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Background: Globally, 64–74 million individuals around the world are estimated to sustain traumatic brain injury every year. Moderate and severe traumatic brain injury can lead to a lifetime physical, cognitive, emotional, and behavioral changes. There were limited studies conducted in Ethiopia regarding to traumatic brain injury mortality. Methods: An institutional based retrospective cohort study was conducted on 429 randomly selected traumatic brain injury patients aged 18 to 64 years who were admitted to East Amhara Comprehensive Specialized Hospitals from January 1, 2016 to December 31, 2021. Kobo toolbox was applied for data collection and exported to Stata version 17 for data processing and analysis. To estimate death free time, a Kaplan Meier failure curve was used. The Cox proportional hazards regression model was used at the 5% level of significance to determine effect of predictor variables on time to death. Result: A total of 429 traumatic brain injury patients aged 18 to 64 years were included with response rate of 91.3% and 145(33.8%) were dead. Open injuries (AHR = 0.25; 95% CI: 0.18–0.36), co-existing injuries (AHR = 0.40; 95% CI: 0.24–0.66), ICU admission (AHR = 0.42; 95% CI: 0.29–0.60), arrival within 4–24 h (AHR = 3.48; 95% CI: 2.01–6.03), arrival after 24 h (AHR = 6.69; 95% CI: 3.49–12.28), subdural hematoma (AHR = 2.72; 95% CI: 1.77–4.19), serum albumin < 3.5 g/dL (AHR = 0.66; 95% CI: 0.49–0.94), moderate (AHR = 0.56; 95% CI: 0.21–0.89), and mild traumatic brain injury (AHR = 0.43; 95% CI: 0.29–0.56) were predictors of traumatic brain injury mortality. Conclusion: The finding of this study showed that the mortality was 1/3rd of the total patients. Open injuries, co-existing injuries, ICU admission, arrival time (4–24 h and > 24 h), subdural hematoma, serum albumin < 3.5 g/dL and severity of traumatic brain injury (mild and moderate) were predictors of traumatic brain mortality. Therefore, working on these factors to reduce the morality of traumatic brain injury patients is very important. [ABSTRACT FROM AUTHOR]

Background and purpose: A stroke or a cerebrovascular accident is a common cause of death and a leading cause of long-term, severe disability in both developed and developing countries. The most recent global burden of disease report states that there were 11.9 million new cases of stroke worldwide; stroke accounts for nearly 1 in 8 deaths globally (12%, 6.5 million deaths) and claims a life every 5 s, making it the second most common cause of death worldwide. The goal of the study was to identify the most important factors influencing stroke patients' time to death at Gambella General Hospital. Methods: Data was gathered from patient files in a hospital using a retrospective study methodology, spanning the period from September 2018 to September 2020. R 3.4.0 statistical software and STATA version 14.2 were used for data entry and analysis. The survival time was compared using the log-rank tests and the Kaplan–Meier survival curve. The fitness of the Cox proportional hazard model was examined. Results: The final model that was fitted was the log-logistic AFT model. A statistically significant correlation was defined as having a p value of less than 0.05 and the accelerated factor (γ) with its 95% confidence interval was employed. Eight days was the total median death time (95% CI 6–10). Significant predictors for shortened mortality time were age (γ = 0.94; 95% CI (0.0.920–0.980), hypertension (γ = 0.63; 95% CI (0.605–0.660), and baseline complications (γ = 0.24; 95% CI (0.223–0.256). Conclusions: The shortened timing of death was significantly predicted by age, hypertension, and baseline complications. In light of the study's findings, health administrators and caregivers should work to improve society's overall health. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease is a progressive disease that affects more than 10% of the world's population and is also the leading cause of death in the twenty-first century. Furthermore, it imposes a significant financial burden on people undergoing hemodialysis. However, there is little research, particularly in the study area, on time to death and its predicators among hemodialysis patients in Ethiopia; therefore, knowing time to death and identifying predicators that affect survival time is crucial in order to improve survival time and enhance the prognosis of hemodialysis patients. The aim of this study was to assess time to death and its predictors among patients with chronic kidney disease on hemodialysis at a dialysis unit in Addis Ababa, Ethiopia, in 2023. Methods: An institution-based retrospective cohort study was carried out among 370 chronic kidney disease patients on hemodialysis from January 1st, 2017 to December 30th, 2022. Data were extracted from April 1st–May 20th, 2023, and each variable was coded and entered into Epi Data version 3.1 and then exported into STATA version 15 software for analysis. Kaplan–Meier and the log-rank test were done. Bivariable Cox-proportional regression was done, and a variable whose p-value was < 0.25 and fulfilled the proportional hazard assumption by using graphical and Shenfield residuals was entered into multivariable Cox-proportional regression. Finally, a variable whose p-value < 0.05 and adjusted hazard ratio with its CI were declared statistically significant predictors. Result: In this study, the overall median survival time was 47 months (95% CI: 36.7, 56), with an incidence rate of death of 16.8 per 1000 people per month of observation (95% CI: 13.8–20.3). Age 64 and above (Adjusted Hazard Ration: 2.8; 95% CI: 1.67–4.98), catheter vascular access (Adjusted Hazard Ration: 3.47; 95% CI: 2.03–5.93), cardiovascular disease (Adjusted Hazard Ration: 1.88; 95% CI: 1.15–3.07), and blood group B (Adjusted Hazard Ration: 2.07; 95% CI: 1.17–3.69) were significant predictors of time to death among hemodialysis patients. Conclusion and recommendation: The median survival time was 47 months, with an interquartile range of 40. Cardiovascular disease, older adults, central venous catheters, and blood type B were significant predictors of time to death for hemodialysis patients. Therefore, in order to improve the survival of hemodialysis patients, health professionals and concerned bodies should give concern to and work on those predictors. [ABSTRACT FROM AUTHOR]

Background: Preterm birth is the leading cause of neonatal mortality accounting for 35% of all neonatal deaths worldwide, and the second most frequent cause of death for under five children. Despite different efforts, preterm neonatal mortality is still persistently high in Ethiopia. Little is known about death and its predictors among preterm neonates in the study area. Objective: This study is aimed at estimating the incidence of mortality and its predictors among preterm neonates admitted to the NICU of NEMMCSH. Methods and materials: : A hospital-based prospective follow-up study was conducted from January to November 2022. A total of 197 preterm neonates were selected consecutively and followed. The Kaplan-Meier survival and failure curves were used to describe the proportion of deaths over time and to compare groups. The independent effects of covariates on the hazard of death were analyzed using a multivariable Cox proportional hazard model. Results: Preterm neonates were followed for 1840 person-days. The mean time to death was 5.68 days (SD = 5.54). The incidence of mortality was 26.08 (95% CI: 19.65, 34.61) per 1000 person days. Preterm neonates of mothers with eclamsia (AHR = 3.03), preterm neonates who have not received KMC (AHR = 2.26), and preterm neonates who have not exclusively breastfed (AHR = 4.4) had higher hazards of death as compared to their counterparts. Conclusion and recommendation: : The mean time to death was 5.68 days (SD = 5.54). The incidence of mortality was 26.08 per 1000 person days. Eclamsia, KMC, and exclusive breastfeeding were significant predictors of death among preterm neonates. The role of KMC in reducing mortality rates and improving outcomes has to be emphasized for mothers and families. Caregivers have to ensure that mothers and families receive adequate support and resources to facilitate KMC, including access to lactation support, counseling, and assistance with practical aspects of caregiving. Counseling and practical support to enhance exclusive breastfeeding initiation and continuation have to be strengthened. Special attention has to be given to the preterm neonates of mothers with eclampsia. [ABSTRACT FROM AUTHOR]

Abstract Background Globally, 64–74 million individuals around the world are estimated to sustain traumatic brain injury every year. Moderate and severe traumatic brain injury can lead to a lifetime physical, cognitive, emotional, and behavioral changes. There were limited studies conducted in Ethiopia regarding to traumatic brain injury mortality. Methods An institutional based retrospective cohort study was conducted on 429 randomly selected traumatic brain injury patients aged 18 to 64 years who were admitted to East Amhara Comprehensive Specialized Hospitals from January 1, 2016 to December 31, 2021. Kobo toolbox was applied for data collection and exported to Stata version 17 for data processing and analysis. To estimate death free time, a Kaplan Meier failure curve was used. The Cox proportional hazards regression model was used at the 5% level of significance to determine effect of predictor variables on time to death. Result A total of 429 traumatic brain injury patients aged 18 to 64 years were included with response rate of 91.3% and 145(33.8%) were dead. Open injuries (AHR = 0.25; 95% CI: 0.18–0.36), co-existing injuries (AHR = 0.40; 95% CI: 0.24–0.66), ICU admission (AHR = 0.42; 95% CI: 0.29–0.60), arrival within 4–24 h (AHR = 3.48; 95% CI: 2.01–6.03), arrival after 24 h (AHR = 6.69; 95% CI: 3.49–12.28), subdural hematoma (AHR = 2.72; 95% CI: 1.77–4.19), serum albumin 24 h), subdural hematoma, serum albumin

