scholarly journals Geografias da Diabetes Mellitus em Portugal: Como as Condições do Contexto Influenciam o Risco de Morrer

2014 ◽  
Vol 27 (3) ◽  
pp. 309 ◽  
Author(s):  
Paula Santana ◽  
Cláudia Costa ◽  
Adriana Loureiro ◽  
João Raposo ◽  
José Manuel Boavida
Keyword(s):  
Diabetes Mellitus ◽  
Relative Risk ◽  
Rural Areas ◽  
Public Health Problem ◽  
Standardized Mortality Ratio ◽  
Geographic Pattern ◽  
Bayesian Hierarchical ◽  
Risk Of Death ◽  
Mortality Ratio ◽  
Relative Risk Of Death

<strong>Introduction:</strong> Diabetes Mellitus is a public health problem that is on the increase throughout the world, including in Portugal. This paper aims to identify the changing geographic pattern of this cause of death in Portugal and its association with sociomaterial deprivation.<br /><strong>Material and Methods:</strong> This is a transversal ecological study of the deaths by Diabetes Mellitus in Portuguese municipalities in three periods (1989-1993, 1999-2003 and 2006-2010). It uses a Bayesian hierarchical model in order to obtain a smooth standardized mortality ratio and the relative risk of death by Diabetes Mellitus associated to sociomaterial deprivation.<br /><strong>Results:</strong> In 1989-1993, the highest smooth standardized mortality ratio values were found in coastal urban municipalities (80% of municipalities with smooth standardized mortality ratio ≥ 161, of which 60% are urban); in 2006-2010, the opposite was found, with the highest smooth standardized mortality ratio values occurring in rural areas in southern inland regions (76.9% of municipalities with smooth standardized mortality ratio ≥ 161, of which 69.2% are rural), particularly the Alentejo. The relative risk of death by Diabetes Mellitus increases with vulnerability associated to social and economic conditions in the area of residence, and is significant in the last two periods (relative risk: 1.00; IC95%: 0.98-1.02).<br /><strong>Discussion:</strong> Diabetes Mellitus presents a geographic pattern marked by coastal-inland and urban-rural asymmetry. However, this has been altering over the last twenty years. 48% of the population reside in municipalities where the smooth standardized mortality ratio has increased in the last twenty years, particularly in the rural areas of inland Portugal.<br /><strong>Conclusion: </strong>The highest smooth standardized mortality ratio are currently found in rural municipalities with the highest index of sociomaterial deprivation.<br /><strong>Keywords:</strong> Demography; Diabetes Mellitus/epidemiology; Diabetes Mellitus/mortality; Portugal; Socioeconomic Factors.

scholarly journals The APACHE II measured on patients' discharge from the Intensive Care Unit in the prediction of mortality

2013 ◽  
Vol 21 (3) ◽  
pp. 811-819 ◽  
Author(s):  
Luciana Gonzaga dos Santos Cardoso ◽  
Paulo Antonio Chiavone
Keyword(s):  
Linear Regression Analysis ◽  
Prognostic Index ◽  
Apache Ii ◽  
Standardized Mortality Ratio ◽  
Good Discrimination ◽  
Risk Of Death ◽  
Prediction Of Mortality ◽  
Significant Area ◽  
Mortality Ratio ◽  
Good Calibration

OBJECTIVE: to analyze the performance of the Acute Physiology and Chronic Health Evaluation (APACHE II), measured based on the data from the last 24 hours of hospitalization in ICU, for patients transferred to the wards. METHOD: an observational, prospective and quantitative study using the data from 355 patients admitted to the ICU between January and July 2010, who were transferred to the wards. RESULTS: the discriminatory power of the AII-OUT prognostic index showed a statistically significant area beneath the ROC curve. The mortality observed in the sample was slightly greater than that predicted by the AII-OUT, with a Standardized Mortality Ratio of 1.12. In the calibration curve the linear regression analysis showed the R2 value to be statistically significant. CONCLUSION: the AII-OUT could predict mortality after discharge from ICU, with the observed mortality being slightly greater than that predicted, which shows good discrimination and good calibration. This system was shown to be useful for stratifying the patients at greater risk of death after discharge from ICU. This fact deserves special attention from health professionals, particularly nurses, in managing human and technological resources for this group of patients.

