Lars-Gunnar Hörte

Observed and relative survival after aortic valve replacement.

OBJECTIVES We sought to evaluate the effects of a number of factors that can potentially determine the optimal time for aortic valve replacement (AVR) and the observed and relative survival after the operation. BACKGROUND Aortic valve replacement is performed in patients within a wide age span, but the proportion of elderly patients is increasing. In survival analyses, adjustment for the effects of age is therefore essential. Analysis of relative survival provides additional information on excess or disease-specific mortality and its risk factors. METHODS Survival was analyzed in 2,359 patients (1,442 without and 917 with concomitant coronary artery bypass graft surgery) undergoing their first AVR. By relating observed survival to that expected among the general Swedish population stratified by age, gender and five-year calendar period, the relative survival and disease-specific survival were estimated. RESULTS Early mortality after AVR (death within 30 days) was 5.6%. Relative survival rates (excluding early deaths) after 5, 10 and 15 years were 94.6%, 84.7% and 74.9%, respectively. There was an excess risk of dying during the entire follow-up period. Advanced New York Heart Association functional class, preoperative atrial fibrillation and pure aortic regurgitation were independent risk factors for observed and relative survival. Patients in the oldest age group showed decreased observed survival but excellent relative survival. CONCLUSIONS Old age was not a risk factor for excess mortality after AVR, whereas atrial fibrillation decreased relative survival substantially.

Outcome after lung cancer surgery. Factors predicting early mortality and major morbidity

OBJECTIVE This study was undertaken to assess mortality, complications and major morbidity during the first 30 days after lung cancer surgery and to estimate the significance of presurgical risk factors. METHODS The study was based on all patients referred for surgery for primary lung cancer from 1 January 1987 to 1 September 1999. There were in total 616 patients with primary lung cancer. Three-hundred and ninety-four were men and 222 women. Postoperative events studied were divided into major and minor complications or death during the first 30 days after surgery. The significance of risk factors for an adverse outcome (defined as death or major complication in the first 30 days postoperatively) was assessed by uni- and multivariate logistic regression analyses. RESULTS During the study period an increasing number of women and of patients older than 70 years underwent surgery. Overall 30-day mortality was 2.9, 0.6% after single lobectomy and 5.7% after pneumonectomy. Major complications occurred in 54 patients (8.8%). Fifty-eight patients (9.5%) had an adverse outcome during the first 30 days. Male gender, smoker, FEV(1)< or =70% of expected value, squamous cell carcinoma and pneumonectomy were risk factors predicting adverse outcome in the univariate model. Pneumonectomy and FEV(1)< or =70%, were the only independently significant factors for adverse outcome. Only pneumonectomy was independently associated with an increased risk for early death. CONCLUSION Our results show low mortality and morbidity after lung cancer surgery. However, patients with reduced lung capacity and those undergoing pneumonectomy should be treated with great care, as they run a considerable risk of major complications or death during the first 30 days postoperatively. Older age (>70 years) does not appear to be a contraindication to lung cancer surgery, but patients in this group should undergo careful preoperative evaluation.

The effects of political and economic transitions on health and safety in Estonia: an Estonian-Swedish comparative study.

A general and dramatic deterioration of health in Estonia during the transition period 1990-1994 was analysed using Sweden as a comparative example. Though there were diverging trends between Estonia and Sweden in the leading cause of death, cardiovascular diseases, the gap in mortality from injury had increased most rapidly. While the injury mortality rate slightly decreased in Sweden from 1990 to 1994, it almost doubled in Estonia. In 1994, the total injury death rate for men was about 6 times higher in Estonia than in Sweden. The death rates for some types of injuries, such as alcohol intoxication and homicide, were many tenfolds higher in Estonia than in Sweden. Injury contributed the most to the widening health gap between the countries, especially in males. The mechanisms of this sudden health deterioration remain to be fully explained. It could be hypothesised that behind the traditional behavioural risk factors, the influence of socio-political factors related to economic and political reconstruction is present. A widespread risk-taking and unhealthy behaviour among Estonians can likely be partly explained as a way of coping with the distress created by the new demands of transition society. An important challenge on the way to improvement is creating the political will among policy-makers to confront the tremendous problems of controlling the factors in society that affect the populations health in Estonia.

