Errors in death certificates in a rural area of Greece.

INTRODUCTION: A death certificate is the formal document in which a physician records the time, cause and circumstances under which the death of an individual has occurred. Morbidity and mortality statistics are mainly based on the analysis of these certificates, and inaccuracies in the detail may lead to biased estimation in several epidemiological parameters. The aim of this study was to examine the quality of cause of death in death certificates in a rural area of Greece, and to identify factors that may be associated with inaccuracies in the completion of these death certificates. METHODS: All death certificates archived in the municipality of Tritaia during the period 1999-2006 were examined. Statistical analysis was performed by comparing the proportions of the unpaired case. The state of independence among the various variables was investigated by considering the class of discrete graphical models. RESULTS: In total, 516 death certificates were examined; 5.6% (29/516) were excluded because of insufficient demographic data. The remaining 487 death certificates were analyzed with the following findings: 51.5% were for males and 48.5% females (median age 82 years, range 5-103 years; and 83 years, range 0-104, respectively); and 39.4% (192/487) were correctly completed. In 168 the mechanism of death was given; in 72 multiple causal sequences were given; in 22 a single/not precise cause was given; and in 33 a single causal sequence with incorrect order was given. In all, 20.1% were completed by a physician of the regional health centre. Gender was not associated with the presence of error (p = 0.352). Errors were present in 63.8% (270/423) of the death certificates in deceased individuals > or =60 years and in 39.1% (25/64) of the death certificates in individuals < or =59 years (p<0.001). In 19.7% of the erroneously completed death certificates, the certifier was a physician working in primary health care. The presence of errors in death certificates decreased from 74.6% in 1999 to 51.8% in 2006 (p = 0.004). CONCLUSIONS: Giving the mechanism instead of the cause of death was the most frequent type of error. A statistically significant increase in the presence of errors was observed as the age of the descendent increased. During these 8 years, there has been a statistically significant decrease in errors. However, efforts should be made by trainers and physicians in order to improve the accuracy of the information in death certificates. If this is accomplished, cause-of-death statistics will be more accurate and so enable better health planning.

Regulation of cytokine and chemokine transcription in a human TH2 type T-cell clone during the induction phase of anergy.

BACKGROUND: Selected cytokines produced by allergen specific CD4+ T cells from atopic individuals contribute to both the specific and non-specific effector mechanisms of the allergic immune response. The chemokine family of cytokines and tumour necrosis factor (TNF)-alpha are leucocyte regulatory and proinflammatory molecules. The chemokines include interleukin (IL)-8 and the RANTES/SIS cytokines. OBJECTIVE: There has been no systematic survey of chemokine production in T-cell subtypes. Because of their wide range of biological properties, it might be expected that they would be closely regulated by T cells. This paper illustrates one way (through the characterization of T-cell clones) these questions might be addressed. METHODS: Northern blot analysis was used to quantitate steady state transcription of selected cytokine genes and enzyme linked immunosorbent assay (ELISA) was used to quantitate soluble product. RESULTS: mRNA expression of the chemokines (IL-8, HuMIP-1 alpha and HuMIP-1 beta) and TNF alpha is upregulated in TH2-like cloned house dust mite reactive human CD4+ T cells under conditions of activation and during the induction phase of anergy. Although the development of anergy superinduces mRNA for both IL-8 and TNF alpha, protein production is low compared with that released during activation. In contrast, RANTES, a chemoattractant for CD4+/CD45RO+ memory T cells, eosinophils and basophils, is constitutively expressed at the RNA level by the T cells and not modulated by signals of activation and anergy induction. The production of IL-2, IL-4 and IL-5 mRNA and proteins during the induction of anergy peaks at 2 h after stimulation, whereas the kinetics following activation of the T cells is delayed in comparison. CONCLUSION: These data show that the induction of the anergic state coincides with post-transcriptional regulation of selected cytokine genes. Further study of these phenomena will impact on our understanding of the mechanisms of induction of anergy and the regulation of allergic immune responses in desensitization.

Analysis of human T cell responses to the group II allergen of Dermatophagoides species: localization of major antigenic sites.

BACKGROUND: IgE antibodies reactive with the group II allergens of Dermatophagoides species (house dust mite [HDM]) are a major component of the allergic immune response in HDM-allergic atopic individuals. METHODS: Here we demonstrate, with the use of overlapping synthetic peptides of the group II allergen of Dermatophagoides pteronyssinus (Der p II), that polyclonal T cells isolated from the majority of atopic HDM-allergic individuals and healthy nonatopic control subjects respond to Der p II and that T-cell epitopes are present in all regions of the protein. RESULTS: From comparison of peptide-specific T-cell proliferation in both groups of individuals, it appears that together peptides 61-86 and 78-104 are the most frequently recognized (16 of 18 individuals). We also observed that nine of the 18 individuals responded to T-cell epitopes in the region 11-50, and with Der p II-reactive T-cell clones, three distinct T-cell epitopes were mapped within the sequence 11-35. Also, with the use of T-cell clones, two additional epitopes were identified at residues 81-96 and 91-101. CONCLUSIONS: These results suggest that T-cell epitopes located in these regions (11-50 and 61-104) are immunodominant. The value of this information in the potential application of Der p II peptides to desensitize HDM allergic responses is discussed.

[Disseminated intravascular coagulation syndrome (D.I.C.) and carcinoma of the prostate (author's transl)]. / Syndrome de coagulation intra-vasculaire disséminée (C.I.D.) et cancer de la prostate.

Carcinoma of the prostate, above all when accompanied by bone metastases, may be associated with a disseminated intravascular coagulation syndrome. The problem was to determine whether even in the absence of metastases the coagulation state of prostatic carcinoma patients predisposes them to disseminated intravascular coagulation. The authors compared coagulation equilibrium in 13 patients with a prostatic adenoma and 21 with carcinoma of the prostate free of metastases or infection. Fibrin breakdown product levels were abnormally high in 85.7 % of the carcinoma patients (as against 46.2 % of the adenoma sufferers). Clotting factor XIII was decreased in 70 % of carcinoma patients (as against 48.5 % of those with an adenoma). One prostatic carcinoma patient in four shows evidence of latent intravascular coagulation even in the absence of bone metastases. This prevalence justifies thorough coagulation studies in all patients with carcinoma of the prostate.