Alcohol consumption and mortality from all causes,coronary heart disease,and stroke: results from a prospective cohort study of Scottish men with 21 years of follow up

ObjectivesTo relate alcohol consumption to mortality.DesignProspective cohort study.Setting27 workplaces in the west of Scotland.Participants5766 men aged 35-64 when screened in 1970-3 who answered questions on their usual weekly alcohol consumption.ResultsRisk for all cause mortality was similar for non-drinkers and men drinking up to 14 units a week. Mortality risk then showed a graded association with alcohol consumption (relative rate compared with non-drinkers 1.34 (95% confidence interval 1.14 to 1.58) for 15-21 units a week, 1.49 (1.27 to 1.75) for 22-34 units, 1.74 (1.47 to 2.06) for 35 or more units). Adjustment for risk factors attenuated the increased relative risks, but they remained significantly above 1 for men drinking 22 or more units a week. There was no strong relation between alcohol consumption and mortality from coronary heart disease after adjustment. A strong positive relation was seen between alcohol consumption and risk of mortality from stroke, with men drinking 35 or more units having double the risk of non-drinkers, even after adjustment.ConclusionsThe overall association between alcohol consumption and mortality is unfavourable for men drinking over 22 units a week, and there is no clear evidence of any protective effect for men drinking less than this.

Key messages

• Results from a large cohort study of employed Scottish men showed different relations between alcohol consumption and mortality than previous studies
• There was no relation between mortality from coronary heart disease and alcohol consumption once adjustments were made for potential confounding factors
• There was a strong relation with mortality from stroke; drinkers of over 35 units a week had double the risk of mortality compared with non-drinkers
• Some but not all of this could be accounted for by alcohol related increases in blood pressure
• Overall, risk of all cause mortality was higher in men drinking 22 or more units a week

     

Smoking Behavior and Healthcare Expenditure in the United States, 1992–2009: Panel Data Estimates

BackgroundReductions in smoking in Arizona and California have been shown to be associated with reduced per capita healthcare expenditures in these states compared to control populations in the rest of the US. This paper extends that analysis to all states and estimates changes in healthcare expenditure attributable to changes in aggregate measures of smoking behavior in all states.ConclusionsChanges in healthcare expenditure appear quickly after changes in smoking behavior. A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. State and national policies that reduce smoking should be part of short term healthcare cost containment.     

Social epidemiology of chronic liver disease and cirrhosis mortality in the United States, 1935-1997: trends and differentials by ethnicity, socioeconomic status, and alcohol consumption

This study examines trends and ethnic and socioeconomic differentials in chronic liver disease and cirrhosis mortality in the United States. Age-adjusted death rates from the National Vital Statistics System were used to analyze race and sex-specific mortality trends from 1968 through 1997. Age-adjusted liver cirrhosis mortality and per capita alcohol consumption data from 1935 through 1996 were modeled using time-series regression. Moreover, the Cox hazards regression was applied to the National Longitudinal Mortality Study, 1979-1989, to examine socioeconomic differentials at the individual level, whereas multivariate ordinary least squares regression was used to model state-specific cirrhosis mortality from 1990 to 1992 as a function of socioeconomic variables and alcohol consumption at the ecological level. Chronic liver disease and cirrhosis continues to be an important cause of death in the United States, even after three decades of consistently declining mortality rates. For both men and women aged 25 years and older, significant mortality differentials were found by age, race/ethnicity, marital status, family income, and employment status. For men, marked differentials were also found by nativity, rural-urban residence, and education. Unemployment, minority concentration, and alcohol consumption were major predictors of state-specific cirrhosis mortality. Both time-series and cross-sectional data indicate a strong correlation between alcohol consumption and US cirrhosis mortality. Substantial ethnic and socioeconomic differences in cirrhosis mortality suggest the need for social and public health policies and interventions that target such high-risk groups as American Indians, Hispanic Americans, the socially isolated, and the poor.     

