Common scab pathogens in Northern Scandinavia

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Monitoring of trends in socioeconomic inequalities in mortality: experiences from a European project

Background. Studies from several countries reported that the relative mortality gap between low and high socioeconomic groups widened during the 1970s and 1980s. While this wellknown finding has important policy implications and prompted research on underlying causes, it also calls for more a detailed and accurate monitoring of past and current trends. Objectives. The aim of this paper is to present new estimates of changes in socioeconomic inequalities in mortality between the 1980s and the 1990s in different European countries. The estimates are given with the specific aim to illustrate (i) large variations, both within and between countries, in the pace by which socioeconomic inequalities in mortality changed over time, and (ii) the considerable degree to which the observed trends may be sensitive to data problems and to the methodological choices made. Data and methods. The paper is based on a EU sponsored project on monitoring of socio-economic inequalities in mortality and morbidity. Data were obtained on all-cause mortality by occupational class and educational level in nine western European countries both in the early 1980s and in early 1990s. Trends in mortality were analysed by assessing trends in (a) group-specific standardised mortality rates and (b) summary measures of the magnitude of mortality differences between socioeconomic groups. Results. The weight of evidence from all countries points towards a widening of relative inequalities in mortality between the early 1980s and early 1990s, while the absolute gap remains about the same. However, important variations were observed in the pace of change, both between countries, and within countries (between men and women, and between age groups). In addition, a widening of relative inequalities was found to concur with decreasing life expectancies of the disadvantaged groups in some cases, but increasing life expectancies in many other cases. A second series of analyses illustrate that, even though there may be little doubt that relative inequalities in mortality widened in many countries, data problems can often impede an accurate assessment of the precise rate of change. For example, trends in mortality differences between occupational classes can strongly depend on (a) the social class scheme used and (b) whether or not economically inactive persons are included in the analysis. The use of "unlinked" cross-sectional studies may suffer from subtle but influential biases. Conclusion. Monitoring of trends in inequalities in mortality should go beyond the simple assessment such as "the gap is widening", and monitor in detail the pace of change, both for the national populations at large and for sub-populations such as specific age-sex groups. This monitoring needs to evaluate carefully the potential effects of data problems as well as the choice for specific methods and indicators

Widening socioeconomic inequalities in mortality in six Western European countries

Objectives: During the past decades a widening of the relative gap in death rates between upper and lower socioeconomic groups has been reported for several European countries. Although differential mortality decline for cardiovascular diseases has been suggested as an important contributory factor, it is not known what its quantitative contribution was, and to what extent other causes of death have contributed to the widening gap in total mortality. Methods: We collected data on mortality by educational level and occupational class among men and women from national longitudinal studies in Finland, Sweden, Norway, Denmark, England/Wales, and Italy (Turin), and analysed age-standardized death rates in two recent time periods (1981–1985 and 1991–1995), both total mortality and by cause of death. For simplicity, we report on inequalities in mortality between two broad socioeconomic groups (high and low educational level, non-manual and manual occupations). Results: Relative inequalities in total mortality have increased in all six countries, but absolute differences in total mortality were fairly stable, with the exception of Finland where an increase occurred. In most countries, mortality from cardiovascular diseases declined proportionally faster in the upper socioeconomic groups. The exception is Italy (Turin) where the reverse occurred. In all countries with the exception of Italy (Turin), changes in cardiovascular disease mortality contributed about half of the widening relative gap for total mortality. Other causes also made important contributions to the widening gap in total mortality. For these causes, widening inequalities were sometimes due to increasing mortality rates in the lower socioeconomic groups. We found rising rates of mortality from lung cancer, breast cancer, respiratory disease, gastrointestinal disease, and injuries among men and/or women in lower socioeconomic groups in several countries. Conclusions: Reducing socioeconomic inequalities in mortality in Western Europe critically depends upon speeding up mortality declines from cardiovascular diseases in lower socioeconomic groups, and countering mortality increases from several other causes of death in lower socioeconomic groups

Perunaruven aiheuttajat ja niiden torjunta : hankeloppuraportti huhtikuu, 2003

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The effect of renal replacement therapy and antibiotic dose on antibiotic concentrations in critically ill patients: data from the multinational Sampling Antibiotics in Renal Replacement Therapy Study

Background: The optimal dosing of antibiotics in critically ill patients receiving renal replacement therapy (RRT) remains unclear. In this study, we describe the variability in RRT techniques and antibiotic dosing in critically ill patients receiving RRT and to relate observed trough antibiotic concentrations to optimal targets. Methods: We performed a prospective, observational, multi-national, pharmacokinetic study in 29 intensive care units from 14 countries. We collected demographic, clinical and RRT data. We measured trough antibiotic concentrations of meropenem, piperacillin-tazobactam and vancomycin and related them to high and low target trough concentrations. Results: We studied 381 patients and obtained 508 trough antibiotic concentrations. There was wide variability (4-8 fold) in antibiotic dosing regimens; RRT prescription, and estimated endogenous renal function. The overall median estimated total renal clearance (eTRCL) was 50 mL/min (interquartile range [IQR] 35-65) and higher eTRCL was associated with lower trough concentrations for all antibiotics (p<0.05). The median (IQR) trough concentration for meropenem was 12.1 mg/L (7.9-18.8), piperacillin 78.6 mg/L (49.5-127.3), tazobactam 9.5 mg/L (6.3-14.2) and vancomycin 14.3 mg/L (11.6-21.8). Trough concentrations failed to meet optimal higher limits in 26%, 36%, 72%, and optimal lower limits in 4%, 4%, and 55% of patients for meropenem, piperacillin and vancomycin respectively. Conclusions: In critically ill patients treated with RRT, antibiotic dosing regimens, RRT prescription and eTRCL varied markedly and resulted in highly variable antibiotic concentrations that failed to meet therapeutic targets in many patients.Jason A. Roberts … Sandra L. Peake … Michael S. Roberts … Mahipal Sinnollareddy … John Turnidge … Tricia Williams … et al. on behalf of the SMARRT Study Collaborators and the ANZICS Clinical Trials Grou