Abstract Background and purpose A stroke or a cerebrovascular accident is a common cause of death and a leading cause of long-term, severe disability in both developed and developing countries. The most recent global burden of disease report states that there were 11.9 million new cases of stroke worldwide; stroke accounts for nearly 1 in 8 deaths globally (12%, 6.5 million deaths) and claims a life every 5 s, making it the second most common cause of death worldwide. The goal of the study was to identify the most important factors influencing stroke patients' time to death at Gambella General Hospital. Methods Data was gathered from patient files in a hospital using a retrospective study methodology, spanning the period from September 2018 to September 2020. R 3.4.0 statistical software and STATA version 14.2 were used for data entry and analysis. The survival time was compared using the log-rank tests and the Kaplan–Meier survival curve. The fitness of the Cox proportional hazard model was examined. Results The final model that was fitted was the log-logistic AFT model. A statistically significant correlation was defined as having a p value of less than 0.05 and the accelerated factor (γ) with its 95% confidence interval was employed. Eight days was the total median death time (95% CI 6–10). Significant predictors for shortened mortality time were age (γ = 0.94; 95% CI (0.0.920–0.980), hypertension (γ = 0.63; 95% CI (0.605–0.660), and baseline complications (γ = 0.24; 95% CI (0.223–0.256). Conclusions The shortened timing of death was significantly predicted by age, hypertension, and baseline complications. In light of the study's findings, health administrators and caregivers should work to improve society's overall health.

Abstract Background Chronic kidney disease is a progressive disease that affects more than 10% of the world's population and is also the leading cause of death in the twenty-first century. Furthermore, it imposes a significant financial burden on people undergoing hemodialysis. However, there is little research, particularly in the study area, on time to death and its predicators among hemodialysis patients in Ethiopia; therefore, knowing time to death and identifying predicators that affect survival time is crucial in order to improve survival time and enhance the prognosis of hemodialysis patients. The aim of this study was to assess time to death and its predictors among patients with chronic kidney disease on hemodialysis at a dialysis unit in Addis Ababa, Ethiopia, in 2023. Methods An institution-based retrospective cohort study was carried out among 370 chronic kidney disease patients on hemodialysis from January 1st, 2017 to December 30th, 2022. Data were extracted from April 1st–May 20th, 2023, and each variable was coded and entered into Epi Data version 3.1 and then exported into STATA version 15 software for analysis. Kaplan–Meier and the log-rank test were done. Bivariable Cox-proportional regression was done, and a variable whose p-value was

Abstract Background Preterm birth is the leading cause of neonatal mortality accounting for 35% of all neonatal deaths worldwide, and the second most frequent cause of death for under five children. Despite different efforts, preterm neonatal mortality is still persistently high in Ethiopia. Little is known about death and its predictors among preterm neonates in the study area. Objective This study is aimed at estimating the incidence of mortality and its predictors among preterm neonates admitted to the NICU of NEMMCSH. Methods and materials : A hospital-based prospective follow-up study was conducted from January to November 2022. A total of 197 preterm neonates were selected consecutively and followed. The Kaplan-Meier survival and failure curves were used to describe the proportion of deaths over time and to compare groups. The independent effects of covariates on the hazard of death were analyzed using a multivariable Cox proportional hazard model. Results Preterm neonates were followed for 1840 person-days. The mean time to death was 5.68 days (SD = 5.54). The incidence of mortality was 26.08 (95% CI: 19.65, 34.61) per 1000 person days. Preterm neonates of mothers with eclamsia (AHR = 3.03), preterm neonates who have not received KMC (AHR = 2.26), and preterm neonates who have not exclusively breastfed (AHR = 4.4) had higher hazards of death as compared to their counterparts. Conclusion and recommendation : The mean time to death was 5.68 days (SD = 5.54). The incidence of mortality was 26.08 per 1000 person days. Eclamsia, KMC, and exclusive breastfeeding were significant predictors of death among preterm neonates. The role of KMC in reducing mortality rates and improving outcomes has to be emphasized for mothers and families. Caregivers have to ensure that mothers and families receive adequate support and resources to facilitate KMC, including access to lactation support, counseling, and assistance with practical aspects of caregiving. Counseling and practical support to enhance exclusive breastfeeding initiation and continuation have to be strengthened. Special attention has to be given to the preterm neonates of mothers with eclampsia.

Background: Tuberculosis is one of the leading causes of death, especially for people living with HIV. However, little is known about the time to death of HIV/TB co-infected patients and associated factors in the study area. This study focused on identifying factors associated with time to death among HIV/TB co-infected patients under antiretroviral therapy in Ethiopia. Methods: From January 2008 to January 2023, a hospital-based retrospective study was conducted on 434 HIV/TB co-infected patients attending the ART clinic at Dilchora Referral Hospital in Dire Dawa, Ethiopia. The medical records were reviewed using a structured data extraction tool. Data were entered with Epi Info version 7 and analyzed with Stata version 17. The Kaplan-Meier survival curve was used along with log-rank tests to estimate and compare survival times. Bi-variable and multivariable Cox regression were performed to identify factors associated with time to mortality in HIV/TB co-infected patients. The adjusted hazard ratio with its 95 % confidence interval was used to estimate the strength of the association and a P-value of 0.05 was considered statistically significant. Results: The study included 434 HIV/TB co-infected patients. The overall median survival time was 144 months (95 % CI: [132, 156]). One hundred thirty-four (30.88 %) deaths were observed during follow-up, resulting in an all-cause mortality rate of 5.1 (95 % CI: [4.29, 6.02]) per 1000 person-months of study follow-up. The independent determinants of mortality were underweight BMI (AHR: 4.52; 95 % CI: [1.30, 15.67]), poor ART adherence (AHR: 1.60; 95 % CI: [1.03, 2.50]), advanced WHO clinical stage (AHR: 1.69; 95 % CI: [1.1, 2.62]), bedridden functional status (AHR: 1.63; 95 % CI: [1.04, 2.57]), initial ART regimen (AHR: 2.68; 95 % CI: [1.74, 4.12]), and smoking status (AHR: 1.48; 95 % CI: [1.01, 2.16]). Conclusion: The mortality rate of HIV/TB co-infected patients in this study was very high. While implementing target improvements in the National Tuberculosis and HIV Program, healthcare providers and policymakers should give higher priority to these risk factors identified in the present study.

Abstract Background Malawi has one of the highest under-five mortality rates in Sub Sahara Africa. Understanding the factors that contribute to child mortality in Malawi is crucial for the development and implementation of effective interventions to reduce child mortality. The aim of this study is to use survival analysis in modeling time to death for under-five children in Malawi. In turn, identify potential risk factors for child mortality and inform the development of interventions to reduce child mortality in the country. Method This study used data from all births that occurred in the five years leading up to the 2015/16 Malawi Demographic and Health Survey. The Frailty hazard model was applied to predict infant survival in Malawi. In this analysis, the outcome of interest was death and it had two possible outcomes: "dead" or "alive". Age at death was regarded as the survival time variable. Infants who were still alive at the time of the study as of the day of the interview were considered as censored observations in the analysis. Results A total of 17,286 live births born during the 5 years preceding the survey were analysed. The study found that the risk of death was higher among children born to mothers aged 30–39 and 40 or older compared to teen mothers. Infants whose mothers attended fewer than four antenatal care visits were also found to be at a higher risk of death. On the other hand, the study found that using mosquito nets and early breastfeeding were associated with a lower risk of death, as were being male and coming from a wealthier household. Conclusion The study reveals a notable decline in infant mortality rates as under-five children age, underscoring the challenge of ensuring newborn survival. Factors such as maternal age, birth order, socioeconomic status, mosquito net usage, early breastfeeding initiation, geographic location, and child's sex are key predictors of under-five mortality. To address this, public health strategies should prioritize interventions targeting these predictors to reduce under-five mortality rates.

