The economics of sepsis.

Sepsis, severe sepsis, and septic shock impose a growing economic burden on health care systems globally. This article first describes the epidemiology of sepsis within the United States and internationally. It then reviews costs associated with sepsis and its management in the United States and internationally, including general cost sources in intensive care, direct costs of sepsis, and indirect costs of the burden of illness imposed by sepsis. Finally, it examines the cost-effectiveness of sepsis interventions, focusing on formal cost-effectiveness analyses of nosocomial sepsis prevention strategies, drotrecogin alfa (activated),and integrated sepsis protocols.

Radiofrequency catheter ablation for atrial fibrillation.

Radiofrequency catheter ablation can lead to improvements in morbidity and mortality rates and quality of life for individuals with atrial fibrillation.

Worldwide mortality in men and women aged 15-59 years from 1970 to 2010: a systematic analysis.

BACKGROUND: Adult deaths are a crucial priority for global health. Causes of adult death are important components of Millennium Development Goals 5 and 6. However, adult mortality has received little policy attention, resources, or monitoring efforts. This study aimed to estimate worldwide mortality in men and women aged 15-59 years. METHODS: We compiled a database of 3889 measurements of adult mortality for 187 countries from 1970 to 2010 using vital registration data and census and survey data for deaths in the household corrected for completeness, and sibling history data from surveys corrected for survival bias. We used Gaussian process regression to generate yearly estimates of the probability of death between the ages of 15 years and 60 years (45q15) for men and women for every country with uncertainty intervals that indicate sampling and non-sampling error. We showed that these analytical methods have good predictive validity for countries with missing data. FINDINGS: Adult mortality varied substantially across countries and over time. In 2010, the countries with the lowest risk of mortality for men and women are Iceland and Cyprus, respectively. In Iceland, male 45q15 is 65 (uncertainty interval 61-69) per 1000; in Cyprus, female 45q15 is 38 (36-41) per 1000. Highest risk of mortality in 2010 is seen in Swaziland for men (45q15 of 765 [692-845] per 1000) and Zambia for women (606 [518-708] per 1000). Between 1970 and 2010, substantial increases in adult mortality occurred in sub-Saharan Africa because of the HIV epidemic and in countries in or related to the former Soviet Union. Other regional trends were also seen, such as stagnation in the decline of adult mortality for large countries in southeast Asia and a striking decline in female mortality in south Asia. INTERPRETATION: The prevention of premature adult death is just as important for global health policy as the improvement of child survival. Routine monitoring of adult mortality should be given much greater emphasis. FUNDING: Bill & Melinda Gates Foundation.

The impact of environmental and occupational exposures on reproductive health.

Environmental exposures during critical periods of susceptibility in utero may result in lifelong or intergenerational adverse health effects. Most chemicals in commercial use in the United States have not been tested for possible developmental toxicity to fetuses, infants, and children. Environmental and occupational exposures can result in adverse effects on female and male reproduction. Nurses can identify at-risk patients, provide education about the impact of chemical toxicants, and empower women to take precautionary action.