Science.gov

Sample records for acute maternal morbidity

  1. Overweight and Severe Acute Maternal Morbidity in a Low-Risk Pregnant Population in The Netherlands

    PubMed Central

    Witteveen, Tom; Zwart, Joost J.; Gast, Karin B.; Bloemenkamp, Kitty W. M.; van Roosmalen, Jos

    2013-01-01

    Objective To investigate the association between overweight and severe acute maternal morbidity (SAMM) in a low-risk pregnant population. Design Nationwide case-control study. Setting The Netherlands, august 2004 to august 2006. Population 1567 cases from initially primary care and 2994 women from primary care practices as controls, out of 371 012 women delivering in the Netherlands during the study period Methods Cases were women with SAMM obtained from a nationwide prospective study. All women in this cohort who initially had low-risk pregnancies were compared with low-risk women without SAMM to calculate odd ratios (ORs) to develop SAMM by body mass index (BMI) category. We divided body mass index in three overweight categories and calculated the ORs (95% CI) of total SAMM and per specific endpoint by logistic regression, with normal weight as reference. We adjusted for age, parity and socio-economic status. Main Outcome Measures SAMM, defined as Intensive Care Unit (ICU)-admission, Uterine Rupture, Eclampsia or Major Obstetric Haemorrhage (MOH) Results SAMM was reported in 1567 cases which started as low-risk pregnancies. BMI was available in 1097 (70.0%) cases and 2994 control subjects were included. Analysis showed a dose response relation for overweight (aOR, 1.3; 95% CI, 1.0-1.5), obese (aOR, 1.4; 95% CI, 1.1-1.9) and morbidly obese (aOR, 2.1; 95% CI, 1.3-3.2) women to develop SAMM compared to normal weight. Sub analysis showed the same dose response relation for ICU-admission, Uterine Rupture and Eclampsia. We found no association for MOH. Conclusion Overweight without pre-existent co-morbidity is an important risk-indicator for developing SAMM. This risk increases with an increasing body mass index. PMID:24069316

  2. Maternal morbidity: Neglected dimension of safe motherhood in the developing world

    PubMed Central

    Hardee, Karen; Gay, Jill; Blanc, Ann K.

    2012-01-01

    In safe motherhood programming in the developing world, insufficient attention has been given to maternal morbidity, which can extend well beyond childbirth. For every woman who dies of pregnancy-related causes, an estimated 20 women experience acute or chronic morbidity. Maternal morbidity adversely affects families, communities and societies. Maternal morbidity has multiple causes, with duration ranging from acute to chronic, severity ranging from transient to permanent and with a range of diagnosis and treatment options. This article addresses six selected relatively neglected aspects of maternal morbidity to illustrate the range of acute and chronic morbidities that can affect women related to pregnancy and childbearing that are prevalent in developing countries: anaemia, maternal depression, infertility, fistula, uterine rupture and scarring and genital and uterine prolapse. Based on this review, recommendations to reduce maternal morbidity include: expand the focus of safe motherhood to explicitly include morbidity; improve data on incidence and prevalence of maternal morbidity; link mortality and morbidity outcomes and programming; increase access to facility- and community-based maternal health care and reproductive health care; and address the antecedents to poor maternal health through a lifecycle approach. PMID:22424546

  3. Severe maternal morbidity in Canada, 1991–2001

    PubMed Central

    Wen, Shi Wu; Huang, Ling; Liston, Robert; Heaman, Maureen; Baskett, Tom; Rusen, I.D.; Joseph, K.S.; for, Michael S. Kramer

    2005-01-01

    Background Although death rates are often used to monitor the quality of health care, in industrialized countries maternal deaths have become rare. Severe maternal morbidity has therefore been proposed as a supplementary indicator for surveillance of the quality of maternity care. Our purpose in this study was to describe severe maternal morbidity in Canada over a 10-year period, among women with or without major pre-existing conditions. Methods We carried out a retrospective cohort study of severe maternal morbidity involving 2 548 824 women who gave birth in Canadian hospitals between 1991 and 2000. Thirteen conditions that may threaten the life of the mother (e.g., eclampsia) and 11 major pre-existing chronic conditions (e.g., diabetes) that could be identified from diagnostic codes were noted. Results The overall rate of severe maternal morbidity was 4.38 per 1000 deliveries. The fatality rate among these women was 158 times that of the entire sample. Rates of venous thromboembolism, uterine rupture, adult respiratory distress syndrome, pulmonary edema, myocardial infarction, severe postpartum hemorrhage requiring hysterectomy, and assisted ventilation increased substantially from 1991 to 2000. The presence of major pre-existing conditions increased the risk of severe maternal morbidity to 6-fold. Interpretation Severe maternal morbidity occurs in about 1 of 250 deliveries in Canada, with marked recent increases in certain morbid conditions such as pulmonary edema, myocardial infarction, hemorrhage requiring hysterectomy, and the use of assisted ventilation. PMID:16186582

  4. Standardized severe maternal morbidity review: rationale and process.

    PubMed

    Kilpatrick, Sarah J; Berg, Cynthia; Bernstein, Peter; Bingham, Debra; Delgado, Ana; Callaghan, William M; Harris, Karen; Lanni, Susan; Mahoney, Jeanne; Main, Elliot; Nacht, Amy; Schellpfeffer, Michael; Westover, Thomas; Harper, Margaret

    2014-08-01

    Severe maternal morbidity and mortality have been rising in the United States. To begin a national effort to reduce morbidity, a specific call to identify all pregnant and postpartum women experiencing admission to an intensive care unit or receipt of 4 or more units of blood for routine review has been made. While advocating for review of these cases, no specific guidance for the review process was provided. Therefore, the aim of this expert opinion is to present guidelines for a standardized severe maternal morbidity interdisciplinary review process to identify systems, professional, and facility factors that can be ameliorated, with the overall goal of improving institutional obstetric safety and reducing severe morbidity and mortality among pregnant and recently pregnant women. This opinion was developed by a multidisciplinary working group that included general obstetrician-gynecologists, maternal-fetal medicine subspecialists, certified nurse-midwives, and registered nurses all with experience in maternal mortality reviews. A process for standardized review of severe maternal morbidity addressing committee organization, review process, medical record abstraction and assessment, review culture, data management, review timing, and review confidentiality is presented. Reference is made to a sample severe maternal morbidity abstraction and assessment form.

  5. Effects of twin gestation on maternal morbidity.

    PubMed

    Young, Brett C; Wylie, Blair J

    2012-06-01

    As the incidence of twin gestation increases, it is important to consider the maternal risks associated with carrying multiples. Compared with singleton gestation, there are increased risks to the mother during the antepartum, intrapartum, and postpartum periods. Certain pregnancy complications are more likely to occur during a twin gestation, including preeclampsia and other hypertensive disorders, antepartum hospitalization for preterm labor or abnormal bleeding, nutritional deficiencies, cesarean delivery, and postpartum hemorrhage. Women carrying twins may benefit from early education regarding these issues, close maternal monitoring as well as physical therapy sessions, and nutrition counseling during their pregnancies.

  6. Long-term maternal morbidity associated with repeat cesarean delivery.

    PubMed

    Clark, Erin A S; Silver, Robert M

    2011-12-01

    Concern regarding the association between cesarean delivery and long-term maternal morbidity is growing as the rate of cesarean delivery continues to increase. Observational evidence suggests that the risk of morbidity increases with increasing number of cesarean deliveries. The dominant maternal risk in subsequent pregnancies is placenta accreta spectrum disorder and its associated complications. A history of multiple cesarean deliveries is the major risk factor for this condition. Pregnancies following cesarean delivery also have increased risk for other types of abnormal placentation, reduced fetal growth, preterm birth, and possibly stillbirth. Chronic maternal morbidities associated with cesarean delivery include pelvic pain and adhesions. Adverse reproductive effects may include decreased fertility and increased risk of spontaneous abortion and ectopic pregnancy. Clinicians and patients need to be aware of the long-term risks associated with cesarean delivery so that they can be considered when determining the method of delivery for first and subsequent births.

  7. Maternal mortality and morbidity. Zimbabwe's birth force.

    PubMed

    Jacobson, J L

    1991-01-01

    The training of traditional birth attendants (TBAs) as a national public health strategy was implemented in the late 1970's in Zimbabwe. Since 1982, the Manicaland rural health programs have trained 6000 women in 12-week courses to change their practices of using unsterilized razor blades, shards of glass, or knives to sever the umbilical cord. These practices and others had led to high rates of neonatal tetanus mortality and maternal mortality. TBAs learned from state certified nurses the basics of personal and domestic hygiene, identification of pregnancy and associated risk factors, the importance of good nutrition, rest, and immunization for pregnant women, and safe practices in labor and delivery. Refresher courses and additional training in prenatal care and family planning have been added recently to the program. Completion of the program leads to a public recognition of their graduation in the base village. Maternity care services are provided as back up. This includes village based maternity waiting homes for women in labor, community health workers, and auxiliary midwives with higher level training. A district health center has been set up for more complicated cases. This access to better health care has led to a 50 and 66% reduction in maternal and infant mortality rates, respectively. A 1988 government survey shows increases in the use of contraceptives and the number of women receiving prenatal care. The components of the program which have contributed to program success and provided similarities to other country's TBA programs are as follows: developing a sense of self esteem and pride among TBAs for their work, utilizing creative ways to teach the largely illiterate TBA population through role plays and songs, and providing involvement in the health care system which reaffirms the TBA's importance. In spite of the advancements made however, there are still problems to solve. Unsafe practices are resorted to when TBAs forget their training

  8. Maternal mortality and morbidity: epidemiology of intensive care admissions in pregnancy.

    PubMed

    Senanayake, H; Dias, T; Jayawardena, A

    2013-12-01

    Maternal mortality reviews are used globally to assess the quality of health-care services. With the decline in the number of maternal deaths, it has become difficult to derive meaningful conclusions that could have an impact on quality of care using maternal mortality data. The emphasis has recently shifted to severe acute maternal morbidity (SAMM), as an adjunct to maternal mortality reviews. Due to its heterogeneity, there are difficulties in recognising SAMM. The problem of identifying SAMM accurately is the main issue in investigating them. However, admission to an intensive care unit (ICU) provides an unambiguous, management-based inclusion criterion for a SAMM. ICU data are available across health-care settings prospectively and retrospectively, making them a tool that could be studied readily. However, admission to the ICU depends on many factors, such as accessibility and the availability of high-dependency units, which will reduce the need for ICU admission. Thresholds for admission vary widely and are generally higher in facilities that handle a heavier workload. In addition, not all women with SAMM receive intensive care. However, women at the severe end of the spectrum of severe morbidity will almost invariably receive intensive care. Notwithstanding these limitations, the epidemiology of intensive care admissions in pregnancy will provide valuable data about women with severe morbidity. The overall rate of obstetric ICU admission varies from 0.04% to 4.54%.

  9. Maternal mortality and severe morbidity in a migration perspective.

    PubMed

    van den Akker, Thomas; van Roosmalen, Jos

    2016-04-01

    Among migrants in high-income countries, maternal mortality and severe morbidity generally occur more frequently as compared to host populations. There is marked variation between groups of migrants and host countries, with much elevated risks in some groups and no elevated risk at all in others. Those without a legal resident permit are most vulnerable. A reason for these elevated risks could be a different risk profile in migrants, but risk factors are unevenly distributed and not always present. Another reason is substandard care, which is identified more frequently in migrants, and comprises patient delays, for example, due to a lack of knowledge about the health system in the host country, and health worker delays, often compounded by communication barriers. Improvements in family planning and antenatal services are needed, and audits and confidential enquiries should be extended to include maternal morbidity and ethnic background. This requires scientific and political efforts.

  10. Lost opportunities for effective management of obstetric conditions to reduce maternal mortality and severe maternal morbidity in Argentina and Uruguay

    PubMed Central

    Karolinski, Ariel; Mazzoni, Agustina; Belizán, José M; Althabe, Fernando; Bergel, Eduardo; Buekens, Pierre

    2010-01-01

    Objective To review the use of evidence-based practices in the care of mothers who died or had severe morbidity attending public hospitals in two Latin American countries. Methods This study is part of a multicenter intervention to increase the use of evidence-based obstetric practice. Data on maternal deaths and women admitted to intensive care units whose deliveries occurred in 24 hospitals in Argentina and Uruguay were analyzed. Primary outcomes were use rates of effective interventions to reduce maternal mortality (MM) and severe maternal morbidity (SMM). Results A total of 106 women were included: 26 maternal deaths and 80 women with SMM. Some effective interventions for severe acute hemorrhage had a high use rate, such as blood transfusion (91%) and timely cesarean delivery (75%), while active management of the third stage of labor (25%) showed a lower rate. The overall use rate of effective interventions was 58% (95% CI, 49%–67%). This implies that 42% of the women did not receive one of the effective interventions to reduce MM and SMM. Conclusion This study shows a low use of effective interventions to reduce MM and SMM in public hospitals in Argentina and Uruguay. Dissemination and implementation of evidence-based practices must be guaranteed to effectively achieve progress on maternal health. PMID:20605151

  11. Postpartum maternal morbidity requiring hospital admission in Lusaka, Zambia – a descriptive study

    PubMed Central

    Vallely, Lisa; Ahmed, Yusuf; Murray, Susan F

    2005-01-01

    Background Information on the extent of postpartum maternal morbidity in developing countries is extremely limited. In many settings, data from hospital-based studies is hard to interpret because of the small proportion of women that have access to medical care. However, in those areas with good uptake of health care, the measurement of the type and incidence of complications severe enough to require hospitalisation may provide useful baseline information on the acute and severe morbidity that women experience in the early weeks following childbirth. An analysis of health services data from Lusaka, Zambia, is presented. Methods Six-month retrospective review of hospital registers and 4-week cross-sectional study with prospective identification of postpartum admissions. Results Both parts of the study identified puerperal sepsis and malaria as, respectively, the leading direct and indirect causes of postpartum morbidity requiring hospital admission. Puerperal sepsis accounted for 34.8% of 365 postpartum admissions in the 6-month period. Malaria and pneumonia together accounted for one-fifth of all postpartum admissions (14.5% & 6% respectively). At least 1.7% of the postpartum population in Lusaka will require hospital-level care for a maternal morbidity. Conclusions In developing country urban settings with high public health care usage, meticulous review of hospital registers can provide baseline information on the burden of moderate-to-severe postpartum morbidity. PMID:15686592

  12. [Model for a comprehensive approach to maternal mortality and severe maternal morbidity].

    PubMed

    Karolinski, Ariel; Mercer, Raúl; Micone, Paula; Ocampo, Celina; Salgado, Pablo; Szulik, Dalia; Swarcz, Lucila; Corte, Vicente R; del Moral, Belén Fernández; Pianesi, Jorge; Balladelli, Pier Paolo

    2015-05-01

    Maternal mortality is an important public health and human rights problem and reflects the effects of social determinants on women's health. Understanding the extent and causes of maternal death has been insufficient to achieve the Millennium Development Goals. This article proposes a model for a comprehensive approach to maternal mortality, covering seven areas: prioritization and definition of the problem, contextual description, methodological scope, knowledge management, innovation, implementation, and a monitoring and evaluation system. This model helps address problems associated with maternal mortality and severe maternal morbidity through early monitoring of potentially fatal complications in the reproductive process. Knowledge management is important for the reorientation of policies, programs, and health care. Interaction and synergies among people, communities, and actors in the health system should be strengthened in order to improve the results of health programs. More validated scientific information is needed on how actions should be implemented in different environments. It is essential to strengthen communication among research centers, cooperation agencies, and government organizations and to include them in programs and in the definition of a new women's health agenda in the Region of the Americas.

  13. Association of Postpartum Maternal Morbidities with Children's Mental, Psychomotor and Language Development in Rural Bangladesh

    PubMed Central

    Tofail, F.; Hilaly, A.; Mehrin, F.; Shiraji, S.; Banu, S.; Huda, S.N.

    2012-01-01

    Little is known from developing countries about the effects of maternal morbidities diagnosed in the postpartum period on children's development. The study aimed to document the relationships of such morbidities with care-giving practices by mothers, children's developmental milestones and their language, mental and psychomotor development. Maternal morbidities were identified through physical examination at 6-9 weeks postpartum (n=488). Maternal care-giving practices and postnatal depression were assessed also at 6-9 weeks postpartum. Children's milestones of development were measured at six months, and their mental (MDI) and psychomotor (PDI) development, language comprehension and expression, and quality of psychosocial stimulation at home were assessed at 12 months. Several approaches were used for identifying the relationships among different maternal morbidities, diagnosed by physicians, with children's development. After controlling for the potential confounders, maternal anaemia diagnosed postpartum showed a small but significantly negative effect on children's language expression while the effects on language comprehension did not reach the significance level (p=0.085). Children's development at 12 months was related to psychosocial stimulation at home, nutritional status, education of parents, socioeconomic status, and care-giving practices of mothers at six weeks of age. Only a few mothers experienced each specific morbidity, and with the exception of anaemia, the sample-size was insufficient to make a conclusion regarding each specific morbidity. Further research with a sufficient sample-size of individual morbidities is required to determine the association of postpartum maternal morbidities with children's development. PMID:22838161

  14. Association of postpartum maternal morbidities with children's mental, psychomotor and language development in rural Bangladesh.

    PubMed

    Hamadani, J D; Tofail, F; Hilaly, A; Mehrin, F; Shiraji, S; Banu, S; Huda, S N

    2012-06-01

    Little is known from developing countries about the effects of maternal morbidities diagnosed in the postpartum period on children's development. The study aimed to document the relationships of such morbidities with care-giving practices by mothers, children's developmental milestones and their language, mental and psychomotor development. Maternal morbidities were identified through physical examination at 6-9 weeks postpartum (n=488). Maternal care-giving practices and postnatal depression were assessed also at 6-9 weeks postpartum. Children's milestones of development were measured at six months, and their mental (MDI) and psychomotor (PDI) development, language comprehension and expression, and quality of psychosocial stimulation at home were assessed at 12 months. Several approaches were used for identifying the relationships among different maternal morbidities, diagnosed by physicians, with children's development. After controlling for the potential confounders, maternal anaemia diagnosed postpartum showed a small but significantly negative effect on children's language expression while the effects on language comprehension did not reach the significance level (p=0.085). Children's development at 12 months was related to psychosocial stimulation at home, nutritional status, education of parents, socioeconomic status, and care-giving practices of mothers at six weeks of age. Only a few mothers experienced each specific morbidity, and with the exception of anaemia, the sample-size was insufficient to make a conclusion regarding each specific morbidity. Further research with a sufficient sample-size of individual morbidities is required to determine the association of postpartum maternal morbidities with children's development.

  15. Occurrence and determinants of postpartum maternal morbidities and disabilities among women in Matlab, Bangladesh.

    PubMed

    Ferdous, J; Ahmed, A; Dasgupta, S K; Jahan, M; Huda, F A; Ronsmans, C; Koblinsky, M; Chowdhury, M E

    2012-06-01

    The burden of maternal ill-health includes not only the levels of maternal mortality and complications during pregnancy and around the time of delivery but also extends to the standard postpartum period of 42 days with consequences of obstetric complications and poor management at delivery. There is a dearth of reliable data on these postpartum maternal morbidities and disabilities in developing countries, and more research is warranted to investigate these and further strengthen the existing safe motherhood programmes to respond to these conditions. This study aims at identifying the consequences of pregnancy and delivery in the postpartum period, their association with acute obstetric complications, the sociodemographic characteristics of women, mode and place of delivery, nutritional status of the mother, and outcomes of birth. From among women who delivered between 2007 and 2008 in the icddr,b service area in Matlab, we prospectively recruited all women identified with complicated births (n=295); a perinatal mortality (n=182); and caesarean-section delivery without any maternal indication (n=147). A random sample of 538 women with uncomplicated births, who delivered at home or in a facility, was taken as the control. All subjects were clinically examined at 6-9 weeks for postpartum morbidities and disabilities. Postpartum women who had suffered obstetric complications during birth and delivered in a hospital were more likely to suffer from hypertension [adjusted odds ratio (AOR)=3.44; 95% confidence interval (CI)=1.14-10.36], haemorrhoids (AOR=1.73; 95% CI=1.11-3.09), and moderate to severe anaemia (AOR=7.11; 95% CI=2.03-4.88) than women with uncomplicated normal deliveries. Yet, women who had complicated births were less likely to have perineal tears (AOR=0.05; 95% CI=0.02-0.14) and genital prolapse (AOR=0.22; 95% CI=0.06-0.76) than those with uncomplicated normal deliveries. Genital infections were more common amongst women experiencing a perinatal death than

  16. The Impact of Cardiac Diseases during Pregnancy on Severe Maternal Morbidity and Mortality in Brazil

    PubMed Central

    Campanharo, Felipe F.; Cecatti, Jose G.; Haddad, Samira M.; Parpinelli, Mary A.; Born, Daniel; Costa, Maria L.; Mattar, Rosiane

    2015-01-01

    Background To evaluate maternal heart disease as a cause or complicating factor for severe morbidity in the setting of the Brazilian Network for Surveillance of Severe Maternal Morbidity. Methods and Findings Secondary data analysis of this multicenter cross-sectional study was implemented in 27 referral obstetric units in Brazil. From July 2009 to June 2010, a prospective surveillance was conducted among all delivery hospitalizations to identify cases of severe maternal morbidity (SMM), including Potentially Life-Threatening Conditions (PLTC) and Maternal Near Miss (MNM), using the new criteria established by the WHO. The variables studied included: sociodemographic characteristics, clinical and obstetric history of the women; perinatal outcome and the occurrence of maternal outcomes (PLTC, MNM, MD) between groups of cardiac and non-cardiac patients. Only heart conditions with hemodynamic impact characterizing severity of maternal morbidity were considered. 9555 women were included in the Network with severe pregnancy-related complications: 770 maternal near miss cases and 140 maternal death cases. A total of 293 (3.6%) cases were related to heart disease and the condition was known before pregnancy in 82.6% of cases. Maternal near miss occurred in 15% of cardiac disease patients (most due to clinical-surgical causes, p<0.001) and 7.7% of non-cardiac patients (hemorrhagic and hypertensive causes, p<0.001). Maternal death occurred in 4.8% of cardiac patients and in 1.2% of non-cardiac patients, respectively. Conclusions In this study, heart disease was significantly associated with a higher occurrence of severe maternal outcomes, including maternal death and maternal near miss, among women presenting with any severe maternal morbidity. PMID:26650684

  17. The WHO Maternal Near-Miss Approach and the Maternal Severity Index Model (MSI): Tools for Assessing the Management of Severe Maternal Morbidity

    PubMed Central

    Souza, Joao Paulo; Cecatti, Jose Guilherme; Haddad, Samira M.; Parpinelli, Mary Angela; Costa, Maria Laura; Katz, Leila; Say, Lale; Almeida, Elson J; Amaral, Eliana M; Amorim, Melania M; Andreucci, Carla B; Aquino, Márcia M; Bahamondes, Maria V; Lima, Antonio C Barbosa; Barroso, Frederico; Bione, Adriana; Brum, Ione R; Calderon, Iracema M; Camargo, Rodrigo S; Campanharo, Felipe F; Carvalho, Luiz E; Carvalho, Simone A; Cecatti, José G; Chaves, George N; Cordioli, Eduardo; Costa, Maria L; Costa, Roberto A; Costa, Sergio M; Feitosa, Francisco E; Freire, Djacyr M; Gonçalves, Simone P; Guanabara, Everardo M; Guimarães, Daniela; Gurgel, Lúcio T; Haddad, Samira M; Katz, Leila; Leite, Debora; Lima, Moises D; Lobato, Gustavo; Lotufo, Fátima A; Luz, Adriana G; Filho, Nelson L Maia; Martins, Marilia G; Matias, Jacinta P; Mattar, Rosiane; Menezes, Carlos A; Moises, Elaine C; Filho, Olímpio B Moraes; Moreira, Joaquim L; Nakamura-Pereira, Marcos; Nascimento, Denis J; Ohnuma, Maria H; Oliveira, Fernando C; Pacagnella, Rodolfo C; Paiva, Cláudio S; Parpinelli, Mary A; Pattinson, Robert C; Paula, Liv B; Peraçoli, Jose C; Peret, Frederico A; Perez, Cynthia D; Pessoni, Cleire; Peterossi, Alessandra; Pfitscher, Lucia C; Silva, João L Pinto e; Quintana, Silvana M; Radaci, Ivelyne; Filho, Edilberto A Rocha; Rodrigues, Simone M; Rohloff, Roger D; Rudge, Marilza V; Saint'ynes, Gloria C; Santana, Danielly S; Santos, Patricia N; Say, Lale; Schmaltz, Luiza E; Sousa, Maria H; Sousa, Maria R; Souza, Joäo P; Surita, Fernanda G; Zanette, Elvira A; Zotareli, Vilma

    2012-01-01

    Objectives To validate the WHO maternal near-miss criteria and develop a benchmark tool for severe maternal morbidity assessments. Methods In a multicenter cross-sectional study implemented in 27 referral maternity hospitals in Brazil, a one-year prospective surveillance on severe maternal morbidity and data collection was carried out. Diagnostic accuracy tests were used to assess the validity of the WHO maternal near-miss criteria. Binary logistic regression was used to model the death probability among women with severe maternal complications and benchmark the management of severe maternal morbidity. Results Of the 82,388 women having deliveries in the participating health facilities, 9,555 women presented pregnancy-related complications, including 140 maternal deaths and 770 maternal near misses. The WHO maternal near-miss criteria were found to be accurate and highly associated with maternal deaths (Positive likelihood ratio 106.8 (95% CI 99.56–114.6)). The maternal severity index (MSI) model was developed and found to able to describe the relationship between life-threatening conditions and mortality (Area under the ROC curve: 0.951 (95% CI 0.909–0.993)). Conclusion The identification of maternal near-miss cases using the WHO list of pregnancy-related life-threatening conditions was validated. The MSI model can be used as a tool for benchmarking the performance of health services managing women with severe maternal complications and provide case-mix adjustment. PMID:22952897

  18. Systematic review of the magnitude and case fatality ratio for severe maternal morbidity in sub-Saharan Africa between 1995 and 2010

    PubMed Central

    2011-01-01

    Background Analysis of severe maternal morbidity (maternal near misses) provides information on the quality of care. We assessed the prevalence/incidence of maternal near miss, maternal mortality and case fatality ratio through systematic review of studies on severe maternal morbidity in sub-Saharan Africa. Methods We examined studies that reported prevalence/incidence of severe maternal morbidity (maternal near misses) during pregnancy, childbirth and postpartum period between 1996 and 2010. We evaluated the quality of studies (objectives, study design, population studied, setting and context, definition of severe acute obstetric morbidity and data collection instruments). We extracted data, using a pre-defined protocol and criteria, and estimated the prevalence or incidence of maternal near miss. The case-fatality ratios for reported maternal complications were estimated. Results We identified 12 studies: six were cross-sectional, five were prospective and one was a retrospective review of medical records. There was variation in the setting: while some studies were health facility-based (at the national referral hospital, regional hospital or various district hospitals), others were community-based studies. The sample size varied from 557 women to 23,026. Different definitions and terminologies for maternal near miss included acute obstetric complications, severe life threatening obstetric complications and severe obstetric complications. The incidence/prevalence ratio and case-fatality ratio for maternal near misses ranged from 1.1%-10.1% and 3.1%-37.4% respectively. Ruptured uterus, sepsis, obstructed labor and hemorrhage were the commonest morbidities that were analyzed. The incidence/prevalence ratio of hemorrhage ranged from 0.06% to 3.05%, while the case fatality ratio for hemorrhage ranged from 2.8% to 27.3%. The prevalence/incidence ratio for sepsis ranged from 0.03% to 0.7%, while the case fatality ratio ranged from 0.0% to 72.7%. Conclusion The

  19. Severe maternal morbidity in the intensive care unit of a havana teaching hospital,1998 to 2004.

    PubMed

    Pérez, Albadio; Bacallao, Jorge; Alcina, Serafín; Gómez, Yamilka

    2008-07-01

    the highest hospital case fatality rates in women with obstetric disorders; while acute chest syndrome, promyelocytic leukemia and pulmonary embolism were associated with the highest hospital case fatality rates among women with non-obstetric disorders. Conclusions Our results concur with most of those published on severe maternal morbidity in ICUs, including a high incidence of hemorrhagic disorders, pre-eclampsia and postpartum sepsis. The number of patients with hematological disorders accounts for the difference between the results of our study and others concerning morbidity and mortality among this patient group. A significant correlation was observed between history of previous illnesses and patient discharge status. Prognosis was worse for patients subjected to several surgical interventions, which can be attributed to the higher risk of complications and the severity of the underlying illness.

  20. [Primary-care morbidity and true morbidity due to acute respiratory infections].

    PubMed

    Pérez Rodríguez, A E; González Ochoa, E; Bravo González, J R; Carlos Silva, L; Linton, T

    1992-01-01

    The present work presents the study of morbidity due to acute respiratory infections (ARI) in areas of the town of Lisa in Ciudad Habana, and Isla Juventud (Cuba), to characterize different aspects of morbidity measured by health care attendance and to measure true morbidity. About 90% of consultations for ARI were first-time consultations, while their ratio to further consultations was 5.3. True morbidity rates (TMR), obtained trough active research, ranged from 110.4 to 163.4 cases per 1000 inhabitants, considerably higher than morbidity rates measured by primary care consultations (MRPCC) in the same time period. The true morbidity index (TMI), as measured by the ratio of the two previous rates, ranged from 5 to 15. A high proportion (47.6%) of cases reported no medical care attendance. These results provide approximate estimates of true morbidity in the study area, and allow the establishment of a new control program, also improving epidemiologic surveillance within primary care activities.

  1. How Communication Among Members of the Health Care Team Affects Maternal Morbidity and Mortality.

    PubMed

    Brennan, Rita Allen; Keohane, Carol Ann

    In the United States, rates of severe maternal morbidity and mortality have escalated in the past decade. Communication failure among members of the health care team is one associated factor that can be modified. Nurses can promote effective communication. We provide strategies that incorporate team training principles and structured communication processes for use by providers and health care systems to improve the quality and safety of patient care and reduce the incidence of maternal mortality and morbidity.

  2. Severe Maternal Morbidity and the Use of Assisted Reproductive Technology in Massachusetts

    PubMed Central

    Belanoff, Candice; Declercq, Eugene R.; Diop, Hafsatou; Gopal, Daksha; Kotelchuck, Milton; Luke, Barbara; Nguyen, Thien; Stern, Judy E.

    2016-01-01

    Objectives To assess whether risk of severe maternal morbidity at delivery differed for women who conceived using assisted reproductive technology (ART), those with indicators of subfertility but no ART (“subfertile”), and those who had neither ART nor subfertility (“fertile”). Methods This retrospective cohort study was part of the larger Massachusetts Outcomes Study of Assisted Reproductive Technology (MOSART). To construct the MOSART database and identify ART deliveries, we linked ART treatment records to birth certificates and maternal and infant hospitalization records occurring in Massachusetts between 2004 and 2010. An algorithm of ICD-9-CM diagnosis and procedure codes identified severe maternal morbidity. We used Logistic Generalized Estimating Equations to estimate odds of severe maternal morbidity associated with fertility status, adjusting for maternal demographic and health factors and gestational age, stratifying on plurality and method of delivery. Results The prevalence of severe maternal morbidity among this population (n = 458,918) was 1.16%. The overall, crude prevalences of severe maternal morbidity among fertile, subfertile and ART deliveries were 1.09%, 1.44% and 3.14%, respectively. The most common indicator of severe maternal morbidity was blood transfusion. In multivariable analyses, among singletons, ART was associated with increased odds of severe maternal morbidity compared to both fertile (Vaginal: aOR 2.27, 95% CI: 1.78 – 2.88; cesarean: aOR 1.67, 95% CI: 1.40 – 1.98, respectively) and subfertile (vaginal: aOR 1.97, 95% CI: 1.30 – 3.00; cesarean: aOR 1.75, 95% CI: 1.30 – 2.35, respectively) deliveries. Among twins, only cesarean ART deliveries had significantly greater severe maternal morbidity compared to cesarean fertile deliveries (aOR 1.48, 95% CI: 1.14, 1.93). Conclusions Women who conceive through ART may have elevated risk severe maternal morbidity at delivery, largely indicated by blood transfusion, even when

  3. Inter-Pregnancy Intervals and Maternal Morbidity: New Evidence from Rwanda.

    PubMed

    Habimana-Kabano, Ignace; Broekhuis, Annelet; Hooimeijer, Pieter

    2015-09-01

    The effects of short and long pregnancy intervals on maternal morbidity have hardly been investigated. This research analyses these effects using logistic regression in two steps. First, data from the Rwanda Demographic and Health Survey 2010 are used to study delivery referrals to District hospitals. Second, Kibagabaga District Hospital's maternity records are used to study the effect of inter-pregnancy intervals on maternal morbidity. The results show that both short and long intervals lead to higher odds of being referred because of pregnancy or delivery complications. Once admitted, short intervals were not associated with higher levels of maternal morbidity. Long intervals are associated with higher risks of third trimester bleeding, premature rupture of membrane and lower limb edema, while a higher age at conception is associated with lower risks. Poor women from rural areas and with limited health insurance are less often admitted to a hospital, which might bias the results.

  4. From planning to practice: building the national network for the surveillance of severe maternal morbidity

    PubMed Central

    2011-01-01

    Background Improving maternal health is one of the Millennium Development Goals for 2015. Recently some progress has been achieved in reducing mortality. On the other hand, in developed regions, maternal death is a relatively rare event compared to the number of cases of morbidity; hence studying maternal morbidity has become more relevant. Electronic surveillance systems may improve research by facilitating complete data reporting and reducing the time required for data collection and analysis. Therefore the purpose of this study was to describe the methods used in elaborating and implementing the National Network for the Surveillance of Severe Maternal Morbidity in Brazil. Methods The project consisted of a multicenter, cross-sectional study for the surveillance of severe maternal morbidity including near-miss, in Brazil. Results Following the development of a conceptual framework, centers were selected for inclusion in the network, consensus meetings were held among the centers, an electronic data collection system was identified, specific software and hardware tools were developed, research material was prepared, and the implementation process was initiated and analyzed. Conclusion The conceptual framework developed for this network was based on the experience acquired in various studies carried out in the area over recent years and encompasses maternal and perinatal health. It is innovative especially in the context of a developing country. The implementation of the project represents the first step towards this planned management. The system online elaborated for this surveillance network may be used in further studies in reproductive and perinatal health. PMID:21549009

  5. Quantifying severe maternal morbidity in Scotland: a continuous audit since 2003.

    PubMed

    Marr, Leslie; Lennox, Christopher; McFadyen, Angus K

    2014-06-01

    Since 2003, a continuous audit of severe maternal morbidity in Scotland has been conducted, collecting data on consistently defined events in all the consultant-led maternity units within Scotland. This review summarizes the methodology of the audit and describes some of the main results accumulated in the 10 years audited [2003-2012 (The 2012 Scottish Confidential Audit of Severe Maternal Morbidity report is yet to be published. This article refers to extracts from 2012 data where available, but on other occasions refers to data from 2003 to 2011.)]. Although most causes of severe maternal morbidity have decreased during the audit, major obstetric haemorrhage, the most common cause of severe maternal morbidity, has increased. Some key findings are as follows: admission to an ICU is required for 1 woman in every 700 births; major obstetric haemorrhage is experienced by 1 in 172 women; cases of eclampsia have decreased during the audit; there were deficiencies in antenatal risk identification and action planning; and the direct involvement of consultant obstetricians and anaesthetists in the care of women was below those recommended by the guidelines. The audit has demonstrated changes in clinical practice and in adherence to clinical guidelines over time. The information has been used to inform clinical practice within the Scottish maternity units.

  6. Effect of time of birth on maternal morbidity during childbirth hospitalization in California

    PubMed Central

    Lyndon, Audrey; Lee, Henry C.; Gay, Caryl; Gilbert, William M.; Gould, Jeffrey B.; Lee, Kathryn A.

    2015-01-01

    Objectives This observational study aimed to determine the relationship between time of birth and maternal morbidity during childbirth hospitalization. Study Design Composite maternal morbidities were determined using ICD9-CM and vital records codes, using linked hospital discharge and vital records data for 1,475,593 singleton births in California from 2005-2007. Time of birth, day of week, sociodemographic, obstetric, and hospital volume risk factors were estimated using mixed effects logistic regression models. Results The odds for pelvic morbidity were lowest between 11PM and 7AM compared to other time periods and the reference value of 7AM-11 AM. The odds for pelvic morbidity peaked between 11AM and 7PM [Adjusted Odds Ratio (AOR) 1101-1500=1.07 (1.06, 1.09); 1501-1900=1.08 (1.06, 1.10)]. Odds for severe morbidity were higher between 11PM and 7AM [AOR 2301-0300=1.31 (1.21, 1.41); 0300-0700=1.30 (1.20-1.41)] compared to other time periods. The adjusted odds were not statistically significant for weekend birth on pelvic morbidity [AOR Saturday=1.00 (0.98, 1.02); Sunday=1.01 (0.99, 1.03)] or severe morbidity [AOR Saturday=1.09 (1.00, 1.18); Sunday=1.03 (0.94, 1.13)]. Cesarean birth, hypertensive disorders, birthweight, and sociodemographic factors that include age, race, ethnicity, and insurance status, were also significantly associated with severe morbidity. Conclusions Even after controlling for sociodemographic factors and known risks such as cesarean birth and pregnancy complications like hypertensive disorders, birth between 11PM and 7AM is a significant independent risk factor for severe maternal morbidity. PMID:26196454

  7. A systematic review of the relationship between severe maternal morbidity and post-traumatic stress disorder

    PubMed Central

    2012-01-01

    Background The incidence of severe maternal morbidity is increasing in high-income countries as a consequence, in part, of increased obstetric intervention and increasingly complex medical needs of women who become pregnant. Access to emergency obstetric care means that for the majority of women in these countries, an experience of severe maternal morbidity is unlikely to result in loss of life. However, little is known about the subsequent impact on postnatal psychological health resulting in an evidence gap to support provision of appropriate care for these women. There has recently been increasing recognition that childbirth can be a cause of post-traumatic stress disorder (PTSD). The combination of experiencing a life-threatening complication and its management may culminate in psychological trauma. This systematic review examined the association between women’s experience of severe maternal morbidity during labour, at the time of giving birth or within the first week following birth, and PTSD and its symptoms. Methods Relevant literature was identified through multiple databases, including MEDLINE, PsycINFO, EMBASE, CINAHL, British Nursing Index, Web of Science, Cochrane library and the British Library, using predetermined search strategies. The search terms included "post-traumatic stress disorder", "PTSD", "stress disorders, post-traumatic", "maternal morbidity", “pregnancy complications” “puerperal disorders”, "obstetric labo(u)r complication", "postpartum h(a)emorrhage", "eclampsia”. Studies identified were categorised according to pre-defined inclusion and exclusion criteria. The quality of included studies was assessed using the relevant CASP appraisal tools. Results Eleven primary studies met review criteria. Evidence of a relationship between severe maternal morbidity and PTSD/PTSD symptoms was inconsistent and findings varied between studies. Nevertheless, there is some evidence that severe pre-eclampsia is a risk factor for PTSD and its

  8. Maternal morbidity and perinatal outcomes among women in rural versus urban areas

    PubMed Central

    Lisonkova, Sarka; Haslam, Matthew D.; Dahlgren, Leanne; Chen, Innie; Synnes, Anne R.; Lim, Kenneth I.