Abstract Introduction Mechanical ventilation is the most common intervention for patients with respiratory failure in the intensive care unit. There is limited data from African countries, including Ethiopia on time to death and its predictors among patients on mechanical ventilators. Therefore, this study aimed to assess time to death and its predictors among adult patients on mechanical ventilation admitted in comprehensive specialized hospitals in West Amhara, Ethiopia. Methods An institutional-based retrospective follow-up study was conducted from January 1, 2020, to December 31, 2022. A simple random sampling was used to select a total of 391 patients’ charts. Data were collected using data the extraction tool, entered into Epi-data version 4.6.0, and exported to STATA version 14 for analysis. Kaplan–Meier failure curve and the log-rank test were fitted to explore the survival difference among groups. The Cox regression model was fitted, and variables with a p-value

Background: Malawi has one of the highest under-five mortality rates in Sub Sahara Africa. Understanding the factors that contribute to child mortality in Malawi is crucial for the development and implementation of effective interventions to reduce child mortality. The aim of this study is to use survival analysis in modeling time to death for under-five children in Malawi. In turn, identify potential risk factors for child mortality and inform the development of interventions to reduce child mortality in the country. Method: This study used data from all births that occurred in the five years leading up to the 2015/16 Malawi Demographic and Health Survey. The Frailty hazard model was applied to predict infant survival in Malawi. In this analysis, the outcome of interest was death and it had two possible outcomes: "dead" or "alive". Age at death was regarded as the survival time variable. Infants who were still alive at the time of the study as of the day of the interview were considered as censored observations in the analysis. Results: A total of 17,286 live births born during the 5 years preceding the survey were analysed. The study found that the risk of death was higher among children born to mothers aged 30–39 and 40 or older compared to teen mothers. Infants whose mothers attended fewer than four antenatal care visits were also found to be at a higher risk of death. On the other hand, the study found that using mosquito nets and early breastfeeding were associated with a lower risk of death, as were being male and coming from a wealthier household. Conclusion: The study reveals a notable decline in infant mortality rates as under-five children age, underscoring the challenge of ensuring newborn survival. Factors such as maternal age, birth order, socioeconomic status, mosquito net usage, early breastfeeding initiation, geographic location, and child's sex are key predictors of under-five mortality. To address this, public health strategies should prioritize interventions targeting these predictors to reduce under-five mortality rates. [ABSTRACT FROM AUTHOR]

Introduction: Mechanical ventilation is the most common intervention for patients with respiratory failure in the intensive care unit. There is limited data from African countries, including Ethiopia on time to death and its predictors among patients on mechanical ventilators. Therefore, this study aimed to assess time to death and its predictors among adult patients on mechanical ventilation admitted in comprehensive specialized hospitals in West Amhara, Ethiopia. Methods: An institutional-based retrospective follow-up study was conducted from January 1, 2020, to December 31, 2022. A simple random sampling was used to select a total of 391 patients' charts. Data were collected using data the extraction tool, entered into Epi-data version 4.6.0, and exported to STATA version 14 for analysis. Kaplan–Meier failure curve and the log-rank test were fitted to explore the survival difference among groups. The Cox regression model was fitted, and variables with a p-value < 0.25 in the bivariable Cox regression were candidates for the multivariable analysis. In the multivariable Cox proportional hazard regression, an adjusted hazard ratio with 95% confidence intervals were reported to declare the strength of association between mortality and predictors when a p value is < 0.05. Results: A total of 391 mechanically ventilated patients were followed for 4098 days at risk. The overall mortality of patients on mechanical ventilation admitted to the intensive care units was 62.2%, with a median time to death of 16 days (95% CI: 11, 22). Those patients who underwent tracheostomy procedure (AHR = 0.40, 95% CI: 0.20, 0.80), received cardio-pulmonary resuscitation (AHR = 8.78, 95% CI: 5.38, 14.35), being hypotensive (AHR = 2.96, 95% CI: 1.11, 7.87), and had a respiratory rate less than 12 (AHR = 2.74, 95% CI: 1.48, 5.07) were statistically significant predictors of time to death among mechanically ventilated patients. Conclusion: The mortality rate of patients on mechanical ventilation was found to be high and the time to death was short. Being cardiopulmonary resuscitated, hypotensive, and had lower respiratory rate were significant predictors of time to death, whereas patients who underwent tracheostomy was negatively associated with time to death. Tracheostomy is needed for patients who received longer mechanical ventilation, and healthcare providers should give a special attention for patients who are cardiopulmonary resuscitated, hypotensive, and have lower respiratory rate. [ABSTRACT FROM AUTHOR]

Jill Morrison-Koechl,1 Sheng Han Liu,1 Albert Banerjee,2 George Heckman,3,4 Heather Keller1,4 1Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; 2Department of Gerontology, St. Thomas University, Fredericton, New Brunswick, Canada; 3Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada; 4School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, CanadaCorrespondence: Jill Morrison-Koechl, Department of Kinesiology & Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2L 3G1, Canada, Email jillkoechl@gmail.comPurpose: Signals of end-of-life decline observed in daily habits, such as mealtime participation, are important for moving towards comfort-focused goals of care in the final months of life of long-term care (LTC) residents. It is unclear how eating issues observed in real-time in LTC homes are used as indicators of suspected end of life. The study quantifies nutrition and key non-nutrition related signals (eg, general decline, unstable vitals) documented to describe end-of-life decline and the subsequent time to death.Patients and Methods: A retrospective chart review identified the first documented conversation where end-of-life decline was considered by members of the care team (eg, nurses, physicians, dietitian, family member) for 76 randomly selected decedents from 9 LTC homes in southwestern Ontario, Canada. Time (days) to death was calculated. A directed content analysis of the free-text description of the suspected end-of-life decline was used to categorize signals. Cox proportional hazards regression analysis tested the risk of mortality associated with each categorized signal.Results: Time to death of residents (mean age = 88 ± 7 years; 60% female) from the first documentation of potential end-of-life decline ranged from 0 days to over 2 years prior to death (median = 27.5 days). Seven nutrition-related and 18 non-nutrition related signals were identified. Swallowing difficulty (HR = 2.99; 95% CI = 1.41, 6.33), cognitive decline (HR = 0.40; 95% CI = 0.20, 0.77), delirium (HR = 13.23; 95% CI = 1.57, 111.69), and cancer (HR = 0.18; 95% CI = 0.07, 0.48) were associated with time to death.Conclusion: This study provides insight into the signals used by care providers in LTC to suspect that residents are declining towards the end of life and identifies four signals that were associated with time to death. When identified by care providers as indicators of end-of-life decline, swallowing difficulty and delirium predicted a shorter time to death, while cancer and cognitive decline predicted a longer time to death. Recognition of nutrition and non-nutrition related signals may be leveraged to systematically introduce timely comfort care conversations.Plain language summary: This study is part of a larger project exploring the experience of older adults living in residential long-term care (LTC) facilities around nutrition-related challenges (eg, refusing to eat, weight loss) in the final months of life. It is well known that residents experience more complex nutrition-related challenges with proximity to the end of life and that such challenges are associated with increased risk of death. Furthermore, LTC staff rely on observable signals, including nutrition-related challenges, to indicate that residents in their care are experiencing end-of-life decline and to reorient goals of care to emphasize comfort. As such, we carried out this study to identify how common nutrition-related challenges observed in residents may be leveraged to introduce comfort conversations between LTC staff, residents, and their family caregivers. To accomplish this, we performed an in-depth review of resident charts of 76 deceased LTC residents. In our review, we identified the point at which the LTC staff first noted a decline in the residents’ health that potentially indicated end-of-life decline. We took detailed notes of the circumstances surrounding the suspected decline and categorized the reasons given. Our study describes these documented reasons (ie, ‘signals’), which included seven nutrition-related challenges, only one of which (ie, swallowing difficulty) was associated with shorter time to death. From these findings, we can conclude that goals of care should be reassessed when LTC residents experience swallowing difficulty, while the other identified signals (eg, food refusal) may prompt LTC staff to initiate comfort-focused conversations despite uncertain imminence of death.Keywords: time to death, dysphagia, delirium, LTC

The present study aimed to investigate the relationship between shooting angle to the head and animal welfare outcomes in the hunt of young harp seals (Pagophilus groenlandicus). The study population consisted of young harp seals belonging to the Greenland Sea harp seal population. A sample of 171, 2–7 weeks old, weaned harp seals of both sexes were included. The study was conducted as an open, randomised parallel group designed trial during the regular hunt. The animals were allocated into four groups, A–D, according to the observed shooting angle to the head, defined as the angle between the direction of the shot and the longitudinal axis of the animal’s head: (A) directly from the front; (B) obliquely from the front; (C) directly from the side; and (D) obliquely or directly from behind. Instantaneous death rate (IDR) and time to death (TTD) were the main variables. The mean IDR differed significantly between groups and was highest in group B (96.8%) and lowest in group C (66.7%). For all groups combined it was 84.2%. The mean TTD for seals not rendered instantaneously unconscious or dead (n = 27) differed significantly between groups and was shortest in group A (16 s) and longest in group C (85 s). However, the number of animals included in the TTD analysis was limited. In conclusion, based on the significantly higher IDR, the shooting angle obliquely from the front is recommended to help achieve the best animal welfare outcomes during the hunt of young harp seals.