Trend and Current Status of Child Injury Fatalities in Thailand Compared with Sweden and Japan

Abstract The aim of this paper was to analyze the trend and current pattern of child injury fatalities in Thailand and compare them to those in Sweden and Japan. The experiences in these higher-income countries will help identify potential crucial areas that might be beneficial to Thailand. In 1996, a total of 4153 Thai children died of injuries, of which two-thirds were due to drowning or transport crashes. Drowning was the leading cause of death in all age-gender groups except for boys aged 10–14 years. Compared to those in Sweden and Japan, a substantial difference in mortality rates was observed, especially drowning deaths in girls aged 5–14 years. Contrary to Sweden and Japan, injury death rates in Thai children showed increasing trends between 1987 and 1996. To improve child survival, recognizing injury as a major child health problem, expanding safety research, and implementing safety promotion programs are crucial factors.

The Horizon of Unintentional Injuries among Children in Low-Income Setting: An Overview from Bangladesh Health and Injury Survey

Introduction. The paper aims to explore the magnitude and distribution of unintentional injuries among Bangladeshi children (<18 years). Methodology. A cross sectional survey was conducted during 2003 (January to December) in 12 randomly selected districts and Dhaka Metropolitan City of Bangladesh. Nationally representative data were collected from 171 366 households comprising of 351 651 children of under 18 years. Information includes the number of deaths and illness at the household in the preceding year. Verbal autopsy and verbal diagnosis form was used to determine the cause of mortality and morbidity respectively. Results. There were 351651 children in the study, of which 5577 had one or more injuries in the past one year. Drowning and falls was the leading cause of injury mortality and morbidity in children over 1 year of age respectively. Incidence of unintentional injuries was significantly higher among boys (95% CI = −2157.8) than girls (95% CI = 968.7 − 1085.8) while rural children were the most vulnerable group. Home and its premises was the most common place for the injury incidence. Conclusion. The result of the study could be an insight to the policy makers to develop realistic and effective strategies to address the issue.

Postoperative atrial fibrillation predicts cause-specific late mortality after coronary surgery

Abstract Objectives. To investigate the association between postoperative atrial fibrillation (POAF) and cause-specific death after coronary artery bypass grafting (CABG) over time. Design. The cohort included 6821 patients undergoing primary isolated CABG between 1996 and 2009. Survival analyses using Cox proportional hazards determined the association between POAF and late mortality and cause of death. Four categories of mortality were examined: cardiac mortality; and death related to arrhythmia, cerebrovascular disease, and heart failure. Results. Median follow-up was 9.8 years and 2152 of 6821 patients (32%) developed POAF. During follow-up, 2302 of 6821 patients (34%) died. For all mortality categories, lower survival rates were found among POAF patients. After adjustment for baseline characteristics, medical history, and preoperative status, POAF was related to increased mortality in all four categories: cardiac mortality (HR 1.4; 95% CI 1.3–1.5); death related to arrhythmia (HR 1.8; 95% CI 1.6–2.0); cerebrovascular disease (HR 1.4; 95% CI 1.2–1.6); and heart failure (HR 1.4; 95% CI 1.3–1.6). The effect remained more than 8 years after surgery. Conclusions. POAF predicts cause-specific late mortality after CABG, with a sustained effect many years postoperatively. This suggests that POAF-episodes are not merely an indication of more advanced disease at surgery, but predicts a persistent negative effect on cause-specific survival.