    2016-01-01

    Background: Most studies examining geographic barriers to maternity care in industrialized countries have focused solely on fetal and neonatal outcomes. We examined the association between rural residence and severe maternal morbidity, in addition to perinatal mortality and morbidity. Methods: We conducted a retrospective population-based cohort study of all women who gave birth in British Columbia, Canada, between Jan. 1, 2005, and Dec. 31, 2010. We compared maternal mortality and severe morbidity (e.g., eclampsia) and adverse perinatal outcomes (e.g., perinatal death) between women residing in areas with moderate to no metropolitan influence (rural) and those living in metropolitan areas or areas with a strong metropolitan influence (urban). We used logistic regression analysis to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results: We found a significant association between death or severe maternal morbidity and rural residence (adjusted OR 1.15, 95% CI 1.03–1.28). In particular, women in rural areas had significantly higher rates of eclampsia (adjusted OR 2.70, 95% CI 1.79–4.08), obstetric embolism (adjusted OR 2.16, 95% CI 1.14–4.07) and uterine rupture or dehiscence (adjusted OR 1.96, 95% CI 1.42–2.72) than women in urban areas. Perinatal mortality did not differ significantly between the study groups. Infants in rural areas were more likely than those in urban areas to have a severe neonatal morbidity (adjusted OR 1.14, 95% CI 1.02–1.29), to be born preterm (adjusted OR 1.06, 95% CI 1.01–1.11), to have an Apgar score of less than 7 at 5 minutes (adjusted OR 1.24, 95% CI 1.13–1.31) and to be large for gestational age (adjusted OR 1.14, 95% CI 1.10–1.19). They were less likely to be small for gestational age (adjusted OR 0.90, 95% CI 0.85–0.95) and to be admitted to an neonatal intensive care unit (NICU) (adjusted OR 0.36, 95% CI 0.33–0.38) compared with infants in urban areas. Interpretation: Compared with women

  9. [Significance of viruses in maternal-child morbidity].

    PubMed

    Mena Castro, E

    1990-01-01

    In developing countries infectious diseases continue to be the primary cause of morbidity in children and they are also responsible for an increasing number of untimely deaths. Viral, bacterial, mycotic, and parasitic agents are responsible for various pathological conditions that are present in the most vulnerable groups of the population. Poverty, crowding, lack of access to potable water, low level of education, and inadequate disposition of excreta provide an ideal environment for infectious agents. During human history viruses have represented an important group of disease-producing agents, both in mothers and children. The teratogenic, immunogenic, and oncogenic capabilities of many viruses has been established, and every so often new activities and characteristics of these agents are identified in relation to epidemiology, physiology, and pathogenics. An interesting work concerning parvovirus B19 by Drs. Mateo and Polanco was published in the Archivos Dominicanos de Pediatria. This virus appears to be responsible for infectious erythema and particularly for the medullar aplasia crisis observed in many chronic hemolytic anemias. For the Dominican Republic this discovery is of interest because of the relatively high prevalence of falciform anemia; this disease most often occurs as hereditary anemia, and the medullar aplasia crisis is one of the forms of expression of this disease.

  10. Intraclass correlation coefficients in the Brazilian network for surveillance of severe maternal morbidity study

    PubMed Central

    2012-01-01

    Background The purpose of the study was to evaluate intraclass correlation coefficients (ICC) of variables concerning personal characteristics, structure, outcome and process in the Brazilian Network for Surveillance of Severe Maternal Morbidity study conducted to identify severe maternal morbidity/near miss cases using the World Health Organization criteria. Method It was a cross-sectional, multicenter study involving 27 hospitals providing care for pregnant women in Brazil. Cluster size and the mean size of the primary sampling unit were described. Estimated prevalence rates, ICC, their respective 95% confidence intervals, the design effect and the mean cluster size were presented for each variable. Results Overall, 9,555 cases of severe maternal morbidity (woman admitted with potentially life-threatening conditions, near miss events or death) were included in the study. ICC ranged from < 0.001 to 0.508, with a median of 0.035. ICC was < 0.1 for approximately 75% of the variables. For process-related variables, median ICC was 0.09, with 0.021 for those related to outcome. These findings confirm data from previous studies. Homogeneity may be considered minor, thus increasing reliability of these findings. Conclusions These results may be used to design new cluster trials in maternal and perinatal health and to help calculate sample sizes. PMID:22998520

  11. [Maternal and perinatal risk factors for neonatal morbidity: a narrative literature review].

    PubMed

    Hernández Núñez, Jónathan; Valdés Yong, Magel; Suñol Vázquez, Yoanca de la Caridad; López Quintana, Marelene de la Caridad

    2015-07-14

    Newborn diseases increase neonatal mortality rates, so a literature review was conducted to establish the risk factors related to maternal and peripartum morbidity affecting the newborn. We searched the following electronic databases: Cumed, EBSCO, LILACS, IBECS and PubMed/MEDLINE. We used specific terms and Boolean operators in Spanish, Portuguese and English. We included longitudinal and cross-sectional descriptive studies, as well as case-control and cohort studies, systematic reviews and meta-analysis, spanning from 2010 to 2015 that responded the topic of interest. The included studies show that multiple maternal and perinatal conditions are risk factors for significant increase of neonatal morbidity, which are described in this narrative review.

  12. Predicting significant maternal morbidity in women attempting vaginal birth after cesarean section.

    PubMed

    Scifres, Christina M; Rohn, Amanda; Odibo, Anthony; Stamilio, David; Macones, George A

    2011-03-01

    Attempting vaginal birth after cesarean section (VBAC) places women at an increased risk for complications. We set out to identify factors that are predictive of major morbidity in women who attempt VBAC. A nested case-control study was performed within a large retrospective cohort study of women with a history of at least one cesarean. Women who attempted VBAC were identified and those who experienced at least one complication of a composite adverse outcome consisting of uterine rupture, bladder injury, and bowel injury (cases) were compared with those who did not experience one of these adverse outcomes (controls). We analyzed risk factors for major maternal morbidity using univariable and multivariable methods. The accuracy of the multivariable prediction model was assessed with receiver operator characteristic (ROC) curve analysis. Of 25,005 women with a history of previous cesarean, 13,706 (54.9%) attempted VBAC. The composite outcome occurred in 300 (2.1%) women attempting VBAC. Using logistic regression analysis, prior abdominal surgery (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.2 to 2.1), augmented labor (OR 1.78, 95% CI 1.29 to 2.46), and induction of labor (OR 2.03, 95% CI 1.48 to 2.76) were associated with an increased risk of the composite outcome. Prior vaginal delivery (OR 0.39, 95% CI 0.29 to 0.54) was associated with decreased risk for the composite outcome. The ROC curve generated from the regression model has an area under the curve of 0.65 and an unfavorable tradeoff between sensitivity and specificity. Women attempting VBAC with a history of abdominal surgery or those who undergo augmentation or induction of labor are at an increased risk for major maternal morbidity, and women with a prior vaginal delivery have a decreased risk of major morbidity. The multivariable model developed cannot accurately predict major maternal morbidity.

  13. Severe maternal morbidity from direct obstetric causes in West Africa: incidence and case fatality rates.

    PubMed Central

    Prual, A.; Bouvier-Colle, M. H.; de Bernis, L.; Bréart, G.

    2000-01-01

    Data on maternal morbidity make it possible to assess how many women are likely to need essential obstetric care, and permit the organization, monitoring and evaluation of safe motherhood programmes. In the present paper we propose operational definitions of severe maternal morbidity and report the frequency of such morbidity as revealed in a population-based survey of a cohort of 20,326 pregnant women in six West African countries. The methodology and questionnaires were the same in all areas. Each pregnant woman had four contacts with the obstetric survey team: at inclusion, between 32 and 36 weeks of amenorrhoea, during delivery and 60 days postpartum. Direct obstetric causes of severe morbidity were observed in 1215 women (6.17 cases per 100 live births). This ratio varied significantly between areas, from 3.01% in Bamako to 9.05% in Saint-Louis. The main direct causes of severe maternal morbidity were: haemorrhage (3.05 per 100 live births); obstructed labour (2.05 per 100), 23 cases of which involved uterine rupture (0.12 per 100); hypertensive disorders of pregnancy (0.64 per 100), 38 cases of which involved eclampsia (0.19 per 100); and sepsis (0.09 per 100). Other direct obstetric causes accounted for 12.2% of cases. Case fatality rates were very high for sepsis (33.3%), uterine rupture (30.4%) and eclampsia (18.4%); those for haemorrhage varied from 1.9% for antepartum or peripartum haemorrhage to 3.7% for abruptio placentae. Thus at least 3-9% of pregnant women required essential obstetric care. The high case fatality rates of several complications reflected a poor quality of obstetric care. PMID:10859853

  14. Geomagnetic Storms and Acute Myocardial Infarctions Morbidity in Middle Latitudes

    NASA Astrophysics Data System (ADS)

    Dimitrova, S.; Babayev, E. S.; Mustafa, F. R.; Stoilova, I.; Taseva, T.; Georgieva, K.

    2009-12-01

    Results of collaborative studies on revealing a possible relationship between solar activity (SA) and geomagnetic activity (GMA) and pre-hospital acute myocardial infarction (AMI) morbidity are presented. Studies were based on medical data from Bulgaria and Azerbaijan. Bulgarian data, covering the period from 01.12.1995 to 31.12.2004, concerned daily distribution of number of patients with AMI diagnose (in total 1192 cases) from Sofia Region on the day of admission at the hospital. Azerbaijani data contained 4479 pre-hospital AMI incidence cases for the period 01.01.2003-31.12.2005 and were collected from 21 emergency and first medical aid stations in Grand Baku Area (including Absheron Economical Region with several millions of inhabitants). Data were "cleaned" as much as possible from social and other factors and were subjected to medical and mathematical/statistical analysis. Medical analysis showed reliability of the used data. Method of ANalysis Of VAriance (ANOVA) was applied to check the significance of GMA intensity effect and the type of geomagnetic storms - those caused by magnetic clouds (MC) and by high speed solar wind streams (HSSWS) - on AMI incidences. Relevant correlation coefficients were calculated. Results were outlined for both considered data. Results obtained for the Sofia data showed statistically significant positive correlation between considered GMA indices and AMI occurrence. ANOVA revealed that AMI incidence number was significantly increased from the day before till the day after geomagnetic storms with different intensities. Geomagnetic storms caused by MC were related to significant increase of AMI number in comparison with the storms caused by HSSWS. There was a trend for such different effects even on -1st and +1st day for the period 1995-2004. Results obtained for the Baku data revealed trends similar to those obtained for Sofia data. AMI morbidity increment was observed on the days with higher GMA intensity and after these days

  15. Early postpartum maternal morbidity among rural women of Rajasthan, India: a community-based study.

    PubMed

    Iyengar, Kirti

    2012-06-01

    The first postpartum week is a high-risk period for mothers and newborns. Very few community-based studies have been conducted on patterns of maternal morbidity in resource-poor countries in that first week. An intervention on postpartum care for women within the first week after delivery was initiated in a rural area of Rajasthan, India. The intervention included a rigorous system of receiving reports of all deliveries in a defined population and providing home-level postpartum care to all women, irrespective of the place of delivery. Trained nurse-midwives used a structured checklist for detecting and managing maternal and neonatal conditions during postpartum-care visits. A total of 4,975 women, representing 87.1% of all expected deliveries in a population of 58,000, were examined in their first postpartum week during January 2007-December 2010. Haemoglobin was tested for 77.1% of women (n=3,836) who had a postnatal visit. The most common morbidity was postpartum anaemia--7.4% of women suffered from severe anaemia and 46% from moderate anaemia. Other common morbidities were fever (4%), breast conditions (4.9%), and perineal conditions (4.5%). Life-threatening postpartum morbidities were detected in 7.6% of women--9.7% among those who had deliveries at home and 6.6% among those who had institutional deliveries. None had a fistula. Severe anaemia had a strong correlation with perinatal death [p<0.000, adjusted odds ratio (AOR)=1.99, 95% confidence interval (CI) 1.32-2.99], delivery at home [p<0.000, AOR=1.64 (95% CI 1.27-2.15)], socioeconomically-underprivileged scheduled caste or tribe [p<0.000, AOR=2.47 (95% CI 1.83-3.33)], and parity of three or more [p<0.000, AOR=1.52 (95% CI 1.18-1.97)]. The correlation with antenatal care was not significant. Perineal conditions were more frequent among women who had institutional deliveries while breast conditions were more common among those who had a perinatal death. This study adds valuable knowledge on postpartum

  16. Awareness about a Life-Threatening Condition: Ectopic Pregnancy in a Network for Surveillance of Severe Maternal Morbidity in Brazil

    PubMed Central

    Filho, Edilberto Alves Rocha; Santana, Danielly Scaranello; Costa, Maria Laura; Haddad, Samira Maerrawe; Parpinelli, Mary Angela; Sousa, Maria Helena; Camargo, Rodrigo Soares; Pacagnella, Rodolfo Carvalho; Surita, Fernanda Garanhani; Pinto e Silva, Joao Luiz

    2014-01-01

    Objective. To assess occurrence of severe maternal complications associated with ectopic pregnancy (EP). Method. A multicenter cross-sectional study was conducted, with prospective surveillance of potentially life-threatening conditions (PLTC), maternal near miss (MNM), and maternal death (MD). EP complications, patient sociodemographic/obstetric characteristics, and conditions of severity management were assessed, estimating prevalence ratios with respective 95% CI. Factors independently associated with greater severity were identified using multiple regression analysis. Results. Of the 9.555 severe maternal morbidity patients, 312 women (3.3%) had complications after EP: 286 (91.7%) PLTC, 25 (8.0%) MNM, and 1 (0.3%) MD. Severe maternal outcome ratio (SMOR) was 0.3/1000 LB among EP cases and 10.8/1000 LB among other causes. Complicated EP patients faced a higher risk of blood transfusion, laparotomy, and lower risk of ICU admission and prolonged hospitalization than women developing complications resulting from other causes. Substandard care was the most common in more severe maternal morbidity and EP cases (22.7% MNM and MD versus 15% PLTC), although not significant. Conclusion. Increased maternal morbidity due to EP raised awareness about the condition and its impact on female reproductive life. No important risk factors for greater severity were identified. Care providers should develop specific guidelines and interventions to prevent severe maternal morbidity. PMID:24772441

  17. Severe maternal morbidity among immigrant women in the Netherlands: patients' perspectives.

    PubMed

    Jonkers, Marina; Richters, Annemiek; Zwart, Joost; Öry, Ferko; van Roosmalen, Jos

    2011-05-01

    This 2006 study investigated ethnicity-related factors contributing to sub-standard maternity care and the effects on severe maternal morbidity among immigrant women in the Netherlands. In-depth interviews were carried out with 40 immigrant and 10 native Dutch women. The immigrant women reported that health care providers often paid insufficient attention to their pregnancy-related complaints, especially in cases of pre-eclampsia. They also reported delays in receiving information about diagnosis and treatment. Obstetricians who reviewed 20 of these cases judged sub-standard care to have played a role in the development of complications in 16 of them. The women themselves had problems identifying medically significant complications, presenting their complaints to health care providers effectively, and taking an active role as patients. Even highly educated migrant women showed low health literacy skills in their interaction with doctors. Patients' perspectives are valuable as one of the tools to evaluate the quality of maternity care. Communication by maternal health professionals can be improved through more sensitivity to social factors that affect immigrant women's health problems. Women with limited health literacy should be empowered through education about danger signs in pregnancy and information about preferences and policies in obstetrics in the Netherlands. They should also be invited to participate in medical decision-making.

  18. Maternal and neonatal morbidity and mortality rate in caesarean section and vaginal delivery

    PubMed Central

    Ghahiri, Ataollah; Khosravi, Mehrnoush

    2015-01-01

    Background: The cesarean section is one of the most common procedures to prevent health-threatening risks to the mother and infant. Increasing rate of cesarean section attracted the attention of professionals and the overall objective of this study was to determine the frequency of maternal and neonatal morbidity and mortality rates in the two methods of delivery. Materials and Methods: In a comparative cohort study, 300 cases undergoing caesarean section and 300 cases with vaginal delivery were selected in two main hospitals of Isfahan, Iran during 2013 and 2014. Demographic characteristics and factors related to mortality and morbidity of mothers and infants were studied. Mothers were also recruited 6 weeks after delivery to ask for complications. Mothers and infants mortality and morbidity were studied and analyzed by SPSS 22 software. Results: Follow-up of deliveries up to 1-month after delivery suggested 2 cases of infant death (7%) in vaginal delivery group, while no case of infant death was reported in cesarean delivery group (P = 0.5). Incidence of fever was observed in first 10 days after delivery in 7 cases in the vaginal delivery group and 11 cases in the cesarean delivery group (2.3% vs. 3.7%, P = 0.4). Conclusion: Despite all the benefits of vaginal delivery compared with cesarean section, in many cases, especially in emergency cesarean section delivery can substantially reduce the maternal and neonatal mortality and morbidity. It is recommended to assess the complications of each method in all pregnant women about to give birth, and then decide on the method of delivery. PMID:26605232

  19. Metasynthesis: Experiences of Women with Severe Maternal Morbidity and Their Perception of the Quality of Health Care

    PubMed Central

    Norhayati, Mohd Noor

    2015-01-01

    Aim To explore the experiences of women with severe maternal morbidity and their perception of the quality of health care. Background The exploration of factors associated with severe maternal morbidity has emerged as an alternative strategy in reducing maternal mortality. This approach is useful for the evaluation and improvement of maternal health services. Design Included a comprehensive search, appraisal of reports of qualitative studies, the classification of studies and the synthesis of findings. Data Sources A literature search was conducted through nine databases for articles published between January 1980 and August 2013. Review Methods The quality of included studies was assessed with a modified Critical Appraisal Skills Program tool. The synthesis applied a meta-ethnographic approach. It involved (1) identifying and comparing the findings; (2) creating a parsimonious thematic structure and (3) searching for disconfirming data. Results Nine studies published between 2005 and 2012, involving 292 women with severe maternal morbidity, were included. Three key themes were identified: 'provision of care', 'severe maternal morbidity' and 'health care seeking behavior'. Barriers to the access and utilization of heath care services were identified. Conclusion The findings appear to suggest that mental and physical health outcomes of women who experienced severe maternal morbidity were poor. There is a need to identify the persistence and severity of these outcomes over a longer period of time. More realistic and less biased information may be obtained in community-based interviews. The impact of potential negative fetal outcomes would be a strong influencing factor for the women. These findings may help to increase awareness of the non-physical components of severe maternal morbidity and provide guidance for professionals regarding preventive measures. PMID:26132107

  20. Maternal HIV and drug use: effect on health and social morbidity.

    PubMed Central

    Mok, J Y; Ross, A; Raab, G; Hamilton, B; Gilkison, S; Johnstone, F D

    1996-01-01

    A retrospective analysis of routine child health surveillance information was performed on health visitor records of 459 children, to examine the independent effects of maternal HIV infection and drug use during pregnancy on morbidity in the first 3 years of life. No significant differences were observed in the developmental progress of children born to HIV infected or drug using women when compared to community controls. The pattern of medical consultations in the first 18 months of life was significantly different, maternal drug use exerting a negative influence on outpatient visits (odds ratio 0.6, 95% confidence interval 0.4 to 1.0). At 6 weeks, the majority of children lived with their birth parent(s), and no differences were observed between the groups. By 10 months of age, only 81% of children born to HIV infected drug using women lived with their parent(s). While maternal drug use and HIV did not have adverse effects on child health and development, these findings highlight the social implications for children affected by the heterosexual spread of HIV. PMID:8787424

  1. Maternal morbidity and mortality associated with interpregnancy interval: cross sectional study

    PubMed Central

    Conde-Agudelo, Agustin; Belizán, José M

    2000-01-01

    Objective To study the impact of interpregnancy interval on maternal morbidity and mortality. Design Retrospective cross sectional study with data from the Perinatal Information System database of the Latin American Centre for Perinatology and Human Development, Montevideo, Uruguay. Setting Latin America and the Caribbean, 1985-97. Participants 456 889 parous women delivering singleton infants. Main outcome measures Crude and adjusted odds ratios of the effects of short and long interpregnancy intervals on maternal death, pre-eclampsia, eclampsia, gestational diabetes mellitus, third trimester bleeding, premature rupture of membranes, postpartum haemorrhage, puerperal endometritis, and anaemia. Results Short (<6 months) and long (>59 months) interpregnancy intervals were observed for 2.8% and 19.5% of women, respectively. After adjustment for major confounding factors, compared with those conceiving at 18 to 23 months after a previous birth, women with interpregnancy intervals of 5 months or less had higher risks for maternal death (odds ratio 2.54; 95% confidence interval 1.22 to 5.38), third trimester bleeding (1.73; 1.42 to 2.24), premature rupture of membranes (1.72; 1.53 to 1.93), puerperal endometritis (1.33; 1.22 to 1.45), and anaemia (1.30; 1.18 to 1.43). Compared with women with interpregnancy intervals of 18 to 23 months, women with interpregnancy intervals longer than 59 months had significantly increased risks of pre-eclampsia (1.83; 1.72 to 1.94) and eclampsia (1.80; 1.38 to 2.32). Conclusions Interpregnancy intervals less than 6 months and longer than 59 months are associated with an increased risk of adverse maternal outcomes. PMID:11082085

  2. Obstetric Complications, Neonatal Morbidity, and Indications for Cesarean Delivery by Maternal Age

    PubMed Central

    Timofeev, Julia; Reddy, Uma M.; Huang, Chun-Chih; Driggers, Rita W.; Landy, Helain J.; Laughon, S. Katherine

    2014-01-01

    OBJECTIVE To delineate adverse obstetric and neonatal outcomes as well as indications for cesarean delivery by maternal age in a contemporaneous large national cohort. METHODS This was a retrospective analysis of electronic medical records from 12 centers and 203,517 (30,673 women aged 35 years or older) women with singleton gestations stratified by maternal age. Logistic regression was performed to investigate maternal and neonatal outcomes for each maternal age strata (referent group, age 25.0–29.9 years), adjusting for race, parity, body mass index, insurance, pre-existing medical conditions, substance and tobacco use, and site. Documented indications for cesarean delivery were analyzed. RESULTS Neonates born to women aged 25.0–29.9 years had the lowest risk of birth weight less than 2,500 g (7.2%; P<.001), admission to neonatal intensive care unit (11.5%; P<.001), and perinatal mortality (0.7%; P<.001). Hypertensive disorders of pregnancy were higher in women aged 35 years or older (cumulative rate 8.5% compared with 7.8%; 25.0–29.9 years; P<.001). Previous uterine scar was the leading indication for cesarean delivery in women aged 25.0 years or older (36.9%; P<.001). For younger women, failure to progress or cephalopelvic disproportion (37.0% for those younger than age 20.0 years and 31.1% for those aged 20.0– 24.9-years; P<.001) and nonreassuring fetal heart tracing (28.7% for those younger than 20.0 years and 21.2% for those aged 20.0–24.9-years; P<.001) predominated as indications. Truly elective cesarean delivery rate was 20.2% for women aged 45.0 years or older (adjusted odds ratio 1.85 [99% confidence interval 1.03–3.32] compared with the referent age group of 25.0–29.9 years). CONCLUSIONS Maternal and obstetric complications differed by maternal age, as did rates of elective cesarean delivery. Women aged 25.0–29.9 years had the lowest rate of serious neonatal morbidity. PMID:24201681

  3. The relationship between severe maternal morbidity and psychological health symptoms at 6–8 weeks postpartum: a prospective cohort study in one English maternity unit

    PubMed Central

    2014-01-01

    Background The incidence of severe maternal morbidity is increasing in high-income countries. However, little has been known about the impact on postnatal morbidity, particularly on psychological health outcomes. The objective of this study was to assess the relationship between severe maternal morbidity (ie. major obstetric haemorrhage, severe hypertensive disorders or intensive care unit/obstetric high dependency unit admission) and postnatal psychological health symptoms, focusing on post-traumatic stress disorder (PTSD) symptoms at 6–8 weeks postpartum. Method A prospective cohort study was undertaken of women who gave birth over six months in 2010 in an inner city maternity unit in England. Primary outcomes were prevalence of PTSD symptoms namely: 1) intrusion and 2) avoidance as measured using the Impact of Event Scale at 6 – 8 weeks postpartum via a self-administered postal questionnaire. Secondary outcomes included probable depression. Data on incidence of severe maternal morbidity were extracted from maternity records. Multivariable logistic regression analysis examined the relationship between severe maternal morbidity and PTSD symptoms taking into account factors that might influence the relationship. Results Of women eligible to participate (n=3509), 52% responded. Prevalence of a clinically significant level of intrusion and avoidance were 6.4% (n=114) and 8.4% (n=150) respectively. There was a higher risk of PTSD symptoms among women who experienced severe maternal morbidity compared with women who did not (adjusted OR = 2.11, 95%CI = 1.17-3.78 for intrusion; adjusted OR = 3.28, 95%CI = 2.01-5.36 for avoidance). Higher ratings of reported sense of control during labour/birth partially mediated the risk of PTSD symptoms. There were no statistically significant differences in the prevalence or severity of symptoms of depression. Conclusion This is one of the largest studies to date of PTSD symptoms among women who had recently given birth. Findings

  4. Acute Morbidity of Proton Therapy for Prostate Cancer: The Hyogo Ion Beam Medical Center Experience

    SciTech Connect

    Mayahara, Hiroshi Murakami, Masao; Kagawa, Kazufumi; Kawaguchi, Atsuya; Oda, Yasue; Miyawaki, Daisuke; Sasaki, Ryohei; Sugimura, Kazuro; Hishikawa, Yoshio

    2007-10-01

    Purpose: To investigate the incidence and influencing factors of acute genitourinary (GU) and gastrointestinal morbidities in patients with prostate cancer treated with proton therapy. Methods and Materials: A total of 287 patients with histologically proven Stage cT1-T4N0M0 prostate cancer were treated with proton therapy between 2003 and 2004. Of these, 204 (71%) received neoadjuvant androgen suppression therapy. The patients were treated with 190-230-MeV protons using lateral-opposed techniques to a dose of 74 GyE. Dose-volume histogram analyses were performed. The incidence of acute morbidity was evaluated using the National Cancer Institute Common Toxicity Criteria, version 2.0. Clinical factors, including age, clinical target volume, initial prostate-specific antigen level, T stage, presence of diabetes mellitus, and the use of androgen suppression therapy, were investigated to determine whether those affected the incidence of acute GU morbidity. Results: None developed Grade 2 or higher acute gastrointestinal morbidity. In contrast, 111 (39%) and 4 (1%) patients experienced acute Grade 2 and Grade 3 GU morbidities, respectively. However, 87% of the patients were successfully relieved by the administration of a selective {alpha}-1 blocker. Multivariate analysis showed that a larger clinical target volume (p = 0.001) and the use of androgen suppression therapy (p = 0.017) were significant factors for the prediction of acute Grade 2-3 GU morbidity. Conclusion: In our experience with proton therapy, a low incidence of acute gastrointestinal morbidity was observed. In contrast, the incidence of acute GU morbidity was similar to that in other reports of photon radiotherapy. Additional follow-up is warranted to elucidate the long-term safety and efficacy of proton therapy for prostate cancer.

  5. Severe maternal morbidity and maternal near miss in the extremes of reproductive age: results from a national cross- sectional multicenter study

    PubMed Central

    2014-01-01

    Background The aim of this study was to assess severe maternal morbidity (SMM) and near miss (NM) cases among adolescent girls and women over 35 years of age in the Brazilian Network for Surveillance of Severe Maternal Morbidity, using a set of standard criteria, compared to pregnant women aged 20 to 34 years. Methods A cross-sectional multicenter study conducted in 27 referral obstetric units in Brazil. All pregnant women admitted to these centers during a one-year period of prospective surveillance were screened to identify cases of maternal death (MD), NM and other SMM. Indicators of maternal morbidity and mortality were evaluated for the three age groups. Sociodemographic, clinical and obstetric characteristics, gestational and perinatal outcomes, main causes of morbidity and delays in care were also compared. Two multiple analysis models were performed, to estimate the adjusted prevalence ratio for identified factors that were independently associated with the occurrence of severe maternal outcome (SMO = MNM + MD). Results Among SMM and MD cases identified, the proportion of adolescent girls and older women were 17% each. The risk of MNM or death was 25% higher among older women. Maternal near miss ratio and maternal mortality ratios increased with age, but these ratios were also higher among adolescents aged 10 to 14, although the absolute numbers were low. On multivariate analysis, younger age was not identified as an independent risk factor for SMO, while this was true for older age (PR 1.25; 1.07-1.45). Conclusions SMO was high among women below 14 years of age and increased with age in Brazilian pregnant women. PMID:24555831

  6. Severe maternal morbidity: a case-control study in Maranhao, Brazil

    PubMed Central

    2013-01-01

    Background Maternal mortality and morbidity are among the top public health priorities in Brazil, being quite high, especially among the most disadvantage women. A case control study was developed to identify risk factors for severe maternal morbidity in Sao Luis, one of the poorest Brazilian State Capitals. Methods The case–control study was carried out between 01/03/2009 and 28/02/2010 in two public high-risk maternities facilities and in two intensive care units (ICUs) for referral of obstetric cases. All cases hospitalized due to complications during gestation period, childbirth or up to 42 days of puerperium and who fulfilled any of Mantel's and/or Waterstone's criteria were identified. Two controls per case were randomly selected among patients of the same clinics discharged for other reasons. Data were obtained through a structured interview as well as from medical charts and prenatal cards and included sociodemographic variables, clinical and obstetric histories, behavioral factors and exposure to stress factors during pregnancy, pre-natal assistance and obstetric complication and childbirth care. Results In the final model of the unconditional logistic regression analysis, being older than 35 years (OR=3.11; 95% CI:1.53-6.31), previous hypertension (OR=2.52; 95% CI:1.09-5.80), history of abortion (OR=1.61; 95% CI:0.97-2.68), 4–5 pre-natal consultations (OR=1.78; 95% CI:1.05-3.01) and 1–3 pre-natal consultations (OR=1.89; 95% CI:1.03-3.49) were independently associated with severe maternal morbidity. Conclusions The results corroborate the importance of reproductive healthcare, of identifying a high-risk pregnancy and of a qualified and complete prenatal care to prevent severe morbid events. Resumo Introdução A mortalidade e morbidade maternas estão entre os tópicos prioritários da Saúde Pública brasileira, especialmente na população de menor nível socioeconômico. Um estudo caso-controle foi desenvolvido para identificar os fatores de risco

  7. Airway pressure release ventilation in morbidly obese surgical patients with acute lung injury and acute respiratory distress syndrome.

    PubMed

    Testerman, George M; Breitman, Igal; Hensley, Sarah

    2013-03-01

    Morbidly obese patients with body mass index greater than 40 kg/m(2) and respiratory failure requiring critical care services are increasingly seen in trauma and acute care surgical centers. Baseline respiratory pathophysiology including decreased pulmonary compliance with dependent atelectasis and abnormal ventilation-perfusion relationships predisposes these patients to acute lung injury (ALI) and adult respiratory distress syndrome (ARDS) as well as prolonged stays in the intensive care unit. Airway pressure release ventilation (APRV) is an increasingly used alternative mode for salvage therapy in patients with hypoxemic respiratory failure that also provides lung protection from ventilator-induced lung injury. APRV provides the conceptual advantage of an "open lung" approach to ventilation that may be extended to the morbidly obese patient population with ALI and ARDS. We discuss the theoretical benefits and a recent clinical experience of APRV ventilation in the morbidly obese patient with respiratory failure at a Level I trauma, surgical critical care, and acute care surgery center.

  8. Acute pain management in morbid obesity - an evidence based clinical update.

    PubMed

    Budiansky, Adele Sandra; Margarson, Michael P; Eipe, Naveen

    2017-03-01

    Increasing numbers of patients with morbid obesity are presenting for surgery and their acute pain management requires an evidence-based clinical update. The objective of this study was to complete a literature review for acute pain management in morbid obesity and provide an evidence-based clinical update with recommendations. Using standardized search terms, in March 2015, we completed a literature search to determine evidence for different acute pain pharmacological modalities in morbid obesity. For each modality the highest level of evidence was ascertained and recommendations for each pharmacological modality are presented. Though overall evidence is limited to few well conducted clinical trials, mostly related to weight loss surgery, multimodal analgesia with step-wise, severity-based, opioid-sparing approach appears to improve acute pain management in morbid obesity. The perioperative use of non-opioid adjuvants appears to offer further improvements in patient safety and outcomes. Further research into standardization of pain assessments and implementation of acute pain management protocols is required.

  9. Population-based study of risk factors for severe maternal morbidity

    PubMed Central

    Gray, Kristen E; Wallace, Erin R; Nelson, Kailey R; Reed, Susan D; Schiff, Melissa A

    2012-01-01

    Summary Background Severe maternal morbidity (SMM) is a serious health condition potentially resulting in death without immediate medical attention, including organ failure, obstetric shock, and elcampsia. SMM affects 20,000 US women every year; however, few population-based studies have examined SMM risk factors. Methods We conducted a population-based case-control study linking birth certificate and hospital discharge data from Washington State (1987–2008), identifying 9,485 women with an antepartum, intrapartum, or postpartum SMM with ≥3-day hospitalization or transfer from another facility and 41,112 random controls. Maternal age, race, smoking during pregnancy, parity, preexisting medical condition, multiple birth, prior cesarean delivery, and BMI were assessed as risk factors with logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI), adjusted for education and delivery payer source. Results Older women [35–39: OR 1.65 CI 1.52, 1.79; 40+: OR 2.48 CI 2.16, 2.81], non-white women [Black: OR 1.82 CI 1.64, 2.01; American Indian: OR 1.52 CI 1.32, 1.73; Asian/Pacific Islander: OR 1.30 CI 1.19, 1.41; Hispanic: OR 1.17 CI 1.07, 1.27], and women at parity extremes [OR 1.83 CI 1.72, 1.95, nulliparous; OR 1.34 CI 1.23, 1.45, parity 3+] were at greater risk of SMM. Women with a preexisting medical condition [OR 2.10 CI 1.88, 2.33], a multiple birth [OR 2.54 CI 2.26, 2.82], and a prior cesarean delivery [OR 2.08 CI 1.93, 2.23] were also at increased risk. Conclusion The risk factors identified are not modifiable at the individual level; therefore, provider and system-level factors may be the most appropriate target for preventing SMM. PMID:23061686

  10. Brazilian network for the surveillance of maternal potentially life threatening morbidity and maternal near-miss and a multidimensional evaluation of their long term consequences

    PubMed Central

    Cecatti, Jose G; Souza, João P; Parpinelli, Mary A; Haddad, Samira M; Camargo, Rodrigo S; Pacagnella, Rodolfo C; Silveira, Carla; Zanardi, Dulce T; Costa, Maria L; Pinto e Silva, João L; Passini, Renato; Surita, Fernanda G; Sousa, Maria H; Calderon, Iracema MP; Say, Lale; Pattinson, Robert C

    2009-01-01

    Background It has been suggested that the study of women who survive life-threatening complications related to pregnancy (maternal near-miss cases) may represent a practical alternative to surveillance of maternal morbidity/mortality since the number of cases is higher and the woman herself is able to provide information on the difficulties she faced and the long-term repercussions of the event. These repercussions, which may include sexual dysfunction, postpartum depression and posttraumatic stress disorder, may persist for prolonged periods of time, affecting women's quality of life and resulting in adverse effects to them and their babies. Objective The aims of the present study are to create a nationwide network of scientific cooperation to carry out surveillance and estimate the frequency of maternal near-miss cases, to perform a multicenter investigation into the quality of care for women with severe complications of pregnancy, and to carry out a multidimensional evaluation of these women up to six months. Methods/Design This project has two components: a multicenter, cross-sectional study to be implemented in 27 referral obstetric units in different geographical regions of Brazil, and a concurrent cohort study of multidimensional analysis. Over 12 months, investigators will perform prospective surveillance to identify all maternal complications. The population of the cross-sectional component will consist of all women surviving potentially life-threatening conditions (severe maternal complications) or life-threatening conditions (the maternal near miss criteria) and maternal deaths according to the new WHO definition and criteria. Data analysis will be performed in case subgroups according to the moment of occurrence and determining cause. Frequencies of near-miss and other severe maternal morbidity and the association between organ dysfunction and maternal death will be estimated. A proportion of cases identified in the cross-sectional study will comprise

  11. [Premature rupture of membranes: maternal - perinatal morbidity and mortality in the Dominican Republic].