To determine the humane use of slaughter methods we examined the clinical signs of life in 61 American alligators harvested on-farm using one of three methods: (i) captive bolt and spinal cord severance; (ii) electrostunning, spinal cord severance and pithing; and (iii) spinal cord severance and pithing. Loss of consciousness and the six clinical signs of life that can be used on-farm were assessed for evidence of irreversible unconsciousness and death at Time 0, 0.5, 1, 2, 5, 10, 20, and 30 min post slaughter. The brains of alligators from each slaughter method were removed to assess brain tissue disruption. A combination of loss of blink reflex, pupillary light response, jaw tone and respiration are a reliable on-farm tool for determining death. Heartbeat and withdrawal reflex persisted. Captive bolt and electrostunning methods were effective in immediately producing loss of response consistent with irreversible unconsciousness, subsequent death and destruction of neural tissue integrity in the mid and hind brain. They are therefore humane forms of slaughter in American alligators. [ABSTRACT FROM AUTHOR]

Background: Leukemia is a group of cancers that usually begin in the bone marrow and results in a large number of abnormal white blood cells. Chronic Lymphocytic Leukemia is the most prevalent leukemia in Western countries, with an estimated incidence rate of less than 1 to 5.5 per 100 000 people, and average age at diagnosis of 64 to 72 years. It is more common in men among Chronic Lymphocytic Leukemia patients in Ethiopia's hospitals at Felege Hiwot Referal Hospital. Methods: A retrospective cohort research design was employed to acquire critical information from patients' medical records in order to achieve the study's purpose. The study comprised the medical records of 312 Chronic Lymphocytic Leukemia who were followed from January 1, 2018 to December 31, 2020. A Cox proportional hazard model was used to determine the risk factors for time to death in Chronic Lymphocytic Leukemia patients. Results: Accordingly the Cox proportional hazard model, age (Hazard Ratio = 11.36; P <.001), sex of male (Hazard Ratio = 1.04; P =.004), married status (Hazard Ratio = 0.03; P =.003), medium stages of Chronic Lymphocytic Leukemia (Hazard Ratio = 1.29; P =.024), high stages of Chronic Lymphocytic Leukemia (Hazard Ratio = 1.99; P <.001), presence of anemia (Hazard Ratio =0.09; P =.005), platelets (Hazard Ratio = 2.11; P =.007), hemoglobin (Hazard Ratio = 0.02; P <.001), lymphocytes (Hazard Ratio = 0.29; P =.006), red blood cell (Hazard Ratio = 0.02; P <.001), which patients with Chronic Lymphocytic Leukemia had a significant relationship with time to death. Conclusions: Age, sex, Chronic Lymphocytic Leukemia stage, anemia, platelets, hemoglobin, lymphocytes, and red blood cells were all statistically significant determinants in the time to death of Chronic Lymphocytic Leukemia patients, according to the data. As a result, healthcare providers should pay particular attention to and emphasize the identified characteristics, as well as provide frequent counseling on how to enhance the health of Chronic Lymphocytic Leukemia patients. [ABSTRACT FROM AUTHOR]

Background and Aims: Cervical cancer is the fourth most common cause of cancer‐related death in the world. The objective of this study was to determine factors that affect the longitudinal change of tumor size and the time to death of outpat Methods: A retrospective follow‐up study was carried out among 322 randomly selected patients with cervical cancer at the University of Gondar Referral Hospital from May 15, 2018 to May 15, 2022. Data were extracted from the patient's chart from all patients' data records. Kaplan–Meier estimator, log‐rank test, the Cox proportional‐hazard model, and the joint model for the two response variables simultaneously were used. Results: Among 322 outpatients with cervical cancer, 148 (46%) of them were human immunodeficiency virus (HIV) positive and 107 (33.3%) of them died. The results of joint and separate models show that there is an association between survival and the longitudinal data in the analysis; it indicates that there is a dependency between longitudinal terms of cervical tumor size and time‐to‐death events. A unit centimeter square rise in tumor size, corresponding to an exp(0.8502) = 2.34 times, significantly raised the mortality risk. Conclusion: The study showed that HIV, stage of cancer, treatment, weight, history of abortion, oral contraceptive use, smoking status, and visit time were statistically significant factors for the two outcomes jointly. Implications: As a result, adequate health services and adequate resource allocations are critical for cervical cancer control and prevention programs. Therefore, the government should provide adequate funding and well‐trained health professionals to hospitals to sustain screening programs with appropriate coverage of cervical cancer patient treatments. [ABSTRACT FROM AUTHOR]

Natnael Moges Misganaw,1 Girum Sebsbie,2 Mekonen Adimasu,2 Fekadeselassie Belege Getaneh,3 Getachew Arage,1 Fisha Alebel GebreEyesus,4 Wubet Alebachew Bayih,1 Ermias Sisay Chanie,1 Berihun Bantie,5 Gashaw Kerebeh,1 Dires Birhanu,6 Tadeg Jemere,7 Anteneh Mengist,8 Amare Kassaw1 1Debre Tabor University, College of Health Science, Department of Paediatrics and Child Health Nursing, Debre Tabor, Ethiopia; 2Addis Ababa University, College of Health Science, School of Nursing and Midwifery, Department of Paediatrics and Child Health Nursing, Addis Ababa, Ethiopia; 3Wollo University, College of Health Science, School of Nursing and Midwifery, Department of Paediatrics and Child Health Nursing, Dessie, Ethiopia; 4Wolkite University, College of Medicine and Health Science, Department of Paediatrics and Child Health Nursing, Wolkite, Ethiopia; 5Debre Tabor University, College of Health Science, Department of Adult Health Nursing, Debre Tabor, Ethiopia; 6Dilla University, College of Health Science, Department of Paediatrics and Child Health Nursing, Dilla, Ethiopia; 7Debre Tabor University, College of Health Science, Department of Biomedical Science, Debre Tabor, Ethiopia; 8Debre Tabor University, College of Health Science, Department of Public Health, Debre Tabor, EthiopiaCorrespondence: Natnael Moges Misganaw, Email natumoges611@gmail.comBackground: Esophageal atresia is an upper gastrointestinal tract developmental abnormality in which the upper and lower esophagus do not connect. Esophageal atresia has a higher incidence of death in sub-Saharan Africa, ranging from 30% to 80%. In Ethiopia, infants with esophageal atresia had a higher mortality rate. The assessment of time to death and predictors of esophageal atresia can help to reduce newborn mortality.Objective: This study was aimed to investigate the time to death and predictors of neonates with esophageal atresia admitted to Tikur Anbessa Specialized Hospital, Ethiopia.Methods: An institutional-based retrospective follow-up study was conducted among 225 neonates diagnosed with esophageal atresia. The median survival time, Kaplan–Meier failure estimation curve, and Log rank test were computed. Bivariable and multivariable Cox regression hazards models were fitted to identify the predictors of time to death. Hazard ratio with a 95% confidence interval was calculated and p-values < 0.05 were considered statistically significant.Results: In the study, the incidence density rate of neonates diagnosed with esophageal atresia was 5.5 (95% CI, 4.7– 6.4) per 100-neonates day. The median time to death was 11 days (95% confidence interval (CI), 8.92– 13.08). Birth weight < 2500 g (adjusted hazard ratio (AHR)=1.49, 95% CI, 1.02 − 2.21), having sepsis (AHR=1.67,95% CI, 1.15– 2.44), being malnourished (AHR = 1.61, 95% CI, 1.03 − 2.58), esophageal atretic neonates without surgery (AHR = 3.72, 95% CI, 1.34– 10.38), diagnosis time at > 48 hours of admission (AHR = 1.48, 95% CI, 1.01– 2.15) and being dehydrated (AHR = 2.38, 95% CI, 1.63– 3.46) were significant predictors of time to death among esophageal atretic neonates.Conclusion: The findings in this study highlighted the necessity of early diagnosis, proper comorbidity treatment, and timely surgical intervention to reduce infant deaths due to esophageal atresia.Keywords: esophageal atresia, time to death, Ethiopia