Relative Risk of Death in Diabetic and Non Diabetic Dialysis PTS: A Useful Marker of a Cohort Features

1991 ◽  
pp. 455-457
Author(s):  
G. B. Piccoli ◽  
G. Beltrame ◽  
F. Bonello ◽  
M. Salomone ◽  
A. Pacitti ◽  
...  
Keyword(s):  
Relative Risk ◽  
Risk Of Death ◽  
Relative Risk Of Death

scholarly journals White Blood Cell and Platelet Dynamics Define Human Inflammatory Recovery

2021 ◽  
Author(s):  
Brody H Foy ◽  
Thor Sundt ◽  
Jonathan CT Carlson ◽  
Aaron D Aguirre ◽  
John M Higgins
Keyword(s):  
Relative Risk ◽  
Blood Cell ◽  
White Blood Cell ◽  
Tissue Damage ◽  
Inflammatory Responses ◽  
Good Prognosis ◽  
Adverse Outcomes ◽  
Acute Phase Reactants ◽  
Risk Of Death ◽  
Relative Risk Of Death

Inflammation is the physiologic reaction to cellular and tissue damage caused by pathologic processes including trauma, infection, and ischemia. Effective inflammatory responses integrate molecular and cellular functions to prevent further tissue damage, initiate repair, and restore homeostasis, while futile or dysfunctional responses allow escalating injury, delay recovery, and may hasten death. Elevation of white blood cell count (WBC) and altered levels of other acute phase reactants are cardinal signs of inflammation, but the dynamics of these changes and their resolution are not established. Patient responses appear to vary dramatically with no clearly defined signs of good prognosis, leaving physicians reliant on qualitative interpretations of laboratory trends. We studied the human acute inflammatory response to trauma, ischemia, and infection by tracking the longitudinal dynamics of cellular and serum markers in hospitalized patients. Unexpectedly, we identified a conserved pattern of recovery defined by co-regulation of WBC and platelet (PLT) populations. Across all inflammatory conditions studied, recovering patients followed a consistent WBC-PLT trajectory shape that is well-approximated by exponential WBC decay and delayed linear PLT growth. This recovery trajectory shape may represent a fundamental archetype of human physiologic response at the cellular population scale, and provides a generic approach for identifying high-risk patients: 32x relative risk of adverse outcomes for cardiac surgery patients, 9x relative risk of death for COVID-19, and 5x relative risk of death for myocardial infarction.

Reply to: Concerns about estimating relative risk of death associated with convalescent plasma for COVID-19

2022 ◽  
Author(s):  
Philippe Bégin ◽  
Jeannie Callum ◽  
Richard Cook ◽  
Erin Jamula ◽  
Yang Liu ◽  
...  
Keyword(s):  
Relative Risk ◽  
Risk Of Death ◽  
Relative Risk Of Death

scholarly journals Antiepileptic drug use and mortality among community-dwelling persons with Alzheimer disease

Neurology ◽  
2020 ◽  
Vol 94 (20) ◽  
pp. e2099-e2108 ◽  
Author(s):  
Tatyana Sarycheva ◽  
Piia Lavikainen ◽  
Heidi Taipale ◽  
Jari Tiihonen ◽  
Antti Tanskanen ◽  
...  
Keyword(s):  
Relative Risk ◽  
Alzheimer Disease ◽  
Antiepileptic Drug ◽  
Cognitive Disorder ◽  
Careful Consideration ◽  
Community Dwelling ◽  
Risk Of Death ◽  
Vulnerable Patients ◽  
Relative Risk Of Death ◽  
First 90 Days