    PubMed

    Garrido Calderon, G; Perdomo, E M; Perez Vilorio, J B; Caputo Antonio, A

    1990-01-01

    Premature rupture of membranes is defined as expulsion of the amniotic liquid occurring at least 1 hour before initiation of uterine contractions and without apparent cervical changes. According to the literature, premature rupture of membranes occurs in 2-15% of all pregnancies, with an average of 10%. The etiology is considered multifactorial, and treatment remains controversial. A retrospective review was conducted to determine the occurrence of maternal or perinatal morbidity and mortality in 230 cases of premature rupture of membranes in a social security hospital in Santo Domingo, Dominican Republic, observed between 1983-88. Premature rupture occurred in 3.5% of cases according to the records. 37.4% of affected mothers were 21-25 years old and 69.6% were 21.30. 62.9% of the women were nulliparas. 2.2% had had no prenatal care, 59.1% had insufficient prenatal care, defined as 1-5 visits and only 36.1% had 6 or more visits. 81.3% of ruptures occurred at 37-42 weeks of gestation. In 64.8% of cases the pregnancy was terminated within 1-24 hours and 35.2% were considered prolonged. Prematurity and low birth weight was the most common perinatal disorders, affecting 10.9%. Respiratory difficulty syndrome affected 4.3%. 60% of infants with respiratory problems were born at less than 37 weeks gestation. Neonatal sepsis occurred in 3% of cases and prolapse of the umbilical cord in 1.3%. Perinatal mortality averaged 2.6%. Prematurity was a factor in all cases. Respiratory distress syndrome and neonatal sepsis were each present in 50% of cases and hyperbilirubinemia in 33%. 8.7% of the mothers developed chorioamnionitis. Only 23.9% terminated their pregnancies spontaneously. Oxytocin was used to induce labor in 30.4% and cesareans were performed in 44.8%.

  12. The Costs, Benefits, and Cost-Effectiveness of Interventions to Reduce Maternal Morbidity and Mortality in Mexico

    PubMed Central

    Hu, Delphine; Bertozzi, Stefano M.; Gakidou, Emmanuela; Sweet, Steve; Goldie, Sue J.

    2007-01-01

    Background In Mexico, the lifetime risk of dying from maternal causes is 1 in 370 compared to 1 in 2,500 in the U.S. Although national efforts have been made to improve maternal services in the last decade, it is unclear if Millennium Development Goal 5 - to reduce maternal mortality by three-quarters by 2015 - will be met. Methodology/Principal Findings We developed an empirically calibrated model that simulates the natural history of pregnancy and pregnancy-related complications in a cohort of 15-year-old women followed over their lifetime. After synthesizing national and sub-national trends in maternal mortality, the model was calibrated to current intervention-specific coverage levels and validated by comparing model-projected life expectancy, total fertility rate, crude birth rate and maternal mortality ratio with Mexico-specific data. Using both published and primary data, we assessed the comparative health and economic outcomes of alternative strategies to reduce maternal morbidity and mortality. A dual approach that increased coverage of family planning by 15%, and assured access to safe abortion for all women desiring elective termination of pregnancy, reduced mortality by 43% and was cost saving compared to current practice. The most effective strategy added a third component, enhanced access to comprehensive emergency obstetric care for at least 90% of women requiring referral. At a national level, this strategy reduced mortality by 75%, cost less than current practice, and had an incremental cost-effectiveness ratio of $300 per DALY relative to the next best strategy. Analyses conducted at the state level yielded similar results. Conclusions/Significance Increasing the provision of family planning and assuring access to safe abortion are feasible, complementary and cost-effective strategies that would provide the greatest benefit within a short-time frame. Incremental improvements in access to high-quality intrapartum and emergency obstetric care will

  13. Economic evaluation of the benefits of reducing acute cardiorespiratory morbidity associated with air pollution

    PubMed Central

    Stieb, David M; De Civita, Paul; Johnson, F Reed; Manary, Matthew P; Anis, Aslam H; Beveridge, Robert C; Judek, Stan

    2002-01-01

    Background Few assessments of the costs and benefits of reducing acute cardiorespiratory morbidity related to air pollution have employed a comprehensive, explicit approach to capturing the full societal value of reduced morbidity. Methods We used empirical data on the duration and severity of episodes of cardiorespiratory disease as inputs to complementary models of cost of treatment, lost productivity, and willingness to pay to avoid acute cardiorespiratory morbidity outcomes linked to air pollution in epidemiological studies. A Monte Carlo estimation procedure was utilized to propagate uncertainty in key inputs and model parameters. Results Valuation estimates ranged from $13 (1997, Canadian) (95% confidence interval, $0–28) for avoidance of an acute respiratory symptom day to $5,200 ($4,000–$6,400) for avoidance of a cardiac hospital admission. Cost of treatment accounted for the majority of the overall value of cardiac and respiratory hospital admissions as well as cardiac emergency department visits, while lost productivity generally represented a small proportion of overall value. Valuation estimates for days of restricted activity, asthma symptoms and acute respiratory symptoms were sensitive to alternative assumptions about level of activity restriction. As an example of the application of these values, we estimated that the observed decrease in particulate sulfate concentrations in Toronto between 1984 and 1999 resulted in annual benefits of $1.4 million (95% confidence interval $0.91–1.8 million) in relation to reduced emergency department visits and hospital admissions for cardiorespiratory disease. Conclusion Our approach to estimating the value of avoiding a range of acute morbidity effects of air pollution addresses a number of limitations of the current literature, and is applicable to future assessments of the benefits of improving air quality. PMID:12537591

  14. Estimation of preterm birth rate, associated factors and maternal morbidity from a demographic and health survey in Brazil.

    PubMed

    Tedesco, Ricardo P; Passini, Renato; Cecatti, José G; Camargo, Rodrigo S; Pacagnella, Rodolfo C; Sousa, Maria H

    2013-11-01

    To determine the prevalence of preterm birth from self-reports by Brazilian women, to assess complications, interventions and outcomes, to identify factors associated with preterm birth, and to improve the preterm birth rates estimates. This is a secondary analysis of data from a Demographic Health Survey. It interviewed a sample of 4,743 Brazilian women who had 6,113 live births from 2001 to 2007. Estimates of preterm birth rates were obtained per region and per year according to self-reported gestational age. The prevalence rate and 95 % confidence interval (CI) for preterm was determined according to the characteristics of mothers and offspring. Odds ratios and 95 % CI were estimated for complications such as severe maternal morbidity. The preterm birth rate was 9.9 %, with regional variations. Preterm birth was more likely to be associated with neonatal death, low birth weight, and longer hospital stay. Maternal factors associated with preterm birth were: white ethnicity, living in an urban area, history of hypertension or heart disease, twin gestation, non-elective Cesarean section, medical insurance for delivery, low number of antenatal visits, and severe morbidity. A self-report survey has indicated that the preterm birth rate in Brazil is higher than official data suggest, with an increasing trend in more developed areas, and is associated with poor neonatal and maternal outcomes.

  15. Maternal Depressive Symptoms in Pediatric Major Depressive Disorder: Relationship to Acute Treatment Outcome

    ERIC Educational Resources Information Center

    Kennard, Betsy D.; Hughes, Jennifer L.; Stewart, Sunita M.; Mayes, Taryn; Nightingale-Teresi, Jeanne; Tao, Rongrong; Carmody, Thomas; Emslie, Graham J.

    2008-01-01

    A study examined maternal depressive symptoms at the beginning and end of acute pediatric treatment of children with major depressive disorder (MDD). Results suggested a direct and possible reciprocal association between maternal and child depression severity.

  16. Social determinants and maternal exposure to intimate partner violence of obstetric patients with severe maternal morbidity in the intensive care unit: a systematic review protocol

    PubMed Central

    Ayala Quintanilla, Beatriz Paulina; Taft, Angela; McDonald, Susan; Pollock, Wendy; Roque Henriquez, Joel Christian

    2016-01-01

    Introduction Maternal mortality is a potentially preventable public health issue. Maternal morbidity is increasingly of interest to aid the reduction of maternal mortality. Obstetric patients admitted to the intensive care unit (ICU) are an important part of the global burden of maternal morbidity. Social determinants influence health outcomes of pregnant women. Additionally, intimate partner violence has a great negative impact on women's health and pregnancy outcome. However, little is known about the contextual and social aspects of obstetric patients treated in the ICU. This study aimed to conduct a systematic review of the social determinants and exposure to intimate partner violence of obstetric patients admitted to an ICU. Methods and analysis A systematic search will be conducted in MEDLINE, CINAHL, ProQuest, LILACS and SciELO from 2000 to 2016. Studies published in English and Spanish will be identified in relation to data reporting on social determinants of health and/or exposure to intimate partner violence of obstetric women, treated in the ICU during pregnancy, childbirth or within 42 days of the end of pregnancy. Two reviewers will independently screen for study eligibility and data extraction. Risk of bias and assessment of the quality of the included studies will be performed by using the Critical Appraisal Skills Programme (CASP) checklist. Data will be analysed and summarised using a narrative description of the available evidence across studies. This systematic review protocol will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. Ethics and dissemination Since this systematic review will be based on published studies, ethical approval is not required. Findings will be presented at La Trobe University, in Conferences and Congresses, and published in a peer-reviewed journal. Trial registration number CRD42016037492. PMID:27895065

  17. The Burden of Eclampsia: Results from a Multicenter Study on Surveillance of Severe Maternal Morbidity in Brazil

    PubMed Central

    Giordano, Juliana C.; Parpinelli, Mary A.; Cecatti, Jose G.; Haddad, Samira M.; Costa, Maria L.; Surita, Fernanda G.; Pinto e Silva, Joao L.; Sousa, Maria H.

    2014-01-01

    Objective Maternal mortality (MM) is a core indicator of disparities in women’s rights. The study of Near Miss cases is strategic to identifying the breakdowns in obstetrical care. In absolute numbers, both MM and occurrence of eclampsia are rare events. We aim to assess the obstetric care indicators and main predictors for severe maternal outcome from eclampsia (SMO: maternal death plus maternal near miss). Methods Secondary analysis of a multicenter, cross-sectional study, including 27 centers from all geographic regions of Brazil, from 2009 to 2010. 426 cases of eclampsia were identified and classified according to the outcomes: SMO and non-SMO. We classified facilities as coming from low- and high-income regions and calculated the WHO’s obstetric health indicators. SPSS and Stata softwares were used to calculate the prevalence ratios (PR) and respective 95% confidence interval (CI) to assess maternal characteristics, clinical and obstetrical history, and access to health services as predictors for SMO, subsequently correlating them with the corresponding perinatal outcomes, also applying multiple regression analysis (adjusted for cluster effect). Results Prevalence of and mortality indexes for eclampsia in higher and lower income regions were 0.2%/0.8% and 8.1%/22%, respectively. Difficulties in access to health care showed that ICU admission (adjPR 3.61; 95% CI 1.77–7.35) and inadequate monitoring (adjPR 2.31; 95% CI 1.48–3.59) were associated with SMO. Conclusions Morbidity and mortality associated with eclampsia were high in Brazil, especially in lower income regions. Promoting quality maternal health care and improving the availability of obstetric emergency care are essential actions to relieve the burden of eclampsia. PMID:24825164

  18. Remote prognosis after primary cesarean delivery: the association of VBACs and recurrent cesarean deliveries with maternal morbidity

    PubMed Central

    Erez, Offer; Novack, Lena; Kleitman-Meir, Vered; Dukler, Doron; Erez-Weiss, Idit; Gotsch, Francesca; Mazor, Moshe

    2012-01-01

    Purpose To determine the effects of vaginal birth after cesarean (VBAC) versus repeated cesarean sections (RCS) after a primary cesarean section (CS), on the rate of intraoperative and postpartum maternal morbidity. Patients and methods This is a retrospective population-based cohort study. During the study period (1988–2005) there were 200,012 deliveries by 76,985 women at our medical center; 16,365 of them had a primary CS, of which 7429 women delivered a singleton infant after the primary CS, met the inclusion criteria, were included in our study, and were followed for four consecutive deliveries. Patients were divided into three study groups according to the outcome of their consecutive delivery after the primary CS: VBAC (n = 3622), elective CS (n = 1910), or an urgent CS (n = 1897). Survival analysis models were used to investigate the effect of the urgency of CS and the numbers of pregnancy predating the primary CS on peripartum complications. Results Women who failed a trial of labor had a higher rate of uterine rupture than those who had a VBAC. Patients who delivered by CS had a higher rate of endometritis than those giving birth vaginally. The rate of cesarean hysterectomy and transfer to other departments increased significantly at the fourth consecutive surgery (P = 0.02 and P = 0.003, respectively). VBAC was associated with a 55% reduction in the risk of intrapartum complications in comparison to a planned CS (hazard ratio [HR] 0.45; 95% confidence interval [CI]: 0.22–0.89. A greater maternal parity at the time of primary CS was associated with lower intrapartum and postpartum morbidities (HR 0.44; 95% CI: 0.24–0.79; HR 0.54; 95% CI: 0.47–0.62, respectively). Conclusions (1) A successful VBAC is associated with a reduction in the intrapartum complications; and (2) maternal morbidity increases substantially from the fourth consecutive cesarean delivery. PMID:22448111

  19. Estimating fetal morbidity and mortality resulting from cigarette smoke exposure by measuring cotinine levels in maternal serum.

    PubMed

    Haddow, J E; Knight, G J; Palomaki, G E; Haddow, P K

    1988-01-01

    An essay for cotinine levels in maternal serum was used to define cigarette smoking exposure level and fetal morbidity and mortality. Cotinine, a metabolite of nicotine, has a circulating half-life of about a day, making it more reliable than nicotine as an indicator or active and passive smoke exposure. Maternal smoking has been linked in previous studies with low Apgar scores, low birthweight, decreased placental blood flow, fetal activity, fetal breathing movements, depressed prostacyclin synthesis in umbilical artery, increased perinatal mortality and spontaneous abortion. In this study, 8063 2nd trimester pregnant women whose serum had been collected and frozen in 1979-1983 were analyzed for smoking habit determined from intake questionnaires. Cotinine levels correlated with 95% of those reporting no smoking, and 93% of those reporting smoking. Smokers with cotinine 10 ng/ml was higher than expected, possible because some women quit before blood was drawn. Cotinine levels did not correlate as well as number of cigarettes per day reported. There was a significant association between serum cotinine and birthweight at the 10 and 20 cigarette/day level, and a trend toward a link between cotinine and fetal deaths in 2nd and 3rd trimesters. Among infants of the 30% of women exposed to passive smoke whose serum cotinine levels were 1 ng/ml, the average birth weight was 107 g lower than those of non-exposed women, a difference remaining after controlling for maternal weight and height, infant's sex, maternal age, gravidity and education.

  20. Preventing infant and child morbidity and mortality due to maternal depression.

    PubMed

    Surkan, Pamela J; Patel, Shivani A; Rahman, Atif

    2016-10-01

    This review provides an overview of perinatal depression and its impacts on the health of mothers, their newborns, and young children in low- and middle-income countries (LMICs). We define and describe the urgency and scope of the problem of perinatal depression for mothers, while highlighting some specific issues such as suicidal ideation and decreased likelihood to seek health care. Pathways through which stress may link maternal depression to childhood growth and development (e.g., the hypo-pituitary axis) are discussed, followed by a summary of the adverse effects of depression on birth outcomes, parenting practices, and child growth and development. Although preliminary studies on the association between maternal depressive symptoms and maternal and child mortality exist, more research on these topics is needed. We describe the available interventions and suggest strategies to reduce maternal depressive symptoms in LMICs, including integration of services with existing primary health-care systems.

  1. Integrating interventions on maternal mortality and morbidity and HIV: a human rights-based framework and approach.

    PubMed

    Fried, Susanna; Harrison, Brianna; Starcevich, Kelly; Whitaker, Corinne; O'Konek, Tiana

    2012-12-15

    Maternal mortality and morbidity (MMM) and HIV represent interlinked challenges arising from common causes, magnifying their respective impacts and producing related consequences. Accordingly, an integrated response will lead to the most effective approach for both. Shared structural drivers include gender inequality; gender-based violence (including sexual violence); economic disempowerment; and stigma and discrimination in access to services or opportunities based on gender and HIV. Further, shared system-related drivers also contribute to a lack of effective access to acceptable, high-quality health services and other development resources from birth forward. HIV and MMM are connected in both outcomes and solutions: in sub-Saharan Africa, HIV is the leading cause of maternal death, while the most recent global report on HIV identifies prevention of unintended pregnancy and access to contraception as two of the most important HIV-related prevention efforts.1 Both are central to reducing unsafe abortion--another leading cause of maternal death globally, and particularly in Africa. A human rights-based framework helps to identify these shared determinants. A human rights-based approach works to establish the health-related human rights standards to which all women are entitled, as well to outline the indivisible and intersecting human rights principles which inform and guide efforts to prevent, protect from, respond to, and provide remedy for human rights violations-in this case related to HIV and maternal mortality and morbidity.The Millennium Declaration and Development Goals (MDGs) help to both set quantifiable goals for achieving the components identified within the human rights-based framework and document the international consensus that no single goal--such as those addressing HIV and MMM--can be achieved without progress on all development goals.

  2. Burden of severe maternal morbidity and association with adverse birth outcomes in sub–Saharan Africa and south Asia: protocol for a prospective cohort study

    PubMed Central

    2016-01-01

    Objectives The AMANHI morbidity study aims to quantify and describe severe maternal morbidities and assess their associations with adverse maternal, fetal and newborn outcomes in predominantly rural areas of nine sites in eight South Asian and sub–Saharan African countries. Methods AMANHI takes advantage of on–going population–based cohort studies covering approximately 2 million women of reproductive age with 1– to 3–monthly pregnancy surveillance to enrol pregnant women. Morbidity information is collected at five follow–up home visits – three during the antenatal period at 24–28 weeks, 32–36 weeks and 37+ weeks of pregnancy and two during the postpartum period at 1–6 days and after 42–60 days after birth. Structured–questionnaires are used to collect self–reported maternal morbidities including hemorrhage, hypertensive disorders, infections, difficulty in labor and obstetric fistula, as well as care–seeking for these morbidities and outcomes for mothers and babies. Additionally, structured questionnaires are used to interview birth attendants who attended women’s deliveries. All protocols were harmonised across the sites including training, implementation and operationalising definitions for maternal morbidities. Importance of the AMANHI morbidity study Availability of reliable data to synthesize evidence for policy direction, interventions and programmes, remains a crucial step for prioritization and ensuring equitable delivery of maternal health interventions especially in high burden areas. AMANHI is one of the first large harmonized population–based cohort studies being conducted in several rural centres in South Asia and sub–Saharan Africa, and is expected to make substantial contributions to global knowledge on maternal morbidity burden and its implications. PMID:27648256

  3. Growth and Morbidity of Gambian Infants are Influenced by Maternal Milk Oligosaccharides and Infant Gut Microbiota

    PubMed Central

    Davis, Jasmine C. C.; Lewis, Zachery T.; Krishnan, Sridevi; Bernstein, Robin M.; Moore, Sophie E.; Prentice, Andrew M.; Mills, David A.; Lebrilla, Carlito B.; Zivkovic, Angela M.

    2017-01-01

    Human milk oligosaccharides (HMOs) play an important role in the health of an infant as substrate for beneficial gut bacteria. Little is known about the effects of HMO composition and its changes on the morbidity and growth outcomes of infants living in areas with high infection rates. Mother’s HMO composition and infant gut microbiota from 33 Gambian mother/infant pairs at 4, 16, and 20 weeks postpartum were analyzed for relationships between HMOs, microbiota, and infant morbidity and growth. The data indicate that lacto-N-fucopentaose I was associated with decreased infant morbidity, and 3′-sialyllactose was found to be a good indicator of infant weight-for-age. Because HMOs, gut microbiota, and infant health are interrelated, the relationship between infant health and their microbiome were analyzed. While bifidobacteria were the dominant genus in the infant gut overall, Dialister and Prevotella were negatively correlated with morbidity, and Bacteroides was increased in infants with abnormal calprotectin. Mothers nursing in the wet season (July to October) produced significantly less oligosaccharides compared to those nursing in the dry season (November to June). These results suggest that specific types and structures of HMOs are sensitive to environmental conditions, protective of morbidity, predictive of growth, and correlated with specific microbiota. PMID:28079170

  4. Growth and Morbidity of Gambian Infants are Influenced by Maternal Milk Oligosaccharides and Infant Gut Microbiota

    NASA Astrophysics Data System (ADS)

    Davis, Jasmine C. C.; Lewis, Zachery T.; Krishnan, Sridevi; Bernstein, Robin M.; Moore, Sophie E.; Prentice, Andrew M.; Mills, David A.; Lebrilla, Carlito B.; Zivkovic, Angela M.

    2017-01-01

    Human milk oligosaccharides (HMOs) play an important role in the health of an infant as substrate for beneficial gut bacteria. Little is known about the effects of HMO composition and its changes on the morbidity and growth outcomes of infants living in areas with high infection rates. Mother’s HMO composition and infant gut microbiota from 33 Gambian mother/infant pairs at 4, 16, and 20 weeks postpartum were analyzed for relationships between HMOs, microbiota, and infant morbidity and growth. The data indicate that lacto-N-fucopentaose I was associated with decreased infant morbidity, and 3‧-sialyllactose was found to be a good indicator of infant weight-for-age. Because HMOs, gut microbiota, and infant health are interrelated, the relationship between infant health and their microbiome were analyzed. While bifidobacteria were the dominant genus in the infant gut overall, Dialister and Prevotella were negatively correlated with morbidity, and Bacteroides was increased in infants with abnormal calprotectin. Mothers nursing in the wet season (July to October) produced significantly less oligosaccharides compared to those nursing in the dry season (November to June). These results suggest that specific types and structures of HMOs are sensitive to environmental conditions, protective of morbidity, predictive of growth, and correlated with specific microbiota.

  5. Impact of Restricted Maternal Weight Gain on Fetal Growth and Perinatal Morbidity in Obese Women With Type 2 Diabetes

    PubMed Central

    Ásbjörnsdóttir, Björg; Rasmussen, Signe S.; Kelstrup, Louise; Damm, Peter; Mathiesen, Elisabeth R.

    2013-01-01

    OBJECTIVE Since January 2008, obese women with type 2 diabetes were advised to gain 0–5 kg during pregnancy. The aim with this study was to evaluate fetal growth and perinatal morbidity in relation to gestational weight gain in these women. RESEARCH DESIGN AND METHODS A retrospective cohort comprised the records of 58 singleton pregnancies in obese women (BMI ≥30 kg/m2) with type 2 diabetes giving birth between 2008 and 2011. Birth weight was evaluated by SD z score to adjust for gestational age and sex. RESULTS Seventeen women (29%) gained ≤5 kg, and the remaining 41 gained >5 kg. The median (range) gestational weight gains were 3.7 kg (−4.7 to 5 kg) and 12.1 kg (5.5–25.5 kg), respectively. Prepregnancy BMI was 33.5 kg/m2 (30–53 kg/m2) vs. 36.8 kg/m2 (30–48 kg/m2), P = 0.037, and median HbA1c was 6.7% at first visit in both groups and decreased to 5.7 and 6.0%, P = 0.620, in late pregnancy, respectively. Gestational weight gain ≤5 kg was associated with lower birth weight z score (P = 0.008), lower rates of large-for-gestational-age (LGA) infants (12 vs. 39%, P = 0.041), delivery closer to term (268 vs. 262 days, P = 0.039), and less perinatal morbidity (35 vs. 71%, P = 0.024) compared with pregnancies with maternal weight gain >5 kg. CONCLUSIONS In this pilot study in obese women with type 2 diabetes, maternal gestational weight gain ≤5 kg was associated with a more proportionate birth weight and less perinatal morbidity. PMID:23248191

  6. Impact of training traditional birth attendants on maternal mortality and morbidity in Sub-Saharan Africa.

    PubMed

    Kayombo, Edmund J

    2013-04-01

    This paper presents discussion on impact of training traditional birth attendants (TBAs) on overall improvement of reproductive health care with focus on reducing the high rate of maternal and new-born mortality in rural settings in sub-Saharan Africa. The importance of TBAs for years has been denied by professional western trained health practitioners and other scientists until during the late 1980s, when World Health Organization through Safe motherhood 1987 found TBAs have a significant role in reducing maternal and new-born mortality. Trained TBAs in sub-Sahara Africa can have positive impact on reducing maternal and new-born mortality if the programme is well implemented with systematic follow-up after training. This could be done through joint meeting between health workers and TBAs as feed and learning experience from problem encountered in process of providing child delivery services. TBAs can help to break socio-cultural barriers on intervention on reproductive health programmes. However projects targeting TBAs should not be of hit and run; but gradually familiarize with the target group, build trust, transparency, and tolerance, willing to learn and creating rappour with them. In this paper, some case studies are described on how trained TBAs can be fully utilized in reducing maternal and new-born mortality rate in rural areas. What is needed is to identify TBAs, map their distribution and train them on basic primary healthcare related to child deliveries and complications which need to be referred to conventional health facilities immediately.

  7. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term

    PubMed Central

    Liu, Shiliang; Liston, Robert M.; Joseph, K.S.; Heaman, Maureen; Sauve, Reg; Kramer, Michael S.

    2007-01-01

    Background The rate of elective primary cesarean delivery continues to rise, owing in part to the widespread perception that the procedure is of little or no risk to healthy women. Methods Using the Canadian Institute for Health Information's Discharge Abstract Database, we carried out a retrospective population-based cohort study of all women in Canada (excluding Quebec and Manitoba) who delivered from April 1991 through March 2005. Healthy women who underwent a primary cesarean delivery for breech presentation constituted a surrogate “planned cesarean group” considered to have undergone low-risk elective cesarean delivery, for comparison with an otherwise similar group of women who had planned to deliver vaginally. Results The planned cesarean group comprised 46 766 women v. 2 292 420 in the planned vaginal delivery group; overall rates of severe morbidity for the entire 14-year period were 27.3 and 9.0, respectively, per 1000 deliveries. The planned cesarean group had increased postpartum risks of cardiac arrest (adjusted odds ratio [OR] 5.1, 95% confidence interval [CI] 4.1–6.3), wound hematoma (OR 5.1, 95% CI 4.6–5.5), hysterectomy (OR 3.2, 95% CI 2.2–4.8), major puerperal infection (OR 3.0, 95% CI 2.7–3.4), anesthetic complications (OR 2.3, 95% CI 2.0–2.6), venous thromboembolism (OR 2.2, 95% CI 1.5–3.2) and hemorrhage requiring hysterectomy (OR 2.1, 95% CI 1.2–3.8), and stayed in hospital longer (adjusted mean difference 1.47 d, 95% CI 1.46–1.49 d) than those in the planned vaginal delivery group, but a lower risk of hemorrhage requiring blood transfusion (OR 0.4, 95% CI 0.2–0.8). Absolute risk increases in severe maternal morbidity rates were low (e.g., for postpartum cardiac arrest, the increase with planned cesarean delivery was 1.6 per 1000 deliveries, 95% CI 1.2–2.1). The difference in the rate of in-hospital maternal death between the 2 groups was nonsignificant (p = 0.87). Interpretation Although the absolute difference is

  8. [Nature of the relation of acute appendicitis morbidity to meteorological and heliogeophysical factors].

    PubMed

    Khaavel', A A; Birkenfeldt, R R

    1978-04-01

    The authors analyzed 2009 appendicitis case records for the period from 1964 to 1973. In a sea climate region an evident season distribution of the apendicitis morbidity was found, with the rise of the incidence rate in January, March and April. The rise of the appendicitis incidence rate during the periods of vast fluctuations of air temperature, increase of air humidity and decrease of actual duration of sun radiance was established. The rise of the incidence of acute appendicitis was also noted during the months of a great and extremely great magnetic storms.

  9. Acute urinary morbidity after a permanent 125I implantation for localized prostate cancer.

    PubMed

    Ohga, Saiji; Nakamura, Katsumasa; Shioyama, Yoshiyuki; Tatsugami, Katsunori; Sasaki, Tomonari; Nonoshita, Takeshi; Yoshitake, Tadamasa; Asai, Kaori; Hirata, Hideki; Naito, Seiji; Honda, Hiroshi

    2014-11-01

    We evaluated the predictive factors of acute urinary morbidity (AUM) after prostate brachytherapy. From November 2005 to January 2007, 62 patients with localized prostate cancer were treated using brachytherapy. The (125)Iodine ((125)I) seed-delivering method was a modified peripheral pattern. The prescribed dose was 144 Gy. Urinary morbidity was scored at 3 months after implantation. The clinical and treatment parameters were analysed for correlation with AUM. In particular, in this study, Du90 (the minimal dose received by 90% of the urethra), Dup90 (the minimal dose received by 90% of the proximal half of the urethra on the bladder side) and Dud90 (the minimal dose received by 90% of the distal half of the urethra on the penile side) were analysed. We found that 43 patients (69.4%) experienced acute urinary symptoms at 3 months after implantation. Of them, 40 patients had Grade 1 AUM, one patient had Grade 2 pain, and two patients had Grade 2 urinary frequency. None of the patients had ≥Grade 3. Univariate and multivariate analysis revealed that Du90 and Dup90 were significantly correlated with AUM. In this study, Du90 and Dup90 were the most significant predictors of AUM after prostate brachytherapy.

  10. [Healthcare and maternal morbidity and mortality: a hospital-based case-control study in two regions of Colombia (Bogotá and Antioquia), 2009-2011].

    PubMed

    Yepes, Francisco J; Gómez, Joaquin G; Zuleta, John Jairo; Londoño, Juan Luis; Acosta-Reyes, Jorge Luis; Sánchez-Gómez, Luz Helena; Ramírez, Marta L

    2016-11-01

    The study aimed to identify whether payment forms and insurance schemes are associated with severe obstetric complications and maternal mortality. A hospital-based case-control study was conducted in two regions of Colombia, 2009-2011. Data were obtained from each woman's clinical history. Unconditional logistic regression was used. The sample included 1,011 patients: 337 cases and 674 controls. No quality component was statistically significant in either region. In Bogotá, the risk of obstetric complications was significantly higher in the contributive insurance scheme than in subsidized coverage or uninsured; Antioquia showed similar associations, but not statistically significant. Differences in maternal morbidity according to payment scheme were not statistically significant in either Antioquia or Bogotá. Factors associated with maternal morbidity and mortality differed according to the study population, suggesting the need for local studies to identify determinants and make appropriate decisions.

  11. Surgical audit: A prospective study of the morbidity and mortality of acute appendicitis.

    PubMed

    Malatani, T S; Latif, A A; Al-Saigh, A; Cheema, M A; Abu-Eshy, S

    1991-03-01

    Between March and September 1989, acute apendicitis was clinically diagnosed in 317 patients who were studied as part of a prospective surgical audit. The study was designed to determine the accuracy of diagnosis, comparison of the macroscopic appearance of the appendix at operation, and subsequent histopathology and complications associated with the morbidity and mortality of emergency appendectomy. The clinical diagnosis was correct in 278 patients (88%). Thirty-nine (12%) of the patients had a negative laparotomy. There was no mortality, and wound infection was the source of increased morbidity in 37 (12%) patients. The highest incidence of wound infection was among those who had pus in the peritoneum (20%) or had a perforated or gangrenous appendix (25%). When the macroscopic appearance of the appendix was compared with the subsequent histopathological findings, a false positive error of 7% and a false negative error of 42% was found. During appendectomy the gross appearance of the appendix must be carefully noted so that a meticulous surgical technique can be complemented by appropriate antibiotic prophylaxis against wound infection, started at the time of surgery.

  12. Postpartum depression and infant-mother attachment security at one year: The impact of co-morbid maternal personality disorders.

    PubMed

    Smith-Nielsen, Johanne; Tharner, Anne; Steele, Howard; Cordes, Katharina; Mehlhase, Heike; Vaever, Mette Skovgaard

    2016-08-01

    Previous studies on effects of postpartum depression (PPD) on infant-mother attachment have been divergent. This may be due to not taking into account the effects of stable difficulties not specific for depression, such as maternal personality disorder (PD). Mothers (N=80) were recruited for a longitudinal study either during pregnancy (comparison group) or eight weeks postpartum (clinical group). Infants of mothers with depressive symptoms only or in combination with a PD diagnosis were compared with infants of mothers with no psychopathology. Depression and PD were assessed using self-report and clinical interviews. Infant-mother attachment was assessed when infants were 13 months using Strange Situation Procedure (SSP). Attachment (in)security was calculated as a continuous score based on the four interactive behavioral scales of the SSP, and the conventional scale for attachment disorganization was used. PPD was associated with attachment insecurity only if the mother also had a PD diagnosis. Infants of PPD mothers without co-morbid PD did not differ from infants of mothers with no psychopathology. These results suggest that co-existing PD may be crucial in understanding how PPD impacts on parenting and infant social-emotional development. Stable underlying factors may magnify or buffer effects of PPD on parenting and child outcomes.

  13. Acute urinary morbidity following I-125 interstitial implantation of the prostate gland.

    PubMed

    Desai, J; Stock, R G; Stone, N N; Iannuzzi, C; DeWyngaert, J K

    1998-01-01

    The objective of this paper was to evaluate the acute urinary morbidity associated with I-125 interstitial implantation of the prostate gland. From 1991-1995, 117 patients underwent ultrasound (U/S)-guided implantation of the prostate gland. Median dose to 90% of the gland (d90) was 14.68 Gy (range = 1.65-21.75 Gy). The patients' urinary symptoms were recorded pre-implantation and at regular intervals after implantation using the International Prostate Symptom Score (IPSS), a self-assessment questionnaire in which patients scored 7 symptoms: incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia. Median follow-up was 12 months. The natural history of implant-related urinary symptoms was assessed in this manner. In addition, dosimetric factors including U/S prostate volume, total activity, activity per seed, dose volume histogram (DVH) values for dose to gland, and dose area histogram (DAH) values for dose to urethra and bladder were examined for correlation to the severity of each symptom as well as to total IPSS (sum of the individual symptom scores). Total IPSS peaked at 1 month post-implant and gradually returned to approximately baseline at 24 months. Total IPSS directly correlated with total activity and DVH for the prostate. Total IPSS, however, did not correlate with bladder or urethral DAH. With the exception of frequency, individual symptoms did not correlate with dose to gland, bladder, or urethra. Frequency scores did, however, correlate not only with dose to prostate gland but also dose to urethra. The acute urinary side effects of I-125 prostate implantation are transient and peak at 1 month post-implant. The severity of the urinary irritative symptoms developed are closely related to total dose to the gland. Urethral dose appears to affect frequency most significantly. Urinary symptoms, therefore, may be a limiting factor when considering dose escalation with I-125.

  14. Racial/ethnic disparities in maternal morbidities: a statewide study of labor and delivery hospitalizations in Wisconsin.

    PubMed

    Cabacungan, Erwin T; Ngui, Emmanuel M; McGinley, Emily L

    2012-10-01

    We examined racial/ethnic disparities in maternal morbidities (MM) and the number of MM during labor and delivery among hospital discharges in Wisconsin. We conducted a retrospective cohort study of hospital discharge data for 206,428 pregnant women aged 13-53 years using 2005-2007 Healthcare Cost and Utilization Project State Inpatient Dataset (HCUP-SID) for Wisconsin. After adjustments for covariates, MM (preterm labor, antepartum and postpartum hemorrhage, hypertension in pregnancy, gestational diabetes, membrane-related disorders, infections and 3rd and 4th perineal lacerations) were examined using logistic regression models, and number of MM (0, 1, 2, >2 MM) were examined using multivariable ordered logistic regressions with partial proportional odds models. African-Americans had significantly higher likelihood of infections (OR = 1.74; 95% CI 1.60-1.89), preterm labor (OR = 1.42; 1.33-1.50), antepartum hemorrhage (OR = 1.63; 1.44-1.83), and hypertension complicating pregnancy (OR = 1.39; 1.31-1.48) compared to Whites. Hispanics, Asian/Pacific Islanders, and Native Americans had significantly higher likelihood of infections, postpartum hemorrhage, and gestational diabetes than Whites. Major perineal lacerations were significantly higher among Asian/Pacific Islanders (OR = 1.53; 1.34-1.75). All minority racial/ethnic groups, except Asians, had significantly higher likelihood of having 0 versus 1, 2 or >2 MM, 0 or 1 versus 2 or >2 MM, and 0, 1 or 2 versus >2 MM than white women. Findings show significant racial/ethnic disparities in MM, and suggest the need for better screening, management, and timely referral of these conditions, particularly among racial/ethnic women. Disparities in MM may be contributing to the high infant mortality and adverse birth outcomes among different racial/ethnic groups in Wisconsin.

  15. What Are the Factors That Interplay From Normal Pregnancy to Near Miss Maternal Morbidity in a Nigerian Tertiary Health Care Facility?

    PubMed Central

    Adeoye, Ikeola A.; Ijarotimi, Omotade O.; Fatusi, Adesegun O.

    2015-01-01

    Researchers in Nigeria examined the epidemiological characteristics and factors associated with maternal outcomes using a mixed method approach: a prospective case control study design involving 375 pregnant women who received maternal care from a tertiary facility and in-depth interviews reporting the experience of near-miss survivors. A generalized ordered logit model was used to generate the estimates of partial proportional odds ratios (and 95% confidence intervals) across categories of the outcome variable. Factors strongly associated with maternal morbidity were late referral of women, presence of complications at booking antenatal visits, low birth weight, and severe birth asphyxia. The nearmiss women were further characterized, and a low proportion (25%) had organ dysfunction or failure. The challenge of such diagnoses in resource-constrained settings raises questions about the appropriateness of using organ dysfunction criteria in developing countries. PMID:25119488

  16. [Effect of sociocultural factors on maternal and perinatal morbidity with or without mortality among adolescents seen in 3 states of the Mexican Republic].