Abstract Background and Aims Cervical cancer is the fourth most common cause of cancer‐related death in the world. The objective of this study was to determine factors that affect the longitudinal change of tumor size and the time to death of outpat Methods A retrospective follow‐up study was carried out among 322 randomly selected patients with cervical cancer at the University of Gondar Referral Hospital from May 15, 2018 to May 15, 2022. Data were extracted from the patient's chart from all patients' data records. Kaplan–Meier estimator, log‐rank test, the Cox proportional‐hazard model, and the joint model for the two response variables simultaneously were used. Results Among 322 outpatients with cervical cancer, 148 (46%) of them were human immunodeficiency virus (HIV) positive and 107 (33.3%) of them died. The results of joint and separate models show that there is an association between survival and the longitudinal data in the analysis; it indicates that there is a dependency between longitudinal terms of cervical tumor size and time‐to‐death events. A unit centimeter square rise in tumor size, corresponding to an exp(0.8502) = 2.34 times, significantly raised the mortality risk. Conclusion The study showed that HIV, stage of cancer, treatment, weight, history of abortion, oral contraceptive use, smoking status, and visit time were statistically significant factors for the two outcomes jointly. Implications As a result, adequate health services and adequate resource allocations are critical for cervical cancer control and prevention programs. Therefore, the government should provide adequate funding and well‐trained health professionals to hospitals to sustain screening programs with appropriate coverage of cervical cancer patient treatments.

Abstract Background Preterm related complications are the single largest direct cause of neonatal deaths throughout the world, responsible for 35% of the world’s neonatal death (1.1 million deaths/year). In Ethiopia preterm related complications are still the leading cause of neonatal mortality. Identifying the hazard time to death and predictors of mortality play an important role to decrease preterm mortality. Therefore, this study aimed to determine the survival and predictors of mortality among preterm neonates admitted to neonatal intensive care unit of Addis Ababa public hospitals, Ethiopia, 2021. Method An institutional based prospective follow up study was conducted among 358 preterm neonates admitted to selected public hospitals of Addis Ababa, Ethiopia from February 12 to May 12, 2021. Systematic random sampling was used to recruit each sample and data was collected prospectively using structured questioner. Epi-data version 4.6 and STATA version 16 was used to data entry and analysis respectively. Kaplan Meier failure curve, Log rank tests were computed. Schoenfeld residual test was used to check overall model fitness. Cox proportional hazards models were fitted to identify independent predictors of preterm mortality. Result At the end of this cohort, 125(34.9%) of the neonates died, with incidence rate of 36.4/1000 (CI: 0.031–0.044) person-day with the median time to death of 6 days. Born from antepartum hemorrhage mother (AHR: 3.1, CI; 1.4–6.6), lack of Kangaroo mother care (AHR: 5.8, CI; 2.37–14.33), unable to start feeding with in 24 h of admission (AHR: 6.4, CI: 3.33–12.28), apnea (AHR: 2.4, CI: 1.3–4.7) and dehydration (AHR: 2.33, CI: 1.3–4.3) were the identified predictors of time to death. Conclusion and recommendation The first 7 days of admission was the hazard time to death with median time of 6 days. Being born to antepartum hemorrhage mother, lack of Kangaroo mother care, unable to start feeding with 24-h, Apnea and dehydration were the predictors of time to death. Therefore, intervention that focuses on the identified predictors could have a paramount effect to prolong time to death and reduce preterm mortality.

BackgroundCoronavirus (COVID-19) disease affected people throughout the globe and has become a severe threat to the health and wellbeing of the global community. Time to death and predictors of mortality vary across settings. So far, no or few related studies have been undertaken in Ethiopia. Studying the time to death from COVID-19 and its predictors is essential to understand the characteristics of the disease and thereby contribute to the identification of indicators for early detection and initiation of treatment. Therefore, this study aimed to estimate time to death and its predictors among adults with COVID-19 in Ethiopia.MethodsA retrospective follow-up study was conducted among 602 adults with COVID-19 attending Eka Kotebe General Hospital, COVID-19 Treatment Center, between 13 March 2020 and 13 November 2020. The data were entered by Epi-data version 4.2 while the analysis was carried out using STATA version 16. A Kaplan–Meier survivor curve was computed to estimate the survival probabilities. A log-rank test was used to compare the difference in survival curves. Cox proportional hazard models were fitted to identify the predictors of time to death.ResultsThe overall median time to death was 21 days. Older adults (aged ≥65 years) [adjusted hazard ratio (AHR) 2.22, 95% confidence interval (CI) 1.02–4.86], being men (AHR 3.04, 95% CI 1.61–5.74), shortness of breathing at admission (AHR 2.29, 95% CI 1.16–4.54), comorbidity (AHR 2.23, 95% CI 1.04–4.80), diabetes mellitus (AHR 2.31, 95% CI 1.30–4.08), altered cardiac function (AHR 2.07, 95% CI 1.21–3.43), and baseline white blood cell count of greater than 10 (103/µl) (AHR 2.62, 95% CI 1.55–4.44) were independent predictors of COVID-19 mortality.ConclusionMale sex, older adults, shortness of breathing at admission, patients with comorbidities, and higher blood cell count were significant predictors of time to death from COVID-19. Therefore, concerned stakeholders should focus on those predictors of mortality and design interventions accordingly to enhance the survival of patients with COVID-19.

Objectives: The estimation of lifetime quality-adjusted life-years (QALYs) requires the extrapolation of both length and quality of life (QoL). The extrapolation of QoL has received little attention in the literature. Here we explore the predictive value of "time to death" (TTD) for extrapolating QoL in oncology.Methods: We used QoL and survival data from the Patient Reported Outcomes Following Initial Treatment and Long-Term Evaluation of Survivorship registry, which is linked to The Netherlands Cancer Registry. QoL was assessed with EQ-5D and SF-6D. We tested the relationship between TTD and QoL using linear, 2-part, and beta regression models. Incremental QALYs were compared using the TTD approach and an annual age-related disutility approach using artificial survival data with varying mortality rates.Results: A total of 6 samples with >100 patients each were used for the analysis. A declining pattern in QoL was observed when patients were closer to death, confirming the predictive value of TTD for QoL. The declining pattern in QoL was most pronounced when QoL was measured with SF-6D. Proximity to death had a larger impact on QoL than age. Incremental QALYs were higher using the TTD approach than annual age-related disutility, ranging from +0.139 to +0.00003 depending on mortality rates.Conclusions: TTD is a predictor variable for QoL. Using TTD allows cost-effectiveness models that lack QoL data to extrapolate morbidity using overall survival estimates. The TTD approach generates more incremental QALYs than an annual age-related disutility, most notably for longer survival periods. [ABSTRACT FROM AUTHOR]