ObjectiveTo evaluate the risk of death in relation to incident antiepileptic drug (AED) use compared with nonuse in people with Alzheimer disease (AD) through the assessment in terms of duration of use, specific drugs, and main causes of death.MethodsThe MEDALZ (Medication Use and Alzheimer Disease) cohort study includes all Finnish persons who received a clinically verified AD diagnosis (n = 70,718) in 2005–2011. Incident AED users were identified with 1-year washout period. For each incident AED user (n = 5,638), 1 nonuser was matched according to sex, age, and time since AD diagnosis. Analyses were conducted with Cox proportional regression models and inverse probability of treatment weighting (IPTW).ResultsNearly 50% discontinued AEDs within 6 months. Compared with nonusers, AED users had an increased relative risk of death (IPTW hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.12–1.36). This was mainly due to deaths from dementia (IPTW HR, 1.62; 95% CI, 1.42–1.86). There was no difference in cardiovascular and cerebrovascular deaths (IPTW HR, 0.98; 95% CI, 0.67–1.44). The overall mortality was highest during the first 90 days of AED use (IPTW HR, 2.40; 95% CI, 1.91–3.03). Among users of older AEDs, relative risk of death was greater compared to users of newer AEDs (IPTW HR, 1.79; 95% CI, 1.52–2.16).ConclusionIn older vulnerable patients with a cognitive disorder, careful consideration of AED initiation and close adverse events monitoring are needed.

scholarly journals Relationship between Volume and Survival in Closed Intensive Care Units Is Weak and Apparent Only in Mechanically Ventilated Patients

2013 ◽  
Vol 119 (4) ◽  
pp. 871-879 ◽  
Author(s):  
Rafael Fernández ◽  
Susana Altaba ◽  
Lluis Cabre ◽  
Victoria Lacueva ◽  
Antonio Santos ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Standardized Mortality Ratio ◽  
Hospital Level ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Risk Of Death ◽  
Mortality Ratio ◽  
Low Volume ◽  
Predicted Risk ◽  
Ventilated Patients

Abstract Background: Recent studies have found an association between increased volume and increased intensive care unit (ICU) survival; however, this association might not hold true in ICUs with permanent intensivist coverage. Our objective was to determine whether ICU volume correlates with survival in the Spanish healthcare system. Methods: Post hoc analysis of a prospective study of all patients admitted to 29 ICUs during 3 months. At ICU discharge, the authors recorded demographic variables, severity score, and specific ICU treatments. Follow-up variables included ICU readmission and hospital mortality. Statistics include logistic multivariate analyses for hospital mortality according to quartiles of volume of patients. Results: The authors studied 4,001 patients with a mean predicted risk of death of 23% (range at hospital level: 14–46%). Observed hospital mortality was 19% (range at hospital level: 11–35%), resulting in a standardized mortality ratio of 0.81 (range: 0.5–1.3). Among the 1,923 patients needing mechanical ventilation, the predicted risk of death was 32% (14–60%) and observed hospital mortality was 30% (12–61%), resulting in a standardized mortality ratio of 0.96 (0.5–1.7). The authors found no correlation between standardized mortality ratio and ICU volume in the entire population or in mechanically ventilated patients. Only mechanically ventilated patients in very low-volume ICUs had slightly worse outcome. Conclusion: In the currently studied healthcare system characterized by 24/7 intensivist coverage, the authors found wide variability in outcome among ICUs even after adjusting for severity of illness but no relationship between ICU volume and outcome. Only mechanically ventilated patients in very low-volume centers had slightly worse outcomes.

scholarly journals Predictors of morbidity and mortality in acromegaly: an Italian survey

2012 ◽  
Vol 167 (2) ◽  
pp. 189-198 ◽  
Author(s):  
M Arosio ◽  
G Reimondo ◽  
E Malchiodi ◽  
P Berchialla ◽  
A Borraccino ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Vascular Diseases ◽  
Nationwide Survey ◽  
Hormonal Control ◽  
Older Age ◽  
Morbidity And Mortality ◽  
Standardized Mortality Ratio ◽  
Therapeutic Procedures ◽  
Mortality Ratio