    PubMed

    León Carmona, Julio César; Hernández Alvarez, Luis Alfredo Ignacio; Hernández Hernández, Ma Adriana Cecilia

    2002-07-01

    This study was aimed on comparing the degree of association between social-cultural factors and maternal or perinatal morbidity and/or mortality of the adolescent. A paired case-control study was designed with adolescent in puerperal immediate stage affiliated to the Mexican Institute of Social Security from Tabasco, Tlaxcala and Northern Veracruz, that were adjusted to the selection criteria of the sample, between June of 1998 and February of 1999. Two groups were integrated, cases, with adolescent in puerperal immediate stage affected (with maternal or perinatal morbidity and/or mortality) and controls, with adolescent not affected in puerperal immediate stage. Information concerned to biological and social-cultural risk factors from each subject was obtained applying a validated survey (EFRASEMA 1) and checking their clinical file, whose information was poured in a database (EFRASEMA 2). Interviewers did not know the outcome of the study, which in turn assured the blindness of the information. Once data was obtained, subjects were assigned to each group of study. Matching factors were age, nutritional status, intergenesic interval and previous pregnancy systemic pathology. Proportion of subjects, cases and controls; with or without social-cultural risk factors was determined. The risk of maternal or perinatal morbidity and/or mortality in the exposed subjects was estimated by odds ratio (OR) and the differences inferred through Mantel and Haenszel chi 2 and Fisher's exact tests (confidence intervals alpha = 0.05 and beta = 0.2). There was a sample of 486 subject, 44 were eliminated due to insufficient data. Studied population was integrated finally with 221 cases and 221 paired controls 1: 1. 71.950% of participants were married, 22.62% in free union, 4.98% single and 0.45% separate, average global age was 17.98 +/- 1.39 years. The inferential analysis showed an OR 0.64 (Cornfield 95% confidence limits: 0.40 < OR < 1.03, p = 0.0510600) concerning desired

  17. [Epidemiological analysis on morbidity of acute flaccid paralysis (AFP) among children under 15 years old in 14 provinces of China].

    PubMed

    Zhang, X L; Wang, K A

    1995-12-01

    Five investigations through analysis of hospital records on morbidity of Acute Flaccid Paralysis (AFP) among children under 15 years old in 14 provinces of China have currently been conducted. In this paper, data from a series of studies published in journals or reported to meetings was combined and analyzed based on Meta-Analysis. Comparisons have been made between AFP, poliomyelitis, Guillian-Barre Syndrome (GBS) and non-polio AFP morbidities and their distributions by age, sex and month. The morbidity rates for these four categories were 1.41, 0.54, 0.55 and 1.05 per 10(5) respectively. An important conclusion drawn from of this study was that the criterion put forward by WHO, reported rate of non-polio AFP should reach over 1.0 per 10(5) among children under 15, can also be used as an indicator for sensitivity evaluation and monitoring of AFP surveillance system in China.

  18. Maternal Plasma Retinol Binding Protein 4 in Acute Pyelonephritis during Pregnancy

    PubMed Central

    Vaisbuch, Edi; Romero, Roberto; Mazaki-Tovi, Shali; Kusanovic, Juan Pedro; Chaiworapongsa, Tinnakorn; Dong, Zhong; Kim, Sun Kwon; Ogge, Giovanna; Gervasi, Maria Teresa; Hassan, Sonia S.

    2010-01-01

    Objective Adipokines have been implicated in metabolic regulation and the immune response thus providing a molecular mechanism for the interaction between these two systems. Retinol binding protein 4 (RBP4) is a novel adipokine that plays a role in the pathophysiology of obesity-induced insulin resistance, as well as in the modulation of inflammation. The aim of this study was to determine whether there are changes in maternal plasma concentrations of RBP4 in pregnant women with acute pyelonephritis. Study design This cross-sectional study included pregnant women in the following groups: 1) normal pregnancy (n=80); 2) pyelonephritis (n=39). Maternal plasma RBP4 concentrations were determined by enzyme-linked immunoassays. Non-parametric statistics were used for analyses. Results 1) The median maternal plasma RBP4 concentration was lower in patients with acute pyelonephritis than in those with a normal pregnancy (3709.6 ng/mL, IQR 2917.7-5484.2 vs. 9167.6 ng/mL, IQR 7496.1-10384.1, p<0.001; 2) the median maternal plasma RBP4 concentration did not differ significantly between patients with acute pyelonephritis who had a positive blood culture and those with a negative culture (3285.3 ng/mL, IQR 2274.1-4741.1 vs. 3922.6 ng/mL, IQR 3126.8-5547.1, respectively, p=0.2); and 3) lower maternal plasma RBP4 concentrations were independently associated with pyelonephritis after adjustment for confounding factors. Conclusions In contrast to what has been reported in preeclampsia, acute pyelonephritis during pregnancy is associated with lower maternal plasma RBP4 concentrations than in normal pregnancy. This finding suggests that the acute maternal inflammatory process associated with pyelonephritis is fundamentally different from that of the chronic systemic inflammatory process suggested in preeclampsia, in which RBP4 concentrations were found to be elevated. PMID:20163326

  19. Risk of preterm delivery and hypertensive disorders of pregnancy in relation to maternal co-morbid mood and migraine disorders during pregnancy.

    PubMed

    Cripe, Swee May; Frederick, Ihunnaya O; Qiu, Chunfang; Williams, Michelle A

    2011-03-01

    We evaluated the risks of preterm delivery and hypertensive disorders of pregnancy among pregnant women with mood and migraine disorders, using a cohort study of 3432 pregnant women. Maternal pre-pregnancy or early pregnancy (<20 weeks gestation) mood disorder and pre-pregnancy migraine diagnoses were ascertained from interview and medical record review. We fitted generalised linear models to derive risk ratios (RR) and 95% confidence intervals (CI) of preterm delivery and hypertensive disorders of pregnancy for women with isolated mood, isolated migraine and co-morbid mood-migraine disorders, respectively. Reported RR were adjusted for maternal age, race/ethnicity, marital status, parity, smoking status, chronic hypertension or pre-existing diabetes mellitus, and pre-pregnancy body mass index. Women without mood or migraine disorders were defined as the reference group. The risks for preterm delivery and hypertensive disorders of pregnancy were more consistently elevated among women with co-morbid mood-migraine disorders than among women with isolated mood or migraine disorder. Women with co-morbid disorders were almost twice as likely to deliver preterm (adjusted RR=1.87, 95% CI 1.05, 3.34) compared with the reference group. There was no clear evidence of increased risks of preterm delivery and its subtypes with isolated migraine disorder. Women with mood disorder had elevated risks of pre-eclampsia (adjusted RR=3.57, 95% CI 1.83, 6.99). Our results suggest an association between isolated migraine disorder and pregnancy-induced hypertension (adjusted RR=1.42, 95% CI 1.00, 2.01). This is the first study examining perinatal outcomes in women with co-morbid mood-migraine disorders. Pregnant women with a history of migraine may benefit from screening for depression during prenatal care and vigilant monitoring, especially for women with co-morbid mood and migraine disorders.

  20. Could introducing vacuum delivery into the education curriculum of community midwives in Yemen improve maternal and neonatal mortality and morbidity outcomes?

    PubMed

    Kizler, Rose; Hollins Martin, Caroline J

    2013-03-01

    At present in Yemen the neonatal mortality rate stands at 12%. A contributing factor is that when abnormalities arise during labour in rural areas, there is an absence of trained medical staff to manage complications. Consequently, childbearing women are expected to travel long distances to hospitals to receive Essential Obstetric Care (EOC). This paper presents a debate over whether vacuum delivery should be introduced into the education curriculum of community midwifery courses in Yemen. It is proposed that this fundamental change to both the educational system and the community midwives role could facilitate a reduction in maternal and neonatal mortality and morbidity figures in Yemen.

  1. Acute Fetal Demise with First Trimester Maternal Infection Resulting from Listeria monocytogenes in a Nonhuman Primate Model.

    PubMed

    Wolfe, Bryce; Wiepz, Gregory J; Schotzko, Michele; Bondarenko, Gennadiy I; Durning, Maureen; Simmons, Heather A; Mejia, Andres; Faith, Nancy G; Sampene, Emmanuel; Suresh, Marulasiddappa; Kathariou, Sophia; Czuprynski, Charles J; Golos, Thaddeus G

    2017-02-21

    Infection with Listeria monocytogenes during pregnancy is associated with miscarriage, preterm birth, and neonatal complications, including sepsis and meningitis. While the risk of these conditions is thought to be greatest during the third trimester of pregnancy, the determinants of fetoplacental susceptibility to infection, the contribution of gestational age, and the in vivo progression of disease at the maternal-fetal interface are poorly understood. We developed a nonhuman primate model of listeriosis to better understand antecedents of adverse pregnancy outcomes in early pregnancy. Four pregnant cynomolgus macaques (Macaca fascicularis) received a single intragastric inoculation between days 36 and 46 of gestation with 10(7) CFU of an L. monocytogenes strain isolated from a previous cluster of human listeriosis cases that resulted in adverse pregnancy outcomes. Fecal shedding, maternal bacteremia, and fetal demise were consistently noted within 7 to 13 days. Biopsy specimens of maternal liver, spleen, and lymph node displayed variable inflammation and relatively low bacterial burden. In comparison, we observed greater bacterial burden in the decidua and placenta and the highest burden in fetal tissues. Histopathology indicated vasculitis, fibrinoid necrosis, and thrombosis of the decidual spiral arteries, acute chorioamnionitis and villitis in the placenta, and hematogenous infection of the fetus. Vascular pathology suggests early impact of L. monocytogenes infection on spiral arteries in the decidua, which we hypothesize precipitates subsequent placentitis and fetal demise. These results demonstrate that L. monocytogenes tropism for the maternal reproductive tract results in infection of the decidua, placenta, and the fetus itself during the first trimester of pregnancy.IMPORTANCE Although listeriosis is known to cause significant fetal morbidity and mortality, it is typically recognized in the third trimester of human pregnancy. Its impact on early

  2. Acute childhood diarrhoea and maternal time allocation in the northern central Sierra of Peru.

    PubMed

    Bentley, M E; Elder, J; Fukumoto, M; Stallings, R H; Jacoby, E; Brown, K

    1995-03-01

    Interventions to improve child health depend, at least implicitly, on changing maternal knowledge and behaviour and a reallocation of maternal time. There have been few studies, however, of the time cost involved in the adoption of new health technologies and even fewer that examine changes in maternal activities in response to child illness. The present study examines maternal daytime activities and investigates changes that occur when children are ill. We examine the impact of acute childhood diarrhoea episodes on the activity patterns of the mother/caretaker in this setting. The results show that mothers alter their usual activity patterns only slightly in response to acute diarrhoea episodes in their children. They continue to perform the same variety of activities as when the children are healthy, although they are more likely to perform them with the child 'carried' on their back. There is some indication that diarrhoea perceived to be more severe did result in the mother acting as caretaker more frequently. These findings have important implications for health interventions that depend on changing the amount of maternal or caretaker time spent for child health technologies, but the implications may vary depending on the reasons for the observed lack of changes in caretaker activities.

  3. Longitudinal Assessment of Morbidity and Acute Graft-Versus-Host Disease after Allogeneic Hematopoietic Cell Transplantation: Retrospective Analysis of a Multicenter Phase III Study

    PubMed Central

    Carnevale-Schianca, Fabrizio; Leisenring, Wendy; Martin, Paul J.; Furlong, Terry; Schoch, Gary; Anasetti, Claudio; Appelbaum, Frederick R.; Carpenter, Paul A.; Deeg, H. Joachim; Kiem, Hans-Peter; Storb, Rainer; McDonald, George B.; Nash, Richard A.

    2009-01-01

    Since morbidity early after HCT results in large part from the development of acute GVHD, we previously proposed that a longitudinal assessment of morbidity involving the skin, liver, and gastrointestinal tract might provide a more complete, objective approach for comparing two arms of open-label randomized clinical trials for acute GVHD prevention. In the current study, we determined both morbidity-across-time and GVHD-across-time in a retrospective analysis of a database from an open-label randomized clinical trial comparing tacrolimus/methotrexate versus cyclosporine/methotrexate after myeloablative conditioning and marrow transplantation from HLA-matched unrelated donors. The results confirmed differences in overall morbidity across time among patients with peak grades II-IV GVHD as compared to those with grades 0-I GVHD, but no significant differences were found between morbidity associated with grade II GVHD as compared to grades 0-I GVHD. We observed less skin and a trend towards less liver morbidity across time in the tacrolimus group (p=0.04; p= 0.09, respectively) but not for gastrointestinal or overall morbidity, despite significantly decreased skin and liver stages and overall grades of GVHD-across-time in the tacrolimus arm. In conclusion, an objective assessment of differences in morbidity (regardless of cause) as a measure of acute GVHD in a randomized clinical tria of acute GVHD prevention had limited utility. The difficulty of demonstrating clinical benefits from objective parameters such as survival and morbidity and the subjectivity of grading acute GVHD emphasize that blinded assessments are required in clinical trials of GVHD prevention. PMID:19450760

  4. Association of Hyperglycemia with In-Hospital Mortality and Morbidity in Libyan Patients with Diabetes and Acute Coronary Syndromes

    PubMed Central

    Benamer, Sufyan; Eljazwi, Imhemed; Mohamed, Rima; Masoud, Heba; Tuwati, Mussa; Elbarsha, Abdulwahab M.

    2015-01-01

    Objective Hyperglycemia on admission and during hospital stay is a well-established predictor of short-term and long-term mortality in patients with acute myocardial infarction. Our study investigated the impact of blood glucose levels on admission and in-hospital hyperglycemia on the morbidity and mortality of Libyan patients admitted with acute coronary syndromes (acute myocardial infarction and unstable angina). Methods In this retrospective study, the records of patients admitted with acute coronary syndrome to The 7th Of October Hospital, Benghazi, Libya, between January 2011 and December 2011 were reviewed. The level of blood glucose on admission, and the average blood glucose during the hospital stay were recorded to determine their effects on in-hospital complications (e.g. cardiogenic shock, acute heart failure, arrhythmias, and/or heart block) and mortality. Results During the study period, 121 patients with diabetes were admitted with acute coronary syndrome. The mortality rate in patients with diabetes and acute coronary syndrome was 12.4%. Patients with a mean glucose level greater than 200mg/dL had a higher in-hospital mortality and a higher rate of complications than those with a mean glucose level ≤200mg/dL (27.5% vs. 2.6%, p<0.001 and 19.7% vs. 45.5%, p=0.004, respectively). There was no difference in in-hospital mortality between patients with a glucose level at admission ≤140mg/dL and those admitted with a glucose level >140mg/dL (6.9% vs. 14.3%; p=0.295), but the rate of complications was higher in the latter group (13.8% vs. 34.1%; p=0.036). Patients with admission glucose levels >140mg/dL also had a higher rate of complications at presentation (26.4% vs. 6.9%; p=0.027). Conclusion In patients with diabetes and acute coronary syndrome, hyperglycemia during hospitalization predicted a worse outcome in terms of the rates of in-hospital complications and in-hospital mortality. Hyperglycemia at the time of admission was also associated with

  5. Social differentiation and embodied dispositions: a qualitative study of maternal care-seeking behaviour for near-miss morbidity in Bolivia

    PubMed Central

    Rööst, Mattias; Jonsson, Cecilia; Liljestrand, Jerker; Essén, Birgitta

    2009-01-01

    Background Use of maternal health care in low-income countries has been associated with several socioeconomic and demographic factors, although contextual analyses of the latter have been few. A previous study showed that 75% of women with severe obstetric morbidity (near-miss) identified at hospitals in La Paz, Bolivia were in critical conditions upon arrival, underscoring the significance of pre-hospital barriers also in this setting with free and accessible maternal health care. The present study explores how health care-seeking behaviour for near-miss morbidity is conditioned in La Paz, Bolivia. Methods Thematic interviews with 30 women with a near-miss event upon arrival at hospital. Near-miss was defined based on clinical and management criteria. Modified analytic induction was applied in the analysis that was further influenced by theoretical views that care-seeking behaviour is formed by predisposing characteristics, enabling factors, and perceived need, as well as by socially shaped habitual behaviours. Results The self-perception of being fundamentally separated from "others", meaning those who utilise health care, was typical for women who customarily delivered at home and who delayed seeking medical assistance for obstetric emergencies. Other explanations given by these women were distrust of authority, mistreatment by staff, such as not being kept informed about their condition or the course of their treatment, all of which reinforced their dissociation from the health-care system. Conclusion The findings illustrate health care-seeking behaviour as a practise that is substantially conditioned by social differentiation. Social marginalization and the role health institutions play in shaping care-seeking behaviour have been de-emphasised by focusing solely on endogenous cultural factors in Bolivia. PMID:19640286

  6. [Selective D1-receptor antagonist SCH23390 decreases maternal reactions in rats upon acute and chronic injections in postpartum period].

    PubMed

    Tanaeva, K K; Dobriakova, Iu V; Dubynin, V A; Kamenskiĭ, A A

    2012-01-01

    The influence of the D1-receptor antagonist SCH23390 on the maternal behavior of female rats has been studied. It is established that a comparatively high dose of the drug (acute injections) significantly decreases both the locomotor activity and manifestations of the parental care. Lower dosages do not affect the locomotor activity, but still suppress the maternal behavior (after both acute and chronic injections of SCH23390). The obtained results are discussed in terms of the analysis of the maternal motivation mechanisms and the development of the D1-induced postpartum depression.

  7. [Strategies to reduce morbidity and mortality caused by acute diarrhea in Latin America].

    PubMed

    Mota-Hernández, F

    1990-01-01

    Following the World Health Organization guidelines, the Latin American Diarrheal Disease Control Programs have directed its efforts towards the promotion of Oral Hydration Therapy (OHT) and appropriate dietary management during the diarrheal episode and convalescent period, aimed at diminishing the mortality secondary to diarrhea. In developing countries, OHT is preventing, annually, one million of childhood deaths due to dehydration. Yet, only one fourth of the total population of children suffering diarrhea are being treated with this therapy. Among the strategies to decrease diarrhea morbidity, breast-feeding and hand washing are top priorities. The fundamental strategy has been to promote educational programs to train health personnel and community members. To continue these actions, we suggested the creation of more secondary and tertiary level hospitals and the installation of community units of OHT. They should become self-sufficient and self-manageable and include other programs of primary health care, such as immunization, growth and development surveillance, family planning and pregnancy control.

  8. Comparison of maternal morbidity and medical costs during pregnancy and delivery between patients with gestational diabetes and patients with pre-existing diabetes

    PubMed Central

    Son, K H; Lim, N-K; Lee, J-W; Cho, M-C; Park, H-Y

    2015-01-01

    Aims To evaluate the effects of gestational diabetes and pre-existing diabetes on maternal morbidity and medical costs, using data from the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. Methods Delivery cases in 2010, 2011 and 2012 (459 842, 442 225 and 380 431 deliveries) were extracted from the Health Insurance Review and Assessment Service database. The complications and medical costs were compared among the following three pregnancy groups: normal, gestational diabetes and pre-existing diabetes. Results Although, the rates of pre-existing diabetes did not fluctuate (2.5, 2.4 and 2.7%) throughout the study, the rate of gestational diabetes steadily increased (4.6, 6.2 and 8.0%). Furthermore, the rates of pre-existing diabetes and gestational diabetes increased in conjunction with maternal age, pre-existing hypertension and cases of multiple pregnancy. The risk of pregnancy-induced hypertension, urinary tract infections, premature delivery, liver disease and chronic renal disease were greater in the gestational diabetes and pre-existing diabetes groups than in the normal group. The risk of venous thromboembolism, antepartum haemorrhage, shoulder dystocia and placenta disorder were greater in the pre-existing diabetes group, but not the gestational diabetes group, compared with the normal group. The medical costs associated with delivery, the costs during pregnancy and the number of in-hospital days for the subjects in the pre-existing diabetes group were the highest among the three groups. Conclusions The study showed that the rates of pre-existing diabetes and gestational diabetes increased with maternal age at pregnancy and were associated with increases in medical costs and pregnancy-related complications. PMID:25472691

  9. Conundrums in the management of malignant ovarian germ cell tumors: Toward lessening acute morbidity and late effects of treatment.

    PubMed

    Gershenson, David M; Frazier, A Lindsay

    2016-11-01

    One of the most extraordinary stories in the chronicles of gynecologic cancers has been that of malignant ovarian germ cell tumors. Prior to the mid-1960s, most patients died of disease. Fifty years later, most survive. Precisely because high cure rates are achievable, the concentration over the past decade has been on minimizing toxicity and late effects. The present review focuses on five areas of interest related to the management of malignant ovarian germ cell tumors that highlight the different therapeutic strategies practiced by pediatric and gynecologic oncologists: 1) primary surgery, 2) surgery alone (surveillance) for patients with FIGO stage IA disease, 3) postoperative management of FIGO stage IC-III disease, 4) postoperative management of pure immature teratoma, and 5) postoperative management of metastatic pure dysgerminoma. All of these topics share a common overarching theme: Lessening acute morbidity and late effects of treatment.

  10. Upper extremity acute compartment syndrome during tissue plasminogen activator therapy for pulmonary embolism in a morbidly obese patient

    PubMed Central

    Tuna, Serkan; Duymus, Tahir Mutlu; Mutlu, Serhat; Ketenci, Ismail Emre; Ulusoy, Ayhan

    2015-01-01

    Introduction Deep vein thrombosis (DVT) and pulmonary embolism (PE) are more frequently observed in morbidly obese patients. Tissue plasminogen activator (tPA) is a thrombolytic agent which dissolves the thrombus more rapidly than conventional heparin therapy and reduces the mortality and morbidity rates associated with PE. Compartment syndrome is a well-known and documented complication of thrombolytic treatment. In awake, oriented and cooperative patients, the diagnosis of compartment syndrome is made based on clinical findings including swelling, tautness, irrational and continuous pain, altered sensation, and severe pain due to passive stretching. These clinical findings may not be able to be adequately assessed in unconscious patients. Presentation of case In this case report, we present compartment syndrome observed, for which fasciotomy was performed on the upper right extremity of a 46-year old morbidly obese, conscious female patient who was receiving tPA due to a massive pulmonary embolism. Discussion Compartment syndrome had occurred due to the damage caused by the repeated unsuccessful catheterisation attempts to the brachial artery and the accompanying tPA treatment. Thus, the bleeding that occurred in the volar compartment of the forearm and the anterior compartment of the arm led to acute compartment syndrome (ACS). After relaxation was brought about in the volar compartment of the forearm and the anterior compartment of the arm, the circulation in the limb was restored. Conclusion As soon as the diagnosis of compartment syndrome is made, an emergency fasciotomy should be performed. Close follow-up is required to avoid wound healing problems after the fasciotomy. PMID:25618841

  11. Predictive value of the fragmented QRS complex in 6-month mortality and morbidity following acute coronary syndrome

    PubMed Central

    Akbarzadeh, Fariborz; Pourafkari, Leili; Ghaffari, Samad; Hashemi, Mohammad; Sadeghi-Bazargani, Homayoun

    2013-01-01

    Background Fragmented QRS encompasses different RSR’ patterns showing various morphologies of the QRS complexes with or without the Q wave on a resting 12-lead electrocardiogram. It has been shown possibly to cause adverse cardiac outcomes in patients with some heart diseases, including coronary artery disease. In view of the need for risk stratification of patients presenting with acute coronary syndrome in the most efficacious and cost-effective way, we conducted this study to clarify the value of developing fragmented QRS in a cohort of patients presenting with their first acute coronary syndrome in predicting 6-month mortality and morbidity. Methods One hundred consecutive patients admitted to the coronary care unit at Shahid Madani Heart Center in Tabriz from December 2008 to March 2009 with their first acute coronary syndrome were enrolled in this prospective study. Demographic and electrocardiographic data on admission, inhospital mortality, and need for revascularization were recorded. Electrocardiography performed 2 months after the index event was examined for development of fragmented QRS. Mortality and morbidity was evaluated at 6-month follow-up in all patients. Results The patients were of mean age 57.7 ± 12.8 years, and 84% were men. The primary diagnosis was unstable angina in 17 (17%) patients, non-ST elevation myocardial infarction (MI) in 11 (11%), anterior or inferior ST elevation MI in 66 (66%), and postero-inferior MI in six (6%). Fragmented QRS was present in 30 (30%) patients during the first admission, which increased to 44% at the 2-month follow-up and to 53% at the 6-month follow-up. The presence of various coronary risk factors and drug therapy given, including fibrinolytic agents, had no effect on development of fragmented QRS. Mortality was significantly higher (P = 0.032) and left ventricular ejection fraction was significantly lower (P = 0.001) in the fragmented QRS group at the 6-month follow-up. Conclusion This study strongly

  12. [Morbidity and mortality of acute renal failure in neonatal period (author's transl)].

    PubMed

    Simón, J; Mendizábal, S; Zamora, I; Roques, V; Orive, B

    1979-04-01

    A retrospective study of 35 newborn with acute renal failure is presented. The main causes of renal failure were neonatal hypoxia by asfixia or hemorrhagic shock (eight), congenital malformations (two) and hypertonic dehydration (25). Mortality rate was 22% including two neonates with severe congenital malformations. Sepsis was considered as the main complicating factor and often as inducer of renal failure. It was present on 55% of cases and on 75% of the deceased newborn. Cerebral injury was frequent but a follow-up study is necessary to establish the rate of neurologic sequelae. Early diagnosis and treatment of renal failure will decrease complications with improvement in prognosis. Etiological analysis of neonatal renal failure shows the need of a better health education of people and also medical control of pregnancy and perinatal period.

  13. Maternal and offspring xenobiotic metabolism haplotypes and the risk of childhood acute lymphoblastic leukemia

    PubMed Central

    Nousome, Darryl; Lupo, Philip J.; Okcu, M. Fatih; Scheurer, Michael E.

    2013-01-01

    Discovering genetic predictors of childhood acute lymphoblastic leukemia (ALL) necessitates the evaluation of novel factors including maternal genetic effects, which are a proxy for the intrauterine environment, and robust epidemiologic study designs. Therefore, we evaluated five maternal and offspring xenobiotic metabolism haplotypes and the risk of childhood ALL among 120 case-parent triads. Two of the five haplotypes were significantly associated with risk: GSTM3/GSTM4 (P=0.01) and GSTP1 (P=0.02). The EPHX1 haplotype was marginally associated with risk (P=0.05), whereas haplotypes in CYP1B1 and GSTA4 were not. Our results suggest genetic variation in xenobiotic metabolism is important in childhood ALL etiology. PMID:23433810

  14. Early Vitamin K Deficiency Bleeding in a Neonate Associated with Maternal Acute Fatty Liver of Pregnancy.

    PubMed

    Arya, Shreyas; Richardson, Carol J; Jain, Sunil; Swischuck, Leonard E

    2015-10-01

    Introduction Acute fatty liver of pregnancy (AFLP) is a rare but potentially fatal condition occurring in the third trimester or early postpartum period. It is characterized by microvesicular fatty infiltration of the liver. Clinically, the three most prominent derangements in women with AFLP are hepatic dysfunction, renal insufficiency, and impaired coagulation. AFLP is associated with an increased incidence of morbidity and mortality in neonates, though the exact cause for this remains unclear. Deficiency of vitamin K in patients with liver disease has been widely reported. Case Description We present a unique case of severe intracranial bleeding because of the early vitamin K deficiency in a neonate whose mother had AFLP along with accompanying renal insufficiency. Conclusion We suggest that monitoring infants born to mothers with AFLP, for vitamin K deficiency bleeding will help reduce morbidity and mortality in these infants.

  15. Neurologic morbidity and quality of life in survivors of childhood acute lymphoblastic leukemia: a prospective cross-sectional study

    PubMed Central

    Khan, Raja B.; Hudson, Melissa M.; Ledet, Davonna S.; Morris, E. Brannon; Pui, Ching-Hon; Howard, Scott C.; Krull, Kevin R.; Hinds, Pamela S.; Crom, Debbie; Browne, Emily; Zhu, Liang; Rai, Shesh; Srivastava, Deokumar; Ness, Kirsten K.

    2014-01-01

    Purpose Childhood acute lymphoblastic leukemia (ALL) is treated with potentially neurotoxic drugs and neurologic complications in long-term survivors are inadequately studied. This study investigated neurologic morbidity and its effect on quality of life in long-term survivors of childhood ALL. Methods Prospective, single institution, cross-sectional, institutional review board-approved study of long-term ALL survivors. Participants were recruited from institutional clinics. Participants answered an investigator-administered questionnaire followed by evaluation by a neurologist. Quality of life (QOL) was also assessed. Results Of the 162 participants recruited over a 3-year period, 83.3 % reported at least one neurologic symptom of interest, 16.7 % had single symptom, 11.1 % had two symptoms, and 55.6 % had three or more symptoms. Symptoms were mild and disability was low in the majority of participants with neurologic symptoms. Median age at ALL diagnosis was 3.9 years (0.4–18.6), median age at study enrollment was 15.7 years (6.9–28.9), and median time from completion of ALL therapy was 7.4 years (1.9–20.3). On multivariable analyses, female sex correlated with presence of dizziness, urinary incontinence, constipation, and neuropathy; use of≥10 doses of triple intrathecal chemotherapy correlated with uri-nary incontinence, back pain, and neuropathy; cranial radiation with ataxia; history of ALL relapse with fatigue; and CNS leukemia at diagnosis with seizures. Decline in mental QOL was associated with migraine and tension type headaches, while physical QOL was impaired by presence of dizziness and falls. Overall, good QOL and physical function was maintained by a majority of participants. Conclusions Neurologic symptoms were present in 83 % long-term ALL survivors. Symptoms related morbidity and QOL impairment is low in majority of survivors. Female sex, ≥10 doses of intrathecal chemotherapy, and history of ALL relapse predispose to impaired QOL

  16. A Rare Case of Acute Lymphoblastic Leukaemia in Pregnancy- Unique Maternal-Fetal Challenges

    PubMed Central

    Munshi, Shabana

    2014-01-01

    Leukaemia in pregnancy is rare and lethal. Its incidence is estimated to be 1 in 75,000 pregnancies. Use of chemotherapeutic agents during pregnancy can give rise to maternal and fetal adversity; resulting in dilemma regarding proper management plan. A 25-year-old pregnant lady was presented at 24 wk of gestational age with cervical and inguinal lymphadenopathy and bicytopenia in complete blood counts. Diagnosis of acute lymphoblastic leukaemia was confirmed by bone marrow biopsy. Treated with appropriate chemotherapeutic regimen with some modification in the standard protocol due to pregnancy and delivered successfully by lower segment caesarean section at 34 wk of gestational age. Diagnosis of acute leukaemia during pregnancy need high index of suspicion and need prompt management with the proper chemotherapeutic regimen. Clinical judgement regarding the risk benefit ratio of using chemotherapeutic drugs ensures better mother and fetal outcome. PMID:25478417

  17. Cytomegalovirus-associated acute hydramnios treated by amniocentesis and maternal indomethacin.

    PubMed

    Suzumori, Nobuhiro; Hattori, Yukio; Kaneko, Saori; Suzuki, Yoshikatsu; Sugiura-Ogasawara, Mayumi

    2009-12-01

    A 22-year-old pregnant woman noticed a rapid increase of abdominal growth, uterine tenderness and irregular contraction, for which she hospitalized at 25 weeks of gestation. An ultrasound examination demonstrated a single fetus with normal anatomy and massive hydramnios. Serial therapeutic amniocentesis was performed for relief of maternal symptoms and indomethacin compress was initiated. Both the maternal and amniotic fluid IgM were positive for cytomegalovirus (CMV). Maternal compress indomethacin was discontinued at 32 weeks. Cesarean section was performed due to fetal distress at 34 weeks of gestation. A female infant was delivered and the neonatal examination was within normal limits with urine culture positive for CMV. At 1 year of age the child was developing normally with normal hearing and no clinical sequelae of intrauterine CMV infection. We postulate that serial and large volume reduction of amniotic fluid by amniocentesis and compress indomethacin in our case interrupted the natural course and provided sufficient time for the fetus to recover from the acute phase of viral infection.

  18. Can computed tomography scan be performed effectively in the diagnosis of acute appendicitis without the added morbidity of rectal contrast?

    PubMed

    Dearing, Daniel D; Recabaren, James A; Alexander, Magdi

    2008-10-01

    The highest degrees of accuracy have been demonstrated for CT scans using rectal contrast in diagnosing appendicitis. However, the administration of rectal contrast is associated with patient discomfort and rarely, rectosigmoid perforation (0.04%). Additionally, the commonly accepted negative appendectomy rate is around 16 per cent. We performed a retrospective review of radiology, operative, and pathology reports of consecutive patients undergoing appendectomy or CT examination for appendicitis during 2006. CT scans were performed without rectal contrast. The accuracy of each type of inpatient CT examination and negative appendectomy rates were determined. Two hundred and thirty-eight patients underwent appendectomy. One hundred and thirty-four appendectomy patients (56%) received a preoperative CT scan. The negative appendectomy rates were 6.3 per cent overall, 8.7 per cent without CT examination and 4.5 per cent with CT (P = 0.3). Two hundred and forty-five inpatient CT scans were performed for suspected appendicitis with a sensitivity of 90 per cent, specificity of 98 per cent, accuracy of 94 per cent, positive predictive value of 98 per cent, and negative predictive value of 91 per cent. CT scanning without rectal contrast is effective for the diagnosis of acute appendicitis making rectal contrast, with its attendant morbidity, unnecessary. The previously acceptable published negative appendectomy rate is higher than that found in current surgical practice likely due to preoperative CT scanning.

  19. Maternal, fetal and renal outcomes of pregnancy-associated acute kidney injury requiring dialysis.

    PubMed

    Krishna, A; Singh, R; Prasad, N; Gupta, A; Bhadauria, D; Kaul, A; Sharma, R K; Kapoor, D

    2015-01-01

    Pregnancy-associated acute kidney injury (PAKI) is encountered frequently in developing countries. We evaluated the maternal, fetal and renal outcomes in women with PAKI who needed at least one session of dialysis. Of the total of 98 cases (mean age 28.85 ± 5.13 years; mean parity 2.65 ± 1.28) of PAKI, the most common cause of PAKI was postabortal sepsis. Eighteen patients died; those with oligoanuria, sepsis and central nervous system (CNS) involvement were at greater risk of mortality. The relative risk (RR) of neonatal mortality was lower after with full-term delivery (RR: 0.17, 95% confidence interval (CI): 0.03-0.96, P = 0.02) compared to preterm delivery. Of the 80 surviving patients, 60 (75%) patients achieved complete recovery of renal function at the end of 3 months; and of the remaining 14 had presumed (n = 4) or, biopsy-proven (n = 10) acute patchy cortical necrosis. The RR of non-recovery of renal function was high (RR: 24.7, 95% CI: 3.4- 179.5) in patients who did not recover at 6 weeks. Of the 14 patients with cortical necrosis, 3 (21.42%) became independent of dialysis at 6 months. PAKI patients should be watched for dialysis independency for 6 months.

  20. Maternal agency influences the prevalence of diarrhea and acute respiratory tract infections among young Indonesian children.

    PubMed

    Agustina, Rina; Shankar, Anita V; Ayuningtyas, Azalea; Achadi, Endang L; Shankar, Anuraj H

    2015-05-01

    To examine the relationship between measures of mother's caretaking, practice and individual agency on acute diarrhea and respiratory tract infections (ARTIs) of Indonesian children. Using population-based household data from the Indonesian Demographic Health Surveys for 2002-2003 (n = 9,151 children) and 2007 (n = 9,714 children), we selected 28 indicators related to mother' caretaking, and applied principal component analysis to derive indices for access to care, practice and experience, and agency. The association between index quartiles (level 1-4) and the prevalence of diarrhea and ARTIs in the youngest child <5 years of age was assessed with multivariate logistic regression adjusting for socioeconomic status, residence type, mother's age and education, family size, child's age and sex, immunization status and received vitamin A supplementation. Moderate levels (level 3) of practice and experience were associated with decreased diarrheal risk (adjusted OR 0.86, 95 % CI 0.75-0.98), but not for ARTIs. Children of mothers with higher levels (level 4) of agency were protected against both diarrhea (adjusted OR 0.68, 95 % CI 0.60-0.77) and ARTIs (adjusted OR 0.77, 95 % CI 0.66-0.91). Stratified analyses with child's age and mother's education, and tests of interaction, showed that agency had a stronger effect on diarrhea and ARTIs prevalence in children <2 years of age. Maternal caretaking, especially agency, is strongly associated with lower prevalence of diarrhea and ARTIs in younger children. Interventions specifically designed to promote maternal autonomy and decision-making may lead to improved child health.

  1. Does Acute Maternal Stress in Pregnancy Affect Infant Health Outcomes? Examination of a Large Cohort of Infants Born After the Terrorist Attacks of September 11, 2001

    DTIC Science & Technology

    2009-01-01

    Spandorfer S, Grill E, Davis O, Fasouliotis S, Rosenwaks Z: Septem- ber 11th in New York City (NYC): the effect of a catastrophe on IVF outcome in a...Naval Health Research Center Does acute maternal stress in pregnancy affect infant health outcomes ? Examination of A Large Cohort of Infants Born...California 92106 BioMed CentralBMC Public Health ssOpen AcceResearch article Does acute maternal stress in pregnancy affect infant health outcomes

  2. Acute bovine viral diarrhea associated with extensive mucosal lesions, high morbidity, and mortality in a commercial feedlot

    Technology Transfer Automated Retrieval System (TEKTRAN)

    In 2008, a northwest Texas feedlot underwent an outbreak of bovine viral diarrhea virus (BVDV) disease causing high morbidity and mortality involving two lots of calves (Lots A and B). Severe mucosal surface lesions were observed grossly in the oral cavity, larynx and esophagus. Mucosal lesions vari...