(1) Background: Tuberculosis is a bacterial disease mainly caused by Mycobacterium tuberculosis. It is one of the major public health problems in the world and now ranks alongside human immunodeficiency virus (HIV) as the leading infectious cause of death. The objective of this study was to investigate the potential risk factors affecting the time to death of TB patients in southwest Ethiopia using parametric shared frailty models. (2) Methods: A retrospective study design was used to collect monthly records of TB patients in three selected hospitals in southwest Ethiopia. The data used in the study were obtained from patients who took part in the directly observed treatment, short-course (DOTS) program from 1 January 2015 to 31 December 2019. The survival probability was analyzed by the Kaplan–Meier method. Log-rank tests and parametric shared frailty models were applied to investigate factors associated with death during TB treatment. (3) Results: Out of the total sample of 604 registered TB patients, 46 (7.6%) died during the study period and 558 (92.4%) were censored. It was found that the median time of death for TB patients was 5 months. Hospitals were used to assess the cluster effect of the frailty model. A Gamma shared frailty model with Weibull distribution for baseline hazard function was selected among all models considered and was used for this study. It was found that the covariates, age, initial weight, extrapulmonary type of TB patient, patient category, and HIV status of TB patient were significant risk factors associated with death status among TB patients. (4) Conclusions: The risk of death was high, especially with cases of HIV co-infected, retreated, and returned-after-treatment categories of TB patients. During the treatment period, the risk of death was high for older TB patients and patients with low baseline body weight measurements. Therefore, health professionals should focus on the identified factors to improve the survival time of TB patients. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis is one of the leading causes of death, especially for people living with HIV. However, little is known about the time to death of HIV/TB co-infected patients and associated factors in the study area. This study focused on identifying factors associated with time to death among HIV/TB co-infected patients under antiretroviral therapy in Ethiopia., Methods: From January 2008 to January 2023, a hospital-based retrospective study was conducted on 434 HIV/TB co-infected patients attending the ART clinic at Dilchora Referral Hospital in Dire Dawa, Ethiopia. The medical records were reviewed using a structured data extraction tool. Data were entered with Epi Info version 7 and analyzed with Stata version 17. The Kaplan-Meier survival curve was used along with log-rank tests to estimate and compare survival times. Bi-variable and multivariable Cox regression were performed to identify factors associated with time to mortality in HIV/TB co-infected patients. The adjusted hazard ratio with its 95 % confidence interval was used to estimate the strength of the association and a P-value of 0.05 was considered statistically significant., Results: The study included 434 HIV/TB co-infected patients. The overall median survival time was 144 months (95 % CI: [132, 156]). One hundred thirty-four (30.88 %) deaths were observed during follow-up, resulting in an all-cause mortality rate of 5.1 (95 % CI: [4.29, 6.02]) per 1000 person-months of study follow-up. The independent determinants of mortality were underweight BMI (AHR: 4.52; 95 % CI: [1.30, 15.67]), poor ART adherence (AHR: 1.60; 95 % CI: [1.03, 2.50]), advanced WHO clinical stage (AHR: 1.69; 95 % CI: [1.1, 2.62]), bedridden functional status (AHR: 1.63; 95 % CI: [1.04, 2.57]), initial ART regimen (AHR: 2.68; 95 % CI: [1.74, 4.12]), and smoking status (AHR: 1.48; 95 % CI: [1.01, 2.16])., Conclusion: The mortality rate of HIV/TB co-infected patients in this study was very high. While implementing target improvements in the National Tuberculosis and HIV Program, healthcare providers and policymakers should give higher priority to these risk factors identified in the present study., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

BackgroundsNeonatal death is the major problem in developing world. Burden and predictors of neonatal mortality vary across countries and even among regions of a country, so understanding the problem concerning these factors is essential to overcome the problem. Therefore, this study aimed to determine time to death and its predictors of neonatal mortality among neonates who were admitted to the neonatal intensive care unit of Tertiary Hospital, Addis Ababa, Ethiopia.MethodsA hospital-based retrospective cohort study was employed among 434 neonates admitted in Tertiary hospital, Addis Ababa, Ethiopia. A Kaplan Meier curve and a log-rank test were used to estimate the survival time and compare survival curves between variables. The cox proportional hazard model was also fitted to identify predictors.ResultsA total of 434 neonates included in the study, 11.1% of which were died, and the incidence rate was 19.2 per 1000 live births. The time to death of neonates was 17 days. Independent predictors of neonatal mortality were incomplete maternal antenatal follow up[AHR: 3.7 (95% CI:1.86,7.60)], low(Appearance, Pulse, Grimily, Activity, and Respiration(APGAR)score[AHR:5.0 (95%CI:1.51–15.04)], perinatal asphyxia [AHR:5.2 (95%CI:1.92–14.30)], preterm 4.2 (95%CI: 1.32–8.83)]. Moreover, small for gestational age [AHR:4.8 (95%CI:2.33–9.72)], respiratory distress[AHR: 2.5 (95%CI: 1.24–5.09)], sepsis [AHR: 3.4 (95%CI: 1.71–4.01)], low birth weight[AHR: 7.3 (95%CI:2.69,1.91)], and tracheoesophageal fistula [AHR: 2.2 (95%CI: 1.13–4.32)].ConclusionThe overall incidence rate was 19.2 deaths per 1,000 live births. Emphasis should be given to incomplete Antenatal care follow up, small for gestation, preterm, low birth weight, low 5th min APGAR score, neonatal sepsis, respiratory distress, perinatal asphyxia, and tracheoesophageal fistula.

Knowledge gaps surrounding animal welfare assessment in hunted terrestrial wild mammals and seals were highlighted in the reviews by Knudsen (2005) and EFSA (2007). Following these reviews, the present paper aims to report on developments in the quantitative assessment of welfare outcomes in wild mammals killed via rifle shooting, and modern explosive harpoon grenades used in the killing of whales. Time to death (TTD) and instantaneous death rate (IDR) are widely accepted ante-mortem variables for assessing the duration of suffering during the killing process. The addition of post-mortem assessments allows for validation of TTD and IDR, thus providing a more accurate appraisal of animal welfare during hunting. While this combined assessment for large cetaceans has been implemented since the 1980s in the Norwegian minke whale (Balaenoptera acutorostrata) hunt, we report that this approach has been implemented in studies of the Icelandic minke and fin whale (Balaenoptera physalus) hunts, as well as the Canadian and Norwegian commercial harp seal (Pagophilus groenlandicus) hunts. Additionally, this approach has been incorporated into welfare studies in terrestrial herbivore management programmes. Quantitative welfare assessment during hunts is capable of effectively evaluating the weapons used and judging modifiable variables such as projectile choice, optimal shooting procedure, as well as identifying areas for improvement in hunter training. In moving towards a standardised approach for welfare outcome assessment, an established framework can effectively allow all hunts to be contrasted and allow for identification of optimal strategies that minimise animal suffering.

Aim. The main aim of this study was to model the effectiveness of multiple myeloma (MM) therapy using machine learning, which was based on the analysis of various methods of MM treatment, a number of prognostic factors and their results in the daily routine clinical practice of medical centers in European countries. Materials and methods. The present study was retrospective, non-interventional, multicenter. A structured database of MM patients provided by the Oncology Information service (O.I.s.) was used for the study. Registration took place in medical institutions in eight countries: Austria, Belgium, Switzerland, Germany, Spain, France, Greece and Great Britain. Results. In total, 57% of men and 43% of women were analyzed in the base of 6074 patients with MM. The median age was 71 years. The median follow-up time along the lines was 387 days. High-risk cytogenetics are represented in 15% of cases. The efficacy endpoint was the best response to each line of therapy, as measured by time to death (TTD) as an indirect indicator of overall survival and time to next treatment (TTNT) as an indirect indicator of progression-free survival. The median TTD and TTNT were 730 and 399 days respectively. After a multi-step selection process, characteristics with the greatest importance for the therapy prognosis were selected: age at the beginning of therapy, line of therapy, time after MM verification, ECOG (Eastern Cooperative Oncology Group), cytogenetic risk, transplant eligibible or not, TTNT after the previous line of therapy, therapy regimen. Discussion. To continue the study it is necessary to analyze literature data and compare with real practice. Also analysis and comparison with Russian data on the treatment of patients with MM is required. Conclusion. The analysis of the presented data provides a basis for modeling a tool for assessing the effectiveness of MM therapy (prognosis of TTD and TTNT) for each patient, based on a number of prognostic factors and the results of routine clinical practice in various medical centers in European countries.

