Trends of autoimmune liver disease inpatient hospitalization and mortality from 2011 to 2017:A United States nationwide analysis

BACKGROUND Autoimmune liver diseases(AiLD)encompass a variety of disorders that target either the liver cells(autoimmune hepatitis,AIH)or the bile ducts[primary biliary cholangitis(PBC),and primary sclerosing cholangitis(PSC)].These conditions can progress to chronic liver disease(CLD),which is characterized by fibrosis,cirrhosis,and hepatocellular carcinoma.Recent studies have indicated a rise in hospitalizations and associated costs for CLD in the US,but information regarding inpatient admissions specifically for AiLD remains limited.AIM To examine the trends and mortality of inpatient hospitalization of AiLD from 2011 to 2017.METHODS This study is a retrospective analysis utilizing the National Inpatient Sample(NIS)databases.All subjects admitted between 2011 and 2017 with a diagnosis of AiLD(AIH,PBC,PSC)were identified using the International Classification of Diseases(ICD-9)and ICD-10 codes.primary AiLD admission was defined if the first admission code was one of the AiLD codes.secondary AiLD admission was defined as having the AiLD diagnosis anywhere in the admission diagnosis(25 diagnoses).Subjects aged 21 years and older were included.The national estimates of hospitalization were derived using sample weights provided by NIS.χ^(2)tests for categorical data were used.The primary trend characteristics were in-hospital mortality,hospital charges,and length of stay.RESULTS From 2011 to 2017,hospitalization rates witnessed a significant decline,dropping from 83263 admissions to 74850 admissions(P<0.05).The patients hospitalized were predominantly elderly(median 53%for age>65),mostly female(median 59%)(P<0.05),and primarily Caucasians(median 68%)(P<0.05).Medicare was the major insurance(median 56%),followed by private payer(median 27%)(P<0.05).The South was the top geographical distribution for these admissions(median 33%)(P<0.05),with most admissions taking place in big teaching institutions(median 63%)(P<0.05).Total charges for admissions rose from 66031 in 2011 to 78987 in 2017(P<0.05),while the inpatient mortality rate had a median of 4.9%(P<0.05),rising from 4.67%in 2011 to 5.43%in 2017.The median length of stay remained relatively stable,changing from 6.94 days(SD=0.07)in 2011 to 6.51 days(SD=0.06)in 2017(P<0.05).Acute renal failure emerged as the most common risk factor associated with an increased death rate,affecting nearly 68%of patients(P<0.05).CONCLUSION AiLD-inpatient hospitalization showed a decrease in overall trends over the studied years,however there is a significant increase in financial burden on healthcare with increasing in-hospital costs along with increase in mortality of hospitalized patient with AiLD.

Incidence and mortality rate of esophageal cancer has decreased during past 40 years in Hebei Province,China

Background： Hebei province is located in North of China with of approximately 6% of whole national population. It is known as a high-risk area for esophageal cancer in China and worldwide. The aim of our study was to estimate the esophageal cancer burden and trend in Hebei Province. Methods： Eight cancer registries in Hebei Province submitted cancer registry data to the Hebei Provincial Cancer Registry Center. All data were qualified and compiled for cancer statistics in 2011. The pooled data were stratified by gender and age group （0, 1-4, 5-9, 10-14...80＋）. Incidence and mortality rates were age-standardized to World Segi＇s population standard and expressed per 100,000 persons. In addition, proportions and cumulative incidence/mortality rates for esophageal cancer were calculated. Esophageal cancer mortality data during the periods 1973-1975, 1990-1992, and 2004-2005 were extracted from the national death surveys. Mortality and incidence rate data from Cixian and Shexian were obtained from population-based cancer registries in each county. Results： The estimated number of newly diagnosed esophageal cancer cases and deaths in 2011 in Hebei Province was 24,318 and 18,226, respectively. The crude incidence rate of esophageal cancer was 33.37/100,000 （males, 42.18/100,000 and females, 24.31/100,000）. The age-standardized rate by world standard population （ASRW） was 28.09/100,000, ranking third among all cancers. The esophageal cancer mortality rate was 25.01/100,000 （males, 31.40/100,000 and females, 18.45/100,000）, ranking third in deaths among all cancers. The mortality rates of esophageal cancer displayed a significant decreasing trend in Hebei Province from 1973-1975 （ASRW =48.69/100,000） to 2004-2005 （ASRW =28.02/100,000）, with a decreased rate of 42.45%. In Cixian, the incidence of esophageal cancer decreased from 250.76/100,000 to 106.74/100,000 in males and from 153.86/100,000 to 75.41/100,000 in females, with annual percentage changes （APC） of 2.13 and 2.16, while the mortality rates declined with an APC of 2.46 for males and 3.10 for females from 1988 to 2011. In Shexian, the incidence rate decreased from 116.90/100,000 to 74.12/100,000 in males and from 46.98/100,000 to 40.64/100,000 in females, while the mortality rates declined, with an APC of 4.89 in males from 2003 to 2011. Conclusions： Although the incidence and mortality rates of esophageal cancer remain high, an obvious decreasing trend has been observed in Hebei Province, as well as in high-risk regions, such as Cixian and Shexian, over the past 40 years.

