Type 2 diabetes mellitus (T2DM) is associated with a high mortality risk, although the magnitude of this association remains unknown in Latin America (LA). We aimed to assess the strength of the association between T2DM and all-cause and cause-specific mortality in population-based cohort studies in LA. Systematic review and meta-analysis: inclusion criteria were (1) men and women 18 years old and above with T2DM; (2) study outcomes all-cause and/or cause-specific mortality; and (3) using people without T2DM as comparison group. Five databases (Scopus, Medline, Embase, Global Health, and LILACS) were searched. Risk of bias was evaluated with the ROBINS-I criteria. Initially, there were 979 identified studies, of which 17 were selected for qualitative synthesis; 14 were included in the meta-analysis (N = 416 821). Self-reported T2DM showed a pooled relative risk (RR) of 2.49 for all-causes mortality (I-squared [I 2 ] = 85.7%, p < 0.001; 95% confidence interval [CI], 1.96-3.15). T2DM based on a composite definition was associated with a 2.26-fold higher all-cause mortality (I 2 = 93.9%, p < 0.001; 95% CI, 1.36-3.74). The pooled risk estimates were similar between men and women, although higher at younger ages. The pooled RR for cardiovascular mortality was 2.76 (I 2 = 59.2%; p < 0.061; 95% CI, 1.99-3.82) and for renal mortality 15.85 (I 2 = 0.00%; p < 0.645; 95% CI, 9.82-25.57). Using available population-based cohort studies, this work has identified and estimated the strength of the association between T2DM and mortality in LA. The higher mortality risk compared with high-income countries deserves close attention from health policies makers and clinicians to improve diabetes care and control hence preventing complications and delaying death. / Revisión por pares

Background Pneumonia, diarrhoea and perinatal factors are the foremost killers of South African children as in other low- and middle-income countries. Poverty, poor access to care and pre-hospital care are reported major pre-hospital factors and lack of triage, poor skills, delays, poor adherence to treatment protocols and inadequate emergency care determining mortality have been reported to increase in-hospital mortality. Objectives To describe the clinical presentation and management of children admitted via the medical emergency unit (MEU) of the Red Cross War Memorial Children's Hospital (RCWMCH) who subsequently died. Methods We did a retrospective study undertaking a cross-sectional review of children who died following admission via RCWMCH MEU in 2008. Demographic information, clinical data, time factors and mortality data were reviewed and summarised by descriptive and inferential statistics. The unit utilised the WHO Emergency Triage Assessment and Treatment (ETAT) triage tool, categorising children into Red (emergency), orange (priority) and Green (non-urgent). Patient management was assessed by means of ETAT and the Integrated Management of Childhood Illness (IMCI) tools, which is used to identify severity of illness and strategize treatment plans accordingly. Results A total of 135 children met the inclusion criteria. The crude mortality rate was of 6.25 per 1000 admissions. Of the 135 children who died, 119 (88%) were under five years of age, 33(24%) were HIV-infected, of whom (88%) were under 5 years old. In 67 (50%), a chronic medical condition could be identified while 67 (50 %) were moderately or severely malnourished. There were 29 (22%) deaths within 24 hours of arrival at the MEU. Fifty-five (41%) presented after hours. Community health centres referred 65 (48%) patients, general practitioners referred 20 (15%) and 38 (28%) were self-referred. Ambulance services provided pre-hospital transport to 69 (51%). The two top presenting illnesses in 88 (65%) of the children were acute respiratory illness and acute gastroenteritis. Prior to referral, oxygen was not provided in 57 (59%) children, 35 (71%) with suspected sepsis did not receive antibiotics and glucose was not checked in 39 (80%) with depressed level of consciousness. The median time to ward transfer was 3.23 (IQR: 2.12-4.92) hours. Twelve deaths (9%) occurred in the MEU, 57 (42%) in PICU, 56 (42%) in medical wards and 10 (7%) in specialist wards. The five most common causes of death were acute respiratory infections in 45 (33%), acute gastroenteritis in 27 (20%), septicaemia 22 (16%), meningitis in 13 (10%) and cardiac conditions in 12 (9%) children. Conclusion The top causes of mortality in this hospital cohort in 2008 were pneumonia, acute gastroenteritis, and septicaemia. Using the IMCI and ETAT standard of care, suboptimal management was identified in pre-hospital management, as well as MEU management. Appropriate training and protocol implementation to improve morbidity and mortality should be undertaken.

Several recent longitudinal studies of large community populations have revealed that people with more extensive network resources live longer. However, it is not known whether this occurs because social ties prevent disease or retard its progression once it occurs. The purpose of this research was to: (1) determine the relationship between social network indicators and mortality in an urban sample; (2) extend that knowledge by addressing the relationship between networks and disease incidence and disease progression; (3) delineate which specific network sectors were the strongest predictors of the health related outcomes. This was uniquely possible because measures of the three dependent variables were available within the same data set at the Kaiser Permanente Center for Health Research. The research design was longitudinal, based on survey data. The conceptual framework posited that social support delivered via social networks modifies disease states. The setting was the Northwest Region, Kaiser Permanente Health Care Plan, an HMO serving the Portland/Vancouver SMSA. The sample included 2603 adults who participated in a 1970 household interview survey. Their health service utilization data from 1967-73 has been computerized and linked with the survey information. As of 1982, 376 have died. To measure the independent variables, four summary social network indexes (scope, size, frequency of contact, and interaction) were prepared according to a network model based upon the survey questions available, network theory, and prior research. Indexes representing nine relationship domains were constructed. Control variables included age, sex, SES, health status indicators, and health behaviors. Multiple logistic regression was used to assess hypothesis 1 and ordinary regression was used to assess hypotheses 2 and 3. Each of the four summary network measures was a statistically significant predictor of 12 year mortality. Network scope was the strongest predictor. Marital, family, and kin relationships were not predictive of death. Extended ties of close friends, other friends, work associates, and social leisure activities were significant predictors. No relationship was found between network scope, disease incidence, or disease progression, so it is still unclear how social connections act to decrease mortality.

