rate, prenatal care rate, post-natal visit rate and hospital delivery rate. The predicted values of national U5MR from 2021 to 2025 were 7.3 ‰, 7.2 ‰, 7.1 ‰, 7.1 ‰ and 7.2 ‰ and the predicted values of national MMR were 13.8/100000, 12.1/100000, 10.6/100000, 9.6/100000 and 8.3/100000.
CONCLUSION
China has made great achievements in reducing the U5MR and MMR. It is necessary for achieving the goals of Healthy China 2030 by promoting the equalization of basic public health services and further optimizing the allocation of government health resources. China's experience in reducing U5MR and MMR can be used as a reference for developing countries to realize the SDGs.
Topics: Infant; Infant, Newborn; Child; Pregnancy; Female; Humans; Child Mortality; Maternal Mortality; Infant Mortality; Socioeconomic Factors; China
PubMed: 37927855
DOI: 10.3389/fpubh.2023.1198356 -
Global Health, Science and Practice Jun 2020As with the Ebola outbreak, global under-5 mortality and morbidity should be considered a public health emergency of international concern.
As with the Ebola outbreak, global under-5 mortality and morbidity should be considered a public health emergency of international concern.
Topics: Cause of Death; Child; Child Health; Child Mortality; Child, Preschool; Democratic Republic of the Congo; Disease Outbreaks; Emergencies; Global Health; Hemorrhagic Fever, Ebola; Humans; Infant; Infant Health; Infant Mortality
PubMed: 32430358
DOI: 10.9745/GHSP-D-19-00422