Articles: mortality.
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Das Gesundheitswesen · Feb 1995
[Frequency analysis for achieving health goals--I: Standardization].
The formal mathematical steps of direct and indirect standardisation are deduced and it is pointed out that standardisation is an analytical concept for processing data within the framework of structurised populations to enable correct interpretation of these data in a manner modified according to specific problems. In particular, this concept is not confined to transforming age-structured mortality data of a population to the age distribution of the members of a larger population by means of a rule of three. Standardisation is in fact a model of the macrolevel (population). ⋯ The standardisation approach can be used in case of weighted arithmetic, geometric or harmonic means. Before effecting standardisation, the type of connection between the employed data should be examined. The examples of concepts of direct standardisation refer to cardiovascular and accident mortality in West Berlin from 1963 to 1991, whereas those of indirect standardisation are based on the accident mortality in West Berlin in 1987 structured according to city districts.
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J. Thromb. Thrombolysis · Jan 1995
Thrombolysis in Acute Myocardial Infarction Complicated by Cardiogenic Shock.
The adverse impact of the development of cardiogenic shock in the setting of acute myocardial infarction was first described by Killip and Kimball in 1967. While the in-hospital mortality rate in patients with myocardial infarction and no evidence of heart failure was only 6%, the mortality rate in those patients who developed cardiogenic shock was 81%. Despite advances in cardiovascular care and therapy since that initial report, including universal institution of cardiac care units, advances in hemodynamic monitoring, new inotropic and vasodilating agents, and even increasing utilization of thrombolytic therapy, the mortality from acute myocardial infarction, when complicated by cardiogenic shock, remains disturbingly high, and cardiogenic shock remains the leading cause of death of hospitalized patients following acute myocardial infarction. ⋯ These low perfusion rates may, in part, be explained by decreased coronary blood flow and perfusion pressure in patients with left ventricular pump failure. Although promising as adjunctive therapy, it is unclear whether institution of balloon counterpulsation has any long-term benefit in patients with cardiogenic shock treated with thrombolytic therapy. Whether other or additional interventions, such as coronary angioplasty and coronary artery bypass graft (CABG), decrease mortality rates in patients with cardiogenic shock remains to be determined.
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With more than 40% of all female deaths attributable to pregnancy, delivery, and the puerperium period, the study established a maternal mortality ratio of 914 deaths per 100,000 live births. The principal risk factors for dying from pregnancy-related causes are: no attendance at antenatal care, too great a distance between the home and the nearest hospital facility, home delivery, belonging to specific ethnic/religious groups, and delivery assistance from family members and TBAs. The health policy implications to improve this situation are: increased coverage with appropriate services, increased numbers of rural midwives, in-service training of existing staff in maternity issues and problems, culture-specific educational approaches using the existing value system, educational campaigns to discourage harmful practices and behaviour, continued educational efforts to upgrade the knowledge of TBAs, and a culturally sensitive integration of TBAs into the government programmes.