基于ARIMA模型的生态足迹动态模拟和预测——以甘肃省为例

生态足迹(EF)是一种定量测量人类对自然利用程度的方法。然而目前对其发展趋势准确的定量分析尚不多见。可采用自回归综合移动平均模型(ARIMA)来模拟并预测区域生态足迹。综合运用生态足迹方法和ARIMA模型对甘肃省1949-2009年的生态足迹和生态承载力进行了动态模拟和分析,在此基础上预测了2010-2015年的生态足迹变化趋势。结果表明:1949-2009年,人均生态足迹呈现上升趋势,预计2010-2015年上升趋势明显加快,2015年会增加到2.6051 hm²/人,是2009年的1.67倍;1997-2004年人均生态承载力逐年减少,2005年之后逐年增加,预计2010-2015年仍会增加;预计2010-2015年所有人均生态足迹组成类型均呈现上升趋势,尤以人均化石能源生态足迹增长显著;1997-2009年人均生态承载力均小于人均生态足迹,导致生态赤字,甘肃省生态环境处于不可持续状态,预计2010-2015年人均生态承载力略有增长,但仍小于人均生态足迹,生态赤字不断增大,预计2015年增长到-2.0468 hm²/人,约为2009年(-1.0262 hm²/人)的两倍,甘肃省生态环境不断恶化;经济的发展依赖于化石能源的消耗而造成对自然资源的过度利用,大量耕地转换为建设用地,草地荒漠化是引起甘肃省生态赤字的主要原因;改变经济发展和资源消费模式,控制人口规模,减少人均生态足迹消耗,优化配置和集约节约利用自然资源,提高生态承载力是促进社会经济和资源环境可持续发展的有效途经。     

Ecological study of social fragmentation,poverty, and suicide

ObjectivesTo investigate the association between suicide and area based measures of deprivation and social fragmentation.DesignEcological study.Setting633 parliamentary constituencies of Great Britain as defined in 1991.ResultsMortality from suicide and all other causes increased with increasing Townsend deprivation score, social fragmentation score, and abstention from voting in all age and sex groups. Suicide mortality was most strongly related to social fragmentation, whereas deaths from other causes were more closely associated with Townsend score. Constituencies with absolute increases in social fragmentation and Townsend scores between 1981 and 1991 tended to have greater increases in suicide rates over the same period. The relation between change in social fragmentation and suicide was largely independent of Townsend score, whereas the association with Townsend score was generally reduced after adjustment for social fragmentation.ConclusionsSuicide rates are more strongly associated with measures of social fragmentation than with poverty at a constituency level.

Key messages

• Place of residence may affect health, and mortality from most common diseases tends to be higher in areas characterised by low socioeconomic position
• Research dating back over 100 years suggests that social fragmentation may influencesuicide
• In the 1980s and 1990s, parliamentary constituencies with high levels of social fragmentation had high rates of suicide, independent of deprivation
• Constituencies with the greatest increases in social fragmentation between 1981 and 1991 also had the greatest increases in suicide rates over the same period
• Any targeting of suicide prevention may be more effective if aimed at socially fragmented rather than deprived areas

     

β Blockade after myocardial infarction: systematic review and meta regression analysis

ObjectivesTo assess the effectiveness of β blockers in short term treatment for acute myocardial infarction and in longer term secondary prevention; to examine predictive factors that may influence outcome and therefore choice of drug; and to examine the clinical importance of the results in the light of current treatment.DesignSystematic review of randomised controlled trials.SettingRandomised controlled trials.SubjectsPatients with acute or past myocardial infarction.Interventionβ Blockers compared with control.Mainoutcome measures All cause mortality and non-fatal reinfarction.ResultsOverall, 5477 of 54 234 patients (10.1%) randomised to β blockers or control died. We identified a 23% reduction in the odds of death in long term trials (95% confidence interval 15% to 31%), but only a 4% reduction in the odds of death in short term trials (−8% to 15%). Meta regression in long term trials did not identify a significant reduction in effectiveness in drugs with cardioselectivity but did identify a near significant trend towards decreased benefit in drugs with intrinsic sympathomimetic activity. Most evidence is available for propranolol, timolol, and metoprolol. In long term trials, the number needed to treat for 2 years to avoid a death is 42, which compares favourably with other treatments for patients with acute or past myocardial infarction.Conclusionsβ Blockers are effective in long term secondary prevention after myocardial infarction, but they are underused in such cases and lead to avoidable mortality and morbidity.