  3. Effects of Maternal Diet During Pregnancy on the Risk of Childhood Acute Lymphoblastic Leukemia: A Systematic Review.

    PubMed

    Abiri, Behnaz; Kelishadi, Roya; Sadeghi, Homa; Azizi-Soleiman, Fatemeh

    2016-10-01

    Acute lymphoblastic leukemia (ALL) is the most common type of leukemia in children that can be affected by maternal diet. The aim of this study was to evaluate maternal dietary risk factors of ALL. We searched MEDLINE, Cochrane Library, Springer Link, Wiley Online, Science Direct, Mosby, ISI Web of Science, OVID, ProQuest, and Scopus from database inception until February 2, 2016. Two reviewers scanned titles, abstracts, and keywords of articles after excluding duplicates. We included case-control studies evaluating the relationship between maternal diet during pregnancy and childhood ALL. The search resulted in 2,940 papers, of which 11 full-text articles met the criteria for inclusion in the review and were analyzed. The finding of these studies suggest that maternal diet composed largely of vegetables, fruits, and protein sources before and during pregnancy can reduce the risk of ALL in offspring. Maternal alcohol intake had no effect. Nevertheless, inherent limitations of case-control studies like measurement error, random error, recall bias, and selection bias preclude conclusive evidence. Persuading pregnant women to follow a healthy diet rich in fruits, vegetables, and protein may reduce the risk of childhood ALL. Avoiding alcohol intake seems prudent.

  4. Maternal Benzene Exposure during Pregnancy and Risk of Childhood Acute Lymphoblastic Leukemia: A Meta-Analysis of Epidemiologic Studies

    PubMed Central

    Li, Zhen; Zhu, Jie; Bi, Yongyi; Bai, YuE; Wang, Hong

    2014-01-01

    Background The prevalence of childhood leukemia is increasing rapidly all over the world. However, studies on maternal benzene exposure during pregnancy and childhood acute lymphoblastic leukemia (ALL) have not been systematically assessed. Therefore, we performed a meta-analysis to investigate the association between maternal solvent, paint, petroleum exposure, and smoking during pregnancy and risk of childhood ALL. Methods Relevant studies up to September 1st, 2013 were identified by searching the PubMed, EMBASE, Cochrane library and the Web of Science databases. The effects were pooled using either fixed or random effect models based on the heterogeneity of the studies. Results Twenty-eight case-control studies and one cohort study were included for analysis, with a total of 16,695 cases and 1,472,786 controls involved. Pooled odds ratio (OR) with 95% confidence interval (CI) for ALL was 1.25 (1.09, 1.45) for solvent, 1.23 (1.02, 1.47) for paint, 1.42 (1.10, 1.84) for petroleum exposure, and 0.99 (0.93, 1.06) for maternal smoking during pregnancy. No publication bias was found in this meta-analysis and consistent results were observed for subgroup and sensitivity analyses. Conclusions Childhood ALL was associated with maternal solvent, paint, and petroleum exposure during pregnancy. No association was found between ALL and maternal smoking during pregnancy. Avoidance of maternal occupational and environmental benzene exposure during pregnancy could contribute to a decrease in the risk of childhood ALL. PMID:25333868

  5. Radial forearm free flap morbidity: A rare case of a normal preoperative arteriogram and acute intraoperative hand ischemia.

    PubMed

    Bruner, Terrence W; Hanasono, Matthew M; Skoracki, Roman J

    2011-01-01

    Since its first description in 1981, the radial forearm free flap has become a valuable tool for reconstructive microsurgery. However, there are potential complications associated with the flap - the most feared being hand ischemia from sacrifice of the radial artery. Fortunately, acute ischemic complications are exceedingly rare, with only two cases reported in the literature. Options for preoperative evaluation of the donor extremity include the Allen's test, ultrasonography and angiography. A preoperative arteriogram is considered to be the definitive method to evaluate arterial anatomy, patency, and collateralization between the radial and ulnar arteries. The current article presents the authors' experience with a patient who had a delayed Allen's test and a normal arteriogram of his left upper extremity, and who developed acute intraoperative hand ischemia, requiring reconstruction of his radial artery, after elevation of a radial forearm free flap.Although exceedingly rare, the occurrence of acute vascular insufficiency is always a possibility and must be kept in mind when harvesting a radial forearm free flap. The surgeon should be prepared to perform an interposition vein graft reconstruction to avoid any potential complications. Clinical examination and judgment may be more important than radiological studies in certain cases.

  6. Simultaneous weekly supplementation of iron and zinc is associated with lower morbidity due to diarrhea and acute lower respiratory infection in Bangladeshi infants.

    PubMed

    Baqui, Abdullah H; Zaman, K; Persson, Lars Ake; El Arifeen, Shams; Yunus, Mohammad; Begum, Nazma; Black, Robert E

    2003-12-01

    Given the high prevalence of micronutrient deficiencies and infectious diseases in infants in developing countries, an evaluation of the efficacy of different micronutrient formulations on infant morbidity is a priority. The efficacy of weekly supplementation of four different micronutrient formulations on diarrhea and acute lower respiratory infection (ALRI) morbidity was evaluated in Bangladeshi infants. In a double-blind, randomized, controlled community trial, 799 infants aged 6 mo were randomly assigned to one of the following 5 groups: 1) 20 mg elemental iron with 1 mg riboflavin, 2) 20 mg elemental zinc with 1 mg riboflavin, 3) 20 mg iron and 20 mg zinc with 1 mg riboflavin, 4) a micronutrient mix (MM) containing 20 mg iron, 20 mg zinc, 1 mg riboflavin along with other minerals and vitamins and 5) a control treatment, 1 mg riboflavin only. Health workers visited each infant weekly until age 12 mo to feed the supplement and to collect data on diarrhea and ALRI morbidity. Hemoglobin, serum ferritin and serum zinc levels of a sample of infants were measured at 6 and 12 mo. Compared with the control group, at 12 mo, serum ferritin levels were higher in the iron + zinc group, and serum zinc levels were higher in the zinc and iron + zinc groups. Simultaneous supplementation with iron + zinc was associated with lower risk of severe diarrhea, 19% lower in all infants and 30% lower in less well-nourished infants with weight-for-age Z-score below -1. Iron + zinc supplementation was also associated with 40% lower risk of severe ALRI in less well-nourished infants. MM supplementation was associated with a 15% higher risk of diarrhea in all infants and 22% higher risk in less well-nourished infants. Intermittent simultaneous supplementation with iron + zinc seems promising; it will be useful to determine whether higher doses would provide greater benefits.

  7. A method of teaching critical care skills to undergraduate student midwives using the Maternal-Acute Illness Management (M-AIM) training day.

    PubMed

    McCarthy, Rose; Nuttall, Janet; Smith, Joyce; Hollins Martin, Caroline J

    2014-11-01

    The most recent Confidential Enquiry into Maternal Deaths (CMACE, 2011) identified human errors, specifically those of midwives and obstetricians/doctors as a fundamental component in contributing to maternal death in the U.K. This paper discusses these findings and outlines a project to provide training in Maternal-Acute Illness Management (M-AIM) to final year student midwives. Contents of the program are designed to educate and simulate AIM skills and increase confidence and clinical ability in early recognition, management and referral of the acutely ill woman. An outline of the Maternal-AIM program delivered at the University of Salford (Greater Manchester, UK) is presented to illustrate how this particular institution has responded to a perceived need voiced by local midwifery leaders. It is proposed that developing this area of expertise in the education system will better prepare student midwives for contemporary midwifery practice.

  8. Maternal near miss and death among women with severe hypertensive disorders: a Brazilian multicenter surveillance study

    PubMed Central

    2014-01-01

    Background Hypertensive disorders represent the major cause of maternal morbidity in middle income countries. The main objective of this study was to identify the prevalence and factors associated with severe maternal outcomes in women with severe hypertensive disorders. Methods This was a cross-sectional, multicenter study, including 6706 women with severe hypertensive disorder from 27 maternity hospitals in Brazil. A prospective surveillance of severe maternal morbidity with data collected from medical charts and entered into OpenClinica®, an online system, over a one-year period (2009 to 2010). Women with severe preeclampsia, severe hypertension, eclampsia and HELLP syndrome were included in the study. They were grouped according to outcome in near miss, maternal death and potentially life-threatening condition. Prevalence ratios and 95% confidence intervals adjusted for cluster effect for maternal and perinatal variables and delays in receiving obstetric care were calculated as risk estimates of maternal complications having a severe maternal outcome (near miss or death). Poisson multiple regression analysis was also performed. Results Severe hypertensive disorders were the main cause of severe maternal morbidity (6706/9555); the prevalence of near miss was 4.2 cases per 1000 live births, there were 8.3 cases of Near Miss to 1 Maternal Death and the mortality index was 10.7% (case fatality). Early onset of the disease and postpartum hemorrhage were independent variables associated with severe maternal outcomes, in addition to acute pulmonary edema, previous heart disease and delays in receiving secondary and tertiary care. Conclusions In women with severe hypertensive disorders, the current study identified situations independently associated with a severe maternal outcome, which could be modified by interventions in obstetric care and in the healthcare system. Furthermore, the study showed the feasibility of a hospital system for surveillance of severe

  9. Maternal folate and other vitamin supplementation during pregnancy and risk of acute lymphoblastic leukemia in the offspring.

    PubMed

    Milne, Elizabeth; Royle, Jill A; Miller, Margaret; Bower, Carol; de Klerk, Nicholas H; Bailey, Helen D; van Bockxmeer, Frank; Attia, John; Scott, Rodney J; Norris, Murray D; Haber, Michelle; Thompson, Judith R; Fritschi, Lin; Marshall, Glenn M; Armstrong, Bruce K

    2010-06-01

    The Australian Study of Causes of Acute Lymphoblastic Leukemia in Children (Aus-ALL) was designed to test the hypothesis, raised by a previous Western Australian study, that maternal folic acid supplementation during pregnancy might reduce the risk of childhood acute lymphoblastic leukemia (ALL). Aus-ALL was a national, population-based, multicenter case-control study that prospectively recruited 416 cases and 1,361 controls between 2003 and 2007. Detailed information was collected about maternal use of folic acid and other vitamin supplements before and during the index pregnancy. Data were analyzed using logistic regression, adjusting for matching factors and potential confounders. A meta-analysis with the results of previous studies of folic acid supplementation was also conducted. We found weak evidence of a protective effect of maternal folate supplementation before pregnancy against risk of childhood ALL, but no evidence for a protective effect of its use during pregnancy. A meta-analysis including this and 2 other studies, but not the study that raised the hypothesis, also found little evidence that folate supplementation during pregnancy protects against ALL: the summary odds ratios (ORs) for folate supplementation were 1.06 [95% confidence interval (CI): 0.77-1.48] with reference to no folate supplementation and 1.02 (95% CI: 0.86-1.20) with reference to no vitamin supplementation. For vitamin supplementation in general, the summary OR from a meta-analysis of 5 studies-including Aus-ALL-was 0.83 (95% CI: 0.73-0.94). Vitamin supplementation in pregnancy may protect against childhood ALL, but this effect is unlikely to be large or, if real, specifically due to folate.

  10. Acute Fetal Demise with First Trimester Maternal Infection Resulting from Listeria monocytogenes in a Nonhuman Primate Model

    PubMed Central

    Wolfe, Bryce; Wiepz, Gregory J.; Schotzko, Michele; Bondarenko, Gennadiy I.; Durning, Maureen; Simmons, Heather A.; Mejia, Andres; Faith, Nancy G.; Sampene, Emmanuel; Suresh, Marulasiddappa; Kathariou, Sophia; Czuprynski, Charles J.

    2017-01-01

    ABSTRACT Infection with Listeria monocytogenes during pregnancy is associated with miscarriage, preterm birth, and neonatal complications, including sepsis and meningitis. While the risk of these conditions is thought to be greatest during the third trimester of pregnancy, the determinants of fetoplacental susceptibility to infection, the contribution of gestational age, and the in vivo progression of disease at the maternal-fetal interface are poorly understood. We developed a nonhuman primate model of listeriosis to better understand antecedents of adverse pregnancy outcomes in early pregnancy. Four pregnant cynomolgus macaques (Macaca fascicularis) received a single intragastric inoculation between days 36 and 46 of gestation with 107 CFU of an L. monocytogenes strain isolated from a previous cluster of human listeriosis cases that resulted in adverse pregnancy outcomes. Fecal shedding, maternal bacteremia, and fetal demise were consistently noted within 7 to 13 days. Biopsy specimens of maternal liver, spleen, and lymph node displayed variable inflammation and relatively low bacterial burden. In comparison, we observed greater bacterial burden in the decidua and placenta and the highest burden in fetal tissues. Histopathology indicated vasculitis, fibrinoid necrosis, and thrombosis of the decidual spiral arteries, acute chorioamnionitis and villitis in the placenta, and hematogenous infection of the fetus. Vascular pathology suggests early impact of L. monocytogenes infection on spiral arteries in the decidua, which we hypothesize precipitates subsequent placentitis and fetal demise. These results demonstrate that L. monocytogenes tropism for the maternal reproductive tract results in infection of the decidua, placenta, and the fetus itself during the first trimester of pregnancy. PMID:28223455

  11. Acute alcohol exposure, acidemia or glutamine administration impacts amino acid homeostasis in ovine maternal and fetal plasma.

    PubMed

    Washburn, Shannon E; Sawant, Onkar B; Lunde, Emilie R; Wu, Guoyao; Cudd, Timothy A

    2013-09-01

    Fetal alcohol syndrome (FAS) is a significant problem in human reproductive medicine. Maternal alcohol administration alters maternal amino acid homeostasis and results in acidemia in both mother and fetus, causing fetal growth restriction. We hypothesized that administration of glutamine, which increases renal ammoniagenesis to regulate acid-base balance, may provide an intervention strategy. This hypothesis was tested using sheep as an animal model. On day 115 of gestation, ewes were anesthetized and aseptic surgery was performed to insert catheters into the fetal abdominal aorta as well as the maternal abdominal aorta and vena cava. On day 128 of gestation, ewes received intravenous administration of saline, alcohol [1.75 g/kg body weight (BW)/h], a bolus of 30 mg glutamine/kg BW, alcohol + a bolus of 30 mg glutamine/kg BW, a bolus of 100 mg glutamine/kg BW, alcohol + a bolus of 100 mg glutamine/kg BW, or received CO2 administration to induce acidemia independent of alcohol. Blood samples were obtained simultaneously from the mother and the fetus at times 0 and 60 min (the time of peak blood alcohol concentration) of the study. Administration of alcohol to pregnant ewes led to a reduction in concentrations of glutamine and related amino acids in plasma by 21-30%. An acute administration of glutamine to ewes, concurrent with alcohol administration, improved the profile of most amino acids (including citrulline and arginine) in maternal and fetal plasma. We suggest that glutamine may have a protective effect against alcohol-induced metabolic disorders and FAS in the ovine model.

  12. Acute alcohol exposure, acidemia or glutamine administration impacts amino acid homeostasis in ovine maternal and fetal plasma

    PubMed Central

    Washburn, Shannon E.; Sawant, Onkar B.; Lunde, Emilie R.; Wu, Guoyao; Cudd, Timothy A.

    2013-01-01

    Fetal alcohol syndrome (FAS) is a significant problem in human reproductive medicine. Maternal alcohol administration alters maternal amino acid homeostasis and results in acidemia in both mother and fetus, causing fetal growth restriction. We hypothesized that administration of glutamine, which increases renal ammoniagenesis to regulate acid-base balance, may provide an intervention strategy. This hypothesis was tested using sheep as an animal model. On day 115 of gestation, ewes were anesthetized and aseptic surgery was performed to insert catheters into the fetal abdominal aorta as well as the maternal abdominal aorta and vena cava. On day 128 of gestation, ewes received intravenous administration of saline, alcohol [1.75 g/kg body weight (BW)/h], a bolus of 30 mg glutamine/kg BW, alcohol + a bolus of 30 mg glutamine/kg BW, a bolus of 100 mg glutamine/kg BW, alcohol + a bolus of 100 mg glutamine/kg BW, or received CO2 administration to induce acidemia independent of alcohol. Blood samples were obtained simultaneously from the mother and the fetus at times 0 and 60 min (the time of peak blood alcohol concentration) of the study. Administration of alcohol to pregnant ewes led to a reduction in concentrations of glutamine and related amino acids in plasma by 21–30%. An acute administration of glutamine to ewes, concurrent with alcohol administration, improved the profile of most amino acids (including citrulline and arginine) in maternal and fetal plasma. We suggest that glutamine may have a protective effect against alcohol-induced metabolic disorders and FAS in the ovine model. PMID:23315157

  13. [Identification of malfunctioning in the treatment and quality of care of maternal morbidity in Abidjan, Côte d'Ivoire].

    PubMed

    Touré, B; Koffi, N M; Gohou, V; Dagnan, S; Diarra-Nama, A J

    2005-03-01

    A study was carried out using a clinical audit aimed at identifying the dysfunctions in the care of female patients with serious morbidity. The study was done at the University Hospital of Cocody (CHU de Codody) and in the health training unit in the southern part of Abobo (Abidjan) from January to May 2000. The study allowed us to track and record the frequency of women who nearly died (40.4%) in both of the sites during the period of the study. Malfunctions were found at all stages of the female patients' care. The provision of medical care during the patients' hospitalisation and care provided in the emergency room were the cases and situations wherein the most frequency was noted, with 42.8% and 39.6% of dysfunctions found respectively. The delay for patients to wait to receive care was long, varying from 80 minutes to 5 days coupled with a lack of follow-up and surveillance of patients. This data demonstrates the inadequacy of the quality of obstetrical care.

  14. Mortality and morbidity in the city of Bern, Switzerland, 1805-1815 with special emphasis on infant, child and maternal deaths.

    PubMed

    Rüttimann, D; Loesch, S

    2012-02-01

    This article contributes to the research on demographics and public health of urban populations of preindustrial Europe. The key source is a burial register that contains information on the deceased, such as age and sex, residence and cause of death. This register is one of the earliest compilations of data sets of individuals with this high degree of completeness and consistency. Critical assessment of the register's origin, formation and upkeep promises high validity and reliability. Between 1805 and 1815, 4,390 deceased inhabitants were registered. Information concerning these individuals provides the basis for this study. Life tables of Bern's population were created using different models. The causes of death were classified and their frequency calculated. Furthermore, the susceptibility of age groups to certain causes of death was established. Special attention was given to causes of death and mortality of newborns, infants and birth-giving women. In comparison to other cities and regions in Central Europe, Bern's mortality structure shows low rates for infants (q0=0.144) and children (q1-4=0.068). This could have simply indicated better living conditions. Life expectancy at birth was 43 years. Mortality was high in winter and spring, and decreased in summer to a low level with a short rise in August. The study of the causes of death was inhibited by difficulties in translating early 19th century nomenclature into the modern medical system. Nonetheless, death from metabolic disorders, illnesses of the respiratory system, and debilitation were the most prominent causes in Bern. Apparently, the worst killer of infants up to 12 months was the "gichteren", an obsolete German term for lethal spasmodic convulsions. The exact modern identification of this disease remains unclear. Possibilities such as infant tetanus or infant epilepsy are discussed. The maternal death rate of 0.72% is comparable with values calculated from contemporaneous sources. Relevance of

  15. Diversity and divergence: the dynamic burden of poor maternal health.

    PubMed

    Graham, Wendy; Woodd, Susannah; Byass, Peter; Filippi, Veronique; Gon, Giorgia; Virgo, Sandra; Chou, Doris; Hounton, Sennen; Lozano, Rafael; Pattinson, Robert; Singh, Susheela

    2016-10-29

    Maternal health is a big issue and is central to sustainable development. Each year, about 210 million women become pregnant and about 140 million newborn babies are delivered-the sheer scale of maternal health alone makes maternal well being and survival vital concerns. In this Series paper, we adopt primarily a numerical lens to illuminate patterns and trends in outcomes, but recognise that understanding of poor maternal health also warrants other perspectives, such as human rights. Our use of the best available evidence highlights the dynamic burden of maternal health problems. Increased diversity in the magnitude and causes of maternal mortality and morbidity between and within populations presents a major challenge to policies and programmes aiming to match varying needs with diverse types of care across different settings. This diversity, in turn, contributes to a widening gap or differences in levels of maternal mortality, seen most acutely in vulnerable populations, predominantly in sub-Saharan Africa. Strong political and technical commitment to improve equity-sensitive information systems is required to monitor the gap in maternal mortality, and robust research is needed to elucidate major interactions between the broad range of health problems. Diversity and divergence are defining characteristics of poor maternal health in the 21st century. Progress on this issue will be an ultimate judge of sustainable development.

  16. Ratio of Systolic Blood Pressure to Right Atrial Pressure, a Novel Marker to Predict Morbidity and Mortality in Acute Systolic Heart Failure.

    PubMed

    Omar, Hesham R; Charnigo, Richard; Guglin, Maya

    2017-04-01

    Congestion is the main contributor to heart failure (HF) morbidity and mortality. We assessed the combined role of congestion and decreased forward flow in predicting morbidity and mortality in acute systolic HF. The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial data set was used to determine if the ratio of simultaneously measured systolic blood pressure (SBP)/right atrial pressure (RAP) on admission predicted HF rehospitalization and 6-month mortality. One hundred ninety-five patients (mean age 56.5 years, 75% men) who received pulmonary artery catheterization were studied. The RAP, SBP, and SBP/RAP had an area under the curve (AUC) of 0.593 (p = 0.0205), 0.585 (p = 0.0359), and 0.621 (p = 0.0026), respectively, in predicting HF rehospitalization. The SBP/RAP was a superior marker of HF rehospitalization compared with RAP alone (difference in AUC 0.0289, p = 0.0385). The optimal criterion of SBP/RAP <11 provided the highest combined sensitivity (77.1%) and specificity (50.9%) in predicting HF rehospitalization. The SBP/RAP had an AUC 0.622, p = 0.0108, and a cut-off value of SBP/RAP <8 had a sensitivity of 61.9% and specificity 64.1% in predicting mortality. Multivariate analysis showed that an SBP/RAP <11 independently predicted rehospitalization for HF (estimated odds ratio 3.318, 95% confidence interval 1.692 to 6.506, p = 0.0005) and an SBP/RAP <8 independently predicted mortality (estimated hazard ratio 2.025, 95% confidence interval 1.069 to 3.833, p = 0.030). In conclusion, SBP/RAP ratio is a marker that identifies a spectrum of complications after hospitalization of patients with decompensated systolic HF, starting with increased incidence of HF rehospitalization at SBP/RAP <11 to increased mortality with SBP/RAP <8.

  17. The social practice of rescue: the safety implications of acute illness trajectories and patient categorisation in medical and maternity settings.

    PubMed

    Mackintosh, Nicola; Sandall, Jane

    2016-02-01

    The normative position in acute hospital care when a patient is seriously ill is to resuscitate and rescue. However, a number of UK and international reports have highlighted problems with the lack of timely recognition, treatment and referral of patients whose condition is deteriorating while being cared for on hospital wards. This article explores the social practice of rescue, and the structural and cultural influences that guide the categorisation and ordering of acutely ill patients in different hospital settings. We draw on Strauss et al.'s notion of the patient trajectory and link this with the impact of categorisation practices, thus extending insights beyond those gained from emergency department triage to care management processes further downstream on the hospital ward. Using ethnographic data collected from medical wards and maternity care settings in two UK inner city hospitals, we explore how differences in population, cultural norms, categorisation work and trajectories of clinical deterioration interlink and influence patient safety. An analysis of the variation in findings between care settings and patient groups enables us to consider socio-political influences and the specifics of how staff manage trade-offs linked to the enactment of core values such as safety and equity in practice.

  18. Feline immunodeficiency virus can be experimentally transmitted via milk during acute maternal infection.

    PubMed Central

    Sellon, R K; Jordan, H L; Kennedy-Stoskopf, S; Tompkins, M B; Tompkins, W A

    1994-01-01

    Postnatal transmission of feline immunodeficiency virus (FIV) in neonates nursed by acutely infected mothers and infection resulting from oral inoculation of kittens with FIV were evaluated. Ten of 16 kittens nursed by four queens with FIV infection established immediately postpartum developed FIV infection. Five of 11 neonates orally administered cell-free FIV culture supernatant developed FIV infection. Kittens that developed FIV infection had greater proportions of CD4+ and Pan-T+ lymphocytes at birth than negative kittens. Infectious virus was recovered from the milk of acutely infected mothers. We conclude that FIV may be experimentally transmitted via milk from queens with acute infections and that oral administration of FIV to neonatal kittens results in infection. Images PMID:8151797

  19. HINDBRAIN AND CRANIAL NERVE DYSMORPHOGENESIS RESULT FROM ACUTE MATERNAL ETHANOL ADMINISTRATION

    EPA Science Inventory

    Acute exposure of mouse embryos to ethanol during stages of hindbrain segmentation results in excessive cell death in specific cell populations. This study details the ethanol-induced cell loss and defines the subsequent effects of this early insult on rhombomere and cranial ner...

  20. Maternal prolactin inhibition during lactation affects physical performance evaluated by acute exhaustive swimming exercise in adult rat offspring.

    PubMed

    Casimiro-Lopes, G; Lisboa, P C; Koury, J C; Boaventura, G; Passos, M C F; Moura, E G

    2012-02-01

    Maternal prolactin inhibition at the end of lactation programs for metabolic syndrome and hypothyroidism in adult offspring, which could negatively affect exercise performance. We evaluated the effects of maternal hypoprolactinemia in late lactation on physical performance in adult progeny. Lactating Wistar rats were treated with bromocriptine (BRO, 1 mg per day) or saline on days 19, 20, and 21 of lactation and offspring were followed until 180 days old. Physical performance was recorded in untrained rats at 90 and 180 days by an acute exhaustive swimming test (exercise group-Ex). At day 90, BRO offspring showed higher visceral fat mass, higher plasma thiobarbituric acid reactive substances, lower total antioxidant capacity, higher liver glycogen, lower glycemia, and normal insulinemia. Although thyroid hormones (TH) levels were unchanged, mitochondrial glycerol phosphate dehydrogenase (mGPD) activity was lower in muscle and in brown adipose tissue (BAT). At this age, BRO-Ex offspring showed higher exercise capacity, lower blood lactate, higher serum T3, and higher muscle and BAT mGPD activities. At day 180, BRO offspring showed central obesity, hypothyroidism, insulin resistance, and lower EDL (extensor digitorum longus) muscle glycogen with unaltered plasma oxidative stress markers. This group showed no alteration of exercise capacity or blood lactate. After exercise, EDL and liver glycogen were lower, while T3 levels, BAT and muscle mGPD activities were normalized. Liver glycogen seem to be related with higher exercise capacity in younger BRO offspring, while the loss of this temporary advantage maybe related to the hypothyroidism and insulin resistance developed with age.

  1. Acute fatty liver of pregnancy: analysis of five consecutive cases from a tertiary centre.

    PubMed

    Barber, M A; Eguiluz, I; Martín, A; Plasencia, W; Valle, L; García, J A

    2010-04-01

    Acute fatty liver of pregnancy is a rare cause of jaundice and liver failure associated with high maternal and fetal mortality. We analysed five consecutive cases of acute fatty liver of pregnancy, along with the associated morbidity, mortality and complications. Between January 1999 and January 2008, a total of 68,524 deliveries were assisted at the Obstetrics and Gynaecology Department of the Hospital Universitario Materno-Infantil de Canarias (Canaries University Hospital Maternity Ward); among them, five cases of acute fatty liver of pregnancy were identified.

  2. [Social inequalities in maternal health].

    PubMed

    Azria, E; Stewart, Z; Gonthier, C; Estellat, C; Deneux-Tharaux, C

    2015-10-01

    Although medical literature on social inequalities in perinatal health is qualitatively heterogeneous, it is quantitatively important and reveals the existence of a social gradient in terms of perinatal risk. However, published data regarding maternal health, if also qualitatively heterogeneous, are relatively less numerous. Nevertheless, it appears that social inequalities also exist concerning severe maternal morbidity as well as maternal mortality. Analyses are still insufficient to understand the mechanisms involved and explain how the various dimensions of the women social condition interact with maternal health indicators. Inadequate prenatal care and suboptimal obstetric care may be intermediary factors, as they are related to both social status and maternal outcomes, in terms of maternal morbidity, its worsening or progression, and maternal mortality.

  3. Maternal outcomes of cesarean sections

    PubMed Central

    Aubrey-Bassler, Kris; Newbery, Sarah; Kelly, Len; Weaver, Bruce; Wilson, Scott

    2007-01-01

    OBJECTIVE To compare maternal outcomes of cesarean sections performed by GPs with the outcomes of those performed by specialists. DESIGN Retrospective, comorbidity-adjusted study. SETTING Mostly small isolated rural hospitals in Ontario, British Columbia, Alberta, and Saskatchewan compared with all levels of specialist obstetric programs offered in Canada. PARTICIPANTS Fifteen GPs with less than 1 year of surgical training who performed cesarean sections. METHOD Using data from the Canadian Institute for Health Information’s Discharge Abstracts Database for the years 1990 to 2001, we matched each of 1448 cesarean section cases managed by these GPs to 3 cases managed by specialists and looked for comorbidity. In total, we analyzed the outcomes of 5792 cesarean sections. MAIN OUTCOME MEASURES Composites of major morbidity possibly attributable to surgery:death, sepsis, cardiac arrest, shock, hypotension, ileus or bowel obstruction,major puerperal infection, septic or fat embolism, postpartum hemorrhage requiring hysterectomy, need for cardiopulmonary resuscitation, or another operation; and all major morbidity: major surgical morbidity, acute coronary syndrome, endocarditis, pulmonary edema, cerebrovascular disorder, pneumothorax, respiratory failure, amniotic fluid embolism, complications of anesthesia, deep vein thrombosis, pulmonary embolism, acute renal failure, and need for mechanical ventilation. RESULTS The rate of all major morbidity was higher among GPs’ patients than among specialists’ patients (3.1% vs 1.9%, odds ratio [OR] 1.6, 95% confidence interval [CI] 1.1 to2.3, P = .009) as was the rate of major surgical morbidity (2.5% vs 1.6%, OR 1.6, 95% CI 1.1 to 2.4, P = .024). Differences in major morbidity variables were not significant if major postpartum infection was excluded (all major morbidity 1.5% vs 1.1%, major surgical morbidity 1.0% vs 0.8%). Secondary outcomes included rate of transfer to acute care institutions (6.0% vs 1.5%, OR 4.6, 95% CI

  4. Maternal immune activation in late gestation enhances locomotor response to acute but not chronic amphetamine treatment in male mice offspring: role of the D1 receptor.

    PubMed

    Zager, Adriano; Mennecier, Gregory; Palermo-Neto, João

    2012-06-15

    Exposure to elevated levels of maternal cytokines can lead to functional abnormalities of the dopaminergic system in the adult offspring, including enhanced amphetamine (AMPH)-induced locomotion. Therefore, it seems reasonable to consider that offspring of challenged mothers would behave differently in models of addictive behavior, such as behavioral sensitization. Thus, we sought to evaluate the effects of prenatal exposure to lipopolysaccharide (LPS) on the locomotor response to acute and chronic AMPH treatment in male mice offspring. For this purpose, LPS (Escherichia coli 0127:B8; 120 μg/kg) was administered intraperitoneally to pregnant Swiss mice on gestational day 17. At adulthood, male offspring were studied under one of the following conditions: (1) locomotor response to acute AMPH treatment (2.5 or 5.0 mg/kg) in an open field test; (2) behavioral sensitization paradigm, which consists of a daily injection of AMPH (1.0 mg/kg) for 10 days and observation of locomotion in the open field on days 1, 5, 10 (development phase), 15 and 17 (expression phase). The LPS stimulated offspring showed enhancement of the locomotor-stimulant effect after an acute AMPH challenge in comparison to baseline and saline pre-treated mice. They also showed development of behavioral sensitization earlier than the saline pre-treated group, although no changes between saline and LPS pre-treated groups were observed on development or expression of locomotor behavioral sensitization to AMPH. Furthermore, there was up-regulation of D1 receptor protein level within striatum in the LPS-stimulated offspring which was strongly correlated with increased grooming behavior. Taken together, our results indicate that motor and dopaminergic alterations caused by maternal immune activation are restricted to the acute AMPH challenge, mostly due to up-regulation of the D1 receptor within the mesolimbic and nigrostriatal pathways, but no locomotor differences were observed for behavioral

  5. Maternal and Fetal Blood and Organ Toluene Levels in Rats Following Acute and Repeated Binge Inhalation Exposure

    PubMed Central

    Bowen, Scott E.; Hannigan, John H.; Irtenkauf, Susan

    2007-01-01

    Inhalation of organic solvents is a persistent form of drug abuse with particular concern being the abuse of inhalants by women of child-bearing age. While studies have begun assessing postnatal outcomes of offspring exposed prenatally to inhalants, relatively little is known about the distribution of toluene in blood and body tissues of pregnant, inhalant-abusing women, or in the fetuses. The present study assessed the tissue toluene levels attained following brief toluene exposures using a pre-clinical rat model of maternal inhalant abuse. Timed-pregnant Sprague-Dawley rats were exposed to toluene at 8,000 or 12,000 parts per million (ppm) for 15, 30 or 45 min/exposure. Exposures occurred twice each day from gestational day 8 (GD8) through GD20. Immediately following the second exposure on GD8, GD14 and GD20 blood was taken from the saphenous vein of the dams. Following saphenous vein blood collection on GD20, dams were sacrificed and trunk blood was collected along with maternal tissue specimens from cerebellum, heart, lung, kidney and liver. The placenta, amniotic fluid and fetal brain were also collected. Results demonstrated that maternal saphenous blood toluene levels increased as the inhaled concentration of toluene and duration of exposure increased. The maternal cerebellum, heart, kidney and liver appeared to be saturated after 30 min on GD20 such that toluene levels in those organs were equivalent across all ambient concentrations of inhaled toluene. Toluene levels also increased in fetal brain as the inhaled concentration of toluene increased and in placenta and amniotic fluid as the duration of exposure increased. Toluene levels in all tissues at GD20, except maternal lung and amniotic fluid, were higher than in maternal saphenous blood suggesting that toluene concentrated in those organs. Measurement of toluene levels in blood and other tissues following repeated toluene exposure demonstrated that toluene readily reaches a variety of potential sites

  6. Effects of Child Psychopathology on Maternal Depression: The Mediating Role of Child-Related Acute and Chronic Stressors

    ERIC Educational Resources Information Center

    Raposa, Elizabeth B.; Hammen, Constance L.; Brennan, Patricia A.

    2011-01-01

    In light of recent research highlighting the potential effects of children's behavior on mothers' mental health, the current study examined 679 mothers and their adolescent children from a community-based sample to determine the effects of youth psychopathology on maternal depression and levels of child-related stress in mothers' lives. It was…

  7. Predicting morbidity and mortality in acute pancreatitis in an Indian population: a comparative study of the BISAP score, Ranson’s score and CT severity index

    PubMed Central

    Yadav, Jitin; Yadav, Sanjay Kumar; Kumar, Satish; Baxla, Ranjan George; Sinha, Dipendra Kumar; Bodra, Pankaj; Besra, Ram Chandra; Baski, Babu Mani; Prakash, Om; Anand, Abhinav

    2016-01-01

    Objective: Our aim was to prospectively evaluate the accuracy of the bedside index for severity in acute pancreatitis (BISAP) score in predicting mortality, as well as intermediate markers of severity, in a tertiary care centre in east central India, which caters mostly for an economically underprivileged population. Methods: A total of 119 consecutive cases with acute pancreatitis were admitted to our institution between November 2012 and October 2014. BISAP scores were calculated for all cases, within 24 hours of presentation. Ranson’s score and computed tomography severity index (CTSI) were also established. The respective abilities of the three scoring systems to predict mortality was evaluated using trend and discrimination analysis. The optimal cut-off score for mortality from the receiver operating characteristics (ROC) curve was used to evaluate the development of persistent organ failure and pancreatic necrosis (PNec). Results: Of the 119 cases, 42 (35.2%) developed organ failure and were classified as severe acute pancreatitis (SAP), 47 (39.5%) developed PNec, and 12 (10.1%) died. The area under the curve (AUC) results for BISAP score in predicting SAP, PNec, and mortality were 0.962, 0.934 and 0.846, respectively. Ranson’s score showed a slightly lower accuracy for predicting SAP (AUC 0.956) and mortality (AUC 0.841). CTSI was the most accurate in predicting PNec, with an AUC of 0.958. The sensitivity and specificity of BISAP score, with a cut-off of ≥3 in predicting mortality, were 100% and 69.2%, respectively. Conclusions: The BISAP score represents a simple way of identifying, within 24 hours of presentation, patients at greater risk of dying and the development of intermediate markers of severity. This risk stratification method can be utilized to improve clinical care and facilitate enrolment in clinical trials. PMID:25733696

  8. Does acute maternal stress in pregnancy affect infant health outcomes? Examination of a large cohort of infants born after the terrorist attacks of September 11, 2001

    PubMed Central

    Endara, Skye M; Ryan, Margaret AK; Sevick, Carter J; Conlin, Ava Marie S; Macera, Caroline A; Smith, Tyler C

    2009-01-01

    Background Infants in utero during the terrorist attacks of September 11, 2001 may have been negatively affected by maternal stress. Studies to date have produced contradictory results. Methods Data for this retrospective cohort study were obtained from the Department of Defense Birth and Infant Health Registry and included up to 164,743 infants born to active-duty military families. Infants were considered exposed if they were in utero on September 11, 2001, while the referent group included infants gestating in the same period in the preceding and following year (2000 and 2002). We investigated the association of this acute stress during pregnancy with the infant health outcomes of male:female sex ratio, birth defects, preterm birth, and growth deficiencies in utero and in infancy. Results No difference in sex ratio was observed between infants in utero in the first trimester of pregnancy on September 11, 2001 and infants in the referent population. Examination of the relationship between first-trimester exposure and birth defects also revealed no significant associations. In adjusted multivariable models, neither preterm birth nor growth deficiencies were significantly associated with the maternal exposure to the stress of September 11 during pregnancy. Conclusion The findings from this large population-based study suggest that women who were pregnant during the terrorist attacks of September 11, 2001 had no increased risk of adverse infant health outcomes. PMID:19619310

  9. Effect of caesarean section on maternal and foetal outcomes in acute fatty liver of pregnancy: a systematic review and meta-analysis

    PubMed Central

    Wang, Hong-Yan; Jiang, Qing; Shi, Hao; Xu, Yun-Qing; Shi, Ai-Chao; Sun, Yuan-Li; Li, Jian; Ning, Qin; Shen, Guan-Xin

    2016-01-01

    Several studies have reported a positive association between caesarean section for expeditious pregnancy termination and perinatal outcomes in acute fatty liver of pregnancy (AFLP); however, the risks remain unclear and independent studies have reported conflicting findings. In this meta-analysis, we aimed to confirm the relationship between caesarean section and perinatal outcomes in AFLP. The PubMed, Embase, and China National Knowledge Infrastructure databases were searched (until July 17, 2015) for observational clinical studies focusing on the association between caesarean section and perinatal outcomes in AFLP. Data were extracted and processed independently by 2 authors. We also compared caesarean section with vaginal delivery to further investigate this relationship. We observed that 2 of the 3 primary outcomes in caesarean section exhibited positive effects—the maternal mortality rate was 44% lower (relative risk [RR], 0.56 [0.41–0.76]) and perinatal mortality rate was also reduced (RR, 0.52 [0.38–0.71]), compared to those for vaginal delivery. We did not find any associations between caesarean section and perinatal outcomes in AFLP in terms of neonatal mortality type and maternal multiple organ complications. These findings emphasise the significant prognostic value and clinical implications of caesarean section in AFLP, and suggest that the adverse outcomes should be reduced. PMID:27387594

  10. Putting the "M" back in maternal-fetal medicine.

    PubMed

    D'Alton, Mary E; Bonanno, Clarissa A; Berkowitz, Richard L; Brown, Haywood L; Copel, Joshua A; Cunningham, F Gary; Garite, Thomas J; Gilstrap, Larry C; Grobman, William A; Hankins, Gary D V; Hauth, John C; Iriye, Brian K; Macones, George A; Martin, James N; Martin, Stephanie R; Menard, M Kathryn; O'Keefe, Daniel F; Pacheco, Luis D; Riley, Laura E; Saade, George R; Spong, Catherine Y

    2013-06-01

    Although maternal death remains rare in the United States, the rate has not decreased for 3 decades. The rate of severe maternal morbidity, a more prevalent problem, is also rising. Rise in maternal age, in rates of obesity, and in cesarean deliveries as well as more pregnant women with chronic medical conditions all contribute to maternal mortality and morbidity in the United States. We believe it is the responsibility of maternal-fetal medicine (MFM) subspecialists to lead a national effort to decrease maternal mortality and morbidity. In doing so, we hope to reestablish the vital role of MFM subspecialists to take the lead in the performance and coordination of care in complicated obstetrical cases. This article will summarize our initial recommendations to enhance MFM education and training, to establish national standards to improve maternal care and management, and to address critical research gaps in maternal medicine.