Heart rate is an independent predictor of all-cause mortality in individuals with type 2 diabetes: The diabetes heart study

AIM To assess the association of resting heart rate with allcause and cardiovascular disease(CVD) mortality in the Diabetes Heart Study(DHS).METHODS Out of a total of 1443 participants recruited into the DHS, 1315 participants with type 2 diabetes who were free of atrial fibrillation and supraventricular tachycardia during the baseline exam were included in this analysis. Heart rate was collected from baseline resting electrocardiogram and mortality(all-cause and CVD) was obtained from state and national death registry. Kaplan-Meier(K-M) and Cox proportional hazard analyses were used to assess the association.RESULTS The mean age, body mass index(BMI) and systolic blood pressure(SBP) of the cohort were 61.4 ± 9.2 years, 32.0 ± 6.6 kg/m2, and 139.4 ± 19.4 mmHg respectively. Fiftysix percent were females, 85% were whites, 15% were blacks, 18% were smokers. The mean ± SD heart rate was 69.8(11.9) beats per minute(bpm). After a median follow-up time of 8.5 years(maximum follow-up time is 14.0 years), 258 participants were deceased. In K-M analysis, participants with heart rate above the median had a significantly higher event rate compared with those below the median(log-rank P = 0.0223). A one standard deviation increase in heart rate was associated with allcause mortality in unadjusted(hazard ratio 1.16, 95%CI: 1.03-1.31) and adjusted(hazard ratio 1.20, 95%CI: 1.05-1.37) models. Similar results were obtained with CVD mortality as the outcome of interest.CONCLUSION Heart rate is an independent predictor of all-cause mortality in this population with type 2 diabetes. In this study, a 1-SD increase in heart rate was associated with a 20% increase in risk suggesting that additional prognostic information may be gleaned from this ubiquitously collected vital sign.

Association of resting heart rate and hypertension stages on all-cause and car- diovascular mortality among elderly Koreans： the Kangwha Cohort Study

Background Elevated resting heart rate and hypertension independently increase the risk of mortality. However, their combined ef- fect on mortality in stages of hypertension according to updated clinical guidelines among dderly population is unclear. Methods We fol- lowed a cohort of 6100 residents （2600 males and 3500 females） of Kangwha County, Korea, ranging from 55 to 99 year-olds as of March 1985, for all-cause and cardiovascular mortality for 20.8 years until December 31, 2005. Mortality data were collected through telephone calls and visits （to 1991）, and were confirmed by death record matching with the National Statistical Office （1992-2005）. Hazard ratios were calculated for all-cause and cardiovascular mortality by resting heart rate and hypertension defined by Eighth Joint National Committee crite- ria using the Cox proportional hazard model after controlling for confounding factors. Results The hazard ratios associated with resting heart rate 〉 80 beats/min were higher in hypertensive men compared with normotensives with heart rate of 61-79 beats/rain, with hazard ratios values of 1.43 （95% CI： 1.00-1.92） on all-cause mortality for prehypertension, 3.01 （95% CI： 1.07-8.28） on cardiovascular mortality for prehypertension, and 8.34 （95% CI： 2.52-28.19） for stage 2 hypertension. Increased risk （HR： 3.54, 95% CI： 1.16-9.21） was observed among those with both a resting heart rate 〉 80 beats/rain and prehypertension on cardiovascular mortality in women. Conclusions Indi- viduals with coexisting elevated resting heart rate and hypertension, even in prehypertension, have a greater risk for all-cause and cardiovas- cular mortality compared to those with elevated resting heart rate or hypertension alone. These findings suggest that elevated resting heart rate should not be regarded as a less serious risk factor in elderly hypertensive patients.