Key messages

• The first randomised trials of β blockade in secondary prevention after myocardial infarction were published in the 1960s
• β blockers were once heralded as a major advance, but their use for secondary prevention has declined in recent years
• Firm evidence shows that long term β blockade remains an effective and well tolerated treatment that reduces mortality and morbidity in unselected patients after myocardial infarction
• The benefits from β blockade compare favourably with other drug treatments for this patient group
• Most evidence is for propranolol, timolol, and metoprolol, whereas atenolol, which is commonly used, is inadequately evaluated for long term use

     

Influence of hospital and clinician workload on survival from colorectal cancer: cohort study

ObjectiveTo determine whether clinician or hospital caseload affects mortality from colorectal cancer.DesignCohort study of cases ascertained between 1990 and 1994 by a region-wide colorectal cancer register.ResultsOf the 3217 new patients registered over the period, 1512 (48%) died before 31 December 1996. Strong predictors of survival both in a logistic regression (fixed follow up) and in a Cox''s proportional hazards model (variable follow up) were Duke''s stage, the degree of tumour differentiation, whether the liver was deemed clear of cancer by the surgeon at operation, and the type of intervention (elective or emergency and curative or palliative intent). In a multilevel model, surgeon’s caseload had no significant effect on mortality at 2 years. Hospital workload, however, had a significant impact on survival. The odds ratio for death within 2 years for cases managed in a hospital with a caseload of between 33 and 46 cases per year, 47 and 54 cases per year, and ⩾55 cases per year (compared to one with ≤23 cases per year) were respectively 1.48 (95% confidence interval 1.03 to 2.13), 1.52 (1.08 to 2.13), and 1.18 (0.83 to 1.68).ConclusionsThere was no detectable caseload effect for surgeons managing colorectal cancer, but survival of patients treated in hospitals with caseloads above 33 cases per year was slightly worse than for those treated in hospitals with fewer caseloads. Imprecise measurement of clinician specific “events rates” and the lack of routinely collected case mix data present major challenges for clinical audit and governance in the years ahead.

Key messages

• Various benefits have been described for multidisciplinary cancer care, but the precise relation between a surgeon''s or hospital''s caseload and the outcome for the patient is not known
• Any investigation of a caseload effect at the hospital or practitioner level has to simultaneously account for each factor and adjust adequately for case mix
• Surgeon had no significant effect on caseload, but patients treated in hospitals with low caseloads (<33 cases per year) had a slightly better survival at 2 years than those treated in hospitals with a higher caseload
• Defining surgical expertise in terms of volume of activity may be a misdirected and imprecise yardstick for the quality of cancer care; other aspects of the organisation of services may be far more important

     

Colony founding in the primitively eusocial wasp, Ropalidia marginata (Hymenoptera: Vespidae)

Abstract.

• 1 In a 16-month study in Bangalore, India, about 35% of the newly founded colonies of Ropalidia marginata were single foundress colonies and the remainder were multiple foundress colonies with two to twenty-two individuals.
• 2 Larger colonies did not have a significantly higher per capita productivity, did not produce significantly heavier progeny and did not produce them significantly faster than smaller colonies did.
• 3 Predation by the hornet Vespa tropica appeared to be independent of group size.
• 4 Single foundress colonies failed more often but not often enough to make them have a lower average per capita productivity, compared to multiple foundress colonies.
• 5 Some of the advantages of multiple foundress associations came from the greater predictability of their attaining the mean per capita productivity, the relatively lower rates of usurpation experienced by them compared to single foundress colonies, and the opportunities provided by queen turnovers for workers to become replacement queens and gain direct individual fitness.

     

Tobacco smoking and alcohol consumption as risk factors for thymoma – A European case-control study

PurposeHardly anything is known about the aetiology of thymoma. This paper presents data regarding tobacco smoking and alcohol consumption in relation to thymoma from the first case-control study performed on this rare tumour.MethodsA European multi-centre case-control study including incident cases aged 35–69 years with thymoma between 1995 and 1997, was conducted in seven countries. A set of controls, used in seven parallel case-control studies by the same research group was used, including population-based controls from five countries and hospital controls with colon cancer from two countries. Altogether 103 cases, accepted by a reference pathologist, 712 colon cancer controls, and 2071 population controls were interviewed.ResultsTobacco smoking was moderately related with thymoma (OR 1.4, 95% CI 0.9–2.2), and a tendency to dose-response was shown (p = 0.04), with an increased risk for heavy smokers defined as ≥41 pack-years (OR 2.1, 95% CI 1.1–3.9). A high consumption of spirits defined as ≥25 g of alcohol per day was associated with an increased risk of thymoma (OR 2.4, 95% CI 1.1–5.4), whereas no association was found with beer or wine.ConclusionsTobacco smoking and a high intake of spirits were indicated as risk factors for thymoma.     

