Population attributable risks of cigarette smoking for deaths of all causes, all cancers and other chronic diseases among adults aged 40-74 years in urban Shanghai, China

Objective： To evaluate the population attributable risks （PARs） between cigarette smoking and deaths of all causes, all cancers, lung cancer and other chronic diseases in urban Shanghai. Methods： In total, 61,480 men aged 40-74 years from 2002 to 2006 and 74,941 women aged 40-70 years from 1997 to 2000 were recruited to undergo baseline surveys in urban Shanghai, with response rates of 74.0% and 92.3%, respectively. A Cox proportional hazards regression model was used to estimate relative risks （RRs） and 95% confidence intervals （95% CIs） of deaths associated with cigarette smoking. PARs and 95 % CIs for deaths were estimated from smoking exposure rates and the estimated RRs. Results： Cigarette smoking was responsible for 23.9% （95% CI： 19.4-28.3%） and 2.4% （95% Ch 1.6- 3.2%） of all deaths in men and women, respectively, in our study population. Respiratory disease had the highest PAR in men [37.5% （95% CI： 21.5-51.6%）], followed by cancer [31.3% （95% Ch 24.6-37.7%）] and cardiovascular disease （CVD） [24.1% （95% CI： 16.7-31.2%）]. While the top three PARs were 12.7% （95% CI： 6.1-19.3%）, 4.0% （95% CI： 2.4-5.6%）, and 1.1% （95% CI： 0.0-2.3%）, for respiratory disease, CVD, and cancer, respectively in women. For deaths of lung cancer, the PAR of smoking was 68.4% （95% CI： 58.2- 76.5%） in men. Conclusions： In urban Shanghai, 23.9% and 2.4% of all deaths in men and women could have been prevented if no people had smoked in the area. Effective control programs against cigarette smoking should be strongly advocated to reduce the increasing smoking-related death burden.

Trends of Ten Leading Causes of Death in Head and Neck Squamous Cell Carcinoma

Objective:An understanding of the leading causes of death in patients with head and neck squamous cell carcinoma(HNSCC)would be helpful to inform doctors,patients,and healthcare providers on disease management.This study aimed to comprehensively study the leading causes of death in these survivors.

Extracting Leading Joint Causes of Death and Mining Associations between Them

The gains in analyzing death from a multiple cause perspective have been recognized for a very long time. Methods that have been adopted have sought to determine additional gains made by treating death as a multiple cause phenomenon as compared to analysis based on a single under-lying cause. This paper shows how association rules mining methodology can be adapted to determine joint morbid causes with strong and interesting associations. Results show that some causes of death that do not appear among the leading causes show strong associations with other causes that would otherwise remain unknown without the use of association rules methodology. Overall, the study found that the leading joint pair of causes of death in South Africa was metabolic disorders and intestinal infectious diseases which accounted for 18.9 deaths per 1000 in 2008, followed by cerebrovascular and hypertensive diseases which accounted for 18.3 deaths per 1000.

The Effect of Coding Method on Cause-of-Death Rankings

Background: Cause-of-death rankings are often used for planning or evaluating health policy measures. In the European Union, some countries produce cause-of-death statistics by a manual coding of death certificates, while other countries use an automated coding system. The outcome of these two different methods in terms of the selected underlying cause of death for statistics may vary considerably. Therefore, this study explores the effect of coding method on the ranking of countries by major causes of death. Method: Age and sex standardized rates were extracted for 33 European (related) countries from the cause-of-death registry of the European Statistical Office (Eurostat). Wilcoxon’s rank sum test was applied to the ranking of countries by major causes of death. Results: Statistically significant differences due to coding method were identified for dementia, stroke and pneumonia. These differences could be explained by a different selection of dementia or pneumonia as underlying cause of death and by a different certification practice for stroke. Conclusion: Coding method should be taken into account when constructing or interpreting rankings of countries by cause of death.