Modified shock index and mortality rate of emergency patients

BACKGROUND:This study aimed to determine whether modified shock index(MSI)is associated with mortality that is superior to heart rate,blood pressure,or the shock index(SI).in emergency patients.METHODS:A retrospective database review was performed on 22 161 patients who presented to Peking Union Medical College Hospital Emergency Department and received intravenous fluids from January 1 to December 31,2009.We gathered data of the patients on age,gender,vital signs,levels of consciousness,presenting complaints,and SI and MSI were calculated for all patients.RESULTS:Multivariate regression analysis was performed to determine the correlation between risk factors and outcome.There is a significant correlation between emergency patient mortality rate and patient's vital signs obtained at the triage desk(HR>120 beats/min,systolic BP<90 mmHg,diastolic BP<60 mmHg).MSI is a stronger predictor of emergency patient mortality compared to heart rate and blood pressure alone,whereas SI does not have a significant correlation with emergency patient mortality rate.CONCLUSION:MSI is a clinically significant predictor of mortality in emergency patients.It may be better than using heart rate and blood pressure alone.SI is not significantly correlated with the mortality rate of the emergency patient.

Infant mortality rate in Al-Ramadi province from 2000 through 2010, retrospective study

Objectives: To determine the IMR in Al-Ramadi province, the center of Al-Anbar Governorate, Western Iraq, from 2000-2010 with rate comparison of the three different stages of that period. Methods: Data collected from the birth and death certificate center in Al-Ramadi province, Western Iraq, included;name, age, sex, residence, date of birth and death, in three different stages (the first stage 2000-2002, the second stage 2003-2007, and the third stage 2008-2010) in a study period from July to December, 2010. The IMRs were analyzed and compared with other studies. Results: The IMR of the last 3 years of sanction was 54.3/1000, 55.7/1000 and 50.6/1000 respectively, this rate had been increased in the war and violence period to reach its maximum rate 58.6/1000 in 2006, then decreased to reach its minimum rate 44.5/1000 in 2008. Approximately two-third of deaths occurred during the neonatal period and one third in the post neonatal period. Males had higher IMR than females, and rural residence higher than urban. Conclusion: Infant mortality rate is still high in Al-Ramadi province, since the American invasion (2003-2007), when compared with other developing countries. This study found increase of IMR in Al-Ramadi province during that period more than other studied years.

Evaluation and Estimation of the Provincial Infant Mortality Rate in China's Sixth Census

Objective To assess the data quality and estimate the provincial infant mortality rate（1q0） from China＇s sixth census. Methods A log-quadratic model is applied to under-fifteen data. We analyze and compare the average relative errors（AREs） for 1q0 between the estimated and reported values using the leave-one-out cross-validation method. Results For the sixth census, the AREs are more than 100% for almost all provinces. The estimated average 1q0 level for 31 provinces is 12.3‰ for males and 10.7‰ for females. Conclusion The data for the provincial 1q0 from China＇s sixth census have a serious data quality problem. The actual levels of 1q0 for each province are significantly higher than the reported values.

