Articles: mortality.
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About one third of hospital mortality in critically ill patients occurs after Intensive Care Unit (ICU) discharge. Some authors have recently hypothesized that unresolved or latent inflammation and sepsis may be an important factor that contributes to death following successful discharge from the ICU. ⋯ At ICU discharge serum CRP concentration was a poor marker of post-ICU prognosis. Post-ICU death appears to be unrelated to the persistent inflammatory response.
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Health benefits of marriage have long been recognised and extensively studied but previous research has yielded inconsistent results for older people, particularly older women. At older ages accumulated benefits or disadvantages of past marital experience, as well as current marital status, may be relevant, but fewer studies have considered effects of marital history. Possible effects of parity, and the extent to which these may contribute to marital status differentials in health, have also been rarely considered. ⋯ Results were consistent with previous studies in showing that the relationship between marital experience and later life health and mortality is considerably modified by socio-economic factors, and additionally showed that taking women's parity into account further moderated associations. Considering marital history rather than simply current marital status provided some insights into differentials between, for example, remarried people according to prior marital status and time remarried, but these groups were relatively small and there were some disadvantages of the approach in terms of loss of statistical power. Consideration of past histories is likely to be more important for later born cohorts whose partnership experiences have been less stable and more heterogeneous.
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Support Care Cancer · Jan 2010
Comparative StudyEvaluation and comparison of two prognostic scores and the physicians' estimate of survival in terminally ill patients.
Most terminally ill patients request information about their remaining life span. Professionals are not generally willing to provide prognosis on survival, even though they are expected to be able to do so from their clinical experience. This study aims to find out whether the standardized instruments Palliative Prognostic Index (PPI) and the Palliative Prognostic Score (PaP-S) are appropriate, specific, and sensitive to estimate survival time in patients receiving inpatient palliative care in Germany. ⋯ The prognostic scores are not able to produce a precise reliable prognosis for the individual patient. Nevertheless, they can be used for ethical decision making and team discussions. Estimating survival time from clinical experience seems to be easier for very bad or very good prognosis for physicians.
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Review Historical Article
Banishing death: the disappearance of the appreciation of mortality.
The experience of death and dying is very different in the 21st century than it was in the 19th. A number of societal changes in the latter part of the 19th and early part of the 20th centuries served to remove contact with the dying and the dead from everyday experience. This article examines four of these changes: 1) falling death rates, 2) the rise of hospitals, 3) the rise of funeral directing as a profession, and 4) the rural cemetery movement. It is proposed that these changes produced an unjustified optimism with regard to the prolongation of life.
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Comparative Study
The challenge of understanding mortality changes among street youth.
According to a cohort study conducted in Montréal, Québec from 1995 to 2000, the mortality rate among street youth was 921/100,000 person-years. Several new community initiatives aiming to increase access to housing and to social and health services for the homeless were implemented in the city between 2000 and 2003. This study aims to update the mortality rate estimate for the period 2001-2006 and to examine factors that could explain a difference between rates, if any. ⋯ It seems that various factors could have contributed to the decline in mortality rates among street youth, one plausible factor being the implementation of new services for the homeless. This study underscores the importance of monitoring risky behaviors among vulnerable populations to ensure that morbidity and mortality data among these populations is correctly interpreted. Setting up a system to monitor the drug market could improve the quality of information collected.