HSP70 cleavage-induced photoreceptor cell death caused by N-methyl-N-nitrosourea

Retinal degenerative diseases （RDs） such as retinitis pigmentosa （RP） are characterized by slowly progressive photoreceptor cell death, but the molecular mechanism underlying RP remains unclear. Animal models for RP have led to a better understand- ing of the disease pathological mechanisms, yet it remains difficult to identify an appropriate genetic model for RDs in general because there are many causative genes （Rossmiller et al., 2012）.

Verbal Autopsy of Stillbirths and Neonatal Deaths in a Rural Area of Burkina Faso

Introduction: In developing countries, many neonatal deaths still occur at home and the causes of these deaths are not ascertained. Objective: To identify the causes of stillbirths and neonatal deaths that occur at home and the factors that have contributed to these deaths. Materials and Method: We have used the method of verbal autopsy to investigate the stillbirths and neonatal deaths in nine villages in the health area of Namsiguia, health district of Ouahigouya, Burkina Faso, during the period January 1, 2007 to December 8, 2012. Results: Over these six years, we have recorded 19 stillbirths and 36 neonatal deaths among 1507 live births, demonstrating a neonatal mortality rate of 28.8 per1000 and a rate of stillbirths of 12.6 per 1000. The average age of newborns at death was 5.6 days and the sex-ratio was 1.6. The major cause of stillbirths was antenatal hypoxia and birth asphyxia (42.1%). The direct causes of neonatal deaths were neonatal sepsis (41.7%), preterm birth (19.4%) and hypoxia and birth asphyxia (11.1%). There were 42.1% deliveries and 58.3% neonatal deaths, which occurred at home. We have noted 89.5% fresh stillbirths. Death occurred more often during the early neonatal period (55.5%). Factors significantly associated with neonatal death were, lack of school education of mothers (OR = 4), precocious marriage of the mother (OR = 8), poor follow-up of pregnancies (OR = 3), birth at home (OR = 4), low socioeconomic level (OR = 6), and low geographical access to the health facility (OR = 4). Conclusions: Strengthening of the health infrastructure and improving their accessibility, reinforcement of the staff for high quality care, and communication for a change in behavior in rural communities, will contribute toward reducing neonatal mortality in the area of health of Namsiguia.

Clinical Predictors for Reduced Long-Term Survival and Cause of Death after Curative Resection for Rectal Cancer

Purpose: To identify clinical predictors for reduced long-term survival and describe the cause of death after surgical treatment for rectal cancer. Methods: A retrospective follow-up study of 442 consecutive, unselected patients treated for rectal cancer at a tertiary centre from 1990 until 2000 and followed for 17 years or until death. Predictors for death were assessed by Cox regression analysis. The cause of death was obtained from the Norwegian Cause of Death Registry. Results: 254 men and 188 women with a median age of 71 years (21 - 95 years) were resected for rectal cancer with low anterior resection (n = 266), abdominoperineal resection (n = 125), Hartmann’s procedure (n = 19) or diverting stoma only (n = 32). Median follow-up was 5 years (0 - 17 years). The relative five-year survival rates for stages I, II, III and IV was 83.9%, 65.2%, 41.1% and 9.3%, respectively. The proportion of deaths due to recurrence from colorectal cancer in stages I, II, III and IV was 23.5%, 55.8%, 72.3% and 98.0%, respectively. Heart, lung and cerebrovascular disease and other malignancies were the cause of death in the other patients. Higher age, abdominoperineal resection compared to low anterior resection, lack of lymph node dissection compared to total mesorectal excision (TME), postoperative reoperations, TNM stages II and III compared to stage I and residual tumours after surgery were all significant independent predictors of reduced survival in the adjusted Cox regression model. Conclusions: Age, tumour stage, type of surgery, lymph node dissection, residual tumour after surgery and reoperations are predictors for survival after surgery for rectal cancer. In the patients who died, the cause of death was due to a condition other than colorectal cancer recurrence in 32.3% of the patients. The five-year relative survival rate was related to tumour stage.