ObjectiveTo describe demographic and hormonal characteristics, comorbidities (diabetes mellitus and hypertension), therapeutic procedures and their effectiveness, as well as predictors of morbidity and mortality in a nationwide survey of Italian acromegalic patients.DesignRetrospective multicenter epidemiological study endorsed by the Italian Society of Endocrinology and performed in 24 tertiary referral Italian centers. The mean follow-up time was 120 months.ResultsA total of 1512 patients, 41% male, mean age: 45±13 years, mean GH: 31±37 μg/l, IGF1: 744±318 ng/ml, were included. Diabetes mellitus was reported in 16% of cases and hypertension in 33%. Older age and higher IGF1 levels at diagnosis were significant predictors of diabetes and hypertension. At the last follow-up, 65% of patients had a controlled disease, of whom 55% were off medical therapy. Observed deaths were 61, with a standardized mortality ratio of 1.13 95% (confidence interval (CI): 0.87–1.46). Mortality was significantly higher in the patients with persistently active disease (1.93; 95% CI: 1.34–2.70). Main causes of death were vascular diseases and malignancies with similar prevalence. A multivariate analysis showed that older age, higher GH at the last follow-up, higher IGF1 levels at diagnosis, malignancy, and radiotherapy were independent predictors of mortality.ConclusionsPretreatment IGF1 levels are important predictors of morbidity and mortality in acromegaly. The full hormonal control of the disease, nowadays reached in the majority of patients with modern management, reduces greatly the disease-related mortality.

scholarly journals DIABETES MELLITUS AND COVID-19. FEATURES OF THE MUTUAL INFLUENCE OF THE TWO PANDEMICS

2021 ◽  
Vol 14 (4) ◽  
pp. 58-66
Author(s):  
JULIYA S. KOVALENKO ◽  
◽  
LIUDMILA A. IVANOVA ◽  
INNA V. KOROL’ ◽  
TAMILA V. BIZHEVA ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Mutual Influence ◽  
Public Health Problem ◽  
Newly Diagnosed ◽  
Global Public Health ◽  
Risk Of Death ◽  
Pubmed Database ◽  
Diagnosed Diabetes ◽  
Hypoglycemic Therapy ◽  
Newly Diagnosed Diabetes

Background.The COVID­19 pandemic that emerged in China in late 2019 continues to be a global public health problem. The growing incidence of diabetes mellitus makes it necessary to assess the mutual impact of these two diseases on the patient prognosis. Aim. The aim of the study was to review the current information about the effect of SARS­CoV­2 virus on the course of diabetes mellitus and mortality, to consider the probability of developing newly diagnosed diabetes mellitus in patients who underwent COVID­19, and to analyze the possibilities of hypoglycemic therapy in the treatment of COVID­19 diabetic disease. Material and methods.Literature sources were searched in the PubMed database, using the keywords: COVID­19, SARS­CoV­2, and diabetes mellitus. The analysis included literature reviews, meta­analyses, systematic reviews, and clinical trials. Results and discussion.After reviewing about 9,000 sources of literature, 295 of the most relevant publications were analyzed, 60 of which were included in this paper. Insufficiently controlled diabetes mellitus appears to be independently associated with COVID­19 severity and high risk of death. Patients with severe COVID­19 in the background of diabetes mellitus are more susceptible to the damaging effects of the cytokine storm. Against the background of SARS­CoV­2 infection joining diabetes mellitus, decompensation of the disease with hyperglycemia occurs, which is difficult to correct even with insulin therapy. SARS­CoV­2 virus has the ability to bind to angiotensin­converting enzyme type 2 receptors that are expressed in β­cells, which can lead to rapid metabolic deterioration with the development of diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome. There is a hypothesis of a potential link between SARS­CoV­2 infection and the development of newly diagnosed diabetes through a direct effect of the virus on pancreatic β­cells. Certain blood glucose­lowering drugs can be continued when infected with SARS­CoV­2 with a positive effect. Conclusions. More research is needed to determine the role of SARS­CoV­2 virus in the development of acute complications and manifestation of diabetes mellitus. Possibilities of modern hypoglycemic therapy of diabetes in COVID­19 are generally evaluated positively and require further study.

scholarly journals Concerns about estimating relative risk of death associated with convalescent plasma for COVID-19

2022 ◽  
Author(s):  
Michael J. Joyner ◽  
Nigel S. Paneth ◽  
Jonathon W. Senefeld ◽  
DeLisa Fairweather ◽  
Katelyn A. Bruno ◽  
...  
Keyword(s):  
Relative Risk ◽  
Risk Of Death ◽  
Relative Risk Of Death
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