Summary. In this paper we describe the methods used to link birth and infant mortality and morbidity surveillance data sets into sibships using deterministic or multistage probabilistic linkage methods. We describe
The suicide rates among the youth in Israel, as in adults, are among the lowest in the world. Army service may be a period of enhanced risk, justifying preventive action. The almost worldwide trend of increasing suicide among the young is only partially present.
In recent years, the possible association of changes in mortality from cardiovascular disease and myocardial infarction (MI) and deaths related to violence and the suicide rate has been repeatedly discussed. This study examined the relationship between cosmic physical changes (solar, geomagnetic and other space activity parameters) and changes in the total number of in-hospital and MI-related deaths and deaths from suicide to determine if a relationship exists between the distribution of total and MI-related deaths with suicide over time; some differences in the serotonergic mechanisms involved in the pathogenesis of MI and suicide were also taken into account. All suicides (n = 2359) registered in the State of Israel from 1981 to 1989 (108 months) were analysed and compared with the total number of deaths (n = 15601) and deaths from MI (n = 1573) in a large university hospital over 180 months (1974-1989). The following were the main features of the Results. (1) Monthly suicide rate was correlated with space proton flux (r = 0.42, P = 0.0001) and with geomagnetic activity (r = -0.22, P = 0.03). (2) Total hospital and MI-related deaths were correlated with solar activity parameters (r = 0.35, P < 0.001) and radiowave propagation (r = 0.52-0.44, P < 0.001), an with proton flux (r = -0.3 to -0.26, P < 0.01). (3) Monthly suicide distribution over 108 months was correlated with MI (r = -0.33, P = 0.0005) and total hospital mortality (r = -0.22, P = 0.024). (4) Gender differences were prominent.(ABSTRACT TRUNCATED AT 250 WORDS)
Objectives-In treating critically ill neonates, situations occasionally arise in which aggressive medical treatment prolongs the inevitable death rather than prolonging life. Decisions as to limitation of neonatal medical intervention remain controversial and the primary responsibility of the generally unpreparedfamily. This research was designed to study response patterns of expectant mothers towards treatment of critically ill and/or malformed infants. Design/setting-Attitudes were studied via comprehensive questionnaires divided into three sections: 1-Sociodemographic data and prior personal experience with perinatal problems; 2-Theoretical philosophical principles used in making medical ethical decisions; and 3-Hypothetical case scenarios with choices of treatment options. Subjects and results-Six hundred andfifty pregnant women were studied. Maternal birthplace (p=0 005) and level of religious observance (p=0 02) were strongly associated with the desire for maximally aggressive medical intervention in the hypothetical case scenario. Specific personal experiences such as infertility problems, previous children with serious mental or physical problems were not correlated with the selection of different treatment choices. Of the theoretical principles studied, only the desire to preserve life at all costs was significantly associated with the choice for maximal medical treatment (p=0 003). Conclusions-Maternal ethnocultural background and philosophical principles more profoundly influenced medical ethical decision-making than did specific personal life experiences.With the increased survival of ever smaller premature infants and the salvage of previously nonviable malformed or critically ill infants, many moral and ethical dilemmas have intensified. What happens when the best of medical intervention can be expected to result in the survival of a severely
Objective: To investigate the role of a patent foramen ovale in the pathogenesis of multiple brain lesions acquired by sport divers in the absence of reported decompression symptoms. Design: Prospective double blind cohort study. Setting: Diving clubs around Heidelberg and departments of neuroradiology and neurology. Subjects: 87 sport divers with a minimum of 160 scuba dives (dives with self contained underwater breathing apparatus). Main outcome measures: Presence of multiple brain lesions visualised by cranial magnetic resonance imaging and presence and size of patent foramen ovale as documented by echocontrast transcranial Doppler ultrasonography. Results: 25 subjects were found to have a right-to-left shunt, 13 with a patent foramen ovale of high haemodynamic relevance. A total of 41 brain lesions were detected in 11 divers. There were seven brain lesions in seven divers without a right-to-left shunt and 34 lesions in four divers with a right-to-left shunt. Multiple brain lesions occurred exclusively in three divers with a large patent foramen ovale (P = 0.004). Conclusions: Multiple brain lesions in sport divers were associated with presence of a large patent foramen ovale. This association suggests paradoxical gas embolism as the pathological mechanism. A patent foramen ovale of high haemodynamic relevance seems to be an important risk factor for developing multiple brain lesions in sport divers.
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