Alcohol consumption and mortality: modelling risks for men and women at different ages

ObjectiveTo estimate the relation between alcohol consumption and risk of death, the level of alcohol consumption at which risk is least, and how these vary with age and sex.DesignAnalysis using published systematic reviews and population data.SettingEngland and Wales in 1997.ResultsA direct dose-response relation exists between alcohol consumption and risk of death in women aged 16-54 and in men aged 16-34. At older ages the relation is U shaped. The level at which the risk is lowest increases with age, reaching 3 units a week in women aged over 65 and 8 units a week in men aged over 65. The level at which the risk is increased by 5% above this minimum is 8 units a week in women aged 16-24 and 5 units a week in men aged 16-24, increasing to 20 and 34 units a week in women and men aged over 65, respectively.ConclusionsSubstantially increased risks of all cause mortality can occur even in people drinking lower than recommended limits, and especially among younger people.

What is already known on this topic

Non-drinkers and heavy drinkers have higher all cause mortality rates than light drinkers—the U shaped curveThe precise shape and location of the U are likely to depend on age and sex, but this has not been quantified

What this study adds

The level of alcohol consumption that carries the lowest mortality ranges from 0 in men and women aged under 35 to 3 units a week in women aged over 65 and 8 units a week in men aged over 65The level of alcohol consumption that carries a 5% increase in mortality increases with age from 8 to 20 units a week in women and from 5 to 34 units a week in menOur calculations were for England and Wales in 1997: nadirs are likely to be lower in the future and in countries with less ischaemic heart disease     

Effect of the California tobacco control program on personal health care expenditures

Background

Large state tobacco control programs have been shown to reduce smoking and would be expected to affect health care costs. We investigate the effect of California''s large-scale tobacco control program on aggregate personal health care expenditures in the state.

Methods and Findings

Cointegrating regressions were used to predict (1) the difference in per capita cigarette consumption between California and 38 control states as a function of the difference in cumulative expenditures of the California and control state tobacco control programs, and (2) the relationship between the difference in cigarette consumption and the difference in per capita personal health expenditures between the control states and California between 1980 and 2004. Between 1989 (when it started) and 2004, the California program was associated with $86 billion (2004 US dollars) (95% confidence interval [CI] $28 billion to $151 billion) lower health care expenditures than would have been expected without the program. This reduction grew over time, reaching 7.3% (95% CI 2.7%–12.1%) of total health care expenditures in 2004.

Conclusions

A strong tobacco control program is not only associated with reduced smoking, but also with reductions in health care expenditures.     

Nutritional status and mortality of refugee and resident children in a non-camp setting during conflict: follow up study in Guinea-Bissau

ObjectiveTo study the effects on children of humanitarian aid agencies restricting help to refugee families (internally displaced people).DesignFollow up study of 3 months.SettingPrabis peninsular outside Bissau, the capital of Guinea-Bissau, which has functioned as a refugee area for internally displaced people in the ongoing war, and the study area of the Bandim health project in Bissau.Participants422 children aged 9-23 months in 30 clusters.ResultsDuring the refugee situation all children deteriorated nutritionally, and mortality was high (3.0% in a 6 week period). Rice consumption was higher in families resident in Prabis than in refugees from Bissau but there was no difference in food expenditure. Nutritional status, measured by mid- upper arm circumference, was not associated with rice consumption levels in the family, and the decline in circumference was significantly worse for resident than for refugee children; the mid-upper arm circumference of refugee children increased faster than that of resident children. For resident children, mortality was 4.5 times higher (95% confidence interval 1.1 to 30.0) than for refugee children. Mortality for both resident and refugee children was 7.2 times higher (1.3 to 133.9) during the refugee’s stay in Prabis compared with the period after the departure of the refugees.ConclusionIn a non-camp setting, residents may be more malnourished and have higher mortality than refugees. Major improvements in nutritional status and a reduction in mortality occurred in resident and refugee children as soon as refugees returned home despite the fact that there was no improvement in food availability.