Epidemiological characteristics and relative factor of hospital death cases with road traffic trauma

Objective: To investigate the epidemiological characteristics and relative factor about hospital death in patients with road traffic trauma. Methods: The age, sex, road-use category, sites of injury, injury severity scale of 159 hospital death cases in 2436 cases with road traffic trauma were observed, and the relation between the causes of death and time elapsed after injury was also studied with likelihood ratio Chi-square test.

Maternal Death and Potential Years of Life Lost(PYLL)in Santa Catarina,Brazil,in 2000 and 2014

Introduction: Indicators of maternal health are often used to evaluate the social development and overall health of a population, as well as the accessibility of health services. Among these indicators, the Potential Years of Life Lost, which is associated with maternal deaths, is useful for the definition of priorities, monitoring, evaluation, and intervention, identifying the highest risk groups. Objective: To analyze the Potential Years of Life Lost by maternal death in Santa Catarina in 2000 and 2014. Method: An Ecological study with exploratory spatial analysis was conducted with data obtained from the Information System on Mortality and Live Births. Results: In the Information System, 35 maternal deaths in the year 2000 were identified and 24 in 2014. The total estimated years of life lost were 845 years in 2000 and 780 years in 2014, dominated by direct obstetric causes. In 2000, women who died lost, on average, 39.8 years of life;and 41.5 years in 2014. Conclusion: The spatial pattern observed in 2000 highlights areas of high risk in different regions of Santa Catarina. The greatest loss of years occurred in younger women, confirming the need to prevent and control maternal mortality and review strategies for compliance with public policies in the State.

Mortality from chronic liver disease:Recent trends and impact of the COVID-19 pandemic

Prepandemic time trends in mortality from chronic liver disease(CLD)differed according to specific cause of death(decreasing for liver cirrhosis,stable or increasing for liver cancer),etiology(increasing for nonalcoholic fatty liver disease,generally decreasing for other etiologies),and world region(decreasing in areas with the highest burden of hepatitis B virus,increasing in Eastern Europe and other countries).The coronavirus disease 2019(COVID-19)pandemic affected mortality of patients with CLD both directly,with a higher risk for severe illness and death depending on age,stage and etiology of the disease,and indirectly,through social isolation and loss of support,harmful drinking,and difficulties in access to care.Nevertheless,only sparse data are available on variations in CLD as a cause of death during the pandemic.In the USA,in 2020-2021 a growth in mortality was registered for all liver diseases,more marked for alcoholic liver disease,especially among young people aged 25-44 years and in selected ethnic groups.COVID-19 related deaths accounted only for a minor part of the excess.Further data from mortality registers of other countries are warranted,preferably adopting the so-called multiple cause-of-death approach,and extended to deaths attributed to viral hepatitis and liver cancer.

An Autopsy and Histopathology-based Study to Ascertain the Cause of Death of Brought Dead Cases

Background and Objectives:The cases of apparent natural deaths are encountered in the hospital casualties who are noted dead at the time of the first medical attention and as such are labeled as“Brought Dead.”These include the cases of sudden death,unexplained death,and unattended death.The cause of such deaths is reported in the literature to emanate principally from the cardiovascular system,though there are some documented geographical,racial,and other variations.In the present study,we endeavored to detect the cause of such natural deaths in terms of the disease and the organ system involved,in the deceased individuals of the contemporary Bengali population,with cases due to obvious unnatural causes being excluded.Materials and Methods:An observational,cross-sectional study with 105(n=105,male:89,female:16)study subjects of age group of 20-80 years,selected by systemic random sampling,from the brought dead subjects coming to the mortuary of the NRS Medical College and Hospital for medicolegal autopsy from April 2011 to March 2012,excluding cases having a history of the obvious unnatural event.Organ system-wise gross examination was done,followed by tissue sampling for histopathological examination.The case-wise findings were tabulated and analyzed for descriptive statistics using SPSS software.Results:In the present study,89 cases were male(84.8%)and 16 cases were female(15.2%),which reflects a male:female ratio of 5.56:1.The dead bodies are mostly recovered from the footpaths(47 cases,44%).Sixty-four(61%)cases are of known identity.In 54 cases out of 105(51.4%),morbid pathology is detected in the respiratory system(RS),lobar pneumonia,and cavitary pulmonary tuberculosis being the most frequent disease entity,in both genders.Fifty-one years-sixty-five years is found to be the most commonly affected age group,in both genders.Interpretation and Conclusions:The present study shows that the most common organ system involved in brought dead cases is the RS,which is supported by a few Indian studies.