Childhood fall: Epidemiologic findings from a population-based survey in Bangladesh

Childhood falls and their complications are a serious public health concern worldwide. However, very few programs have been developed to address the problem because of the lack of convincing data, especially in developing countries. Our study aimed at exploring the magnitude and associated factors of the childhood fall in Bangladesh. Methods·. A descriptive cross-sectional survey was conducted during 2003 (January to December) in 12 randomly selected districts and Dhaka Metropolitan City of Bangladesh. Nationally representative data were collected from 171,366 households comprising 351,651 children of below 18 years of age. Information includes the number of deaths and illness at-the household in the preceding year. Verbal autopsy and verbal diagnosis form was used to determine the cause of mortality and morbidity respectively. Results: Fall was the 4 leading cause of morbidity after infancy and the leading cause of morbidity among 5-9 years age group. The incidence of childhood fall was significantly higher among boys than in girls (642.8 vs 298.2 per 100,000 children year). Rural children (594.7 per 100,000 children-years) were the most vulnerable group, whereas the home and its premises were found as the most common place for the incidence. Fall (28.9%) was the leading cause of injury-related permanent disability. Conclusion: The result of the study could provide insight to policymakers for future action on one of the leading causes of morbidity and disability among children in Bangladesh and possibly in other developing countries.

The research group, the conference programme and academic training in safety promotion – a report of the activities at Karolinska Institutet, Sweden

The research group was established in 1967 at Lund University and moved to Karolinska Institutet in 1980. Work began with epidemiological studies of all injuries in the local community in support of various experimental local interventions. An important element was the creation of ‘surveillance systems’ in healthcare. The work resulted in the establishment of a WHO Collaborating Centre and an international safety-building programme called ‘Safe Communities’. In parallel, training at both masters and doctoral level and the building of a conference programme were embarked upon. The research group consists of three sections. Specific efforts are being made by some countries to address their own injury problems.

Unintentional injuries among children in a low-income country: result form the largest population-based survey in Bangladesh

Introduction Unintentional childhood injuries are recognised as a major public health problem globally, but little is known about their patterns in most low-income countries including Bangladesh. However, no specific intervention has yet been developed to address the issue in Bangladesh. Objectives Objectives of the paper are to explore the magnitude and distribution of unintentional injuries among Bangladeshi children (<18 years). Methodology: A cross sectional survey was conducted during 2003 (January – December) in 12 randomly selected districts and Dhaka Metropolitan City of Bangladesh. Nationally representative data were collected from 171 366 households comprising of 351 651 children of under 18 years. Information includes the number of deaths and illness at the household in the preceding year. Verbal autopsy and verbal diagnosis form was used to determine the cause of mortality and morbidity respectively. Results There were 351 651 children in the study, of which 5577 had one or more injuries in the past 1 year. Drowning was the leading cause of injury mortality in children over 1 year of age and falls was the leading cause of injury morbidity. Incidence of unintentional injuries was significantly higher among boys (95% CI 1994.9 to 2157.8) than girls (95% CI 968.7 to 1085.8) while rural children were the most vulnerable group. Home and its premises was the most common place for the injury incidence. Conclusion The result of the study could be an insight to the policy makers and public health planners for developing realistic and effective strategies to address the issue.

Childhood fall, a major cause of morbidity and disability: epidemiological findings from the largest population based survey in Bangladesh

Childhood falls and their complications are a serious public health concern worldwide. However, very few programs have been developed to address the problem because of the lack of convincing data, especially in developing countries. Our study aimed at exploring the magnitude and associated factors of the childhood fall in Bangladesh. Methods A descriptive cross-sectional survey was conducted during 2003 (January to December) in 12 randomly selected districts and Dhaka Metropolitan City of Bangladesh. Nationally representative data were collected from 171 366 households comprising 351 651 children of below 18 years of age. Information includes the number of deaths and illness at the household in the preceding year. Verbal autopsy and verbal diagnosis form was used to determine the cause of mortality and morbidity respectively. Results Fall was the fourth leading cause of morbidity after infancy and the leading cause of morbidity among 5–9 years age group. The incidence of childhood fall was significantly higher among boys than in girls (642.8 vs 298.2 per 100 000 children year). Rural children (594.7 per 100 000 children-years) were the most vulnerable group, whereas home and its premises were found as the most common place for the incidence. Fall (28.9%) was the leading cause of injury-related permanent disability. Conclusion The result of the study could provide insight to policymakers for future action on one of the leading causes of morbidity and disability among children in Bangladesh and possibly in other developing countries.