Mortality in Cardiology in Sub-Saharan Africa: Case of the Cardiology Department of the Teaching Hospital Sylvanus Olympio of Lome

Background: Cardiovascular disease is the leading cause of death worldwide. The specificities of cardiology mortality in Togo are not well known. The objective of this study was to determine the profile of deaths in the cardiology department of the Sylvanus Olympio Teaching Hospital (CHU SO) in Lome. Materials and Methods: This was a cross-sectional study conducted over a period of 06 years, from January 1, 2015 to December 31, 2021, in the cardiology department of the Sylvanus Olympio Teaching Hospital in Lome. In this study, we included all medical records of patients who died in hospital in the cardiology department during the study period. Results: During the study period, 2762 patients were hospitalized in the cardiology unit at CHU SO. We recorded 112 deaths meeting our criteria, for an intrahospital mortality rate of 4.19%. The average age of patients was 53.79 ± 18.27 years. Hypertension was present in 47.3%. Sickness insurance coverage was not available for 94.64% of those who died. The major cardiovascular diseases observed were myocardium in 43.75% whose dilated cardiomyopathy accounted for 71.42%;and rhythmic lesions in 34.82%. Biological infectious syndrome (56.25%), renal failure (48.21%), anemia (47.27%), lung infection (32.14%), hyponatremia (33.04%) were the main comorbidities observed. Among the circumstances of death, sudden death was found in 32.14%, cardiogenic shock in 20.54% and septic shock in 13.39%. Conclusion: The profile of deaths in the cardiology department of the CHU SO reveals that myocardial injuries are more present with circumstances of death dominated by sudden death.

Estimating time-based instantaneous total mortality rate based on the age-structured abundance index

The instantaneous total mortality rate(Z) of a fish population is one of the important parameters in fisheries stock assessment. The estimation of Z is crucial to fish population dynamics analysis,abundance and catch forecast,and fisheries management. A catch curve-based method for estimating time-based Z and its change trend from catch per unit effort(CPUE) data of multiple cohorts is developed. Unlike the traditional catch-curve method,the method developed here does not need the assumption of constant Z throughout the time,but the Z values in n continuous years are assumed constant,and then the Z values in different n continuous years are estimated using the age-based CPUE data within these years. The results of the simulation analyses show that the trends of the estimated time-based Z are consistent with the trends of the true Z,and the estimated rates of change from this approach are close to the true change rates(the relative differences between the change rates of the estimated Z and the true Z are smaller than 10%). Variations of both Z and recruitment can affect the estimates of Z value and the trend of Z. The most appropriate value of n can be different given the effects of different factors. Therefore,the appropriate value of n for different fisheries should be determined through a simulation analysis as we demonstrated in this study. Further analyses suggested that selectivity and age estimation are also two factors that can affect the estimated Z values if there is error in either of them,but the estimated change rates of Z are still close to the true change rates. We also applied this approach to the Atlantic cod(G adus morhua) fishery of eastern Newfoundland and Labrador from 1983 to 1997,and obtained reasonable estimates of time-based Z.

CHARACTERISTICS OF MORTALITY RATES FROM BREAST AND OVARIAN CANCER IN JAPAN

Objective: Breast and ovarian cancer is rare in Japan compared with other developed countries but their mortality rates are increasing. It is necessary to examine the experience of Japan as a guide to further prevent breast and ovarian cancer in our country. Methods: We conducted an epidemiological study of breast and ovarian cancer in the past 50 years to investigate the trends and characteristics of the mortality rates in Japan. The numbers of age-specific death from breast and ovarian cancer and the population of 5-year groups were obtained from the Vital Statistics of Japan. The truncated age specific mortality rates were calculated according to the patterns of age specific mortality rates from both cancers. Age adjustments were made to the standard world population. Results: In the past 50 years, mortality rates of breast and ovarian cancer increased about 2 or 6 fold, respectively. This increase was most marked over 50 years old. The death pattern of breast cancer was same as that of ovarian cancer, but that of ovarian cancer changed greatly with time. The birth cohort study had some interesting findings. Common to breast and ovarian cancer, the later the year of birth, the higher the mortality rates from both malignancies in later life. Conclusion: The increase of the yearly mortality rates from breast and ovarian cancer might be due to changes in lifestyle and environmental factors. We are very concerned about dietary practices. Further investigation is needed to clarify the possible causes of animal food.