Common underlying diseases do not contribute in determining the causes of sudden unexplained death

Background Underlying diseases have a statistically significant positive correlation to sudden death. However, sudden unexplained death （SUD） is different from sudden death, as there is no clinical evidence to support the sudden death due to the original underlying disease, nor a lethal pathological basis to be found during autopsy. In addition, SUD are more common in young, previously healthy individuals, usually without any signs of disease, with no positive lesions found after autopsy. Therefore, a causal relationship between SUD and the underlying disease needs to be further explored. This study aimed to explore the role that common underlying diseases play in patients with SUD and to reveal the correlation between them. Methods The medical records, history and case information of 208 patients with SUD were collected for the survey. All these SUD occurred in the emergency room of Peking University Third Hospital from January 2006 to December 2009. The patients were stratified by with and without common underlying diseases. To examine possible associations between the underlying diseases and the cause of unexplained sudden death, the chi-squared and Fisher＇s exact tests were used. Results Among the 208 patients, 65 were diagnosed with common underlying diseases while 143 were not. Within these two groups, there were 45 patients for whom the clear cause of death was determined. However, there were no statistically significant differences or strong associations （x2=1.238, P 〉0.05） between the 11 patients with （16.90%） and 34 without （23.78%） common underlying disease among these 45 patients. We also found that occurrence of the common underlying diseases, such as neurological system, cardiovascular and pulmonary system diseases, are not statistically significant （P 〉0.05） in the diagnosis of the SUD. Conclusion Common underlying diseases make no obvious contributions to SUD and are not useful in diagnosing the underlying reasons for death.

Trends in the major causes of death in China, 1982-2010

Since the introduction of a series of reform and open policies in its economic system in 1976,China has been in a boom period of social and economic fields.Rapid development in economy and the consequent improvement in living conditions,nutrition,and health care help to decrease infant mortality and deaths from infectious diseases,and notably effected the patterns of mortality.For example,respiratory diseases,acute infectious diseases,and tuberculosis were the leading causes of death in 1957,while diseases of heart,cerebrovascular disease,and malignant neoplasm were the fifth,sixth,and seventh leading causes of death.1 Up to 1975,cerebrovascular diseases,diseases of heart,and malignant neoplasm were the top three death causes,followed by respiratory diseases,digestive diseases,and pulmonary tuberculosis.1 A prospective cohort study involving a representative sample of the adult Chinese population was conducted in 2005,which revealed that the five leading causes of death were malignant neoplasm,diseases of heart,cerebrovascular disease,accidents,and infectious diseases among men and diseases of heart,cerebrovascular disease,malignant neoplasm,pneumonia and influenza,and infectious diseases among women.

Cancer situation in China:what does the China cancer map indicate fromthe first national death survey to the latest cancer registration?