Key messages

• During the war in Guinea-Bissau, most of the population fled from the capital and moved in with relatives, friends, or strangers
• International agencies insisted on only providing help to refugees (internally displaced people)
• During the first month of conflict, there were already profound effects on the nutritional status and mortality of young children
• Food consumption was higher in resident families, but resident children were more malnourished and had higher mortality than refugee children
• Nutritional status and survival improved for both refugee and resident children once the refugees returned to Bissau

     

基于不同需求层次的中国城镇居民消费隐含碳排放时空演变机制

正确认识不同需求水平下人均隐含碳排放量的变化,对实现低碳经济及低碳生活具有重要的参考价值。基于居民消费需求层次建立不同需求层次与隐含碳排放的对应关系,将人均隐含碳排放分解为生存型、发展型、奢侈型三类,并运用投入产出法进行核算,在对不同需求层次人均隐含碳排放的空间格局演变分析的基础上采用空间面板方法对其驱动机制进行甄别。结果显示,在全国层面,各需求层次人均隐含碳排放均呈现上升趋势,空间分布不均衡性主要体现在南北差异上,北部地区始终是各需求层次人均隐含碳排放的主要空间载体,其中多数省分生存型人均隐含碳排放上升势头较强,发展型和奢侈型的高值区在省份数量上分别呈现先减后增与逐渐增加的变化趋势;不同需求层次人均隐含碳排放水平相似的地区在空间上呈集聚分布,具有较强的"马太效应";空间面板模型结果显示技术减排是降低不同需求层次人均隐含碳排放的重要举措,而人口规模在各需求层次上的负向减排作用远小于正向的人口结构效应,宏观经济因素主要表现为增排效应,而居民消费因素的作用通道存在差异。此外,部分因素在各需求层次上存在显著空间外溢效应,应重视区域间的横向联动减排效应,做好隐含碳减排的统筹协调工作。     

Social structure and energy efficiency: A preliminary cross-national analysis

This study questions the assumption that there is an immutably positive relationship between per capita GNP and per capita energy consumption among human societies. A ratio of per capita GNP to per capita energy consumption ($U.S./kg coal equivalent) is proposed as a measure of energy efficiency for a cross-national analysis of 118 world nation-states and a subset of 25 developed market economies. This ratio is found to vary considerably, between 0.19 and 9.80. A review of literature suggests possible relationships among several sociodemographic characteristics of nations and levels of efficiency with which energy is converted into goods and services. Among the total sample, level of production (measured in terms of per capita GNP) bears a substantial inverse association with energy efficiency. When per capita GNP is held constant, agricultural share of gross domestic product and percentage of labor force in agriculture continue to be positively associated with energy efficiency among the total sample. Variables measuring defense expenditure, urbanization, and population density exhibit somewhat smaller multivariate relationships with energy efficiency when per capita GNP is controlled, i.e., these variables have significant multivariate parameters, but are less closely related to energy efficiency than level of production and agricultural composition of the economy and labor force. Agricultural composition of the economy and labor force is the major predictor of energy efficiency among the subset of 25 developed market economies. The results suggest that among the developed industrial societies level of production is less important than the composition of production activities in determining aggregate energy efficiency.This paper was originally presented at the annual meeting of the North Central Sociological Association, Pittsburgh, Pennsylvania, May 1977. This research was supported by funds from the Michigan Agricultural Experiment Station, the Ohio Agricultural Research and Development Center, and the National Research Council, National Academy of Sciences.     

Sex matters: secular and geographical trends in sex differences in coronary heart disease mortality

ObjectiveTo examine secular trends and geographical variations in sex differences in mortality from coronary heart disease and investigate how these relate to distributions in risk factors.Design National and international data were used to examine secular trends and geographical variations in sex differences in mortality from coronary heart disease and risk factors.SettingEngland and Wales, 1921-98; Australia, France, Japan, Sweden, and the United States, 1947-97; 50 countries, 1992-6.ResultsThe 20th century epidemic of coronary heart disease affected only men in most industrialised countries and had a very rapid onset in England and Wales, which has been examined in detail. If this male only epidemic had not occurred there would have been 1.2 million fewer deaths from coronary heart disease in men in England and Wales over the past 50 years. Secular trends in mean per capita fat consumption show a similar pattern to secular trends in coronary heart disease mortality in men. Fat consumption is positively correlated with coronary heart disease mortality in men (r_s=0.79; 95% confidence interval 0.70 to 0.86) and inversely associated with coronary heart disease mortality in women (−0.30; −0.49 to −0.08) over this time. Although sex ratios for mortality from coronary heart disease show a clear period effect, those for lung cancer show a cohort effect. Sex ratios for stroke mortality were constant and close to unity for the entire period. Geographical variations in the sex ratio for coronary heart disease were associated with mean per capita fat consumption (0.64; 0.44 to 0.78) but were not associated with the sex ratio for smoking.ConclusionSex differences are largely the result of environmental factors and hence not inevitable. Understanding the factors that determine sex differences has important implications for public health, particularly for countries and parts of countries where the death rates for coronary heart disease are currently increasing.