Knee Arthroplasty Incidence Rate vs. Revision of Knee Arthroplasty and Its Associated Comorbidities in Colombia

Introduction: Total knee arthroplasty (TKA) has been established as a transformative solution in the treatment of advanced degenerative diseases of the knee, such as osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis. In this sense, TKA surgery, which seeks to replace the damaged joint with prosthetic components, has proven to be highly effective in relieving pain, improving joint function, and, ultimately, significantly increasing patients’ quality of life. The present study describes the TKA and revision knee arthroplasty (RKA) rates and, identifies the associated co morbidities in the Colombian context. Methods: A retrospective cohort study was carried out. It describes demographic and clinical characteristics between two groups of patients, TKA or RKA, and its association with mortality at 30 days, 90 days, or one year after the intervention. Results: The incidence rate of the population undergoing TKA was approximately 11.71 cases per 100,000 inhabitants. Furthermore, the incidence rate for revision knee arthroplasty (RKA) procedures in the same period was around 0.96 per 100,000 inhabitants. In both groups at 30 days postoperatively, a total mortality rate of 0.09%was recorded. When the follow-up was extended to 90 days, it increased to 0.15%;at one year postoperatively, it rose to 0.88%. Conclusion: Mortality after surgery was low in Colombia in 2019. Although RKA is a beneficial procedure, in certain circumstances, it was noted that it carries a higher risk compared to primary TKA. Our results emphasize the importance of careful evaluation of co morbidities and risk factors in patients undergoing these surgical procedures. The application of quality-of-life questionnaires should be considered in future studies on effectiveness and mortality for TKA and RKA in our country.

Growth, Mortality Parameters and Exploitation Rate of West African Ilisha (<i>Ilisha africana</i>Bloch, 1795, Clupeidae) off Benin Coastal Waters (West Africa): Implications for Management and Conservation

West African Ilisha was the third most abundant species of Clupeidae off Benin coastal waters after Sardinella spp and Ethmalosa frimbriata. The fishing effort of these fisheries increased with a dominance of small-sized specimens in the catches. This paper allowed updating some demographic parameters and the exploitation rate of Ilisha africana collected between July 2013 and June 2014 from the coastal waters of Benin for management and conservation of these fisheries. The growth pattern showed a negative allometric growth with an abundance of small-sized specimens. The von Bertalanffy growth function (VBGF) estimations were: L∞= 21.31 cm standard length;K = 1.20 year-1;and t0 = -0.138 year. The total mortality rate (Z), natural mortality rate (M) and fishing mortality rate (F) were 4.040 year-1, 2.27 year-1 and 1.77 year-1 respectively. The Z/K ratio was 3.667 and the exploitation rate (E = F/Z) was 0.44 showing an under exploitation of this species. The estimated potential longevity (tmax) was 2.5 years. In addition, the fisheries management should be devolved from the state to the local level to compel fishermen to take greater responsibility for the sustainability and conservation of the fisheries such as size-limit regulation by gradually increasing fishing gears mesh size.

National Breast Cancer Mortality and Incidence Rates According to the Human Development Index: An Ecological Study

Background: This study aimed to identify the role of human development index (HDI) in the incidence and mortality rates of breast cancer (BC) worldwide. Methods: Data on the age-standardized incidence and mortality rates of BC for 184 countries were obtained from the GLOBOCAN. Data about the HDI and other indices were obtained from the World Bank Report 2013. Linear regression model was used for assessment the effect of HDI on BC occurrence rates. Results: In 2012, BCs were estimated to have affected a total of 1,671,149 individuals (crude rate: 47.8 per 100,000 individuals), and caused 521,907 deaths worldwide (crude rate: 14.7 per 100,000 individuals). Nearly half of total female BC cases (46.3%) with the highest risk of incidence (age-standardized Rate (ASR): 128 per 100,000) had occurred in very high HDI regions. The most proportion of the mortality burden was in low HDI and medium HDI areas. Linear regression analyses showed a direct significant correlation between the incidence of BC and HDI at the global level (B = 104.5, P < 0.001). The mortality rate of BC was not significantly associated with HDI (B = 3.26, P = 0.160). Conclusion: Our study showed that the burden of female BC is enormous in very high HDI and low HID regions. Targeted interventions have the ability to reduce this number significantly through resource-dependent interventions. Moreover, further reductions in mortality could be brought about by increasing access to curative treatment for patients with BC.