Background:Over the past four decades,the Chinese government has conducted three surveys on the distribution of causes of death and built cancer registration.In order to shine a new light on better cancer prevention strategies in China,we evaluated the profile of cancer mortality over the forty years and analyzed the policies that have been implemented.Methods:We described spatial and temporal changes in both cancer mortality and the ranking of major cancer types in China based on the data collected from three national surveys during 1973-1975,1990-1992,2004-2005,and the latest cancer registration data published by National Central Cancer Registry of China.The mortality data were compared after conversion to age-standardized mortality rates based on the world standard population(Segi’s population).The geographical distribution characteristics were explored by marking hot spots of different cancers on the map of China.Results:From 1973 to 2016,China witnessed an evident decrease in mortality rate of stomach,esophageal,and cervical cancer,while a gradual increase was recorded in lung,colorectal,and female breast cancer.A slight decrease of mortality rate has been observed in liver cancer since 2004.Lung and liver cancer,however,have become the top two leading causes of cancer death for the last twenty years.From the three national surveys,similar profiles of leading causes of cancer death were observed among both urban and rural areas.Lowermortality rates from esophageal and stomach cancer,however,have been demonstrated in urban than in rural areas.Rural areas had similar mortality rates of the five leading causes of cancer death with the small urban areas in 1973-1975.Additionally,rural areas in 2016 also had approximate mortality rates of the five leading causes with urban areas in 2004-2005.Moreover,stomach,esophageal,and liver cancer showed specific geographical distributions.Althoughmortality rates have decreased atmost of the hotspots of these cancers,they were still higher than the national average levels during the same time periods.Conclusions:Building up a strong primary public health system especially among rural areas may be one critical step to reduce cancer burden in China.

Profile of men＇s health in Malaysia： problems and ：hallenges

Men＇s health concerns have evolved from the traditional andrology and male sexual health to a more holistic approach that encompasses male psychological, social and physical health. The poor state of health in men compared to their female counterparts is well documented. A review of the epidemiological data from Malaysia noted a similar trend in which men die at higher rates in under 1 and above 15 years old groups and most disease categories compared to women. In Malaysia, the main causes of death in men are non-communicable diseases and injuries. Risk factors, such as risk-taking behaviour, smoking and hypertension, are prevalent and amenable to early interventions. Erectile dysfunction, premature ejaculation and prostate disorders are also prevalent. However, many of these morbidities go unreported and are not diagnosed early; therefore, opportunities for early intervention are missed. This reflects poor health knowledge and inadequate health-care utilisation among Malaysian men. Their health-seeking behaviour has been shown to be strongly influenced by family members and friends. However, more research is needed to identify men＇s unmet health-care needs and to develop optimal strategies for addressing them. Because the Malaysian population is aging and there is an increase in sedentary lifestyles, optimizing men＇s health will remain a challenge unless effective measures are implemented. The existing male-unfriendly health-care system and the negative influence of masculinity on men＇s health behaviour must be addressed. A national men＇s health policy based on a male-friendly approach to health-care delivery is urgently needed to provide a framework for addressing these challenges.

Situation and Strategies of the Maternal and Infant Health in Tunisia

This paper presents then makes a retrospective and descriptive evaluation of the Tunisian strategy implemented to reduce maternal and infant mortality and morbidity. The objectives of this bibliography work are to make a diagnosis of the situation of the maternal and infant mortality and morbidity, to develop the philosophy and the orientations of the strategic axis and to underline the keys of the success as well as the limits of the strategy.

Early Mortality (120 Days) amongst Incident Hemodialysis with End Stage Kidney Disease: A 5-Year Retrospective Study

Background: End stage kidney failure (ESKF) is a major public health problem worldwide. Haemodialysis is the principal method in its management, and is associated with high mortality mostly owing to cardiovascular disease (CVD). In Cameroon, data on its predictors is lacking. Objectives: This study aimed at determining the 120 day mortality, causes of death and its predictors and amongst incident haemodialysis patients with end stage kidney disease in Cameroon. Methods: We retrospectively reviewed medical records of patients admitted for ESKF who started haemodialysis between January 2016 and December 2020 (5 years) and who died within 120 days. For these patients, the variables collected were: age, gender, comorbidities, dialysis parameters, para-clinical parameters, cause of death. The causes of death were registered as stated by the attending physician. Data were analysed using SPSS 20. A p-value Results: Out of 1012 incident patients, 258 died giving a mortality rate of 25.5%. Of these, 59.7% were males. The mean age (SD) was 46.52 (15.6) years. The main causes of death included sepsis (45.61%), CVD (12.86%), and severe anaemia (9.94%);and were comparable between males and females except for anaemia which was more prevalent in females (p = 0.003). Catheters related infections (77.9%), and chest infections (9.0%) were the main sources of sepsis while sudden death (76.2%), myocardial infarction (9.5%), and heart failure (9.5%) were the main cardiovascular causes of death. Hypertension (65%), CVD (35.6%), and diabetes (9.19%) were the main comorbidities associated to death. The main vascular access was central venous catheter 96%. CVD (p = 0016, aOR;4.107), Albumin ≤ 3.5 g/dl (p = 0.015, aOR;23.083), and Creatinine > 20 mg/dl (p = 0.024, aOR;5.649) were independent predictors of mortality. Conclusion: One in four patients on haemodialysis died early. CVD, hypoalbuminemia and late initiation were predictors of mortality. Majority of patients die from preventable causes, with sepsis from catheter being the most frequent.

