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There was a strong association between lower household income and increased mortality rate among CF patients. Additional understanding of this effect will require more complete and direct measurement of socioeconomic status and a better understanding of treatment adherence, local environmental conditions, and especially the care of CF patients during the early years of life.

Comparison of patient mortality rates in cystic fibrosis (CF) obtained from different institutions requires the use of case-mix adjustment methods to account for baseline differences in patient and disease characteristics. There is no current professional consensus on the use of case-mix adjustment methods for use in comparing mortality rates in CF. Characteristics used for this case-mix adjustment should include those that are different across institutions and are associated with patient survival. They should not include characteristics of disease severity that may be a consequence of effectiveness of treatment. The goal of these analyses was to identify a set of these characteristics of patients or disease that would be useful for case-mix adjustment of CF mortality rates. Data from the Cystic Fibrosis Foundation Patient Registry and from the United States Census of the Population (1990) were used in these analyses. Kaplan-Meier techniques, the log-rank test, and Cox proportional hazards regression were used to estimate survivorship, calculate hazard ratios (HR), 95% confidence intervals (CI(95%)), and to conduct tests of statistical significance. The data set included all 30,469 CF patients seen at CF Care Centers from 1982-1998. There were 5,906 deaths during 508,721 person-years of follow-up. In multivariate analyses, female gender (HR 1.30, CI(95%) (1.16, 1,47), P < 0.001), nonwhite race (HR 1.48, CI(95%) (1.07, 2.04), P = 0.018), Hispanic ethnicity (HR 1.85, CI(95%) (1.42, 2.43), P < 0.001), and symptomatic presentation (respiratory, gastrointestinal, respiratory and gastrointestinal, meconium ileus, and other symptomatic presentations; HRs 1.38-1.83; P values, 0.028 to < 0.001) were associated with higher risk of death. The homozygous Delta F508 genotype (HR 1.36, CI(95%) (1.19, 1.55), P < 0.001) and neither mutation being Delta F508 (HR 1.40, CI(95%) (1.15, 1.71), P = 0.001) were also associated with higher risk of death. Patients diagnosed after 36 months of age had almost 50% reduction in risk of death compared to those diagnosed before 6 months of age (HR 0.52 CI(95%) (0.44, 0.61), P < 0.001). When patients living in zip codes with a median household income > $50,000/year (corrected for the 1999 consumer price index) were compared with those living in areas with a median household income < $20,000/year, it was apparent that those in the wealthier areas had a 40% reduced risk of death (HR 0.60, CI(95%) (0.44, 0.82), P = 0.001). All of these characteristics were independently significant predictors of death, and all of these characteristics differed significantly across the CF Care Centers. This case-mix adjustment model uses patient and disease characteristics available at the time of diagnosis of CF, and is not believed to be influenced by subsequent treatment to predict the risk of death. If these case-mix adjustment methods are adopted broadly, they will make it possible to study treatment effects and differences in mortality outcomes, while adjusting for baseline differences in patient and disease ...

Summary 1.Reintroducing carnivores has become a widely used technique to restore the natural integrity of ecosystems. Accurate estimates of demographic parameters for reintroduced populations are essential to evaluate the success of the reintroduction programme, assess the need to release additional animals and to develop management recommendations. 2. In an effort to establish a viable population of Canada lynx Lynx canadensis in Colorado, USA, the Colorado Division of Wildlife released 218 wild-caught lynx from 1999 to 2006. All lynx were released with very high frequency (VHF) and ⁄ or satellite transmitters from which locations, mortality, reproduction, habitat use and movement patterns were documented. We present estimates of mortality. 3. Known-fate models could not be applied here to estimate mortality due to excessive missing location data because of either extensive movement outside of the study area or transmitter failure. Instead we employed a multistate model to address these issues. 4. We describe how the more general multistate mark-recapture model can accommodate missing data to estimate monthly mortality rates of released lynx both inside and outside the study area. We also explored factors possibly affecting lynx survival such as sex, time spent in pre-release captivity, movement patterns and origin. 5. Monthly mortality rate was lower inside the study area than outside, and slightly higher for males than for females, although 95% confidence intervals overlapped for sexes. Mortality was higher immediately after release [first month = 0AE0368 (SE = 0AE0140), and 0AE1012 (SE = 0AE0359) respectively, inside and outside the study area], and then decreased according to a quadratic trend. Annual survival was 0AE9315 (SE = 0AE0325) within the study area and 0AE8219 (SE = 0AE0744) outside the study area. 6. Synthesis and applications. For those contemplating lynx, or other carnivore reintroductions, we suggest identifying a high-quality release site to minimize mortality. We recommend that managers consider the demography of animals separately within and outside the reintroduction area for valid assessment of the reintroduction. Movements of reintroduced animals and their subsequent loss through death or permanent emigration may require the need for additional individuals to be released for a successful reintroduction effort.

Chlamydia and gonorrhea prevalence was very high in females in all project sites. In males, chlamydia prevalence was high in some areas; however, gonorrhea prevalence was substantially lower. These prevalence data justify screening for chlamydia and gonorrhea among female adolescents in juvenile detention centers nationally.