What is already known on this topic

Mortality for coronary heart disease is greater in men than women in most industrialised countriesThe most widely accepted explanation for this difference is that women are protected by oestrogen

What this study adds

The sex difference in mortality from coronary heart disease varies over time and between countries in a way that cannot be explained by endogenous oestrogenThese trends indicate that sex differences in mortality from coronary heart disease are driven primarily by environmental factorsSex differences in coronary heart disease are not inevitableUnderstanding more about the factors that cause the sex differences in mortality from coronary heart disease has important public health implications     

西藏生态足迹与承载力动态分析

利用生态足迹模型,对2005—2010年西藏的生态足迹和生态承载力以及生态盈余进行了测算。研究发现,西藏2005—2010年人均生态足迹呈现出振荡式上升趋势,从2005年的0.34 hm2/人波动上升到2010年的0.83 hm2/人,其中人均林地消费所占比重最大,多年平均值占总消费的39.8%;人均耕地消费基本稳定在0.18—0.2 hm2/人之间,其他类型土地消费所占比重相对较少;人均生态承载力呈现平滑下降趋势,从2005年的14.78 hm2/人下降到了2010年的13.77 hm2/人,其中林地和牧草地及其转换的化石能源地人均生态承载力所占比重达到了95%,可耕地、牧草地、林地的人均生态承载力在2005—2010年之间呈现缓慢下降趋势,水域人均生态承载力变化不大;人均生态盈余较大,但呈现出递减趋势,2005年为14.44 hm2/人,而2010年下降到12.94 hm2/人;生态盈余中比重最大的是林地,但其足迹波动较大,介于1%—30%之间;草地人均生态足迹仅占生态承载力的5%左右,水域人均生态足迹占生态承载力的比例可忽略不计。     

Nutritional availability and larval density dependence in Aedes aegypti

1. Density dependence is the effect of density on population growth. Density dependence is an aggregate term for a suite of complex interactions between animals and their environment. 2. Mechanistic studies of density dependence in mosquito ecology are sparse, and the role of environmental factors is poorly understood. 3. Two empirical study designs were compared to consider the interaction between nutritional availability and density in Aedes aegypti. First, larvae were fed per capita. Second, larvae were fed a fixed amount of food unadjusted for the number of individuals; therefore, at higher densities, individuals received less per capita. 4. Survivorship, wing length, and development rate were lower at high densities when larvae were fed a fixed, unadjusted amount of food. The opposite was observed when food was adjusted per capita, suggesting that high densities may be beneficial for larval development when per capita nutrition is held constant 5. These results demonstrate that negative associations between Ae. aegypti larval density and larval development are a manifestation of decreased per capita nutrient uptake at high densities. 6. Population regulation is a proportional response to environmental variability in Ae. aegypti. Increased survivorship at high densities when larvae were fed per capita demonstrates that nutritional availability is not the only mechanism of density dependence in mosquitoes. Further studies should characterise density dependence in mosquitoes by using mechanistic study designs across diverse environmental conditions.     

Hunger, partial consumption of prey and prey size preference in a carabid beetle

ABSTRACT.

• 1 Partial consumption of prey and prey size preference were studied in females of the carabid Notiophilus biguttatus F., using different size-classes of the springtail Orchesella cincta (L.) as prey.
• 2 Time to ingest a prey increases disproportionately with prey size, mainly as a consequence of satiation.
• 3 During consumption of a prey the predator's rate of ingestion decreases, partly because of diminishing returns from the prey over feeding time.
• 4 The hypothesis that the diminishing returns from the prey induce partial consumption was refuted.
• 5 Partial consumption in the beetle is due to gut limitation; its occurrence depends on prey size.
• 6 Average weight of prey remains in four prey size classes were close to weights expected from average intercatch intervals and estimates of hunger.
• 7 Prey choice depends on level of food deprivation.
• 8 Partial consumption of prey, prey size preference and profitability of prey in relation to hunger of the beetle are discussed.