Background: Preterm related complications are the single largest direct cause of neonatal deaths throughout the world, responsible for 35% of the world's neonatal death (1.1 million deaths/year). In Ethiopia preterm related complications are still the leading cause of neonatal mortality. Identifying the hazard time to death and predictors of mortality play an important role to decrease preterm mortality. Therefore, this study aimed to determine the survival and predictors of mortality among preterm neonates admitted to neonatal intensive care unit of Addis Ababa public hospitals, Ethiopia, 2021.Method: An institutional based prospective follow up study was conducted among 358 preterm neonates admitted to selected public hospitals of Addis Ababa, Ethiopia from February 12 to May 12, 2021. Systematic random sampling was used to recruit each sample and data was collected prospectively using structured questioner. Epi-data version 4.6 and STATA version 16 was used to data entry and analysis respectively. Kaplan Meier failure curve, Log rank tests were computed. Schoenfeld residual test was used to check overall model fitness. Cox proportional hazards models were fitted to identify independent predictors of preterm mortality.Result: At the end of this cohort, 125(34.9%) of the neonates died, with incidence rate of 36.4/1000 (CI: 0.031-0.044) person-day with the median time to death of 6 days. Born from antepartum hemorrhage mother (AHR: 3.1, CI; 1.4-6.6), lack of Kangaroo mother care (AHR: 5.8, CI; 2.37-14.33), unable to start feeding with in 24 h of admission (AHR: 6.4, CI: 3.33-12.28), apnea (AHR: 2.4, CI: 1.3-4.7) and dehydration (AHR: 2.33, CI: 1.3-4.3) were the identified predictors of time to death.Conclusion and Recommendation: The first 7 days of admission was the hazard time to death with median time of 6 days. Being born to antepartum hemorrhage mother, lack of Kangaroo mother care, unable to start feeding with 24-h, Apnea and dehydration were the predictors of time to death. Therefore, intervention that focuses on the identified predictors could have a paramount effect to prolong time to death and reduce preterm mortality. [ABSTRACT FROM AUTHOR]

Background: Severe acute malnutrition (SAM) is still the leading cause of global child morbidity and mortality, with a greater burden in sub-Saharan Africa. A facility-based treatment of SAM demands critical care for improved outcomes and survival of children. However, there is a need to understand predictors for time to death among SAM children for effective interventions. Objective: To assess the predictors of death from complicated severe acute malnutrition among admitted children treated in East Ethiopia. Methods: A 31-month retrospective cohort study was conducted among a total of 665 under-five children admitted with complicated SAM in Dilchora hospital, eastern Ethiopia. The data was extracted from the patient register and medical charts using the kobo tool. The life table, survival, and hazard curves were plotted. Kaplan–Meier with Log rank tests was used to estimate and compare the mean survival time. The bivariable and multivariable Cox proportional hazards models were used to identify predictors of time to death. Crude and adjusted hazard ratios with 95% confidence intervals and p-values were reported. Results: A total of 665 full medical charts were reviewed with a total of 60 (9%; 95% CI: 6.8– 11.2%) deaths were observed, where most of the deaths occurred during the first two weeks of admission, while 74 (11%) and 449 (68%) were cured and recovered (stabilized and transferred to outpatient), respectively. Admitted children having good appetite (AHR=0.15; 95% CI: 0.64– 0.33), pneumonia (AHR=2.46, 95% CI: 1.436, 4.22), diarrhea (AHR=2.16, 95% CI: 1.16, 4.06), tuberculosis (AHR=2.86, 95% CI: 1.08, 7.63) and having a nasogastric tube inserted (AHR=2.33, 95% CI: 1.15, 4.72) were significant predictors of time to death among SAM children. Conclusion: There is unacceptably high under-five mortality due to SAM, which is predicted by co-morbidities (pneumonia, diarrhea, and tuberculosis), with medical complications and nasogastric tubes. [ABSTRACT FROM AUTHOR]

Yonatan Eshete Ashine,1 Belete Achamyelew Ayele,2 Yared Asmare Aynalem,3 Getachew Yideg Yitbarek4 1Department of Nutrition, North Wollo Zone Health Office, Amhara Regional Health Bureau, Woldia, Ethiopia; 2Wogeda Primary Hospital, Amhara Regional Health Bureau, South Gondar, Ethiopia; 3Department of Nursing, College of Health Sciences, Debre Berhan University, Debre Birhan, Ethiopia; 4Department of Biomedical Sciences (Medical Physiology), College of Health Sciences, Debre Tabor University, Debre Tabor, EthiopiaCorrespondence: Yonatan Eshete Ashine; Getachew Yideg Yitbarek Email yonataneshete2009@gmail.com; getachewyideg@gmail.comBackground: Severe acute malnutrition (SAM) is the leading cause of child mortality in developing nations. In Ethiopia, despite the presence of clinical management protocols, under-five mortality is still high. Moreover, many of the predictors for mortality during inpatient care were not well addressed. Therefore, the aim of the current study was to determine the time to death and its predictors among children under five with severe acute malnutrition.Patients and Methods: A 48-month retrospective cohort study was carried out among 346 children under five from 6 to 59 months of SAM. Data were collected from patient charts by using simple random sampling and entered in EpiData 3.1 and analyzed with STATA 14. A Kaplan–Meier curve and long rank test were used to estimate the survival time and compare survival curves between variables. A Cox proportional hazard model was fitted to identify predictors. Variable with P-value < 0.05 with 95% confidence interval was considered as significant for this study.Results: A total of 346 children were followed with an incidence rate of 5.5 deaths per 1000 person-day observation (95%CI: 3.5– 8.5). During the follow-up, 212 (61%) were males, 20 (5.8%) had died. This study also showed that males were nearly twice as likely to die than females. Sepsis (AHR: 1.62; 95%CI: 1.10– 2.37), hospital admission (AHR: 2.29; 95%CI: 1.43– 3.65), presence of edema, (AHR: 1.81; 95%CI: 1.2– 2.19), TB (AHR: 1.62; 95%CI: 1.10– 2.37) and breast feeding (AHR: 0.41; 95%CI: 0.29– 2.37) were predictors of mortality.Conclusion: The overall mean survival time and death was in line with the minimum SPHERE standard. The main predictors of death were having edema, sepsis, hospital admission and breast feeding status at admission. Therefore, it should be better to treat patients with TB, sepsis, edema according to SAM national protocol and promote breast feeding practice.Keywords: censored, malnutrition, predictors, time to death, Ethiopia

We identify the determinants of the change in CD4 cell count and survival time of children living with HIV taking antiretroviral therapy. In a retrospective study, a cohort of 201 children living with HIV/AIDS aged less than 15 years were followed from October 2013 to March 2017. Separate linear effect models were done for the longitudinal outcome of CD4 cell count. The Cox PH model was conducted for the time-to-event outcome. Joint modeling was performed both for the longitudinal and survival outcomes, results were compared with the separate analysis. However, with the specific interest in identifying the determinants and characterizing the relationship between longitudinal CD4 cell count and time-to-event outcomes, the study focused on joint modeling. The finding from the joint model indicated that the estimated association parameter was −0.10, this shows lower values of CD4 cells associated with higher death. Seemingly; observation time, age, WHO clinical stages, history of Tuberculosis (assuming that Tuberculosis is active), and functional status were determinants for the mean change in the square root of CD4 cell count. Furthermore, WHO clinical stages, functional status, history of TB, and Body Mass Index have a significant negative impact on the survival probabilities of children living with HIV. [ABSTRACT FROM AUTHOR]

(1) Background: Tuberculosis is a bacterial disease mainly caused by Mycobacterium tuberculosis. It is one of the major public health problems in the world and now ranks alongside human immunodeficiency virus (HIV) as the leading infectious cause of death. The objective of this study was to investigate the potential risk factors affecting the time to death of TB patients in southwest Ethiopia using parametric shared frailty models. (2) Methods: A retrospective study design was used to collect monthly records of TB patients in three selected hospitals in southwest Ethiopia. The data used in the study were obtained from patients who took part in the directly observed treatment, short-course (DOTS) program from 1 January 2015 to 31 December 2019. The survival probability was analyzed by the Kaplan–Meier method. Log-rank tests and parametric shared frailty models were applied to investigate factors associated with death during TB treatment. (3) Results: Out of the total sample of 604 registered TB patients, 46 (7.6%) died during the study period and 558 (92.4%) were censored. It was found that the median time of death for TB patients was 5 months. Hospitals were used to assess the cluster effect of the frailty model. A Gamma shared frailty model with Weibull distribution for baseline hazard function was selected among all models considered and was used for this study. It was found that the covariates, age, initial weight, extrapulmonary type of TB patient, patient category, and HIV status of TB patient were significant risk factors associated with death status among TB patients. (4) Conclusions: The risk of death was high, especially with cases of HIV co-infected, retreated, and returned-after-treatment categories of TB patients. During the treatment period, the risk of death was high for older TB patients and patients with low baseline body weight measurements. Therefore, health professionals should focus on the identified factors to improve the survival time of TB patients.

Abstract Objectives This study aimed to determine mortality rate, time to death and factors affecting the time to death among children with severe acute malnutrition admitted to therapeutic feeding unit of Felege Hiwot Referral Hospital, Bahirdar. Result A total of 401 children with severe acute malnutrition who were admitted to therapeutic feeding units from September 2012 to January 2016 were included in the study. The incidence of death rate was 8.47% (95% CI 6.11%, 11.65%). The median time to death was 3 days (Inter Quartile Range of 4 days). Children’s of age > 24 months (AHR = 0.27; 95% CI 0.1, 0.73), fully vaccinated status (AHR = 0.16; 95% CI 0.07, 0.36), HIV infection (AHR = 3.82; 95% CI 1.3, 11.15) and congestive heart failure (AHR = 6.98; 95% CI 2.42, 20.09) were significant predictors of mortality among children admitted for severe acute malnutrition.