Age,growth,and mortality rate of the yellow goosefish Lophius litulon(Jordan,1902)in the Yellow Sea

With the decline in the most fisheries resources in the Yellow Sea,the yellow goosefish Lophius litulon has increased in commercial and ecological importance in recent years.We studied the length distribution,length-weight relationship,age composition,growth pattern,mortality,and exploitation rates of the yellow goosefish in the Yellow Sea.Total length(TL)of females and males ranged from 173 to 582 mm and 178 to 500 mm,respectively.The length-weight relationships were also estimated for females and males.Age classes from 2 to 4 years predominated in the samples.The von Bertalanffy growth function(VBGF),estimated based on non-linear least-squares methodology,showed significant differences between sexes.Females attained a greater estimated asymptotic total length(765 mm TL)compared to males(579 mm TL).The VBGF did not differ significantly between stocks of the northern Yellow Sea and the southern Yellow Sea.Estimated natural instantaneous mortality rate(M)ranged from 0.25/a to 0.33/a based on four age-and length-based methods.Total instantaneous mortality rate(Z)of total samples calculated by the age-based catch curve method was 0.591/a and the average fishing mortality(F)was 0.30/a.Estimated exploitation rate(E)was approximately 0.5,indicating that the population of L.litulon in the Yellow Sea may be sustainable.These results provide a reference for the present status of L.litulon and information for the management.

Impact of index admission cholecystectomy vs interval cholecystectomy on readmission rate in acute cholangitis: National Readmission Database survey

BACKGROUND Elective cholecystectomy(CCY)is recommended for patients with gallstone-related acute cholangitis(AC)following endoscopic decompression to prevent recurrent biliary events.However,the optimal timing and implications of CCY remain unclear.AIM To examine the impact of same-admission CCY compared to interval CCY on patients with gallstone-related AC using the National Readmission Database(NRD).METHODS We queried the NRD to identify all gallstone-related AC hospitalizations in adult patients with and without the same admission CCY between 2016 and 2020.Our primary outcome was all-cause 30-d readmission rates,and secondary outcomes included in-hospital mortality,length of stay(LOS),and hospitalization cost.RESULTS Among the 124964 gallstone-related AC hospitalizations,only 14.67%underwent the same admission CCY.The all-cause 30-d readmissions in the same admission CCY group were almost half that of the non-CCY group(5.56%vs 11.50%).Patients in the same admission CCY group had a longer mean LOS and higher hospitalization costs attrib-utable to surgery.Although the most common reason for readmission was sepsis in both groups,the second most common reason was AC in the interval CCY group.CONCLUSION Our study suggests that patients with gallstone-related AC who do not undergo the same admission CCY have twice the risk of readmission compared to those who undergo CCY during the same admission.These readmis-sions can potentially be prevented by performing same-admission CCY in appropriate patients,which may reduce subsequent hospitalization costs secondary to readmissions.