  11. Treatment for morbid obesity

    PubMed Central

    Carmichael, A

    1999-01-01

    There is no single unifying theory to explain the aetiology of obesity but several environmental factors, such as decreased physical activity and increased fat intake may contribute to its development in genetically predisposed individuals. Dietary and pharmacological treatments of morbid obesity have been proven to be unsuccessful. Modern surgical treatments have been shown to be effective in achieving significant weight loss with consequent reduction in morbidity. Despite the fact that surgical treatment of morbid obesity is the only therapeutic form that has stood the test of time, it still remains a crisis-driven form of therapy in the UK. It is probable that a better understanding of the aetiology and physiology of obesity may lead to the development of an effective pharmacological treatment of obesity in the future. However, until then, surgical treatment of morbid obesity should be considered as an effective and efficient way of treatment in selected cases.


Keywords: obesity PMID:10396579

  12. Reflections on maternal health care within the Victorian Maternal and Child Health Service.

    PubMed

    Hooker, Leesa; Taft, Angela; Small, Rhonda

    2016-01-01

    Women suffer significant morbidity following childbirth and there is a lack of focussed, primary maternal health care to support them. Victorian Maternal and Child Health (MCH) nurses are ideally suited to provide additional care for women when caring for the family with a new baby. With additional training and support, MCH nurses could better fill this health demand and practice gap. This discussion paper reviews what we know about maternal morbidity, current postnatal services for women and the maternal healthcare gap, and makes recommendations for enhancing MCH nursing practice to address this deficit.

  13. [Maternal and foetal prognostic during severe toxemia].

    PubMed

    Rachdi, Radhouane; Kaabi, Mehdi; Zayene, Houssine; Basly, Mohamed; Messaoudi, Fathi; Messaoudi, Lotfi; Chibani, Mounir

    2005-02-01

    Severe gravidic toxemia gives heavy maternal and foetal morbidity and mortality. The purpose of our study is to loosen the factors of bad maternal and foetal prognostic. It's a retrospective study about 100 cases of severe and complicated gravidic toxemia repertorieted in the maternity of Military Hospital of Tunis. Maternal morbidity is dominated by the complications of hypertension and a blood disorders. We raised 4 cases of eclampsia, 9 cases of retro placental hematome and 5 cases of HELLP syndrome. We don't deplore any maternal death. Perinatal mortality is 28.8%. The rate of delay intra-uterine growth was 43.8% and the prematurity 65.9%. More toxemia appears early during pregnancy more maternal and foetal prognostic is compromised.

  14. Characteristics of RSV-Specific Maternal Antibodies in Plasma of Hospitalized, Acute RSV Patients under Three Months of Age

    PubMed Central

    Widjaja, Ivy; Ahout, Inge M. L.; de Groot, Ronald; Guichelaar, Teun; Luytjes, Willem; de Jonge, Marien I.; de Haan, Cornelis A. M.; Ferwerda, Gerben

    2017-01-01

    Respiratory syncytial virus (RSV) is the leading cause for respiratory illness that requires hospitalization in infancy. High levels of maternal antibodies can protect against RSV infection. However, RSV-infected infants can suffer from severe disease symptoms even in the presence of high levels of RSV-specific antibodies. This study analyzes several serological characteristics to explore potential deficiencies or surpluses of antibodies that could relate to severe disease symptoms. We compare serum antibodies from hospitalized patients who suffered severe symptoms as well as uninfected infants. Disease severity markers were oxygen therapy, tachypnea, oxygen saturation, admission to the intensive care unit and duration of hospitalization. Antibodies against RSV G protein and a prefusion F epitope correlated with in vitro neutralization. Avidity of RSV-specific IgG antibodies was lower in RSV-infected infants compared to uninfected controls. Severe disease symptoms were unrelated to RSV-specific IgG antibody titers, avidity of RSV-IgG, virus neutralization capacity or titers against pre- and postfusion F or G protein ectodomains and the prefusion F antigenic site Ø. In conclusion, the detailed serological characterization did not indicate dysfunctional or epitope-skewed composition of serum antibodies in hospitalized RSV-infected infants suffering from severe disease symptoms. It remains unclear, whether specific antibody fractions could diminish disease symptoms. PMID:28135305

  15. The WHO Maternal Near Miss Approach: Consequences at Malawian District Level

    PubMed Central

    van den Akker, Thomas; Beltman, Jogchum; Leyten, Joey; Mwagomba, Beatrice; Meguid, Tarek; Stekelenburg, Jelle; van Roosmalen, Jos

    2013-01-01

    Introduction WHO proposes a set of organ-failure based criteria for maternal near miss. Our objective was to evaluate what implementation of these criteria would mean for the analysis of a cohort of 386 women in Thyolo District, Malawi, who sustained severe acute maternal morbidity according to disease-based criteria. Methods and Findings A WHO Maternal Near Miss (MNM) Tool, created to compare disease-, intervention- and organ-failure based criteria for maternal near miss, was completed for each woman, based on a review of all available medical records. Using disease-based criteria developed for the local setting, 341 (88%) of the 386 women fulfilled the WHO disease-based criteria provided by the WHO MNM Tool, 179 (46%) fulfilled the intervention-based criteria, and only 85 (22%) the suggested organ-failure based criteria. Conclusions In this low-resource setting, application of these organ-failure based criteria that require relatively sophisticated laboratory and clinical monitoring underestimates the occurrence of maternal near miss. Therefore, these criteria and the suggested WHO approach may not be suited to compare maternal near miss across all settings. PMID:23372770

  16. Morbidity assessment in sand flea disease (tungiasis).

    PubMed

    Kehr, Judith Dorothea; Heukelbach, Jörg; Mehlhorn, Heinz; Feldmeier, Hermann

    2007-01-01

    Tungiasis, caused by the sand flea Tunga penetrans, is a health problem in many impoverished communities in Latin America, the Caribbean, and sub-Saharan Africa. Sand flea disease is associated with a broad spectrum of clinical and histological pathology. The factors determining the disease burden in endemic communities are not well understood, and severity of clinical pathology has never been assessed quantitatively. Thus, two severity scores were developed: one for acute disease and one for chronic sequels. These scores were evaluated in a cohort of 70 severely infested patients living in a shantytown in Fortaleza, a capital city in Northeast Brazil. Patients were examined during a period of 25 days and followed-up after a twice daily application of a plant-based repellent to prevent reinfestation. The severity score for acute disease symptoms significantly correlated with the infestation rate and the number of embedded fleas. It turned zero when reinfestation was prevented. The score for chronic disease also significantly correlated with the infestation rate. Tungiasis is associated with considerable acute and chronic morbidity. The degree of acute morbidity is directly related to the number of embedded sand fleas. When transmission is interrupted, the chronic morbidity reflects the infestation rates individuals have experienced in the past.

  17. [Maternity blues].

    PubMed

    Gonidakis, F

    2007-04-01

    Maternity blues is a transient change of mood that occurs mainly between the 1st and 10th day of puerpartum and is characterized by bursts of tears, mild depressive mood, anxiety and liability of mood. The frequency of maternity blues varies in different studies form 4% to 80%. A number of biological and psychosocial parameters have been studied in order to determine their correlation with maternity blues. The most well studied biological parameters are progesterone and cortizol although their relation with maternity blues has not yet been clearly defined. Stress and the emotional state of the woman during pregnancy as well as history of mood disorders or maternity blues in a previous birth are the psychosocial parameters that are more likely to correlate with the occurrence of maternity blues. Most of the authors suggest that information on maternity blues and reassurance of the woman are the best way to deal with maternity blues both on preventive and therapeutical basis.

  18. Single megadose vitamin A supplementation of Indian mothers and morbidity in breastfed young infants

    PubMed Central

    Basu, S; Sengupta, B; Paladhi, P

    2003-01-01

    Background and objective: In developing countries low maternal vitamin A stores combined with increased demands of pregnancy and lactation may lead to its deficiency in breastfed infants. This study evaluates the effects of maternal supplementation with a high dose of vitamin A on the serum retinol levels of exclusively breastfed infants, and their morbidity in the first six months of life. Setting: Hospital based. Study design: Randomised controlled trial. Subjects and methods: Mothers of the test group (n=150) were orally supplemented with a single dose of retinol (209 µmol) soon after delivery and were advised exclusive breastfeeding for six months. Before supplementation retinol levels were estimated in the mothers' and newborns' blood, and in colostrum. On follow up, breastmilk and infants' serum retinol contents were assessed monthly for six months. Retinol level <0.7 µmol/l indicated vitamin A deficiency. Morbidity patterns like vitamin A deficiency, diarrhoea, febrile illnesses, acute respiratory infection, measles, and ear infection were also studied and compared between the two groups. Results: Presupplement mean maternal serum retinol levels were 0.98 and 0.92 µmol/l and mean breastmilk levels were 3.85 and 3.92 µmol/l in the test and control groups respectively (p>0.05). Mean cord blood retinol levels were also comparable (0.68 v 0.64 µmol/l). After supplementation, the test group showed a rise in mean breastmilk retinol content (12.08 v 2.96 µmol/l) which remained significantly higher for four months. The infants' mean serum retinol level, initially 322.06% of the baseline value, was significantly higher for five months. In the control group, significant numbers of mothers and infants showed deficient breastmilk and serum retinol throughout the follow up (p<0.01). Decreased incidence and duration of various diseases were also found in the test group suggesting lesser morbidity. Conclusion: Maternal supplementation with single megadose vitamin A

  19. Morbidity associated with failed vaginal birth after cesarean section.

    PubMed

    Oboro, Victor; Adewunmi, Adeniyi; Ande, Anibaba; Olagbuji, Biodun; Ezeanochie, Michael; Oyeniran, Ayodeji

    2010-09-01

    We investigated morbidity and factors associated with failed vaginal birth after cesarean delivery (VBAC). In a retrospective cohort study maternal and neonatal outcomes of women who underwent VBAC in three Nigerian University Teaching Hospitals were reviewed. Univariate, followed by multivariate analyses, were conducted. VBAC was successful in 683 of 1,013 women (67.4%), whereas 330 (32.6%) had failed VBAC. Failed VBAC was associated with higher incidence of chorioamnionitis, postpartum hemorrhage, blood transfusion, uterine rupture, hysterectomy, and composite major neonatal morbidities. Younger age, lack of previous vaginal delivery, induction of labor and fetal weight >4,000 g were risk factors for failed VBAC. A majority of women who try VBAC achieve a vaginal delivery. Failed VBAC is associated with increased maternal and neonatal morbidity and is somewhat predictable.

  20. Acute kidney injury in pregnancy: a clinical challenge.

    PubMed

    Machado, Susana; Figueiredo, Nuno; Borges, Andreia; São José Pais, Maria; Freitas, Luís; Moura, Paulo; Campos, Mário

    2012-01-01

    The incidence of acute kidney injury in pregnancy declined significantly over the second half of the 20th century; however, it is still associated with major maternal and perinatal morbidity and mortality. A set of systemic and renal physiological adaptive mechanisms occur during a normal gestation that will constrain several changes in laboratory parameters of renal function, electrolytes, fluid and acid-base balances. The diagnosis of acute kidney injury in pregnancy is based on the serum creatinine increase. The usual formulas for estimating glomerular filtration rate are not validated in this population. During the first trimester of gestation, acute kidney injury develops most often due to hyperemesis gravidarum or septic abortion. In the third trimester, the differential diagnosis is more challenging for the obstetrician and the nephrologist and comprises some pathologies that are reviewed in this article: preeclampsia/HELLP syndrome, acute fatty liver of pregnancy and thrombotic microangiopathies.

  1. Psychiatric morbidity in prisoners

    PubMed Central

    Goyal, Sandeep Kumar; Singh, Paramjit; Gargi, Parshotam D.; Goyal, Samta; Garg, Aseem

    2011-01-01

    Context: The prevalence of psychiatric illness in correctional settings is significantly elevated, with higher than community rates reported for most mental disorders. Aims: (1) To examine the socio-demographic profile of convicted prisoners. (2) To evaluate the prevalence of psychiatric disorders in convicted prisoners. Materials and Methods: 500 convicts were assessed for psychiatric morbidity with the help of (a) Socio-demographic proforma, (b) Pareek Udai and Trivedi G's socio-economic status scale (rural) (household schedule), (c) Kuppuswamy's economic status scale (urban) and (d) Present State Examination (PSE). Results: 23.8% of the convicted prisoners were suffering from psychiatric illness excluding substance abuse. 56.4% of the prisoners had history of substance abuse / dependence prior to incarceration. Conclusions: The results suggest that a substantial burden of psychiatric morbidity exists in the prison population of India and the burden of psychiatric illness in this vulnerable and marginalized population poses a serious challenge to psychiatrists. PMID:22135446

  2. Perinatal Morbidity and Mortality in Offsprings of Diabetic Mothers in Qatif, Saudi Arabia.

    ERIC Educational Resources Information Center

    Al-Dabbous, Ibrahim A. Al-; And Others

    1995-01-01

    Studied perinatal and neonatal morbidity and mortality of diabetic mothers and their offspring in Qatif, Saudi Arabia. Suggests diabetes mellitus in pregnancy may be a common problem in Saudi Arabia, as poor maternal diabetic control results in high perinatal morbidity and mortality. Results suggest that health education and improved coverage of…

  3. [Maternal phenylketonuria].

    PubMed

    Bókay, János; Kiss, Erika; Simon, Erika; Szőnyi, László

    2013-05-05

    Elevated maternal phenylalanine levels during pregnancy are teratogenic, and may result in embryo-foetopathy, which could lead to stillbirth, significant psychomotor handicaps and birth defects. This foetal damage is known as maternal phenylketonuria. Women of childbearing age with all forms of phenylketonuria, including mild variants such as hyperphenylalaninaemia, should receive detailed counselling regarding their risks for adverse foetal effects, optimally before contemplating pregnancy. The most assured way to prevent maternal phenylketonuria is to maintain the maternal phenylalanine levels within the optimal range already before conception and throughout the whole pregnancy. Authors review the comprehensive programme for prevention of maternal phenylketonuria at the Metabolic Center of Budapest, they survey the practical approach of the continuous maternal metabolic control and delineate the outcome of pregnancies of mothers with phenylketonuria from the introduction of newborn screening until most recently.

  4. Effect on Infant Illness of Maternal Supplementation With 400 000 IU Vs 200 000 IU of Vitamin A

    PubMed Central

    Figueiroa, José Natal; Grande de Arruda, Ilma Kruze; Diniz, Alcides da Silva

    2012-01-01

    BACKGROUND AND OBJECTIVE: Postpartum vitamin A supplementation is a strategy used to combat vitamin A deficiency and seems to reduce maternal/infant morbidity and mortality. However, studies have shown that a dose of 200 000 IU (World Health Organization [WHO] protocol) does not seem to provide adequate retinol levels in maternal breast milk, infant serum, and infant tissue. The objective of this study was to compare the effect of postpartum maternal supplementation with 400 000 IU (International Vitamin A Consultative Group protocol) compared with 200 000 IU of vitamin A on infant morbidity. METHODS: This was a randomized controlled, triple-blinded clinical trial conducted at 2 public maternity hospitals in Recife in northeastern Brazil. There were 276 mother–child pairs that were allocated to 2 treatment groups: 400 000 IU or 200 000 IU of vitamin A. They were followed up for >6 months to evaluate infant morbidity. RESULTS: Fever (rate ratio [RR]: 0.92 [95% confidence interval (CI): 0.75–1.14]), diarrhea (RR: 0.96 [95% CI: 0.72–1.28]), otitis (RR: 0.94 [95% CI: 0.48–1.85]), acute respiratory infection (RR: 1.03 [95% CI: 0.88–1.21]), the need for intravenous rehydration (RR: 2.08 [95% CI: 0.64–2.07]), and the use of antibiotic treatment (RR: 0.80 [95% CI: 0.43–1.47]) did not differ significantly between the 2 treatment groups. CONCLUSIONS: Our findings suggest that postpartum maternal supplementation with 400 000 IU of vitamin A does not provide any additional benefits in the reduction of illness in children aged <6 months; therefore, we do not support the proposal to increase the standard vitamin A dose in the existing WHO protocol. PMID:22412025

  5. Estimating lifetime healthcare costs with morbidity data

    PubMed Central

    2013-01-01

    Background In many developed countries, the economic crisis started in 2008 producing a serious contraction of the financial resources spent on healthcare. Identifying which individuals will require more resources and the moment in their lives these resources have to be allocated becomes essential. It is well known that a small number of individuals with complex healthcare needs consume a high percentage of health expenditures. Conversely, little is known on how morbidity evolves throughout life. The aim of this study is to introduce a longitudinal perspective to chronic disease management. Methods Data used relate to the population of the county of Baix Empordà in Catalonia for the period 2004–2007 (average population was N = 88,858). The database included individual information on morbidity, resource consumption, costs and activity records. The population was classified using the Clinical Risk Groups (CRG) model. Future morbidity evolution was simulated under different assumptions using a stationary Markov chain. We obtained morbidity patterns for the lifetime and the distribution function of the random variable lifetime costs. Individual information on acute episodes, chronic conditions and multimorbidity patterns were included in the model. Results The probability of having a specific health status in the future (healthy, acute process or different combinations of chronic illness) and the distribution function of healthcare costs for the individual lifetime were obtained for the sample population. The mean lifetime cost for women was €111,936, a third higher than for men, at €81,566 (all amounts calculated in 2007 Euros). Healthy life expectancy at birth for females was 46.99, lower than for males (50.22). Females also spent 28.41 years of life suffering from some type of chronic disease, a longer period than men (21.9). Conclusions Future morbidity and whole population costs can be reasonably predicted, combining stochastic microsimulation with a

  6. Morbidly adherent placenta.

    PubMed

    Abuhamad, Alfred

    2013-10-01

    Morbidly adherent placenta, which describes placenta accreta, increta, and percreta, implies an abnormal implantation of the placenta into the uterine wall. The incidence of placenta accreta has increased significantly over the past several decades, with the main risk factors include prior cesarean section and placental previa. Sonographic markers of placenta accreta can be present as early as the first trimester and include a low uterine implantation of a gestational sac, multiple vascular lacunae within the placenta, loss of the normal hypoechoic retroplacental zone, and abnormality of the uterine serosa-bladder interface, among others. Ultrasound has high sensitivity and specificity for the diagnosis of placenta accreta and MRI should be reserved for rare cases in which the ultrasound is non-diagnostic. The optimum time for planned delivery for a patient with placenta accreta is around 34-35 weeks following a course of corticosteroid injection. The successful management of placenta accreta includes a multidisciplinary care team approach with the successful management relying heavily on the prenatal diagnosis of this entity and preparing for the surgical management in a multidisciplinary approach by assuring the most skilled team is available for those patients.

  7. Maternal Immunization

    PubMed Central

    Chu, Helen Y.; Englund, Janet A.

    2014-01-01

    Maternal immunization has the potential to protect the pregnant woman, fetus, and infant from vaccine-preventable diseases. Maternal immunoglobulin G is actively transported across the placenta, providing passive immunity to the neonate and infant prior to the infant's ability to respond to vaccines. Currently inactivated influenza, tetanus toxoid, and acellular pertussis vaccines are recommended during pregnancy. Several other vaccines have been studied in pregnancy and found to be safe and immunogenic and to provide antibody to infants. These include pneumococcus, group B Streptococcus, Haemophilus influenzae type b, and meningococcus vaccines. Other vaccines in development for potential maternal immunization include respiratory syncytial virus, herpes simplex virus, and cytomegalovirus vaccines. PMID:24799324

  8. Understanding maternal mental illness: psychiatric autopsy of a maternal death.

    PubMed

    Chen, Helen

    2012-05-01

    Maternal mental illness is a significant public health concern, with established adverse outcomes on both mother and infant, such as impaired mother-infant bonding and infant cognitive and emotional development. In severe cases, maternal mortality and infanticide can tragically occur. This is a report on the suicide of a mother who jumped to her death at three months postpartum. She suffered from puerperal psychosis with bipolar features, with onset at six weeks postpartum. The case highlights the burden of maternal mental illness in our community as well as the need for resources and services to care well for mothers. With a better understanding of its presentation and risk factors, early identification and intervention can reduce morbidity and mortality.

  9. Relation between economic disadvantage and psychosocial morbidity in children.

    PubMed Central

    Lipman, E L; Offord, D R; Boyle, M H

    1994-01-01

    OBJECTIVE: To examine the relation between low income and child psychosocial morbidity cross-sectionally and longitudinally. DESIGN: Cross-sectional survey with follow-up. SETTING: Ontario. PARTICIPANTS: Children aged 4 to 16 years from families selected by means of stratified, clustered and random sampling of 1981 Canada Census data. Results were based on the responses of 2503 children interviewed in 1983 and 1076 re-interviewed in 1987. OUTCOME MEASURES: Prevalence rates of psychiatric disorders, poor school performance and social impairment. RESULTS: There was a significant relation between low income and psychosocial morbidity, with a threshold at an income level of less than $10,000. Poor children 4 to 11 years of age were at greater risk of morbidity than poor children 12 to 16, but there were no significant age differences. Logistic regression revealed that low income and noneconomic factors (low maternal education and family dysfunction) shared significant independent influences on the prevalence of psychosocial morbidity. CONCLUSIONS: Low income is strongly associated with psychosocial morbidity in children. Both economic and noneconomic factors showed independent influences on morbidity. These findings have important clinical, scientific and policy implications. PMID:8055403

  10. From ideals to tools: applying human rights to maternal health.

    PubMed

    Yamin, Alicia Ely

    2013-11-01

    Alicia Yamin argues that applying human rights frameworks and approaches to maternal health offers strategies and tools to address the root causes of maternal morbidity and mortality within and beyond health systems, in addition to addressing other violations of women's sexual and reproductive health and rights. Please see later in the article for the Editors' Summary.

  11. Acute bacterial parotitis following acute stroke.

    PubMed

    Lee, V K; Kimbrough, D J; Jarquin-Valdivia, A A

    2009-06-01

    Acute bacterial parotitis (ABP) is a relatively uncommon condition that tends to occur in debilitated older patients. We report a case of an older woman that presented with an acute intracerebral hemorrhage who developed ABP. This morbidity led to endotracheal intubation, mechanical ventilation, tracheostomy and gastrostomy, all of which were not initially needed. We discuss the proposed physiopathology and etiopathogenesis of ABP in adults.

  12. Serious maternal complications after early preterm delivery (24–33 weeks’gestation)

    PubMed Central

    Reddy, Uma M.; Rice, Madeline Murguia; Grobman, William A.; Bailit, Jennifer L.; Wapner, Ronald J.; Varner, Michael W.; Thorp, John M.; Leveno, Kenneth J.; Caritis, Steve N.; Prasad, Mona; Tita, Alan T. N.; Saade, George R.; Sorokin, Yoram; Rouse, Dwight J.; Blackwell, Sean C.; Tolosa, Jorge E.

    2015-01-01

    OBJECTIVE To describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route and type of cesarean incision. STUDY DESIGN Trained personnel abstracted data from maternal and neonatal charts for all deliveries on randomly selected days representing 1/3 of deliveries across 25 US hospitals over 3 years (n=115,502). All women delivering non-anomalous singletons between 23 and 33 weeks’ gestation were included. Women were excluded for antepartum stillbirth and highly morbid conditions for which route of delivery would not likely impact morbidity including non-reassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe, unstable maternal conditions (cardiopulmonary collapse, acute respiratory distress syndrome, seizures). Serious maternal complications were defined as: hemorrhage (blood loss ≥1500 mL, blood transfusion, or hysterectomy for hemorrhage); infection (endometritis, wound dehiscence, or wound infection requiring antibiotics, reopening or unexpected procedure); ICU admission; or death. Delivery route was categorized as classical cesarean delivery (CCD), low transverse cesarean delivery (LTCD), low vertical cesarean delivery (LVCD), and vaginal delivery (VD). Association of delivery route with complications was estimated using multivariable regression models yielding adjusted relative risks (aRR) controlling for maternal age, race, body mass index, hypertension, diabetes, preterm premature rupture of membranes, preterm labor, GA, and hospital of delivery. RESULTS Of 2659 women who met criteria for inclusion in this analysis, 8.6% of women experienced serious maternal complications. Complications were associated with GA and were highest between 23–27 weeks of gestation. The frequency of complications was associated with delivery route; compared with 3.5% of SVD, 23.0% of CCD (aRR 3.54, 95%CI 2.29–5.48), 12.1% of LTCD (aRR 2.59, 95%CI 1.77–3

  13. [Morbidity in draft military personnel].

    PubMed

    Mukhametzhanov, A M; Smagulov, N K

    2015-01-01

    Military service activity appeared to influence health state of military personnel. Body strain at initial stages of the service, connected with stress situation, affects general body resistance and manifests in higher general morbidity level with transitory disablement that decreases with adaptation. Based on normalized intensity parameters, the equation enables to ease a procedure of evaluation and forecast of transitory disablement morbidity in draft military personnel.

  14. The morbidity of trauma nephrectomy.

    PubMed

    Edwards, Norma M; Claridge, Jeffrey A; Forsythe, Raquel M; Weinberg, Jordan A; Croce, Martin A; Fabian, Timothy C

    2009-11-01

    Mortality has been shown to be high in patients after trauma nephrectomy (TN). However, there are little data regarding morbidity in survivors. The objective of this study was to determine the morbidity rates associated with TN with attention directed to renal failure (RF) and formation of intra-abdominal abscess (IAA). Patients who underwent TN over a 9-year period (1996 to 2004) were identified from the trauma registry. Records were reviewed for all complications after TN in patients surviving at least 48 hours. Eighty-nine patients were identified with TN; 61 per cent resulted after penetrating trauma. Overall mortality was 34 per cent. Seventy-one patients survived greater than 48 hours; 51 (72%) experienced at least one morbidity. There was no difference in morbidity rates between patients undergoing blunt trauma and those undergoing penetrating trama. Patients with morbidities were significantly older, more severely injured, and had higher mortality rates and longer hospital courses. Infectious complications were seen in 52 per cent, respiratory in 48 per cent, gastrointestinal in 30 per cent, coagulopathy in 25 per cent, and RF and IAA were each seen in 14 per cent of patients. Patients undergoing TN are severely injured with significant morbidity. The results from this study allow us to establish benchmarks to assess complication rates for patients who undergo TN, which can provide prognostic information and goals to improve patient outcomes.

  15. Parental psychosocial stress and asthma morbidity in Puerto Rican twins

    PubMed Central

    Lange, Nancy E.; Bunyavanich, Supinda; Silberg, Judy L.; Canino, Glorisa; Rosner, Bernard A.; Celedón, Juan C.

    2010-01-01

    Background Little is known about paternal psychosocial factors and childhood asthma. Objective To examine the link between maternal and paternal psychosocial stress and asthma outcomes in young children. Methods Parents of 339 pairs of Puerto Rican twins were interviewed individually about their own psychosocial stress and about asthma in their children at age 1 and again about their child’s asthma at age 3. Fathers were asked about symptoms of post-traumatic stress disorder (PTSD), depression, and anti-social behavior. Mothers were asked about depressive symptoms. Outcomes assessed in children included recent asthma symptoms, oral steroid use and hospitalizations for asthma in the prior year, and asthma diagnosis. Generalized estimated equation models were used for the multivariate analysis of parental psychosocial stress and asthma morbidity in childhood. Results After multivariable adjustment, paternal PTSD symptoms, depression, and anti-social behavior were each associated with increased asthma symptoms at age 1 (e.g., OR =1.08 for each 1-point increase in PTSD score, 95% CI=1.03–1.14). Maternal depressive symptoms were associated with an increased risk of asthma hospitalizations at age 1 year. At age 3 years, maternal depressive symptoms were associated with asthma diagnosis and hospitalizations for asthma (OR for each 1-point increase in symptoms=1.16, 95% CI=1.00–1.36]). In an analysis combining 1 and 3 year outcomes, paternal depression was associated with oral steroid use, maternal depressive symptoms were associated with asthma hospitalizations and asthma diagnosis, and parental depression was associated with hospitalizations for asthma. Conclusions Both paternal and maternal psychosocial factors may influence asthma morbidity in young Puerto Rican children. PMID:21194742

  16. RTOG 0529: A Phase 2 Evaluation of Dose-Painted Intensity Modulated Radiation Therapy in Combination With 5-Fluorouracil and Mitomycin-C for the Reduction of Acute Morbidity in Carcinoma of the Anal Canal

    SciTech Connect

    Kachnic, Lisa A.; Winter, Kathryn; Myerson, Robert J.; Goodyear, Michael D.; Willins, John; Esthappan, Jacqueline; Haddock, Michael G.; Rotman, Marvin; Parikh, Parag J.; Safran, Howard; Willett, Christopher G.

    2013-05-01

    Purpose: A multi-institutional phase 2 trial assessed the utility of dose-painted intensity modulated radiation therapy (DP-IMRT) in reducing grade 2+ combined acute gastrointestinal and genitourinary adverse events (AEs) of 5-fluorouracil (5FU) and mitomycin-C (MMC) chemoradiation for anal cancer by at least 15% compared with the conventional radiation/5FU/MMC arm from RTOG 9811. Methods and Materials: T2-4N0-3M0 anal cancer patients received 5FU and MMC on days 1 and 29 of DP-IMRT, prescribed per stage: T2N0, 42 Gy elective nodal and 50.4 Gy anal tumor planning target volumes (PTVs) in 28 fractions; T3-4N0-3, 45 Gy elective nodal, 50.4 Gy ≤3 cm or 54 Gy >3 cm metastatic nodal and 54 Gy anal tumor PTVs in 30 fractions. The primary endpoint is described above. Planned secondary endpoints assessed all AEs and the investigator’s ability to perform DP-IMRT. Results: Of 63 accrued patients, 52 were evaluable. Tumor stage included 54% II, 25% IIIA, and 21% IIIB. In primary endpoint analysis, 77% experienced grade 2+ gastrointestinal/genitourinary acute AEs (9811 77%). There was, however, a significant reduction in acute grade 2+ hematologic, 73% (9811 85%, P=.032), grade 3+ gastrointestinal, 21% (9811 36%, P=.0082), and grade 3+ dermatologic AEs 23% (9811 49%, P<.0001) with DP-IMRT. On initial pretreatment review, 81% required DP-IMRT replanning, and final review revealed only 3 cases with normal tissue major deviations. Conclusions: Although the primary endpoint was not met, DP-IMRT was associated with significant sparing of acute grade 2+ hematologic and grade 3+ dermatologic and gastrointestinal toxicity. Although DP-IMRT proved feasible, the high pretreatment planning revision rate emphasizes the importance of real-time radiation quality assurance for IMRT trials.

  17. Acute kidney injury in the pregnant patient.

    PubMed

    Nwoko, Rosemary; Plecas, Darko; Garovic, Vesna D

    2012-12-01

    Acute kidney injury (AKI) is costly and is associated with increased mortality and morbidity. An understanding of the renal physiologic changes that occur during pregnancy is essential for proper evaluation, diagnosis, and management of AKI. As in the general population, AKI can occur from prerenal, intrinsic, and post-renal causes. Major causes of pre-renal azotemia include hyperemesis gravidarum and uterine hemorrhage in the setting of placental abruption. Intrinsic etiologies include infections from acute pyelonephritis and septic abortion, bilateral cortical necrosis, and acute tubular necrosis. Particular attention should be paid to specific conditions that lead to AKI during the second and third trimesters, such as preeclampsia, HELLP syndrome, acute fatty liver of pregnancy, and TTP-HUS. For each of these disorders, delivery of the fetus is the recommended therapeutic option, with additional therapies indicated for each specific disease entity. An understanding of the various etiologies of AKI in the pregnant patient is key to the appropriate clinical management, prevention of adverse maternal outcomes, and safe delivery of the fetus. In pregnant women with pre-existing kidney disease, the degree of renal dysfunction is the major determining factor of pregnancy outcomes, which may further be complicated by a prior history of hypertension.

  18. Caring for the woman with acute fatty liver of pregnancy.

    PubMed

    Holub, Karen; Camune, Barbara

    2015-01-01

    Acute fatty liver of pregnancy, although rare, is usually a third trimester of pregnancy occurrence that may be life threatening for both the pregnant woman and the fetus. Often, the onset resembles gastroenteritis or cholecystitis and correct diagnosis is delayed. Because it can also present with preeclampsia and eclampsia, it may be mistakenly diagnosed as hemolysis, elevated liver enzymes, low platelet syndrome. This article presents diagnostic differences between liver conditions that can complicate pregnancy and management strategies for treating and maintaining the well-being of pregnant women, fetuses, and infants who are affected by acute fatty liver of pregnancy. Early recognition and rapid intervention from antepartum diagnosis through delivery and the postpartum period are required by the nursing team and medical providers to reduce maternal and neonatal morbidity and mortality.

  19. Snake Bite-Induced Acute Kidney Injury: Report of a Successful Outcome during Pregnancy.

    PubMed

    Vikrant, Sanjay; Parashar, Anupam

    2017-02-06

    Snake bite is an important health hazard in tropics. Snake envenomation in pregnancy may cause fetal death and maternal mortality or morbidity. However, little is known about the toxic effects and optimal management during pregnancy after snake envenomation because of the rarity of cases. Herein, we report a case of a pregnant woman who was successfully treated for snake bite-induced acute kidney injury during the third trimester. She was treated with equine-derived polyvalent anti-snake venom without development of any adverse effects, hemodialysis, and supportive therapy. She fully recovered and subsequently gave birth to a healthy child.

  20. ROLE OF THE MATERNAL ACUTE PHASE RESPONSE AND TUMOR NECROSIS FACTOR ALPHA IN THE DEVELOPMENTAL TOXICITY OF LIPOPOLYSACCHARIDE IN THE CD-1 MOUSE

    EPA Science Inventory

    ABSTRACT
    The acute phase response (APR) functions to reset metabolic homeostasis following infectious, toxic or traumatic insult. TNF- , a putative mediator of the APR, has been associated with fetal death in rodents and preterm labor and delivery in humans. We hypothesized...

  1. Are the acute effects of particulate matter on mortality in the National Morbidity, Mortality, and Air Pollution Study the result of inadequate control for weather and season? A sensitivity analysis using flexible distributed lag models.

    PubMed

    Welty, Leah J; Zeger, Scott L

    2005-07-01

    Time-series studies have linked daily variations in nonaccidental deaths with daily variations in ambient particulate matter air pollution, while controlling for qualitatively larger influences of weather and season. Although time-series analyses typically include nonlinear terms for weather and season, questions remain as to whether models to date have completely controlled for these important predictors. In this paper, the authors use two flexible versions of distributed lag models to control extensively for the confounding effects of weather and season. One version builds on the current approach to controlling for weather, while the other version offers a new approach. The authors conduct a comprehensive sensitivity analysis of the particulate matter-mortality relation by applying these methods to the recently updated National Morbidity, Mortality, and Air Pollution Study database that comprises air pollution, weather, and mortality time series from 1987 to 2000 for 100 US cities. They combine city-specific estimates of the short-term effects of particulate matter on mortality using a Bayesian hierarchical model. They conclude that, within the broad classes of models considered, national average estimates of particulate matter relative risk are consistent with previous estimates from this study and are robust to model specification for weather and seasonal confounding.

