Stroke-attributable death among older persons during the great recession

Epidemiological evidence indicates an elevated risk for stroke among stressed persons, in general, and among individuals who have lost their job, in particular. We, therefore, tested the hypothesis that stroke accounted for a larger fraction of deaths during the Great Recession than expected from other deaths and from trends, cycles, and other forms of autocorrelation. Based on vital statistics death data from California spanning 132 months from January 2000 through December 2010, we found support for the hypothesis. These findings appear attributable to non-Hispanic white men, who experienced a 5% increase in their monthly odds of stroke-attributable death. Total mortality in this group, however, did not increase. Findings suggest that 879 deaths among older white men shifted from other causes to stroke during the 36 months following the start of the Great Recession. We infer the Great Recession may have affected social, biologic, and behavioral risk factors that altered the life histories of older white men in ways that shifted mortality risk toward stroke.     

Comparative chlorine and temperature tolerance of the oyster crassostrea madrasensis: Implications for cooling system fouling

Crassostrea madrasensis is an important fouling oyster in tropical industrial cooling water systems. C. madrasensis individuals attach to surfaces by cementing one of their two valves to the substratum. Therefore, oyster fouling creates more problems than mussel fouling in the cooling conduits of power stations, because unlike the latter, the shell of the former remains attached to the substratum even after the death of the animal. However, there are no published reports on the tolerance of this species to chlorination and heat treatment. The mortality pattern and physiological behaviour (oxygen consumption and filtration rate) of three size groups (13 mm, 44 mm and 64 mm mean shell length) of C. madrasensis were studied at different residual chlorine concentrations (0.25, 0.5, 0.75, 1, 2, 3 to 5 mg l^{m 1}) and temperatures (30°C to 45°C). The effect of shell size (=age) on C. madrasensis mortality in the presence of chlorine and taking into account temperature was significant, with the largest size group oysters showing highest resistance. At 1 mg l^{m 1} residual chlorine, the 13 mm and 64 mm size group oysters took 504 h (21 d) and 744 h (31 d), respectively to reach 100% mortality. At 39°C, the 13 mm size group oysters took 218 min to reach 100% mortality, whereas the 64 mm size group oysters took 325 min. The oxygen consumption and filtration rate of C. madrasensis showed progressive reduction with increasing residual chlorine concentrations. However, the filtration rate and oxygen consumption responses of C. madrasensis were not significantly different between 30°C (control) and 37.5°C. There was a sharp decrease in the filtration rate and oxygen consumption at 38.5°C. A comparison of the present mortality data with previous reports on other bivalves suggests that the chlorine tolerance of C. madrasensis lies in between that of Perna viridis and Perna perna, while its temperature tolerance is significantly higher than that of the other two bivalve species. However, in power station heat exchangers, where simultaneous chlorine and thermal stresses are existent, C. madrasensis may have an edge over other common foulants, because of its high temperature tolerance.     

The age-sex structure of the slave population in Harris County, Texas: 1850 and 1860

The effect of the slave system on demography can be revealed by examining the age-sex structure of slave populations. The age-sex structure of slaves in Harris County, Texas is investigated using the 1850 and 1860 slave schedules. Median ages for black and mulatto slaves suggest that the population was young. Population pyramids exhibit a narrow base and top with a broad middle. The high proportion of slaves between 10 and 30 years of age and the increase in population size between 1850 and 1860 were mainly related to the importation of slaves and only partly due to natural increase. The data also show that black slaves were older on small plantations while mulattoes were older on larger farms. It is suggested that differential treatment in terms of purchase practices, assignment of tasks, food allocation, and/or differential susceptibility to infectious diseases may account for this pattern.     

The epidemiologic transition in a frontier town — Manti,Utah: 1849–1977

Census reports and information in burial records of Manti, Utah from 1849 to July 1977 are examined in order to (1)document mortality trends and differentials by age, sex, cause-of-death, and seasonality as Manti passed from a frontier settlement to a rural agricultural community; and (2) ascertain whether the shifts in the cause-of-death structure follow those patterns outlined by Omran (1971, 1974, 1977) in his theory of the epidemiologic transition. Findings parallel patterns suggested by Omran. Major factors accounting for mortality reductions are (1) elimination of the population's dependence upon a contaminated water supply, and (2) adoption of medical advances as they became available.     

