The excess mortality of patients with diabetes and concurrent psychiatric illness is markedly reduced by structured personal diabetes care: A 19-year follow up of the randomized controlled study Diabetes Care in General Practice (DCGP).
To assess the effectiveness of an intervention in Type 2 diabetic patients with concurrent psychiatric illness (PI) and compare this with the effectiveness in patients without PI.
In the Diabetes Care in General Practice trial, 1381 patients newly diagnosed with Type 2 diabetes were randomized to 6 years of structured personal diabetes care or routine diabetes care (ClinicalTrials.gov NCT01074762). In this observational post-hoc analysis, the effectiveness of the intervention for diabetes in 179 patients with concurrent PI was analyzed.
During the 19-year follow-up period, patients with PI in the structured personal care group experienced a lower risk for all-cause mortality [105.3 vs. 140.4 events per 1000 patient-years; hazard ratio (HR): 0.63, P=0.023, multivariably adjusted], diabetes-related death (66.0 vs. 95.1; HR: 0.57, P=0.015), any diabetes-related endpoint (169.5 vs. 417.5; HR: 0.47, P=0.0009) and myocardial infarction (54.1 vs. 104.4; HR: 0.48, P=0.013), compared to patients with PI in the routine care group. This translates into a number needed to treat over 10 years of three or lower for these outcomes.
These findings suggest that in primary care, structured diabetes care allowing for individualization was highly effective among diabetic patients with co-occurring PI.
Morbidity and mortality cannot be explained by biological factors alone; socio-economic factors, environment, life-style and health care delivery system also affect mortality rates. Many changes have taken place in socio-economic factors and environment among the elderly, and the health care system has expanded over the last few decades in Finland. However, the social changes have not only been for the better; and the changes in different causes of death among the elderly may have been different. Overall mortality among elderly Finnish males and females decreased in the 1950s, but increased at the beginning of the 1960s. From the later half of the 1960s overall mortality decreased. The decrease in female death rates began earlier and was more rapid than among males. Over one-half of the decrease from 1960-1969 to 1970-1979 among elderly males was due to the decrease in cardiovascular and cerebrovascular mortality; one-fifth was due to the decrease in genitourinary mortality. The male death rates in neoplasms and in violent causes increased during the period under study. Over one-half of the decrease from 1960-1969 to 1970-1979 among elderly females was attributable to the decrease in cardiovascular and cerebrovascular mortality. Lessening genitourinary mortality, gastrointestinal mortality, respiratory mortality, mortality from neoplasms and from violent causes accounted for less than 5% decrease in overall mortality.
Mortality from various urogenital diseases including the malignant neoplasms of the genito-urinary system and the breast in Finland in 1955-1973 was studied. Only minor changes were found in the total death rate of all these diseases between 1955 and 1973. However, the age-specific death rates of the nephritis-nephrosis group decreased both among males and females. Also mortality from all other urogenital diseases than malignant neoplasms decreased among elderly and middle-aged people. Mortality from malignant neoplasms of the breast increased slightly among elderly women and that of the prostate among elderly men. The autopsy rate of the deaths due to all other urogenital diseases (33.5% in 1973) than malignant neoplasms (27.4%) was of the same order as that recorded for all natural deaths (33.2%) in Finland between 1963 and 1973. Many types of malignant urogenital neoplasms remained significantly under-autopsied. The highest autopsy rates of the single urogenital diseases were recorded for acute nephritis and unqualified nephritis; the respective national rates were 90 and 71%, in 1973. These rates exceeded highly significantly the mean national autopsy rate of all deaths which was 38.2%.
Age-standardized proportional mortality ratios (PMRs) were calculated for 10 036 metal workers in British Columbia with the use of information on cause of death and occupation recorded in death registrations from 1950 to 1978. Metal workers were found to have a significantly increased risk of death from lung cancer (PMR = 134). In addition, certain occupational groups of metal workers were found, for the first time, to be at increased risk of death from other types of cancer; these included leukemia (PMR = 356) and cancer of the rectum (PMR = 248) in metal mill workers, Hodgkin's disease in welders (PMR = 242) and multiple myeloma in machinists (PMR = 209).
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Spinal cord injury resulting in paraplegia or tetraplegia has from time immemorial led to early death. Mortality figures as high as 80% over a few years have been noted. Following World War II as a consequence of the intensive care extended to these casualties, the mortality has been significantly diminished. The mortality has been studied on three occasions by the authors and two previous papers have been published, the first in 1961 and the second in 1968. The present paper is based on a mortality and longevity study which covers the period from 1 January 1945 to 30 November 1973, an interval of 29 years less one month. It deals with the mortality of spinal cord injured persons following treatment in Lyndhurst Lodge Hospital and reveals that there has been significant improvement over the period of study.
A defined general population of 159,200 male and female native Swedes born in the period 1911-1940 from an urban catchment area of the then only general hospital, was followed over a decade (1970-79) with regard to in-patient hospitalization for all kinds of diagnoses. As a part of this population cohort study, multiple sclerosis cases (n = 351) and epilepsy cases (n = 648) were studied for association with other diseases. Unexpectedly, a cluster of diseases encompassing tuberculosis, bronchial asthma, diabetes mellitus and myocardial infarction, among the diseases associated with multiple sclerosis, also forms a gradient; this suggests a quantitative rather than a qualitative multifactorial model of disease for the understanding of the pathogenesis of MS. In epilepsy, heterogeneity was suggested as being mainly linked to the presence or absence of co-existing alcoholism. Brain tumours in cases of epilepsy were found almost exclusively in the latter subset and prevailing among younger people independent of sex (with an almost 100-fold excess rate of that disease combination as expected by chance only).
The aims of the study were: (i) to identify trends in the underlying cause-of-death statistics that are due to changes in the coders' selection and coding of causes, and (ii) to identify changes in the coders' documented registration principles that can explain the observed trends in the statistics. 31 Basic Tabulation List categories from the Swedish national cause-of-death register for 1970-1988 were studied. The coders' tendency to register a condition as the underlying cause of death (the underlying cause ratio) was estimated by dividing the occurrence of the condition as underlying cause (the underlying cause rate) with the total registration of the condition (the multiple cause rate). When the development of the underlying cause rate series followed more closely the underlying cause ratio series than the multiple cause rate series, and a corresponding change in the registration rules could be found, the underlying cause rate trend was concluded to be due to changes in the coders' tendency to register the condition. For thirteen categories (fourteen trends), the trends could be explained by changes in the coders' interpretation practice: five upward, four insignificant, and five downward trends. In addition, for three categories the trends could be explained by new explicit ICD-9 rules.