  2. Update on the management of non-obstetric acute abdomen in pregnant patients.

    PubMed

    Barber-Millet, Sebastián; Bueno Lledó, José; Granero Castro, Pablo; Gómez Gavara, Immaculada; Ballester Pla, Neus; García Domínguez, Rafael

    2016-05-01

    Acute abdomen is a rare entity in the pregnant patient, with an incidence of one in 500-635 patients. Its appearance requires a quick response and an early diagnosis to treat the underlying disease and prevent maternal and fetal morbidity. Imaging tests are essential, due to clinical and laboratory masking in this subgroup. Appendicitis and complicated biliary pathology are the most frequent causes of non-obstetric acute abdomen in the pregnant patient. The decision to operate, the timing, and the surgical approach are essential for a correct management of this pathology. The aim of this paper is to perform a review and update on the diagnosis and treatment of non-obstetric acute abdomen in pregnancy.

  3. Morbidity and mortality following induced abortion in Nnewi, Nigeria.

    PubMed

    Ikechebelu, J I; Okoli, C C

    2003-07-01

    We present a study of the maternal morbidity and mortality among 76 patients treated at the Nnamdi Azikiwe University Teaching Hospital, Nnewi for complications of induced abortion from January 1996 to December 2000. The total number of maternal admissions over this period was 5750, and illegal induced abortion was responsible for 1.3% of the admissions, with a mortality rate of 5.3% (n = 4) for induced abortion. This accounted for 21.1% of the total maternal deaths (n = 19) for the period. The mean age of the women was 20.6 years (range 15-34 years), 94.7% (n = 72) were unmarried, 93.5% (n = 71) were nulliparous and 76.5% (n = 58) were unemployed, 67.1% (n = 51) had had a mid-trimester termination at > 13 weeks gestational age. It is significant that 55.3% of the patients were teenagers and 45.1% of the mid-trimester abortions occurred in this group. Genital sepsis, haemorrhage, pelvic infection with peritonitis and abscess formation, uterine perforation, and gut injury were the major complications encountered. This study demonstrates that induced abortion is still a major cause of maternal mortality in Nigeria. Integrated family health education, planned parenthood and contraceptive education, a mass literacy campaign and improvement of the existing national health services are recommended in order to ameliorate the problems of illegally induced abortion in Nigeria.

  4. Reducing morbidity and mortality among pregnant obese.

    PubMed

    Harper, Ann

    2015-04-01

    Obesity is increasing; in the UK, almost 20% of pregnant women have a body mass index (BMI) of ≥30 kg/m(2). Obese mothers have increased risks of pregnancy complications including miscarriage, congenital anomaly, gestational diabetes, pre-eclampsia, macrosomia, induction of labour, caesarean section, anaesthetic and surgical complications, post-partum haemorrhage, infection and venous thromboembolism. Complications tend to be greater in those with the highest BMIs. In recent triennia, obesity (27-29%) was over-represented in maternal mortality figures. Strategies to reduce morbidity and mortality include calculating BMI at booking visit to identify obese mothers and plan their antenatal care and delivery. This should include nutritional and lifestyle advice, screening for gestational diabetes and pre-eclampsia, thromboembolism risk assessment, antenatal anaesthetic review if BMI is ≥ 40 kg/m(2), ensuring availability of robust theatre tables and other equipment and involving senior doctors, especially in the labour ward. Afterwards, continuing weight reduction should be encouraged to reduce future pregnancy and health risks.

  5. Burns in Morbidly Obese Patients,

    DTIC Science & Technology

    1992-12-01

    tract infection and one episode C obesity. The clinical records of these patients were reviewed in of sinusitis. Two patients had documented bacteremias...veloped pneumonia and two developed tracheobronchitis. 0 Research, seven of whom clearly fulfilled the criteria for morbid There were one urinary

  6. Morbidity and growth performance of infants in Madura, Indonesia.

    PubMed

    Kolsteren, P W; Kusin, J A; Kardjati, S

    1997-09-01

    Between January 1987 and July 1988, all children born in two villages on the island of Madura, Indonesia were visited weekly by a field worker trained to interview mothers on disease symptoms. The maximum recall period was 1 week. All infants were measured (weight and height) at monthly intervals. Information on growth and morbidity is analysed for infants from birth until the age of 11 months. Morbidity, defined as acute respiratory tract infection (ARI), diarrhoea, fever and other diseases, is analysed over 4-week periods and related to growth performance. In total, there are 1373 4-week reporting periods with morbidity information from birth to the age of 12 months. Of all the diseases recorded (1021), 47% were ARI, 13% diarrhoea, 14% fever and 26% other diseases. The average (SD) duration of diarrhoea was 7 (11) days, ARI 14 (9) days, fever 6 (4) days and 16 (10) days for other diseases. The most striking results in this analysis are: (i) the lack of a relationship between morbidity and growth (either linear or weight) during the 1st 6 months of life; (ii) the existence of a relationship between illness and weight increment for which only ARI showed significant influence for infants of 6 months and more; (iii) the lack of a relationship between morbidity and linear growth performance at all ages; and (iv) the fact that no cumulative effect of disease on growth performance was found to explain the observations.

  7. Maternal vaccination: moving the science forward

    PubMed Central

    Faucette, Azure N.; Unger, Benjamin L.; Gonik, Bernard; Chen, Kang

    2015-01-01

    BACKGROUND Infections remain one of the leading causes of morbidity in pregnant women and newborns, with vaccine-preventable infections contributing significantly to the burden of disease. In the past decade, maternal vaccination has emerged as a promising public health strategy to prevent and combat maternal, fetal and neonatal infections. Despite a number of universally recommended maternal vaccines, the development and evaluation of safe and effective maternal vaccines and their wide acceptance are hampered by the lack of thorough understanding of the efficacy and safety in the pregnant women and the offspring. METHODS An outline was synthesized based on the current status and major gaps in the knowledge of maternal vaccination. A systematic literature search in PUBMED was undertaken using the key words in each section title of the outline to retrieve articles relevant to pregnancy. Articles cited were selected based on relevance and quality. On the basis of the reviewed information, a perspective on the future directions of maternal vaccination research was formulated. RESULTS Maternal vaccination can generate active immune protection in the mother and elicit systemic immunoglobulin G (IgG) and mucosal IgG, IgA and IgM responses to confer neonatal protection. The maternal immune system undergoes significant modulation during pregnancy, which influences responsiveness to vaccines. Significant gaps exist in our knowledge of the efficacy and safety of maternal vaccines, and no maternal vaccines against a large number of old and emerging pathogens are available. Public acceptance of maternal vaccination has been low. CONCLUSIONS To tackle the scientific challenges of maternal vaccination and to provide the public with informed vaccination choices, scientists and clinicians in different disciplines must work closely and have a mechanistic understanding of the systemic, reproductive and mammary mucosal immune responses to vaccines. The use of animal models should be

  8. Endothelial dysfunction in morbid obesity.

    PubMed

    Mauricio, Maria Dolores; Aldasoro, Martin; Ortega, Joaquin; Vila, José María

    2013-01-01

    Morbid obesity is a chronic multifunctional disease characterized by an accumulation of fat. Epidemiological studies have shown that obesity is associated with cardiovascular and metabolic disorders. Endothelial dysfunction, as defined by an imbalance between relaxing and contractile endothelial factors, plays a central role in the pathogenesis of these cardiometabolic diseases. Diminished bioavailability of nitric oxide (NO) contributes to endothelial dysfunction and impairs endothelium- dependent vasodilatation. But this is not the only mechanism that drives to endothelial dysfunction. Obesity has been associated with a chronic inflammatory process, atherosclerosis, and oxidative stress. Moreover levels of asymmetrical dimethyl-L-arginine (ADMA), an endogenous inhibitor of endothelial nitric oxide synthase (eNOS), are elevated in obesity. On the other hand, increasing prostanoid-dependent vasoconstriction and decreasing vasodilator prostanoids also lead to endothelial dysfunction in obesity. Other mechanisms related to endothelin-1 (ET-1) or endothelium derived hyperpolarizing factor (EDHF) have been proposed. Bariatric surgery (BS) is a safe and effective means to achieve significant weight loss, but its use is limited only to patients with severe obesity including morbid obesity. BS also proved efficient in endothelial dysfunction reduction improving cardiovascular and metabolic comorbidities associated with morbid obesity such as diabetes, coronary artery disease, nonalcoholic fatty liver disease and cancer. This review will provide a brief overview of the mechanisms that link obesity with endothelial dysfunction, and how weight loss is a cornerstone treatment for cardiovascular comorbidities obesity-related. A better understanding of the mechanisms of obesity-induced endothelial dysfunction may help develop new therapeutic strategies to reduce cardiovascular morbidity and mortality.

  9. Acute respiratory failure and mechanical ventilation in pregnant patient: A narrative review of literature

    PubMed Central

    Bhatia, Pradeep Kumar; Biyani, Ghansham; Mohammed, Sadik; Sethi, Priyanka; Bihani, Pooja

    2016-01-01

    Physiological changes of pregnancy imposes higher risk of acute respiratory failure (ARF) with even a slight insult and remains an important cause of maternal and fetal morbidity and mortality. Although pregnant women have different respiratory physiology and different causes of ARF, guidelines specific to ventilatory settings, goals of oxygenation and weaning process could not be framed due to lack of large-scale randomized controlled trials. During the 2009 H1N1 pandemic, pregnant women had higher morbidity and mortality compared to nonpregnant women. During this period, alternative strategies of ventilation such as high-frequency oscillatory ventilation, inhalational of nitric oxide, prone positioning, and extra corporeal membrane oxygenation were increasingly used as a desperate measure to rescue pregnant patients with severe hypoxemia who were not improving with conventional mechanical ventilation. This article highlights the causes of ARF and recent advances in invasive, noninvasive and alternative strategies of ventilation used during pregnancy. PMID:28096571

  10. Maternal and neonatal herpes simplex virus infections.

    PubMed

    Pinninti, Swetha G; Kimberlin, David W

    2013-02-01

    Genital herpes infections are extremely common worldwide and ~22% of pregnant women are infected with herpes simplex virus. Eighty percent of those affected with genital herpes are unaware of being infected. The most devastating consequence of maternal genital herpes is neonatal herpes disease. Fortunately, neonatal herpes simplex infections are uncommon but due to the morbidity and mortality associated with the infection are often considered in the differential diagnosis of ill neonates. The use of polymerase chain reaction assay for diagnosis of central nervous system infections and the development of safe and effective antiviral therapy have revolutionized the diagnosis and management of these infants. Most recently, the initiation of long-term antiviral suppressive therapy in these infants has led to significant improvement in morbidity. This review will summarize the epidemiology of maternal and neonatal herpes infections and discuss clinical presentation, diagnosis, management, and follow-up of infants with neonatal herpes disease.

  11. Acute kidney injury in pregnancy-current status.

    PubMed

    Acharya, Anjali; Santos, Jolina; Linde, Brian; Anis, Kisra

    2013-05-01

    Pregnancy-related acute kidney injury (PR-AKI) causes significant maternal and fetal morbidity and mortality. Management of PR-AKI warrants a thorough understanding of the physiologic adaptations in the kidney and the urinary tract. Categorization of etiologies of PR-AKI is similar to that of acute kidney injury (AKI) in the nonpregnant population. The causes differ between developed and developing countries, with thrombotic microangiopathies (TMAs) being common in the former and septic abortion and puerperal sepsis in the latter. The incidence of PR-AKI is reported to be on a decline, but there is no consensus on the exact definition of the condition. The physiologic changes in pregnancy make diagnosis of PR-AKI difficult. Newer biomarkers are being studied extensively but are not yet available for clinical use. Early and accurate diagnosis is necessary to improve maternal and fetal outcomes. Timely identification of "at-risk" individuals and treatment of underlying conditions such as sepsis, preeclampsia, and TMAs remain the cornerstone of management. Questions regarding renal replacement therapy such as modality, optimal prescription, and timing of initiation in PR-AKI remain unclear. There is a need to systematically explore these variables to improve care of women with PR-AKI.

  12. Impact of maternal obesity on perinatal and childhood outcomes.

    PubMed

    Santangeli, Louise; Sattar, Naveed; Huda, Shahzya S

    2015-04-01

    Maternal obesity is of major consequence, affecting every aspect of maternity care including both short- and long-term effects on the health of the offspring. Obese mothers are at a higher risk of developing gestational diabetes and pre-eclampsia, potentially exposing the foetus to an adverse intrauterine environment. Maternal obesity is linked to foetal macrosomia, resulting in increased neonatal and maternal morbidity. Foetal macrosomia is a result of a change in body composition in the neonate with an increase in both percentage fat and fat mass. Maternal obesity and gestational weight gain are associated with childhood obesity, and this effect extends into adulthood. Childhood obesity in turn increases chances of later life obesity, thus type 2 diabetes, and cardiovascular disease in the offspring. Further clinical trials of lifestyle and, potentially, pharmacological interventions in obese pregnant women are required to determine whether short- and long-term adverse effects for the mother and child can be reduced.

  13. National Partnership for Maternal Safety: Consensus Bundle on Obstetric Hemorrhage.

    PubMed

    Main, Elliott K; Goffman, Dena; Scavone, Barbara M; Low, Lisa Kane; Bingham, Debra; Fontaine, Patricia L; Gorlin, Jed B; Lagrew, David C; Levy, Barbara S

    2015-07-01

    Hemorrhage is the most frequent cause of severe maternal morbidity and preventable maternal mortality and therefore is an ideal topic for the initial national maternity patient safety bundle. These safety bundles outline critical clinical practices that should be implemented in every maternity unit. They are developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. The safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and System Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. References contain sample resources and "Potential Best Practices" to assist with implementation.

  14. National Partnership for Maternal Safety Consensus Bundle on Obstetric Hemorrhage.

    PubMed

    Main, Elliott K; Goffman, Dena; Scavone, Barbara M; Low, Lisa Kane; Bingham, Debra; Fontaine, Patricia L; Gorlin, Jed B; Lagrew, David C; Levy, Barbara S

    2015-01-01

    Hemorrhage is the most frequent cause of severe maternal morbidity and preventable maternal mortality and therefore is an ideal topic for the initial national maternity patient safety bundle. These safety bundles outline critical clinical practices that should be implemented in every maternity unit. They are developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. The safety bundle is organized into 4 domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. References contain sample resources and "Potential Best Practices" to assist with implementation.

  15. National Partnership for Maternal Safety: consensus bundle on obstetric hemorrhage.

    PubMed

    Main, Elliott K; Goffman, Dena; Scavone, Barbara M; Low, Lisa Kane; Bingham, Debra; Fontaine, Patricia L; Gorlin, Jed B; Lagrew, David C; Levy, Barbara S

    2015-07-01

    Hemorrhage is the most frequent cause of severe maternal morbidity and preventable maternal mortality and therefore is an ideal topic for the initial national maternity patient safety bundle. These safety bundles outline critical clinical practices that should be implemented in every maternity unit. They are developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. The safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and System Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. References contain sample resources and "Potential Best Practices" to assist with implementation.

  16. Case report: anesthetic management of acute fatty liver of pregnancy in the postpartum period.

    PubMed

    Spence, Dennis

    2010-06-01

    Acute fatty liver of pregnancy (AFLP) is a potentially fatal metabolic disorder that manifests during the third trimester. Early diagnosis, termination of pregnancy, and treatment of complications associated with AFLP significantly reduce maternal morbidity and mortality. While most cases of AFLP occur before delivery, some may occur after vaginal delivery. Anesthesia providers should have a high level of suspicion for AFLP in a patient with altered mental status and elevated liver function test results in the postpartum period. Anesthetic implications include early recognition of liver dysfunction and aggressive resuscitation and treatment of hypoglycemia, disseminated intravascular coagulopathy, and other associated complications and reduction or avoidance of medications with substantial hepatic metabolism. This is a case report describing the management of a woman with AFLP in whom acute liver failure rapidly developed after a vaginal delivery with epidural analgesia at a small overseas hospital.

  17. Estimating risk factors and causes for postpartum febrile morbidity in teenage mothers.

    PubMed

    Haeri, S; Baker, A M

    2013-02-01

    In this cohort study, our objective was to identify potentially modifiable risk factors and causes for febrile morbidity in teenage mothers. We identified all cases of febrile morbidity using the United States Joint Commission on Maternal Welfare definition in a cohort of teenage deliveries over a 4-year period at one institution. Of the 730 included teenage deliveries, 49 (7%) women suffered postpartum febrile morbidity. Higher maternal pre-pregnancy body mass index (BMI: 34.0 ± 8.6 vs 30.3 ± 6.0 kg/m(2), p = 0.0001), caesarean delivery (RR 21.3, 95% CU 8.9-54.9) and postpartum haemorrhage (RR 3.0, 95% CI 1.1-6.7) were associated with postpartum febrile morbidity. Risk factors for febrile morbidity in the teenage parturient include obesity, caesarean delivery and postpartum haemorrhage. Considering the increasing rates of teenage obesity and overall caesarean delivery rates, attention must be focused on these modifiable risk factors to avoid this complication during a tenuous time for the teenage parent.

  18. Social factors and cardiovascular morbidity.

    PubMed

    Brunner, Eric John

    2017-03-01

    Recent progress in population health at aggregate level, measured by life expectancy, has been accompanied by lack of progress in reducing the difference in health prospects between groups defined by social status. Cardiovascular disease is an important contributor to this undesirable situation. The stepwise gradient of higher risk with lower status is accounted for partly by social gradients in health behaviors. The psychosocial hypothesis provides a stronger explanation, based on social patterning of living and working environments and psychological assets that individuals develop during childhood. Three decades of research based on Whitehall II and other cohort studies provide evidence for psychosocial pathways leading to cardiovascular morbidity and mortality. Job stress is a useful paradigm because exposure is long term and depends on occupational status. Studies of social-biological translation implicate autonomic and neuroendocrine function among the biological systems that mediate between chronic adverse psychosocial exposures and increased cardiometabolic risk and cardiovascular disease incidence.

  19. Cancer morbidity in alcohol abusers.

    PubMed Central

    Tønnesen, H.; Møller, H.; Andersen, J. R.; Jensen, E.; Juel, K.

    1994-01-01

    Data on the association between alcohol abuse and cancer morbidity are scarce in large cohorts of non-hospitalised alcoholic men and women. Of 18,368 alcohol abusers who entered an outpatient clinic in Copenhagen during 1954-87, 18,307 were followed and their cancer incidence was compared with that of the total Danish population. On average the 15,214 men were observed for 12.9 years and the 3,093 women for 9.4 years. The overall morbidity of cancer was increased significantly. Of the men, 1,441 developed cancer [relative risk (RR) = 1.6; 95% confidence interval (CI) = 1.5-1.7], while 182 women did (RR = 1.5; 95% CI 1.3-1.8). Significantly increased incidences were found of cancer in the tongue, mouth, pharynx, oesophagus, liver, larynx, lung and pleura and secondary cancer. The women had significantly increased risk of cervical cancer (RR = 2.0; 95% CI 1.2-3.0). The men developed prostatic cancer significantly more frequently than expected (RR = 1.4; 95% CI 1.2-1.8). The risk of melanomas (RR = 0.5; 95% CI 0.2-0.8) was significantly lower than expected. The relative risks of cancer of the stomach, pancreas, kidney and endocrine system were only slightly increased. The study group did not develop more colonic (RR = 1.0; 95% CI 0.8-1.3) or rectal cancer (RR = 1.0; CI 0.7-1.3) than expected. The risk of breast cancer in women was slightly increased (RR = 1.3; 95% CI 0.9-1.7), but not statistically significant. Thus, the associations between alcohol and cancer of the upper digestive and respiratory tract and the liver are confirmed. In addition, this study indicates an increased occurrence of cancer of the prostate gland, pleura and uterine cervix in alcohol abusers. PMID:8297729

  20. Resting energy expenditure of morbidly obese patients using indirect calorimetry: a systematic review.

    PubMed

    Kee, A-L; Isenring, E; Hickman, I; Vivanti, A

    2012-09-01

    The increasing proportion of acutely ill hospital patient admissions presenting with a morbidly obese body mass index (BMI ≥ 40 kg m(-2) ) as a comorbidity is an emerging clinical concern. Suboptimal food intake and malnutrition is prevalent in the acute care hospital setting. The energy requirements necessary to prevent malnutrition in acutely ill patients with morbid obesity remains unclear. The aim of this systematic review was to identify studies in the literature that have used indirect calorimetry to measure the resting energy expenditure of patients with morbid obesity to establish their minimum energy requirements and the implications for optimal feeding practices in acutely ill hospitalized patients. A total of 20 studies from PubMed, Cochrane Library and Embase met the inclusion criteria and were reviewed. All articles were graded using the Australian National Health and Medical Research Council levels of evidence and given a quality rating using the American Dietetic Association recommendations. Studies were categorized according to the mean BMI of its subjects. The most commonly measured resting energy expenditures for morbidly obese patients are between 2,000 and 3,000 kcal d(-1) (8,400-12,600 kJ d(-1) ). Activity and injury factors of acutely ill morbidly obese patients could result in significantly greater energy requirements for this patient group and are unlikely to be met by standard hospital menus. Establishing the minimum energy requirements for this population group will help inform adequate and accurate energy provision in the acute setting. Outcomes of underfeeding and overfeeding in morbidly obese patients warrant further research.

  1. Tracheo-Esophageal Fistula (TEF) in a Newborn Following Maternal Antenatal Exposure to Olanzapine.

    PubMed

    Maharshi, Vikas; Banerjee, Indranil; Nagar, Pravesh; Rehan, Harmeet Singh

    2017-12-01

    There is a dearth of evidence on the safety of the use of antipsychotics during pregnancy. Olanzapine, a pregnancy category C drug, has no unequivocal evidence of harm to the fetus. Against this backdrop, we report the first case of a tracheo-esophageal fistula (TEF) in a newborn following maternal antenatal exposure to olanzapine. A 29-year-old woman with acute psychotic disorder had been treated with olanzapine for the last 7 years. Her first pregnancy, while taking olanzapine, resulted in a miscarriage at 4 months' gestation, following which she discontinued olanzapine. She reconceived after a few months and delivered a full-term normal child. However, due to the recurrence of psychiatric illness after her second pregnancy, she was prescribed olanzapine again, which was continued throughout her third pregnancy. The outcome of the third pregnancy was a full-term female baby with a TEF. The baby was managed surgically and discharged with satisfactory vital signs. Unfortunately, however, the baby did not survive beyond 11 months of age. Causality between antenatal maternal olanzapine exposure and TEF in the newborn was determined to be 'probable' (score +5) as per the Naranjo causality assessment scale. Greater knowledge of this potential teratogenicity caused by olanzapine is needed to reduce morbidity and mortality in newborns.

  2. Assessment of morbidity due to Schistosoma japonicum infection in China

    PubMed Central

    2014-01-01

    This paper presents a historical assessment of morbidity due to the Schistosoma japonicum infection in China. Due to the socio-economic situation, which did not allow for a control program to be implemented until the early 1950s, morbidity was serious and mortality was high before this. Based on a few investigations and published papers, it can be said that the disease caused millions of deaths, and destroyed numerous families and villages. Since the 1950s, there has been a national control program, intensive control and prevention work has been carried out, and consequently the disease is being controlled. At present, both the prevalence and the morbidity of the disease have been decreasing substantially. The morbidity of the three phases of the disease is outlined in this paper. Comparatively higher morbidity is seen in the acute and advanced phases of the disease. The four major forms of advanced schistosomiasis i.e., ascites, megalosplenia, dwarfism, and colonic tumoroid proliferation, are outlined with their characteristic clinical presentations; their proportions are different during various periods of the national control program. Ectopic schistosomiasis and the relationship between the S. japonicum infection and colorectal cancer are also discussed. Post-transmission schistosomiasis is briefly discussed (which can happen even if the disease reaches the criteria of elimination, and the infection and transmission have stopped, but yet it still develops). The problem of mammalian reservoir hosts of S. japonicum makes the epidemiology and control of schistosomiasis in China even more complicated and arduous, and the control progress in animal reservoirs is briefly presented. PMID:24529186

  3. Maternal anxiety, maternal sensitivity, and attachment.

    PubMed

    Stevenson-Hinde, Joan; Chicot, Rebecca; Shouldice, Anne; Hinde, Camilla A

    2013-01-01

    Previous research has related maternal anxiety to insecurity of attachment. Here we ask whether different aspects of maternal sensitivity mediate this link. From a community sample of intact families with 1-3 children, mothers with 4.5-year-olds were selected for low, medium, or high anxiety levels (N = 98). Following Mary Ainsworth's lead, our maternal sensitivity measures were primarily based on ratings of direct observations. Six sets of measures were obtained: positive maternal style at home (a mean of four different ratings); providing a sensitive framework, limit setting, allowing autonomy, criticizing/cutting in (each a mean over two laboratory joint tasks); and tension-making (a mean of three different ratings in a fear-inducing task). Regression analyses showed firstly that maternal anxiety rather than behavioral inhibition or sex of child was the significant predictor of each maternal sensitivity measure; and secondly that these measures rather than maternal anxiety or sex were the significant predictors of security of attachment. Finally, ANOVA's indicated which sets of maternal ratings were associated with each pattern of attachment (Avoidant, Secure, Ambivalent, or Controlling).

  4. Civil law problems and morbidity

    PubMed Central

    Pleasence, P; Balmer, N; Buck, A; O'Grady, A; Genn, H

    2004-01-01

    Study objective: In the United Kingdom, recognition of the links between social and health problems has led to government initiatives such as health action zones. The principles of civil law apply to many types of social problem, and the civil justice system provides one means through which they can be tackled. However, little research has been undertaken into the particular links between problems to which civil legal principles and processes can be applied and morbidity. This study examines these links, and the role of legal advice and services in preventing ill health. Design: This study examined survey respondents' self reports of longstanding illness/disability and experience of 18 problems to which legal principles can be applied. Setting: A random national survey conducted across England and Wales. Participants: 5611 adults drawn from 3348 residential households. Main results: Significant associations were found between illness/disability and 13 of the problem types. Moreover, experience of greater numbers of problems increased the likelihood of reported illness/disability. In attempting to resolve problems respondents' health also frequently suffered. Conclusions: This study highlights the contribution that public legal education and legal advice can make to the promotion of public health, and the importance of further integration of health and civil justice initiatives through health action zones, community legal service partnerships, etc, to further this end. PMID:15194714

  5. Maternal mortality and unsafe abortion.

    PubMed

    Fawcus, Susan R

    2008-06-01

    Unsafe abortions refer to terminations of unintended pregnancies by persons lacking the necessary skills, or in an environment lacking the minimum medical standards, or both. Globally, unsafe abortions account for 67,900 maternal deaths annually (13% of total maternal mortality) and contribute to significant morbidity among women, especially in under-resourced settings. The determinants of unsafe abortion include restrictive abortion legislation, lack of female empowerment, poor social support, inadequate contraceptive services and poor health-service infrastructure. Deaths from unsafe abortion are preventable by addressing the above determinants and by the provision of safe, accessible abortion care. This includes safe medical or surgical methods for termination of pregnancy and management of incomplete abortion by skilled personnel. The service must also include provision of emergency medical or surgical care in women with severe abortion complications. Developing appropriate services at the primary level of care with a functioning referral system and the inclusion of post abortion contraceptive care with counseling are essential facets of abortion care.

  6. Background Rates of Adverse Pregnancy Outcomes for Assessing the Safety of Maternal Vaccine Trials in Sub-Saharan Africa

    PubMed Central

    Orenstein, Lauren A. V.; Orenstein, Evan W.; Teguete, Ibrahima; Kodio, Mamoudou; Tapia, Milagritos; Sow, Samba O.; Levine, Myron M.

    2012-01-01

    Background Maternal immunization has gained traction as a strategy to diminish maternal and young infant mortality attributable to infectious diseases. Background rates of adverse pregnancy outcomes are crucial to interpret results of clinical trials in Sub-Saharan Africa. Methods We developed a mathematical model that calculates a clinical trial's expected number of neonatal and maternal deaths at an interim safety assessment based on the person-time observed during different risk windows. This model was compared to crude multiplication of the maternal mortality ratio and neonatal mortality rate by the number of live births. Systematic reviews of severe acute maternal morbidity (SAMM), low birth weight (LBW), prematurity, and major congenital malformations (MCM) in Sub-Saharan African countries were also performed. Findings Accounting for the person-time observed during different risk periods yields lower, more conservative estimates of expected maternal and neonatal deaths, particularly at an interim safety evaluation soon after a large number of deliveries. Median incidence of SAMM in 16 reports was 40.7 (IQR: 10.6–73.3) per 1,000 total births, and the most common causes were hemorrhage (34%), dystocia (22%), and severe hypertensive disorders of pregnancy (22%). Proportions of liveborn infants who were LBW (median 13.3%, IQR: 9.9–16.4) or premature (median 15.4%, IQR: 10.6–19.1) were similar across geographic region, study design, and institutional setting. The median incidence of MCM per 1,000 live births was 14.4 (IQR: 5.5–17.6), with the musculoskeletal system comprising 30%. Interpretation Some clinical trials assessing whether maternal immunization can improve pregnancy and young infant outcomes in the developing world have made ethics-based decisions not to use a pure placebo control. Consequently, reliable background rates of adverse pregnancy outcomes are necessary to distinguish between vaccine benefits and safety concerns. Local studies that

  7. Reduced social morbidity of laparoscopic appendectomy in children.

    PubMed

    Tantoco, Joselito G; Levitt, Marc A; Hollands, Celeste M; Brisseau, Guy F; Caty, Michael G; Glick, Philip L

    2004-09-01

    Laparoscopic appendectomy has not been uniformly adopted by pediatric surgeons. Our children's hospital adopted laparoscopic appendectomy due to perceived benefits to patients and their families. We hypothesized that laparoscopic appendectomy in children resulted in less social morbidity than those undergoing open appendectomy. A questionnaire focused on a set of postoperative variables affecting the patient's and the family's return to normal activities. Families expressed their answers as a range of days. Five different ranges were assigned a numerical value for 10 different social morbidity variables. The numerical values were analyzed using Pearson chi2 test; statistical significance was defined as P < 0.05. The response rate was 55 per cent (134 of 244). Seventy-four had open and 47 laparoscopic appendectomy with a comparable incidence of acute and perforated appendicitis. Children undergoing laparoscopic appendectomy had shorter hospital stays and earlier resumption of feeding, return to school, return to pain-free walking and stair climbing, and resumption of normal activities including gym. Additionally, they had fewer wound problems, shorter duration of oral pain medication usage, and their parents returned to work quicker than the open group. All these were statistically significant. Laparoscopic appendectomy results in significantly reduced social morbidity for children and their families.

  8. [Occupational morbidity of railway transport workers].

    PubMed

    Karetskaia, T D; Pfaf, V F; Chernov, O E

    2015-01-01

    The authors present results of medical social monitoring of occupationalhazards that are the most prevalent in railway occupations workers, statistic data on occupational morbidity of railway transport workers over last 10 years. The article covers major causes of unfavorable effects resulting from occupational hazards in various workers categories. Dynamics of occupational morbidity parameters and its structure concerning separate nosologic entities are analyzed.

  9. Correlates of asthma morbidity in primary care.

    PubMed Central

    Jones, K. P.; Bain, D. J.; Middleton, M.; Mullee, M. A.

    1992-01-01

    OBJECTIVES--To explore the morbidity of patients diagnosed as asthmatic in general practice, to examine the determinants of this morbidity, and to derive a simple morbidity screening tool for use in primary care. DESIGN--Patient interviews, lung function measurements, and data extraction from general practice case notes. SUBJECTS--300 asthmatic patients aged 5 to 65 years randomly selected from the repeat prescribing registers of three general practices in the Southampton area. MAIN OUTCOME MEASURES--Reported morbidity using a calculated index based on three questions (Are you in a wheezy or asthmatic condition at least once per week; Have you had time off work or school in the past year because of your asthma; Do you suffer from attacks of wheezing during the night?); mean forced expiratory volume in one second and mean peak expiratory flow (over a seven day period); diurnal variation in peak flow; and the relation of the morbidity index to lung function. RESULTS--Mean forced expiratory volume in one second was 67% predicted (SD 18.4), mean peak expiratory flow was 80% predicted (SD 18.9), and mean diurnal variation was 10% (SD 7.7). 76 subjects were classified as having low morbidity, 95 medium, and 125 high. The morbidity index was significantly associated with forced expiratory volume in one second, mean peak expiratory flow rate, and diurnal variation (p less than 0.05); it was not significantly associated with inhaler technique or use of prophylaxis. CONCLUSIONS--There was a large burden of persisting morbidity across all ages of patients diagnosed as asthmatic in the three well resourced practices studied. The use of the morbidity index may help to target the asthmatic patients needing more attention by concentrating on those reporting medium to high morbidity. PMID:1540736

  10. Maternal and young child nutrition adversely affected by external shocks such as increasing global food prices.

    PubMed

    Darnton-Hill, Ian; Cogill, Bruce

    2010-01-01

    Rising food prices, resulting from the ongoing global economic crisis, fuel price volatility, and climate change, have an adverse impact upon the poor, especially those in food-importing, resource-limited countries. The conventional approach by large organizations has been to advocate for increased staple crop yields of mainly cereals. High food prices are predicted to continue to at least 2015. Past shocks and their known impacts upon nutrition were reviewed. Price instability and increases have long been an existing global problem, which has been exacerbated by recent macroeconomic shocks such as acute emergencies due to war and civil strife, acute climatic events, increase in food prices, fuel price volatility, dysfunction of the global financial systems, long-term climate change, and the emergence of failed states. The FAO estimated that there were 815 million "hungry" people in 2006, with a now additional 75-135 million with increased vulnerability, and currently it is estimated that there are one billion people at risk of food insecurity. The shocks initially compromise maternal and child nutrition, mainly through a reduction in dietary quality and an increase in micronutrient deficiencies and concomitant increases in infectious disease morbidity and mortality. A further reduction in the quantity of diet may follow with greater underweight and wasting. Recent macroeconomic shocks have greatly increased the number of people who are vulnerable to hunger in developing countries. Nutritional surveillance systems need to be strengthened and expanded to inform policy decisions.

  11. The Role of Obstetrics/Gynecology Hospitalists in Reducing Maternal Mortality.

    PubMed

    Stevens, Tobey A; Swaim, Laurie S; Clark, Steven L

    2015-09-01

    The United States experienced a 6.1% annual increase in the maternal death rate from 2000 to 2013. Maternal deaths from hemorrhage and complications of preeclampsia are significant contributors to the maternal death rate. Many of these deaths are preventable. By virtue of their continuous care of laboring patients, active involvement in hospital safety initiatives, and immediate availability, obstetric hospitalists are uniquely positioned to evaluate patients, initiate care, and coordinate a multidisciplinary effort. In cases of significant maternal hemorrhage, hypertensive crisis, and acute pulmonary edema, the availability of an obstetrics hospitalist may facilitate improved patient safety and fewer maternal deaths.

  12. Co-Morbid Disorders in Tourette Syndrome

    PubMed Central

    Mol Debes, Nanette M. M.

    2013-01-01

    Tourette syndrome (TS) is often accompanied by other symptoms and syndromes. The two best-known co-morbidities are Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD), but also other conditions like rage-attacks, depression, and sleeping disturbances are frequent in persons with TS. Both in clinical cohorts and in population-based cohorts the prevalence of co-morbidities is high. The presence of co-morbid ADHD and/or OCD has an impact on psychosocial, educational, and neuropsychological consequences of TS and it is associated with higher rates of other co-morbid disorders, like rage, anxiety, and conduct disorders. The symptoms of a co-morbid disorder might appear prior to the time that tics reach clinical attention. The TS phenotype probably changes during the course of the disease. The exact aetiology of the co-occurrence of co-morbid disorders and TS is not known, but they probably all are neurotransmitter disorders. European guidelines recommend first-choice pharmacological treatment, but randomised double-blinded trials are needed. Professionals need to be aware of the close relationship between TS and co-morbidities in order to give the patients the right treatment and support. PMID:23187139

  13. Acute liver failure due to acute fatty liver of pregnancy.

    PubMed

    Wand, S; Waeschle, R M; Von Ahsen, N; Hawighorst, T; Bräuer, A; Quintel, M

    2012-04-01

    Acute fatty liver of pregnancy (AFLP) is a rare but serious liver disease and typically occurs during the third trimester. It carries the risk for significant perinatal and maternal mortality. Therefore an early diagnosis and delivery, followed by close monitoring and optimized management of the impaired liver function with all associated problems are necessary to prevent maternal and foetal death. This case report focuses on the management of acute liver failure due to AFLP in a 31 year old women treated in our intensive care unit (ICU) after an emergency C-section.