Seedling ecology of two miombo woodland trees

The development of seedlings of two miombo trees, Brachystegia spiciformis Benth. and Julbernardia paniculata (Benth.) Troupin, was studied during two growing seasons (December 1989–April 1991) at a Zambian grassland site. Seed germination rates under laboratory and field conditions were not significantly different although germination in the field was delayed by 1–2 weeks due to insufficient rainfall. After one year of storage J. paniculata seed germination had declined from 67% to 17% while germination of B. spiciformis seeds remained at about 83%.Leaf production was confined to the rainy season. Leaf fall occurred during the dry season and in J. paniculata this was followed by shoot die-back during the hot dry period (August–November). Two-thirds of B. spiciformis seedlings experienced shoot die-back but shoot die-back did not necessarily result in seedling mortality. Seedling deaths occurred during the germination period (6–10 weeks after planting) and in the hot dry period (40–50 weeks after planting) during September–November. Survivorship of B. spiciformis seedlings was 74% at the end of the second growing season while this was 46% for J. paniculata.Shoot growth was negligible during the second growing season. In fact mean maximum leaf area of B. spiciformis decreased significantly from 19.7 cm² (SD=5.7) per plant at the end of the first growing season to 13.3 cm² (SD=5.8) at the end of the second growing season (t=3.31, P<0.01). However, root biomass of B. spiciformis seedlings increased 2.8 times during the second growing season.These results suggest that shoot die-back in seedlings of miombo trees is caused by drought and that the slow shoot growth is the result of allocating most of the biomass to root growth during seedling development.     

Burden of disease due to cancer in a Southern Brazilian state

Background: Despite the considerable epidemiological relevance of cancer in developing countries, there are very few studies of the burden related to cancer. The aim of this study was to present and discuss data from a burden-of-cancer study performed in a Southern Brazilian state. Methods: An epidemiological study of ecological design was performed to calculate the disability-adjusted life year (DALY) index. The study was based on records of individuals admitted and treated for cancer in the Brazilian National Health System Hospitals, or individuals who had died of cancer while residing in the state of Santa Catarina in 2008. Results: A total of 73,872.9 DALYs were estimated, which generated a rate of 1220.5 DALYs/100,000 inhabitants. The highest DALYs were those for cancer of the trachea, bronchus and lung with 179.0/100,000 inhabitants, gastric cancer with 101.7/100,000 inhabitants, and breast cancer with 99.7/100,000 inhabitants. The percentage contribution of the DALY component varied according to cancer type; however, mortality was the major component in all types. The highest rates were observed in 60–69-year-olds with 6071.3/100,000 inhabitants, in 70–79-year-olds with 5095.4/100,000 inhabitants, and in 45–59-year-olds with 3189.0 DALY/100,000 inhabitants; 53.7% of DALYs occurred in males. Conclusions: The greatest burden of disease due to cancer in Santa Catarina was attributed to cancer of the trachea, bronchus and lung, followed by gastric and breast cancers. The mortality component was responsible for the greatest burden.     

Assessing changes over time in healthcare provider performance: Addressing regression to the mean over multiple time points

In recent years, the evaluation of healthcare provider performance has become standard for governments, insurance companies, and other stakeholders. Often, performance is compared across providers using indicators in one time period, for example a year. However it is often important to assess changes in the performance of individual providers over time. Such analyses can be used to determine if any providers have significant improvements, deteriorations, unusual patterns or systematic changes in performance. Studies which monitor healthcare provider performance in this way have to date typically been limited to comparing performance in the most recent period with performance in a previous period. It is also important to consider a longer‐term view of performance and assess changes over more than two periods. In this paper, we develop test statistics that account for variable numbers of prior performance indicators, and show that these are particularly useful for assessing consecutive improvements or deteriorations in performance. We apply the tests to coronary artery bypass graft mortality rates in New York State hospitals, and mortality data from Australian and New Zealand intensive care units. Although our applications are to medical data, the new tests have broad application in other areas.     

Biomarkers in critically ill patients with systemic inflammatory response syndrome or sepsis supplemented with high-dose selenium

ObjectiveLow levels of selenium (Se) and glutathione peroxidase (GSHPx), a key selenoenzyme, were documented in systemic inflammatory response syndrome (SIRS) and sepsis, both associated with high mortality. Se supplementation had mixed effects on outcome. We hypothesized that Se supplementation could have a different impact on biomarkers and 28-day mortality in patients with SIRS vs. sepsis.MethodsAdult patients with SIRS or sepsis were randomized to either high-dose (Se+, n = 75) or standard-dose (Se−, n = 75) Se supplementation. Plasma Se, whole blood GSHPx activity, C-reactive protein (CRP), procalcitonin (PCT), prealbumin, albumin and cholesterol levels were measured serially up to day 14.ResultsThere was no difference in mortality between Se− (24/75) vs. Se+ group (19/75; p = 0.367) or between SIRS and septic patients (8/26 vs. 35/124; p = 0.794). There was a trend to reduced mortality in SIRS patients in the Se+ vs. Se− group (p = 0.084). Plasma Se levels increased in the Se+ group only in patients with sepsis but not in patients with SIRS. Plasma Se levels correlated with GSHPx. In SIRS/Se+ group, Se correlated only with GSHPx. In SIRS/Se− group, Se correlated with cholesterol but not with other biomarkers. In sepsis patients, Se levels correlated with cholesterol, GSHPx and prealbumin. Cholesterol levels were higher in survivors in the Se− group.ConclusionsSe levels correlated with GSHPx activity and other nutritional biomarkers with significant differences between SIRS and sepsis groups. High-dose Se supplementation did not affect mortality but a strong trend to decreased mortality in SIRS patients warrants further studies in this population.