Forensic Significance of Messenger RNA and Protein Expression of Genes Downstream of Hypoxia Inducible Factor 2 in Myocardial Tissue for Death Discrimination

Background: As a heterodimeric transcription factor, hypoxia-inducible factor 2 alpha subunit (HIF2A), is an important member of the HIF family. It plays a significant role in the hypoxia adaptation process by regulating the different types of downstream transcription factors and auxiliary regulatory factors. HIF2A-related factors are believed to participate in the progression of myocardial injury or myocardial ischemia, support the protection of ischemic myocardium, and provide guiding significance for the diagnosis and discrimination of sudden cardiac death in forensic pathology. Aim and Objectives: This study aimed to explore the discriminability and applicability of HIF2A-related factors in myocardial infarction cases compared with other causes of death, provide further insights for the forensic diagnosis of heart failure (HF) cases with myocardial infarction, and support the clinical treatment of patients with HF after myocardial infarction. Materials and Methods: The relative expression levels of HIF2A, amphiregulin (AREG), potassium large conductance calcium-activated channel subfamily M β1 (KCNMB1), peroxisome proliferator-activated receptor α (PPARA), vascular endothelial growth factor (VEGF), and VEGFR2 messenger RNAs (mRNAs) in myocardial tissue samples were performed using quantitative reverse transcriptase-polymerase chain reaction. A partial least squares-discriminant analysis model was constructed to select the indicators with better identification effects for myocardial infarction cases. The protein levels of HIF2A, AREG, KCNMB1, and PPARA were further detected by immunohistochemistry. The forensic autopsy cases (27 cases in total, postmortem interval <72 h) included seven cases of acute myocardial infarction and ten cases of myocardial ischemia. There were ten cases in the control group, including four cases of traffic injury, one case of injury by fall from height, and five cases of blunt force injury. Results: Characteristic results were observed in the myocardial ischemia/infarction samples. Compared with the control group, the relative mRNA expression levels of AREG, KCNMB1, and PPARA were significantly increased during the progression of myocardial ischemia, but this was not observed for HIF2A, VEGF, or VEGFR2 mRNA. Immunohistochemistry assays further verified the expression levels of the related factors at the protein level, and H and E staining showed signs of angiogenesis and inflammation in the ischemia/infarction group. Conclusions: By controlling the expression of downstream target genes (AREG, KCNMB1, and PPARA) during myocardial cell hypoxia adaptation, HIF2A has a potential significance in the diagnosis of myocardial infarction in forensic medicine. We believe that HIF2A, AREG, KCNMB1, and PPARA can be used as molecular pathological biomarkers for the discrimination of causes of death in myocardial infarction cases.

Validation of the China＇s maternal and child mortality surveillance in the diagnosis of infant deaths in two counties in Guizhou Province

The infant mortality rate in China declined from 50.2‰ to 13.8‰ between 1991 and 2009.1 Although China has made good progress,there were still about 190 thousand infants who died in 2009.Reliable birth and death registration and the causes of death in populations are essential for public health planning.The National Maternal and Child Mortality Surveillance System （MCMS） is the major system to register maternal and infant deaths.It samples 126 districts and 210 counties,totally 336 sites,covering 12% of counties and 9% of the population.Causes of deaths are determined by the attending clinician.For those who die out hospital or clinic,a community health provider will be asked to visit that family and make a decision as to the cause of death.