Abstract Background Prematurity accounts about 1 million neonatal deaths worldwide and the second causes of both neonatal and under five-child mortality. Neonatal mortality accounts for 43% of under-five child mortality in Ethiopia. From this preterm is the second leading cause of death and is steadily increased in low-income countries. Therefore, the aim of this study was to assess time to death and predictors among preterm neonates admitted in University of Gondar comprehensive specialized hospital neonatal intensive care unit North West Ethiopia 2018. Methods Institution-based retrospective follow-up study was conducted among 516 preterm neonates from January 2016 to March 2018. Data were extracted retrospectively from patients’ records using a pretested structured checklist. Descriptive summary statistics like median survival time, Kaplan Meier failure estimation curve and Log-rank test were computed. Bivariate and multivariable Gompertz parametric hazards models were fitted to identify the predictors of mortality. Hazard ratio with a 95% confidence interval was calculated and p-values

The present study aimed to investigate the relationship between shooting angle to the head and animal welfare outcomes in the hunt of young harp seals ( Pagophilus groenlandicus ). The study population consisted of young harp seals belonging to the Greenland Sea harp seal population. A sample of 171, 2-7 weeks old, weaned harp seals of both sexes were included. The study was conducted as an open, randomised parallel group designed trial during the regular hunt. The animals were allocated into four groups, A-D, according to the observed shooting angle to the head, defined as the angle between the direction of the shot and the longitudinal axis of the animal's head: (A) directly from the front; (B) obliquely from the front; (C) directly from the side; and (D) obliquely or directly from behind. Instantaneous death rate (IDR) and time to death (TTD) were the main variables. The mean IDR differed significantly between groups and was highest in group B (96.8%) and lowest in group C (66.7%). For all groups combined it was 84.2%. The mean TTD for seals not rendered instantaneously unconscious or dead (n = 27) differed significantly between groups and was shortest in group A (16 s) and longest in group C (85 s). However, the number of animals included in the TTD analysis was limited. In conclusion, based on the significantly higher IDR, the shooting angle obliquely from the front is recommended to help achieve the best animal welfare outcomes during the hunt of young harp seals., Competing Interests: None., (© The Author(s) 2024.)

Competing Interests: Conflict of interest: C.S. and K.S. are proctors for Medtronic Inc. All remaining authors have declared no conflicts of interest.

Despite increasing research on the relationship between time to death (TTD) and health care expenditures, further investigation is necessary to verify this phenomenon in specific countries. As the world's largest developing country, China is rapidly aging and the old population is huge.This study analyses the impact of TTD on the health care expenditures of elderly people in China using data from the 2011 and 2013 China Health and Retirement Longitudinal Survey (CHARLS). We found that when people were near death, their health care expenditures increased insignificantly with age due to the relative concentration of total health care expenditures before death. When people were approaching death, their health care expenditures increased and then declined along with the increase in age. Thus, the Chinese government should take 15a cautious view of the relationship between population ageing and health care expenditures, although the rising proportion of the elderly population will result in an enormous medical expense burden for the whole society. [ABSTRACT FROM AUTHOR]

The ‘red herring’ hypothesis (RHH) claims that apart from income and medical technology, proximity to death rather than age constitutes the main determinant of healthcare expenditure (HCE). This paper seeks to underpin the RHH with some theory to derive new predictions also for a rationed setting, and to test them against published empirical evidence. One set comprising ten predictions uses women’s longer life expectancy as an indicator of the difference in time to death in their favor. Out of 28 testing opportunities drawn from the published evidence, in the case of no rationing seven out of eleven result in full and two in partial confirmation; in the case of rationing, twelve out of 17 result in full and one in partial confirmation. The other set, containing 35 testing opportunities, concerns the age profile of HCE. In the case of no rationing, seven out of twelve result in full and four in partial confirmation; in the case of rationing, eleven out of 23 in full and nine in partial confirmation. There are but ten contradictions in total. Overall, the new tests of the RHH can be said to receive a good deal of empirical support, both from countries and settings with and without rationing.

Abstract Objective The main objective of this study was to assess time to death and associated risk factors among tuberculosis (TB) patients. Results A total of 769 TB patients were studied and of those, 87 (11.3%) patients died. All of the deaths occurred within 7 months of anti-tuberculosis therapy. Extra-pulmonary TB (AHR = 17.376, 95% CI; 3.88–77.86, p

We study the effect of ageing, defined as an extra year of life, on health care utilisation. We disentangle the direct effect of ageing, from other alternative explanations such as the presence of comorbidities and endogenous time to death (TTD) that are argued to absorb the effect of ageing (so‐called 'red herring' hypothesis). We exploit individual level end of life data from several European countries that record the use of medicine, outpatient and inpatient care and long‐term care. Consistently with the 'red herring hypothesis', we find that corrected TTD estimates are significantly different from uncorrected ones, and their effect size exceeds that of an extra year of life, which in turn is moderated by individual comorbidities. Corrected estimates suggest an overall attenuated effect of ageing, which does not influence outpatient care utilisation. These results suggest the presence of 'more than one red herring' depending on the type of health care examined. [ABSTRACT FROM AUTHOR]

This paper provides new estimates of the impact of the time to death on health care expenditures when the time to death is assumed endogenous. It further proposes estimation methods that take into account the right censoring of time to death. The data consist of twins from Denmark aged over 70 in 1999. The age of death of the mother and the living status of the co-twin are used as instruments for time to death. The results show that IV estimators give estimates higher than those obtained in previous studies when the time to death is assumed exogenous. Furthermore, the estimators proposed in this paper provide estimates that are generally lower compared to the ones obtained with the IV estimator. These results indicate that the impact of time to death has been potentially overestimated in previous studies. [ABSTRACT FROM AUTHOR]

Background: Most people in the United States and other countries cite their preferred location of death as their homes. However, intractable symptoms sometimes require hospitalization, especially if significant sedation becomes necessary. For over a decade, Hospice of Central New York has been using compounded phenobarbital suppositories with individuals in whom adequate sedation has not been achieved using sufficient doses of antipsychotics or benzodiazepines but prefer to remain in their homes. Objectives: (1) Describe the use of phenobarbital suppositories in homes for the purpose of sedation. (2) Understand patient characteristics of potential users and those in whom suppositories were actually used. (3) Measure time to death after initiating the phenobarbital suppositories. Setting: Medicare-certified not-for-profit hospice organization in New York State. Method: Retrospective case series. Results: Of 1675 patients enrolled in hospice over an 18-month period, phenobarbital suppositories were placed in the homes of 90 patients for potential use. Suppositories were initiated in 31 of the 90 patients. Agitated delirium was the major symptom for which suppositories were placed and initiated. Both groups had a greater prevalence of cancer diagnoses than the target population. The mean time to death after initiation of phenobarbital suppositories was 38.8 hours. None of the users were hospitalized. Conclusion: The use of compounded phenobarbital suppositories for the purpose of palliative sedation is an alternative for patients and families who desire to remain home despite refractory symptoms. [ABSTRACT FROM AUTHOR]

In this study, we investigated the relationship between changes in demand-side determinants and changes in hospital admissions. We used longitudinal market-wide data, including a novel detailed measure of population morbidity. To assess the effect of ageing, we interacted age with shifts in the population structure for both the surviving population and the population in their last year of life. We used fixed effects models and addressed the endogeneity of morbidity with instrumental variables. We found that changes in morbidity had the largest impact on changes in hospital admissions. Changes in the size of the surviving population had the second largest impact, which differed substantially across the age spectrum. There was a large response in admissions to changes in the size of the population aged 60-79 years. The end-of-life effect had the smallest impact and began to play a greater role only in the population aged 80 years and older. In many studies, end of life presumably approximates high morbidity. Our results demonstrated robustness in several tests. We performed estimations in separate major diagnostic categories and included changes in personal preferences. We argue that the determinants included in our estimations capture the vast majority of change on the demand side. Taken together, our findings provide evidence that these determinants explain one-fifth of changes in hospital admissions. [ABSTRACT FROM AUTHOR]