SutteARIMA:A Novel Method for Forecasting the Infant Mortality Rate in Indonesia

This study focuses on the novel forecasting method(SutteARIMA)and its application in predicting Infant Mortality Rate data in Indonesia.It undertakes a comparison of the most popular andwidely used four forecasting methods:ARIMA,Neural Networks Time Series(NNAR),Holt-Winters,and SutteARIMA.The data used were obtained from the website of the World Bank.The data consisted of the annual infant mortality rate(per 1000 live births)from 1991 to 2019.To determine a suitable and best method for predicting InfantMortality rate,the forecasting results of these four methods were compared based on the mean absolute percentage error(MAPE)and mean squared error(MSE).The results of the study showed that the accuracy level of SutteARIMA method(MAPE:0.83%andMSE:0.046)in predicting InfantMortality rate in Indonesia was smaller than the other three forecasting methods,specifically the ARIMA(0.2.2)with a MAPE of 1.21%and a MSE of 0.146;the NNAR with a MAPE of 7.95%and a MSE of 3.90;and the Holt-Winters with aMAPE of 1.03%and aMSE:of 0.083.

Infant Mortality Rate Statistic Method and Difference Analysis in China

Infant mortality rate (IMR) has been viewed as the vital index which can be used to measure the health level of a country or a district, and also can indirectly illustrate the economic development level of the country or district. In this paper, the authors 1) introduce three calculation methods of IMR and compare the differences among them;2) calculate the IMR using one method above, and find the IMRs recorded in China Population Statistic Yearbook (CPSY) from National Statistics Institute and in China Health Statistic Yearbook from Ministry of National Hygiene are both overestimated;3) point out three main reasons for this overestimation: firstly, confusion of methods of calculation and concepts, secondly, inconsistent statistical caliber among different yearbooks, thirdly, flaws within the registration system.

Trends of incidence and mortality rates of stroke from 1983 to 2000 in Hanzhong rural population

Objective: To explore the trends of incidence and mortality rates of stroke in Hanzhong rural population. Methods: Acting as the WHO MONICA project. Results: The incidence rate of stroke was 152.9/100 000. There was decline trend in male(P<0.05). The mortality rate of stroke was 115.9/100 000. There was no significant decline trend during 18-year period (P<0.05). The incidence and mortality rates of stroke of male were higher than those of female(P<0.05).The incidence and mortality rates were all increased with age(P<0.01). Conclusion: It must stick to the long- term prevention measures to decrease incidence rate, and improve the condition of medical treatment to reduce the mortality rate in rural population.

Study of Natural and Fishing Mortality and Exploitation Rate of Anchovy Kilka Clupeonella engraufiformis in Southeast Part of the Caspian Sea （Babolsar）

The objective of this study was to estimate natural, fishing and total mortality, survival and exploitation rates of Clupeonella engrauliformis in the southern Caspian Sea. Survival rate and natural mortality were calculated using catch curve and Pauly methods, respectively. Natural and fishing mortality have been estimated up to 0.633 yr^-1 and 0.437 yr^-1, respectively. According to catch curve method, the annual survival rate of anchovy kilka has been estimated up to 0.343 yr^-1. With owning this survival rate, the instantaneous coefficient of total mortality of anchovy kilka has been estimated up to 1.07 yr^-1. The exploitation rate of anchovy kilka has been estimated up to 0.408. The catch amounts of anchovy kilka decreased gradually mainly due to overfishing, predators and ecological disturbances occurred in the Caspian Sea. The results suggest that the population of anchovy kilka were overexploited in the past years and were vulnerable to their natural predators.

Maternal Mortality Rate—A Reliable Indicator?

Introduction: Through forensic auditing a new way to monitor medical data was opened. Forensic auditing uses Benford’s law, which explains the frequency distribution in naturally occurring data sets. We applied this law on data for Maternal Mortality. This is an extremely important number in policy-making for sustainable project implementation. Methodology: The law states that the probability of a leading occurring number can be calculated through the following equation: observed and expected values were compared. To confirm statistical significance examination we used the Chi-square test. Results: The chi-square value for MMR was 21.08 for the 2012 report and 19.97 for the 2014 report. Chi-square was higher than the cut off value, which leads to the rejection the null hypothesis. The rejection of the null hypothesis means that the numbers observed in the publication are not following Benford’s law. Explanations can reach from errors, operational discrepancies and psychological challenges to manipulations in the struggle for international funding. Conclusion: Knowledge on this mathematical relation is not used widely in medicine, despite being a very valuable and quick tool to identify datasets in need of close scrutiny.