     

Explaining differences in English hospital death rates using routinely collected data

ObjectivesTo ascertain hospital inpatient mortality in England and to determine which factors best explain variation in standardised hospital death ratios.DesignWeighted linear regression analysis of routinely collected data over four years, with hospital standardised mortality ratios as the dependent variable.SettingEngland.SubjectsEight million discharges from NHS hospitals when the primary diagnosis was one of the diagnoses accounting for 80% of inpatient deaths.ResultsThe four year crude death rates varied across hospitals from 3.4% to 13.6% (average for England 8.5%), and standardised hospital mortality ratios ranged from 53 to 137 (average for England 100). The percentage of cases that were emergency admissions (60% of total hospital admissions) was the best predictor of this variation in mortality, with the ratio of hospital doctors to beds and general practitioners to head of population the next best predictors. When analyses were restricted to emergency admissions (which covered 93% of all patient deaths analysed) number of doctors per bed was the best predictor.ConclusionAnalysis of hospital episode statistics reveals wide variation in standardised hospital mortality ratios in England. The percentage of total admissions classified as emergencies is the most powerful predictor of variation in mortality. The ratios of doctors to head of population served, both in hospital and in general practice, seem to be critical determinants of standardised hospital death rates; the higher these ratios, the lower the death rates in both cases.

Key messages

• Between 1991-2 and 1994-5 average standardised hospital mortality ratios in English hospitals reduced by 2.6% annually, but the ratios varied more than twofold among the hospitals
• After adjustment for the percentage of emergency cases and for age, sex, and primary diagnosis, the best predictors of standardised hospital death rates were the numbers of hospital doctors per bed and of general practitioners per head of population in the localities from which hospital admissions were drawn
• England has one of the lowest number of physicians per head of population of the OECD countries, being only 59% of the OECD average
• It is now possible to control for factors outside the direct influence of hospital policy and thereby produce a more valid measure of hospital quality of care

     

Double blind, cluster randomised trial of low dose supplementation with vitamin A or beta carotene on mortality related to pregnancy in Nepal. The NNIPS-2 Study Group

ObjectiveTo assess the impact on mortality related to pregnancy of supplementing women of reproductive age each week with a recommended dietary allowance of vitamin A, either preformed or as β carotene.DesignDouble blind, cluster randomised, placebo controlled field trial.SettingRural southeast central plains of Nepal (Sarlahi district).Subjects44 646 married women, of whom 20 119 became pregnant 22 189 times.Intervention270 wards randomised to 3 groups of 90 each for women to receive weekly a single oral supplement of placebo, vitamin A (7000 μg retinol equivalents) or β carotene (42 mg, or 7000 μg retinol equivalents) for over 3½ years.ResultsMortality related to pregnancy in the placebo, vitamin A, and β carotene groups was 704, 426, and 361 deaths per 100 000 pregnancies, yielding relative risks (95% confidence intervals) of 0.60 (0.37 to 0.97) and 0.51 (0.30 to 0.86). This represented reductions of 40% (P<0.04) and 49% (P<0.01) among those who received vitamin A and β carotene. Combined, vitamin A or β carotene lowered mortality by 44% (0.56 (0.37 to 0.84), P<0.005) and reduced the maternal mortality ratio from 645 to 385 deaths per 100 000 live births, or by 40% (P<0.02). Differences in cause of death could not be reliably distinguished between supplemented and placebo groups.ConclusionSupplementation of women with either vitamin A or β carotene at recommended dietary amounts during childbearing years can lower mortality related to pregnancy in rural, undernourished populations of south Asia.

Key messages

• Maternal vitamin A deficiency, evident as night blindness or low serum retinol concentration during pregnancy, is widely prevalent in rural south Asia
• In Nepal, women of reproductive age who were given 7000 μg retinol equivalents of vitamin A on a weekly basis showed a reduction in mortality related to pregnancy of 40%
• Weekly dosing with 42 mg β carotene (also providing 7000 μg retinol equivalents) lowered their mortality by 49%
• Preventing maternal vitamin A deficiency in rural South Asia can lower the risk of mortality of women during and after pregnancy