Long-term survival in WHO grade I meningioma is challenged in patients more than 45 years of age. Excess mortality seems to be associated with both tumor recurrence and stroke. The majority of patients have long-term neurological problems.

Background: Cause-of-death statistics are a major source of information for epidemiological research or policy decisions. Information on the reliability of these statistics is important for interpreting trends in time or differences between populations. Variations in coding the underlying cause of death could hinder the attribution of observed differences to determinants of health. Therefore we studied the reliability of cause-of-death statistics in the Netherlands. Methods:We performed a double coding study. Death certificates from the month of May 2005 were coded again in 2007. Each death certificate was coded manually by four coders. Reliability was measured by calculating agreement between coders (intercoder agreement)and by calculating the consistency of each individual coder in time (intracoder agreement).Our analysis covered an amount of 10 833 death certificates. Results:The intercoder agreement of four coders on the underlying cause of death was 78%. In 2.2% of the cases coders agreed on a change of the code assigned in 2005. The (mean) intracoder agreement of four coders was 89%. Agreement was associated with the specificity of the ICD-10 code (chapter, three digits, four digits), the age of the deceased, the number of coders and the number of diseases reported on the death certificate. The reliability of cause-of-death statistics turned out to be high (> 90%) for major causes of death such as cancers and acute myocardial infarction. For chronic diseases, such as diabetes and renal insufficiency, reliability was low (< 70%). Conclusions:The reliability of cause-of-death statistics varies by ICD-10 code/chapter. A statistical office should provide coders with (additional) rules for coding diseases with a low reliability and evaluate these rules regularly. Users of cause-of-death statistics should exercise caution when interpreting causes of death with a low reliability. Studies of reliability should take into account the number of coders involved and the number of codes on a death certificate.

Aims To compare short-and long-term mortality after a first acute myocardial infarction (AMI) in patients with and without diabetes mellitus. Methods and results A nationwide cohort of 2,018 diabetic and 19,547 nondiabetic patients with a first hospitalized AMI in 1995 was identified through linkage of the national hospital discharge register and the population register. Follow-up for mortality lasted until the end of 2000. At 28 days and 5 years respectively, absolute mortality risks were 18 and 53% in diabetic men, 12 and 31% in nondiabetic men, 22 and 58% in diabetic women, and 19 and 42% in nondiabetic women. Crude mortality was significantly higher in diabetic patients than in nondiabetic patients in both men (28-day hazard ratio (HR) 1.55; 95% confidence interval (CI) 1.32-1.81, 5-year HR 2.01; 95% CI 1.84-2.21) and women (28-day HR 1.19; 95% CI 1.03-1.37, 5-year HR 1.53; 95% CI 1.40-1.67). After multivariate adjustment, risk differences became nonsignificant at 28 days, but diabetes was still associated with a significantly higher long-term mortality in both men (28-day HR 1.16; 95% CI 0.99-1.36, 5-year HR 1.49; 95% CI 1.36-1.64) and women (28-day HR 1.12; 95% CI 0.97-1.28, 5-year HR 1.39; 95% CI 1.27-1.52). The interaction between diabetes mellitus and gender did not reach significance in the analyses. Conclusion Our findings in an unselected cohort covering a complete nation show a significantly higher long-term mortality after a first acute myocardial infarction in diabetic patients. Yet, short-term mortality is not significantly higher in diabetic patients. Risks appear to be equally elevated in men and women.

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Literature data on the diagnostic performance of phlebography, myelography, and CT scan applied to patients with suspected lumbar disk herniation (LDH) are analyzed to extract maximal information about their relative discriminatory power. Seventeen papers meeting the selection criteria contain 13 reports on myelography, 6 on phlebography, and 5 on CT. Sensitivity and specificity are considered simultaneously in logistic ROC space. The reports of each procedure are effectively summarized by a linear regression in logistic ROC space. Taking into account the individual confidence regions of sensitivity and specificity obtained from each report, the slope of the regression line is estimated by Generalized Least Squares (ML). This approach also allows to test the assumption of a common odds ratio (i.e., of a unit slope). The simply to determine common odds ratio as well as the perpendicular distance between the origin and the regression line (as a good approximation to the area under the ROC curve) are used as a measure for the discriminatory power of the procedures. For CT, homogeneity of sensitivity turns out to be much more likely than a common odds ratio. Based on the available, retrospective data, phlebography appears to have the highest performance in visualizing an LDH, followed by myelography and CT.

A case-control study of 271 testicular cancer cases aged 18-42, including 60 seminomas and 206 other germinal cell tumours, and 259 controls was carried out to study the association between occupation and testicular cancer risk. Study subjects were identified at three medical centres, two of which treat military personnel. Controls were men diagnosed with a cancer other than of the genital tract. Associations were identified between professional employment (administrators, teachers and other professionals) and risk for testicular seminoma, OR = 2.8 (95% Cl: 1.4-5.4) and between employment in production work and risk for other germinal cell tumours, OR = 1.8 (95% Cl: 1.1-2.7). No specific occupations within these broad groups were responsible for observed increases. Self-reported exposure to microwave and other radio waves was associated with an excess risk for both seminomas and other germinal cell tumours. However, an assessment of radio wave exposure based on job title did not support this finding. Although testicular cancer has been increasing in recent decades among young males, occupational factors did not appear to account for a substantial proportion of testicular cancer occurrence in the population studied.