Background: Cancer patients are at higher risk of infection and severity of Coronavirus Disease-19 (COVID-19). Management of patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is challenging due to the scarce scientific information and treatment guidelines. In this work, we present our Institutional experience with our first 100 patients with oncological malignancies and COVID-19. Patients and methods: We conducted a cross-sectional study of the first 100 patients hospitalised at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru) who were positive for SARS-CoV-2 by reverse transcriptase (RT)-PCR during the period 30 March to 20 June. Clinicopathological variables of the oncological disease as well as risk factors, management and outcomes to COVID-19 were evaluated. Results: The mean age was 43.5 years old (standard deviations: ±24.8) where 57% were male patients. In total, 44%, 37% and 19% were adult patients bearing solid tumours, adults with haematologic malignancies and paediatric patients, respectively. Hypertension was the most frequent comorbidity (23%) followed by chronic lung disease (10%). COVID-19-associated symptoms included cough (65%), fever (57%) and dyspnoea (56%). Twelve percent of patients were asymptomatic. Nosocomial infections were more frequent in paediatric patients (84.2%) than in adult patients (16.0%). Patients with uncontrolled oncological disease were most frequent (72%). Anaemia was present in 67% of patients, 68% had lymphopenia, 62% had ferritin value > 500 mcg/L, 85% had elevated lactate dehydrogenase (LDH), 83% D-dimer > 500 ng/mL and 80% C-Reactive Protein > 8 mg/L. The most common complication was acute respiratory failure (42%). Overall fatality rate was 39% where the main cause of mortality was acute respiratory distress syndrome (64.1%). Conclusion: Paediatric patients had better outcomes than adult populations, and a high number of asymptomatic carriers and nosocomial infection, early diagnosis are recommended. Considering oncological treatments 30 days before COVID-19 diagnosis, our data did not reveal an increased mortality. / Revisión por pares

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21621号 / 医博第4427号 / 新制||医||1033(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 湊谷 謙司, 教授 佐藤 俊哉, 教授 横出 正之 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Roads cause substantial wildlife mortality, but there is currently limited understanding of the relative magnitude of this mortality source. There are also substantial gaps in knowledge concerning the ecological ramifications of carrion introduced to the environment from vehicle collisions and in particular how vertebrate scavengers may consume carrion resulting from vehicle collisions. Although a variety of factors influence scavenger use of carcasses, the mechanisms influencing competition for this resource between obligate and facultative scavengers have not been thoroughly explored. I conducted a global synthesis of mortality of terrestrial vertebrates documenting 42,755 mortalities of known cause from 120,657 individuals representing 305 vertebrate species. Overall, 28% of mortalities were directly caused by humans and 72% were from natural sources. Vehicle collisions accounted for 4% of mortality overall. Larger birds were more likely than smaller birds to die from vehicle collisions and vehicle mortality of mammals increased over time. There was no difference in proportion of rabbit carcasses scavenged or scavenger arrival time between those placed along roads, power line clearings, and forests. No species arrived at roads quicker than other treatments. Turkey vultures (Cathartes aura) and coyotes (Canis latrans) scavenged equally across treatments, whereas gray foxes (Urocyon cinereoargenteus) scavenged along roads and power lines, but not in forests. Scavenger use of carrion near roads likely relates to factors besides carrion availability, such as traffic avoidance and predation risk. Because some scavengers make substantial use of carrion on roads, this resource could be an important mechanism by which human activities impact wildlife. Scavenging by facultative scavengers did not increase in the absence of competition with vultures. I found no difference in scavenger presence between control carcasses and those from which vultures were excluded. Facultative scavengers did not functionally replace vultures during summer in this study. These results suggest that under the conditions of this study, facultative scavengers would not compensate for loss of vultures. Carcasses would persist longer in the environment and consumption of carrion would likely shift from vertebrates to decomposers. Such changes could have substantial implications for disease transmission, nutrient cycling, and ecosystem functioning.

Does allocating large amounts of international aid specifically for fighting HIV/AIDS in Sub-Saharan Africa have an influence on mortality rates in this region? This paper explores the relationship between total Official Development Assistance and Official Development Assistance earmarked for HIV/AIDS with AIDS mortality and overall mortality within Sub-Saharan Africa between 2000 and 2006. There are no definitive findings from this study to conclude that the amount of any form of assistance aid has a positive or negative effect on mortality. The results suggest that focusing on establishing greater development and less government corruption would more effectively alleviate the high mortality rates in Sub-Saharan Africa than increasing funding for HIV/AIDS.

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