From 1954 to 1961, pulmonary function was assessed in 2,718 British men by forced expiratory maneuvers, and mucus hypersecretion and smoking habits were assessed by questionnaires. In 20 to 25 yr of follow-up, 104 men (all of whom had smoked) died of chronic obstructive pulmonary disease (COPD). The risk of death from COPD was strongly correlated with the initial degree of air-flow obstruction. Among men with similar initial air-flow obstruction, however, age-specific COPD death rates were not significantly related to initial mucus hypersecretion, supporting the concept that air-flow obstruction and mucus hypersecretion are largely independent disease processes. A moderate relationship existed between initial mucus hypersecretion and subsequent lung cancer mortality, but it is not known whether this was due solely to a common correlation of both conditions with the effective degree of exposure of the large bronchi to causative factors such as tobacco smoke.
SUMMARYThe relationship between age-specific mortality rates and some indices of health facilities and some environmental and dietary factors has been studied in 18 developed countries. The indices of health care are not negatively associated with mortality, and there is a marked positive association between the prevalence of doctors and mortality in the younger age groups. No explanation of this doctor anomaly has so far been found. Gross national product per head is the principal variable which shows a consistently strong negative association with mortality.
ObjectivesTo describe the epidemiology of assaults resulting in stab injuries among young people. We hypothesised that there are specific patterns and risk factors for injury in different age groups.DesignEleven-year retrospective cohort study.SettingUrban major trauma centre in the UK.Participants1824 patients under the age of 25 years presenting to hospital after a stab injury resulting from assault.OutcomesIncident timings and locations were obtained from ambulance service records and triangulated with prospectively collected demographic and injury characteristics recorded in our hospital trauma registry. We used geospatial mapping of individual incidents to investigate the relationships between demographic characteristics and incident timing and location.ResultsThe majority of stabbings occurred in males from deprived communities, with a sharp increase in incidence between the ages of 14 and 18 years. With increasing age, injuries occurred progressively later in the day (r2=0.66, p<0.01) and were less frequent within 5 km of home (r2=0.59, p<0.01). Among children (age <16), a significant peak in injuries occurred between 16:00 and 18:00 hours, accounting for 22% (38/172) of injuries in this group compared with 11% (182/1652) of injuries in young adults. In children, stabbings occurred earlier on school days (hours from 08:00: 11.1 vs non-school day 13.7, p<0.01) and a greater proportion were within 5 km of home (90% vs non-school day 74%, p=0.02). Mapping individual incidents demonstrated that the spike in frequency in the late afternoon and early evening was attributable to incidents occurring on school days and close to home.ConclusionsAge, gender and deprivation status are potent influences on the risk of violent injury in young people. Stab injuries occur in characteristic temporal and geographical patterns according to age group, with the immediate after-school period associated with a spike in incident frequency in children. This represents an opportunity for targeted prevention strategies in this population.
Transpulmonary access to the left-sided atrium for patients with prior EC Fontan surgery is a feasible strategy for transvenous atrial pacing. Lead placement in this location is associated with excellent pacing characteristics and involves a limited segment of lead within the pulmonary venous atrium. The approach is technically straightforward and avoids the need for surgical pacemaker placement.
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