  14. Acute renal failure in pregnancy: our experience.

    PubMed

    Aggarwal, Rohina S; Mishra, Vineet V; Jasani, Anil F; Gumber, Manoj

    2014-03-01

    Acute renal failure (ARF) is a serious medical complication during pregnancy, and, in the post-partum period, is associated with significant maternal morbidity and mortality as well as fetal loss. The objective of our study is to find the etiology and maternal outcome of ARF during pregnancy. The study was conducted at the Obstetrics and Gynecology Department of the Institute of Kidney Disease and Research Center, Ahmedabad, India from January 2009 to January 2011. Fifty previously healthy patients who developed ARF, diagnosed on oliguria and serum creatinine >2 mg%, were included in the study. Patients with a known history of renal disease, diabetes and hypertension were excluded from the study. All patients were followed-up for a period of six months. Patient re-cords, demographic data, urine output on admission and preceding history of antepartum hemorrhage (APH), post-partum hemorrhage (PPH), septicemia, operative interventions and retained product of conception were noted and need for dialysis was considered. Patients were thoroughly examined and baseline biochemical investigations and renal and obstetrical ultrasound were performed on each patient and bacterial culture sensitivity on blood, urine or vaginal swabs were performed in selected patients. The age range was 19-38 years (mean 26 ± 3.8). The first trimester, second trimester and puerperal groups comprised of four (8%), 25 (50%) and 21 patients (42%), respectively. Hemorrhage was the etiology for ARF in 15 (30%), APH in ten (20%) and PPH in five (10%) patients. Eleven (22%) patients had lower segment cesarian section (LSCS) while 36 (78%) patients had normal vaginal delivery. In 20 (40%) patients, puerperal sepsis was the etiological factor, while pre-eclampsia, eclampsia and HELLP syndrome accounted for 18 (36%) patients. Two (4%) patients had disseminated intravascular coagulation on presentation while one (2%) patient was diagnosed with hemolytic uremic syndrome. Maternal mortality was 12% (n = 6

  15. Inflammation and Epidural-Related Maternal Fever: Proposed Mechanisms.

    PubMed

    Sultan, Pervez; David, Anna L; Fernando, Roshan; Ackland, Gareth L

    2016-05-01

    Intrapartum fever is associated with excessive maternal interventions as well as higher neonatal morbidity. Epidural-related maternal fever (ERMF) contributes to the development of intrapartum fever. The mechanism(s) for ERMF has remained elusive. Here, we consider how inflammatory mechanisms may be modulated by local anesthetic agents and their relevance to ERMF. We also critically reappraise the clinical data with regard to emerging concepts that explain how anesthetic drug-induced metabolic dysfunction, with or without activation of the inflammasome, might trigger the release of nonpathogenic, inflammatory molecules (danger-associated molecular patterns) likely to underlie ERMF.

  16. Global obstetric medicine: Collaborating towards global progress in maternal health

    PubMed Central

    Ateka-Barrutia, Oier; Rojas-Suarez, Jose Antonio; Wijeyaratne, Chandrika; Castillo, Eliana; Lombaard, Hennie; Magee, Laura A

    2015-01-01

    Globally, the nature of maternal mortality and morbidity is shifting from direct obstetric causes to an increasing proportion of indirect causes due to chronic conditions and ageing of the maternal population. Obstetric medicine can address an important gap in the care of women by broadening its scope to include colleagues, communities and countries that do not yet have established obstetric medicine training, education and resources. We present the concept of global obstetric medicine by highlighting three low- and middle-income country experiences as well as an example of successful collaboration. The article also discusses ideas and initiatives to build future partnerships within the global obstetric medicine community. PMID:27512469

  17. Acute Chorioamnionitis and Funisitis: Definition, Pathologic Features, and Clinical Significance

    PubMed Central

    Kim, Chong Jai; Romero, Roberto; Chaemsaithong, Piya; Chaiyasit, Noppadol; Yoon, Bo Hyun; Kim, Yeon Mee

    2015-01-01

    Acute inflammatory lesions of the placenta consist of diffuse infiltration of neutrophils at different sites in the organ. These lesions include acute chorioamnionitis, funisitis, and chorionic vasculitis, and represent a host response (maternal or fetal) to a chemotactic gradient in the amniotic cavity. While acute chorioamnionitis is evidence of a maternal host response, funisitis and chorionic vasculitis represent fetal inflammatory responses. Intra-amniotic infection has been generally considered to be the cause of acute histologic chorioamnionitis and funisitis; however, recent evidence indicates that “sterile” intra-amniotic inflammation, which occurs in the absence of demonstrable microorganisms but can be induced by “danger signals”, is frequently associated with these lesions. In the context of intra-amniotic infection, chemokines (such as interleukin-8 and granulocyte chemotactic protein) establish a gradient favoring the migration of neutrophils from maternal or fetal circulation into the chorioamniotic membranes or umbilical cord, respectively. Danger signals released during the course of cellular stress or cell death can also induce the release of neutrophil chemokines. The prevalence of chorioamnionitis is a function of gestational age at birth, and is present in 3-5% of placentas delivered at term, but in 94% of placentas delivered between 21-24 weeks of gestation. The frequency is higher in patients with spontaneous labor, preterm labor, clinical chorioamnionitis (preterm or term), or ruptured membranes. Funisitis and chorionic vasculitis are the hallmarks for the fetal inflammatory response syndrome, a condition characterized by an elevation in fetal plasma concentrations of interleukin-6, associated with the impending onset of preterm labor, a higher rate of neonatal morbidity (after adjustment for gestational age), and multi-organ fetal involvement. This syndrome is the counterpart of the systemic inflammatory response syndrome in adults

  18. The neglected role of insulin-like growth factors in the maternal circulation regulating fetal growth.

    PubMed

    Sferruzzi-Perri, A N; Owens, J A; Pringle, K G; Roberts, C T

    2011-01-01

    Maternal insulin-like growth factors (IGFs) play a pivotal role in modulating fetal growth via their actions on both the mother and the placenta. Circulating IGFs influence maternal tissue growth and metabolism, thereby regulating nutrient availability for the growth of the conceptus. Maternal IGFs also regulate placental morphogenesis, substrate transport and hormone secretion, all of which influence fetal growth either via indirect effects on maternal substrate availability, or through direct effects on the placenta and its capacity to supply nutrients to the fetus. The extent to which IGFs influence the mother and/or placenta are dependent on the species and maternal factors, including age and nutrition. As altered fetal growth is associated with increased perinatal morbidity and mortality and a greater risk of developing degenerative diseases in adult life, understanding the role of maternal IGFs during pregnancy is essential in order to identify mechanisms underlying altered fetal growth and offspring programming.

  19. Pathophysiology of acute pancreatitis.

    PubMed

    Bhatia, Madhav; Wong, Fei Ling; Cao, Yang; Lau, Hon Yen; Huang, Jiali; Puneet, Padmam; Chevali, Lakshmi

    2005-01-01

    Acute pancreatitis is a common clinical condition. It is a disease of variable severity in which some patients experience mild, self-limited attacks while others manifest a severe, highly morbid, and frequently lethal attack. The exact mechanisms by which diverse etiological factors induce an attack are still unclear. It is generally believed that the earliest events in acute pancreatitis occur within acinar cells. Acinar cell injury early in acute pancreatitis leads to a local inflammatory reaction. If this inflammatory reaction is marked, it leads to a systemic inflammatory response syndrome (SIRS). An excessive SIRS leads to distant organ damage and multiple organ dysfunction syndrome (MODS). MODS associated with acute pancreatitis is the primary cause of morbidity and mortality in this condition. Recent studies have established the role played by inflammatory mediators in the pathogenesis of acute pancreatitis and the resultant MODS. At the same time, recent research has demonstrated the importance of acinar cell death in the form of apoptosis and necrosis as a determinant of pancreatitis severity. In this review, we will discuss about our current understanding of the pathophysiology of acute pancreatitis.

  20. Risk factors and case management of acute diarrhoea in North Gondar Zone, Ethiopia.

    PubMed

    Mediratta, Rishi P; Feleke, Amsalu; Moulton, Lawrence H; Yifru, Sisay; Sack, R Bradley

    2010-06-01

    In Ethiopia, evidence is lacking about maternal care-taking and environmental risk factors that contribute to acute diarrhoea and the case management of diarrhoea. The aim of this study was to identify the risk factors and to understand the management of acute diarrhoea. A pretested structured questionnaire was used for interviewing mothers of 440 children in a prospective, matched, case-control study at the University of Gondar Referral and Teaching Hospital in Gondar, Ethiopia. Results of multivariate analysis demonstrated that children who were breastfed and not completely weaned and mothers who were farmers were protective factors; risk factors for diarrhoea included sharing drinking-water and introducing supplemental foods. Children presented with acute diarrhoea for 3.9 days with 4.3 stools per day. Mothers usually did not increase breastmilk and other fluids during diarrhoea episodes and generally did not take children with diarrhoea to traditional healers. Incorporating messages about the prevention and treatment of acute diarrhoea into child-health interventions will help reduce morbidity and mortality associated with this disease.

  1. Risk Factors and Case Management of Acute Diarrhoea in North Gondar Zone, Ethiopia

    PubMed Central

    Mediratta, Rishi P.; Feleke, Amsalu; Moulton, Lawrence H.; Yifru, Sisay

    2010-01-01

    In Ethiopia, evidence is lacking about maternal care-taking and environmental risk factors that contribute to acute diarrhoea and the case management of diarrhoea. The aim of this study was to identify the risk factors and to understand the management of acute diarrhoea. A pretested structured questionnaire was used for interviewing mothers of 440 children in a prospective, matched, case-control study at the University of Gondar Referral and Teaching Hospital in Gondar, Ethiopia. Results of multivariate analysis demonstrated that children who were breastfed and not completely weaned and mothers who were farmers were protective factors; risk factors for diarrhoea included sharing drinking-water and introducing supplemental foods. Children presented with acute diarrhoea for 3.9 days with 4.3 stools per day. Mothers usually did not increase breastmilk and other fluids during diarrhoea episodes and generally did not take children with diarrhoea to traditional healers. Incorporating messages about the prevention and treatment of acute diarrhoea into child-health interventions will help reduce morbidity and mortality associated with this disease. PMID:20635636

  2. Inhaled /sup 147/Pm and/or total-body gamma radiation: Early mortality and morbidity in rats

    SciTech Connect

    Filipy, R.E.; Lauhala, K.E.; McGee, D.R.; Cannon, W.C.; Buschbom, R.L.; Decker, J.R.; Kuffel, E.G.; Park, J.F.; Ragan, H.A.; Yaniv, S.S.; Scott, B.R.

    1989-05-01

    Rats were given doses of /sup 60/Co gamma radiation and/or lung burdens of /sup 147/Pm (in fused aluminosilicate particles) within lethal ranges in an experiment to determine and compare morbidity and mortality responses for the radiation insults within 1 year after exposure. Radiation-induced morbidity was assessed by measuring changes in body weights, hematologic parameters, and pulmonary-function parameters. Acute mortality and morbidity from inhaled promethium were caused primarily by radiation pneumonitis and pulmonary fibrosis that occurred more than 53 days after exposure. Acute mortality and morbidity from total-body gamma irradiation occurred within 30 days of exposure and resulted from the bone-marrow radiation syndrome. Gamma radiation caused transient morbidity, reflected by immediately depressed blood cell levels and by reduced body weight gain in animals that survived the acute gamma radiation syndrome. Inhaled promethium caused a loss of body weight and diminished pulmonary function, but its only effect on blood cell levels was lymphocytopenia. Combined gamma irradiation and promethium lung burdens were synergistic, in that animals receiving both radiation insults had higher morbidity and mortality rates than would be predicted based on the effect of either kind of radiation alone. Promethium lung burdens enhanced the effect of gamma radiation in rats within the first 30 days of exposure, and gamma radiation enhanced the later effect of promethium lung burdens. 70 refs., 68 figs., 21 tabs.

  3. Maternal hair--an appropriate matrix for detecting maternal exposure to pesticides during pregnancy.

    PubMed

    Ostrea, Enrique M; Villanueva-Uy, Esterlita; Bielawski, Dawn M; Posecion, Norberto C; Corrion, Melissa L; Jin, Yan; Janisse, James J; Ager, Joel W

    2006-07-01

    , Baygon, and propoxur in maternal hair at birth (P=0.001) and between the use of a slow-burning mosquito coil and the presence of bioallethrin in maternal hair at midgestation and at birth (P=0.001, P < or = 0.041, respectively). There is significant exposure of the pregnant woman to pesticides, particularly to pesticides that are used at home. Our study demonstrates the advantages of analyzing maternal hair as a readily available biologic matrix for studying maternal exposure to toxicants in the environment, compared to blood. For propoxur, there was a 3- to 15-fold higher detection rate of the pesticide in maternal hair as compared to blood. As for the other pesticides, bioallethrin, malathion, chlorpyrifos, and DDT were exclusively found in maternal hair compared to blood. On the other hand, pesticide metabolites were infrequently found in maternal hair or maternal blood. Pesticides in blood most likely represent acute exposure, whereas pesticides in hair represent past and/or concurrent exposure. The high sensitivity, wide window of exposure, availability, and ease of hair collection are distinct advantages in using hair to detect exposure to pesticides among pregnant women. However, pesticides in maternal hair may also be secondary to passive exposure and therefore not truly representative of the internal pesticide dose. Finally, the analysis of maternal hair for pesticides as an index of maternal exposure to pesticides in the environment allows the institution of measures to prevent further exposure during pregnancy.

  4. [Wernicke encephalopathy after subtotal gastrectomy for morbid obesity].

    PubMed

    Gabaudan, C; La-Folie, T; Sagui, E; Soulier, B; Dion, A-M; Richez, P; Brosset, C

    2008-05-01

    Wernicke's encephalopathy (WE) is one of the potential complications of obesity surgery. It is an acute neuropsychiatric syndrome resulting from thiamine deficiency often associated with repeated vomiting. The classic triad is frequently reported in these patients (optic neuropathy, ataxia and confusion), associated with uncommon features. Cerebral impairment affects the dorsal medial nucleus of the thalamus and the periaqueductal grey area, appearing on MRI, as hyperintense signals on T2, Flair and Diffusion weighted imaging. Early diagnosis and parenteral thiamine are required to decrease morbidity and mortality. We report a case of WE and Korsakoff's syndrome in a young obese patient after subtotal gastrectomy, who still has substantial sequelae. The contribution of MRI with diffusion-weighted imaging is illustrated. The interest of nutritional supervision in the first weeks and preventive thiamine supplementation in case of repeated vomiting are of particular importance in these risky situations.

  5. Individual Effect Modifiers of Dust Exposure Effect on Cardiovascular Morbidity

    PubMed Central

    Vodonos, Alina; Friger, Michael; Katra, Itzhak; Krasnov, Helena; Zahger, Doron; Schwartz, Joel; Novack, Victor

    2015-01-01

    Background High concentrations of particulate matter (PM) air pollution have been associated with death and hospital admissions due to cardiovascular morbidity. However, it is not clear a) whether high levels of non-anthropogenic PM from dust storms constitute a health risk; and b) whether these health risks are exacerbated in a particular demographic. Methods This study comprised all patients above 18 years old admitted to Soroka University Medical Center (1000 bed tertiary hospital, Be’er- Sheva, Israel, 2001–2010) with a primary diagnosis of acute coronary syndrome (ACS). Data on meteorological parameters and PM10 (particulate matter <10 μm in aerodiameter) were obtained from monitoring stations in the city of Be'er-Sheva. Data were analyzed using a case crossover analysis to examine the effect of dust exposure on hospitalization due to ACS and the interaction with co-morbidities and demographic factors. Results There were 16,734 hospitalizations due to ACS during the study period. The estimated odds of hospitalization due to ACS was significantly associated with PM10 during non dust storm days at the same day of the exposure (lag0); OR = 1.014 (95%CI 1.001–1.027) for a 10 μg/m3 increase, while a delayed response (lag1) was found during the dust storm days; OR = 1.007 (95%CI 1.002–1.012). The effect size for the dust exposure association was larger for older (above the age of 65), female or Bedouin patients. Conclusions Exposure to non-anthropogenic PM is associated with cardiovascular morbidity. Health risk associated dust exposure is gender and age specific with older women and Bedouin patients being the most vulnerable groups. PMID:26381397

  6. Group B Streptococcus vaccination in pregnancy: moving toward a global maternal immunization program.

    PubMed

    Munoz, Flor M; Ferrieri, Patricia

    2013-08-28

    A group B streptococcus vaccine for pregnant women would add to the currently available vaccines given during pregnancy to protect mothers and their infants against serious and potentially lethal diseases, including tetanus, influenza, pertussis and meningococcal infection. Implementation of the administration of these high priority vaccines during routine prenatal care would result in a maternal immunization program with the potential to have a positive impact in public health globally, by reducing maternal and neonatal morbidity and mortality.

  7. [Morbidity parameters in mining industry workers of Southern Urals].

    PubMed

    Askarova, Z F; Askarov, R A

    2009-01-01

    The authors presented parameters of transitory disablement morbidity, occupational morbidity for workers in two mining enterprises (Bashkortostan Republic), calculated integral parameter of disablement.

  8. Morbidity pattern among refugees in Eastern Ethiopia.

    PubMed

    Bisrat, F; Berhane, Y; Mamo, A; Asefa, E

    1995-11-01

    The population of refugees in eastern Africa and the health problems affecting them are enormous. This study was conducted to document the morbidity pattern among refugees in eastern Ethiopia. The study was conducted to document the morbidity pattern among refugees in eastern Ethiopia. The study utilized a descriptive cross sectional design. Data were collected using a uniform format from all refugee camps in the eastern Ethiopia. Respiratory tract infection and diarrhoeal diseases were identified to be the major causes of morbidity, accounting for 31.8% and 27.3% respectively in children under five years, and for 34.9% and 8.5% respectively in the other age groups. The findings were consistent with other studies done in refugee populations elsewhere. Universality of the problems was noted and a coordinated multidisciplinary approach is recommended to alleviate the health problems of refugees.

  9. Factors influencing the morbidity of colostomy closure.

    PubMed

    Demetriades, D; Pezikis, A; Melissas, J; Parekh, D; Pickles, G

    1988-04-01

    A series consisting of 110 patients who had colostomy closure was studied in an attempt to define the role of various factors in causing colon-related morbidity. The overall complication rate was 14.5 percent (wound sepsis 11.8 percent and anastomotic leak 2.7 percent). Patient age, the underlying pathologic abnormality (trauma versus nontrauma), the type of colostomy (loop versus end colostomy), the site of the stoma (right side, left side, or transverse), whether a drain was inserted or not, and the timing of the operation did not influence morbidity. Oral preoperative antibiotics appeared to be associated with less morbidity than parenteral antibiotics (p less than 0.01), and experienced surgeons had less complications than junior surgeons (p less than 0.05).

  10. Acute Intraoperative Pulmonary Aspiration.

    PubMed

    Nason, Katie S

    2015-08-01

    Acute intraoperative aspiration is a potentially fatal complication with significant associated morbidity. Patients undergoing thoracic surgery are at increased risk for anesthesia-related aspiration, largely due to the predisposing conditions associated with this complication. Awareness of the risk factors, predisposing conditions, maneuvers to decrease risk, and immediate management options by the thoracic surgeon and the anesthesia team is imperative to reducing risk and optimizing patient outcomes associated with acute intraoperative pulmonary aspiration. Based on the root-cause analyses that many of the aspiration events can be traced back to provider factors, having an experienced anesthesiologist present for high-risk cases is also critical.

  11. Collecting baseline information for national morbidity alleviation programs: different methods to estimate lymphatic filariasis morbidity prevalence.

    PubMed

    Mathieu, Els; Amann, Josef; Eigege, Abel; Richards, Frank; Sodahlon, Yao

    2008-01-01

    The lymphatic filariasis elimination program aims not only to stop transmission, but also to alleviate morbidity. Although geographically limited morbidity projects exist, few have been implemented nationally. For advocacy and planning, the program coordinators need prevalence estimates that are currently rarely available. This article compares several approaches to estimate morbidity prevalence: (1) data routinely collected during mapping or sentinel site activities; (2) data collected during drug coverage surveys; and (3) alternative surveys. Data were collected in Plateau and Nasarawa States in Nigeria and in 6 districts in Togo. In both settings, we found that questionnaires seem to underestimate the morbidity prevalence compared with existing information collected through clinical examination. We suggest that program managers use the latter for advocacy and planning, but if not available, questionnaires to estimate morbidity prevalence can be added to existing surveys. Even though such data will most likely underestimate the real burden of disease, they can be useful in resource-limited settings.

  12. Maternal and Child Health Issues and Female Labor Force Participation.

    ERIC Educational Resources Information Center

    Howze, Dorothy C.; And Others

    Reviewing health related "costs" of female labor force participation, this paper examines four highly salient maternal and child health issues. Discussion of acute illness in day care settings begins with an overview of studies on day care and illness and focuses on hepatitis A, appropriate sanitation, and indications of research on…

  13. Correlation of serum neutrophil gelatinase-associated lipocalin with acute kidney injury in hypertensive disorders of pregnancy.

    PubMed

    Patel, Ml; Sachan, Rekha; Gangwar, Radheyshyam; Sachan, Pushpalata; Natu, Sm

    2013-01-01

    Hypertensive disorders of pregnancy (HDP) remain one of the largest single causes of maternal and fetal morbidity and mortality, accounting for 16.1% of maternal deaths in developed countries. The aim of the study was to evaluate acute kidney injury (AKI) in hypertensive disorders of pregnancy and to examine the correlation of serum neutrophil gelatinase-associated lipocalin (NGAL) with acute kidney injury. This prospective case control study was carried out over a period of 1 year. After written, informed consent and ethical clearance, 149 cases of hypertensive disorders of pregnancy were screened, and seven were lost to follow-up. Acute kidney injury was detected in 88 cases and acute renal failure in 30 cases of HDP. Thirty-one healthy pregnant nonhypertensive women were enrolled as controls. Quantitative measurement of serum NGAL levels was done by enzyme linked immunosorbent assay technique using a sandwich enzyme-linked immunosorbent assay kit. As per the Kidney Diseases Improving Global Outcomes International guidelines acute kidney injury network (AKIN), 50 cases (42.37%) of AKI stage I, 38 (32.2%) cases of AKI stage II, and 30 (25.42%) cases of renal failure were detected. Serum NGAL had a positive association with increasing proteinuria. It also had a positive correlation with systolic blood pressure (r∼0.36), diastolic blood pressure (r∼0.37), and serum creatinine (r∼0.4). NGAL was found to be significantly correlated with creatinine in the cases with the value of the correlation coefficient being 0.4. This direct correlation might be a consequence of endothelial dysfunction on which hypertension and proteinuria probably depends.

  14. Fetal and maternal metabolic responses to exercise during pregnancy.

    PubMed

    Mottola, Michelle F; Artal, Raul

    2016-03-01

    Pregnancy is characterized by physiological, endocrine and metabolic adaptations creating a pseudo-diabetogenic state of progressive insulin resistance. These adaptations occur to sustain continuous fetal requirements for nutrients and oxygen. Insulin resistance develops at the level of the skeletal muscle, and maternal exercise, especially activity involving large muscle groups improve glucose tolerance and insulin sensitivity. We discuss the maternal hormonal and metabolic changes associated with a normal pregnancy, the metabolic dysregulation that may occur leading to gestational diabetes mellitus (GDM), and the consequences to mother and fetus. We will then examine the acute and chronic (training) responses to exercise in the non-pregnant state and relate these alterations to maternal exercise in a low-risk pregnancy, how exercise can be used to regulate glucose tolerance in women at risk for or diagnosed with GDM. Lastly, we present key exercise guidelines to help maintain maternal glucose regulation and suggest future research directions.

  15. Minor psychiatric morbidity and labour turnover.

    PubMed Central

    Jenkins, R

    1985-01-01

    The relation of minor psychiatric morbidity with labour turnover is examined, using data from a study of young, predominantly middle class, white collar men and women. The results suggest that the presence of psychiatric symptomatology is at least as important as occupational attitudes in identifying individuals who would subsequently leave the organisation. PMID:4016004

  16. Morbidity and Infant Development: A Hypothesis.

    ERIC Educational Resources Information Center

    Pollitt, Ernesto

    1983-01-01

    Results of a study conducted in 14 villages of Sui Lin Township, Taiwan, suggest the hypothesis that, under conditions of extreme economic impoverishment and among children within populations where energy protein malnutrition is endemic, there is an inverse relationship between incidence of morbidity in infancy and measures of motor and mental…

  17. Co-Morbidity of Conditions among Prisoners

    ERIC Educational Resources Information Center

    Shinkfield, Alison J.; Graffam, J.; Meneilly, Sharn

    2009-01-01

    Eighty seven adult prisoners (58 males, 29 females) completed the Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), and a questionnaire on current health in order to examine both the prevalence of co-morbid conditions and the relation of depression and anxiety to ill-health and prior substance use. High prevalence rates of…

  18. The morbid anatomy of high altitude

    PubMed Central

    Heath, Donald

    1979-01-01

    The morbid anatomical changes which take place in man and animals exposed to the chronic hypoxia of residence at high altitude are briefly reviewed. ImagesFig. 1Fig. 2Fig. 3Fig. 5Fig. 4Fig. 6Fig. 7Fig. 8 PMID:493205

  19. Perinatal Depression – the Fourth Inflammatory Morbidity of Pregnancy? Theory and Literature Review

    PubMed Central

    Osborne, Lauren M.; Monk, Catherine

    2015-01-01

    Perinatal depression is one of the leading causes of maternal morbidity and mortality. The biological etiology of this disorder remains in question, despite considerable research into the contributions of hormonal imbalance, the role of monoamines, and dysregulation of the HPA axis. Because inflammation is known to be associated with major depression in men and non-perinatal women as well as with other important morbidities of pregnancy (such as preeclampsia, preterm birth, and gestational diabetes), and because these morbidities may correlate with perinatal depression, inflammation may be a common physiological pathway that can also help explain perinatal depression. In this paper, we review the theoretical background of inflammation in perinatal depression and then review the literature concerning immune and inflammatory factors in the etiology and course of perinatal depression. We close with recommendations for future studies in this still relatively unexplored area. Identification and understanding of a common pathophysiology between other pregnancy morbidities and perinatal depression would link physical and mental well-being, likely leading to better treatment and prevention. PMID:23608136

  20. Actionable theranostics for global maternal health: a focus on HIV and malaria.

    PubMed

    Madadi, Parvaz; Enato, Ehijie F O; Walfisch, Asnat

    2012-11-01

    A new wave of rapid and accurate molecular diagnostics, which harness the power of genomics and proteomics, hold great potential to improve aspects of maternal health on a global scale. This review will provide a context to issues related to global maternal health and highlight international endeavors aimed to alleviate morbidity and mortality during pregnancy, childbirth and into the postnatal period. The authors will couple these efforts to actionable and promising theranostic advancements in the detection and treatment of HIV and malaria through the lens of maternal global health strategies.

  1. Perioperative morbidity of intracavitary gynecologic brachytherapy

    SciTech Connect

    Lanciano, R.; Corn, B.; Martin, E.; Schulthesis, T.; Hogan, W.M.; Rosenblum, N.

    1994-07-30

    The purpose was to define the incidence and severity of perioperative morbidity and its subsequent management with standard tandem and ovoid insertions to evaluate pretreatment and treatment factors associated with an increased risk of perioperative morbidity. Intraoperative complications were seen in 3% of implants and included two perforations and a vaginal laceration in two patients. Twenty-four percent of implants (16 patients) developed temperatures of > 100.5 (range 100.6 to 103), although only one patient required implant removal because of fever. Management of fever included antibiotics in 35% and acetaminophen only in 65%. Five implants were removed emergently secondary to presumed sepsis, exacerbation of chronic obstructive pulmonary disease, hypotension, change in mental status, and myocardial infarction/congestive heart failure. No patient developed a deep-vein thrombosis, pulmonary embolism, gastrointestinal obstruction, or died of a postoperative complication. Univariate analysis of pretreatment and treatment factors revealed older age and spinal/epidural anesthesia to be associated with increased perioperative morbidity, and older age and higher ASA classification to be associated with severe complications requiring removal of implant. Multivariate analysis revealed only older age to be significantly related to perioperative morbidity. Fever of > 100.5 was seen in 24% of implants and can be managed successfully without removal of the implant in 96% of cases. Use of antibiotics preoperatively and intraoperatively did not reduce the risk of perioperative temperature elevation. Use of routine diphenoxylate hydrochloride prophylaxis was tolerated without ileus or gastrointestinal obstruction clinically. Although routine deep-vein thrombosis prophylaxis is reasonable, the data would support a low risk of deep-vein thrombosis for untreated patients. Severe perioperative morbidity necessitated premature implant removal in only 5% of cases. 24 refs., 2 tabs.

  2. Impacts of temperature extremes on cardiovascular morbidity and mortality in the Czech Republic

    NASA Astrophysics Data System (ADS)

    Davídkovová, H.; Kyselý, J.; Plavcová, E.; Urban, A.; Kriz, B.; Kyncl, J.

    2012-04-01

    Elevated mortality associated with high ambient temperatures in summer represents one of the main impacts of weather extremes on human society. Increases in cardiovascular mortality during heat waves have been reported in many European countries; much less is known about which particular cardiovascular disorders are most affected during heat waves, and whether similar patterns are found for morbidity (hospital admissions). Relatively less understood is also cold-related mortality and morbidity in winter, when the relationships between weather and human health are more complex, less direct, and confounded by other factors such as epidemics of influenza/acute respiratory infections. The present study analyses relationships between temperature extremes and cardiovascular morbidity and mortality. We make use of the datasets on hospital admissions and daily mortality in the population of the Czech Republic (about 10.3 million) over 1994-2009. The data have been standardized to remove the effects of the long-term trend and the seasonal and weekly cycles. Periods when the morbidity/mortality data were affected by epidemics of influenza and other acute respiratory infections have been removed from the analysis. We use analogous definitions for hot and cold spells based on quantiles of daily average temperature anomalies, which allows for a comparison of the findings for summer hot spells and winter cold spells. The main aims of the study are (i) to identify deviations of mortality and morbidity from the baseline associated with hot and cold spells, (ii) to compare the hot- and cold-spell effects for individual cardiovascular diseases (e.g. ischaemic heart disease I20-I25, cerebrovascular disease I60-I69, hypertension I10, aterosclerosis I70) and to identify those diagnoses that are most closely linked to temperature extremes, (iii) to identify population groups most vulnerable to temperature extremes, and (iv) to compare the links to temperature extremes for morbidity and

  3. Environmental exposures and respiratory morbidity among very low birth weight infants at 1 year of life

    PubMed Central

    Halterman, J S; Lynch, K A; Conn, K M; Hernandez, T E; Perry, T T; Stevens, T P

    2016-01-01

    Introduction Preterm infants have a substantially increased risk of developing respiratory illnesses. The goal of this study was to consider the impact of modifiable postnatal exposures on respiratory morbidity among a cohort of very low birth weight (VLBW) infants. Objectives (1) Assess the rates of respiratory morbidity and exposure to indoor respiratory triggers in a population of VLBW infants at 1 year; (2) determine the association between exposures and respiratory morbidity. Methods We enrolled 124 VLBW infants into a prospective cohort study. Parents were called at 1 year to assess respiratory outcomes and environmental exposures. We used bivariate and multivariate analyses to assess the relationship between environmental exposures and acute care for respiratory illnesses. Results At 1 year, 9% of infants had physician-diagnosed asthma, 47% required ≥1 acute visit and 11% required hospitalisation for respiratory illness. The majority of infants (82%) were exposed to at least one indoor respiratory trigger. Infants living with a smoker (61% vs 40%) and infants exposed to pests (62% vs 39%) were more likely than unexposed infants to require acute care for respiratory problems. In a multivariate regression controlling for demographics, birth weight, bronchopulmonary dysplasia, and family history of asthma or allergies, both living with a smoker (OR 2.62; CI 1.09 to 6.29) and exposure to pests (OR 4.41; CI 1.22 to 15.94) were independently associated with the need for acute care for respiratory illnesses. Conclusions In this sample, respiratory morbidity and exposure to triggers were common. VLBW infants may benefit from interventions that decrease exposure to respiratory triggers. PMID:18703545

  4. Epidemiology and aetiology of maternal bacterial and viral infections in low- and middle-income countries

    PubMed Central

    Velu, Prasad Palani; Gravett, Courtney A.; Roberts, Tom K.; Wagner, Thor A.; Zhang, Jian Shayne F.; Rubens, Craig E.; Gravett, Michael G.; Campbell, Harry; Rudan, Igor

    2011-01-01

    Background Maternal morbidity and mortality in low- and middle-income countries has remained exceedingly high. However, information on bacterial and viral maternal infections, which are important contributors to poor pregnancy outcomes, is sparse and poorly characterised. This review aims to describe the epidemiology and aetiology of bacterial and viral maternal infections in low- and middle-income countries. Methods A systematic search of published literature was conducted and data on aetiology and epidemiology of maternal infections was extracted from relevant studies for analysis. Searches were conducted in parallel by two reviewers (using OVID) in the following databases: Medline (1950 to 2010), EMBASE (1980 to 2010) and Global Health (1973 to 2010). Results Data from 158 relevant studies was used to characterise the epidemiology of the 10 most extensively reported maternal infections with the following median prevalence rates: Treponema pallidum (2.6%), Neisseria gonorrhoeae (1.5%), Chlamydia trachomatis (5.8%), Group B Streptococcus (8.6%), bacterial vaginosis (20.9%), hepatitis B virus (4.3%), hepatitis C virus (1.4%), Cytomegalovirus (95.7% past infection), Rubella (8.9% susceptible) and Herpes simplex (20.7%). Large variations in the prevalence of these infections between countries and regions were noted. Conclusion This review confirms the suspected high prevalence of maternal bacterial and viral infections and identifies particular diseases and regions requiring urgent attention in public health policy planning, setting research priorities and donor funding towards reducing maternal morbidity and mortality in low- and middle-income countries. PMID:23198117

  5. Applying the lessons of maternal mortality reduction to global emergency health

    PubMed Central

    Skog, Alexander P; Tenner, Andrea G; Wallis, Lee A

    2015-01-01

    Abstract Over the last few decades, maternal health has been a major focus of the international community and this has resulted in a substantial decrease in maternal mortality globally. Although, compared with maternal illness, medical and surgical emergencies account for far more morbidity and mortality, there has been less focus on global efforts to improve comprehensive emergency systems. The thoughtful and specific application of the concepts used in the effort to decrease maternal mortality could lead to major improvements in global emergency health services. The so-called three-delay model that was developed for maternal mortality can be adapted to emergency service delivery. Adaptation of evaluation frameworks to include emergency sentinel conditions could allow effective monitoring of emergency facilities and further policy development. Future global emergency health efforts may benefit from incorporating strategies for the planning and evaluation of high-impact interventions. PMID:26240463

  6. Applying the lessons of maternal mortality reduction to global emergency health.

    PubMed

    Calvello, Emilie J; Skog, Alexander P; Tenner, Andrea G; Wallis, Lee A

    2015-06-01

    Over the last few decades, maternal health has been a major focus of the international community and this has resulted in a substantial decrease in maternal mortality globally. Although, compared with maternal illness, medical and surgical emergencies account for far more morbidity and mortality, there has been less focus on global efforts to improve comprehensive emergency systems. The thoughtful and specific application of the concepts used in the effort to decrease maternal mortality could lead to major improvements in global emergency health services. The so-called three-delay model that was developed for maternal mortality can be adapted to emergency service delivery. Adaptation of evaluation frameworks to include emergency sentinel conditions could allow effective monitoring of emergency facilities and further policy development. Future global emergency health efforts may benefit from incorporating strategies for the planning and evaluation of high-impact interventions.

  7. Qualitative study on maternal referrals in rural Tanzania: decision making and acceptance of referral advice.

    PubMed

    Pembe, Andrea B; Urassa, David P; Darj, Elisabeth; Carlsted, Anders; Olsson, Pia

    2008-08-01

    The aim of this study was to describe perceptions of maternal referrals in a rural district in Tanzania. Focus group discussions (FGDs) with health workers and community members, stratified by age and gender, were conducted. The FGDs revealed that husbands and relatives are the decision makers in maternal referrals, whereas the women had limited influence, especially on emergency referrals. The process in deciding to seek referral care is envisaged within community perception of seriousness of the condition, difficulty to access and cost involved in transport, living expenses at the hospital, and perceived quality of care at facility level. The hospitals were seen as providing acceptable quality of care, whereas, the health centres had lower quality than expected. To improve maternal referral compliance and reduce perinatal and maternal morbidity and mortality, community views of existing referral guidelines, poverty reduction, women's empowerment and male involvement in maternal care are necessary.

  8. The relationship between maternal-fetal attachment and cigarette smoking over pregnancy.

    PubMed

    Magee, Susanna R; Bublitz, Margaret H; Orazine, Christina; Brush, Bridget; Salisbury, Amy; Niaura, Raymond; Stroud, Laura R

    2014-05-01

    Cigarette smoking during pregnancy is one of the most preventable causes of infant morbidity and mortality, yet 80 % of women who smoked prior to pregnancy continue to smoke during pregnancy. Past studies have found that lower maternal-fetal attachment predicts smoking status in pregnancy, yet past research has not examined whether maternal-fetal attachment predicts patterns or quantity of smoking among pregnant smokers. The aim of this study was to examine the relationship between maternal-fetal attachment and patterns of maternal smoking among pregnant smokers. We used self-reported and biochemical markers of cigarette smoking in order to better understand how maternal-fetal attachment relates to the degree of fetal exposure to nicotine. Fifty-eight pregnant smokers participated in the current study. Women completed the Maternal-Fetal Attachment Scale, reported weekly smoking behaviors throughout pregnancy using the Timeline Follow Back interview, and provided a saliva sample at 30 and 35 weeks gestation and 1 day postpartum to measure salivary cotinine concentrations. Lower maternal-fetal attachment scores were associated with higher salivary cotinine at 30 weeks gestation and 1 day postpartum. As well, women who reported lower fetal attachment reported smoking a greater maximum number of cigarettes per day, on average, over pregnancy. Lower maternal-fetal attachment is associated with greater smoking in pregnancy. Future research might explore whether successful smoking cessation programs improve maternal assessments of attachment to their infants.

  9. [Maternal morbidity and mortality in a unit of tertiary care without obstetrics].

    PubMed

    Garibaldi-Zapatero, Julio; Than-Gómez, M Teresa; Guerrero-Rivera, Susana; Cuevas-García, Carlos Fredy

    2016-01-01

    Introducción: la morbimortalidad materna representa un problema de salud en los países en desarrollo, las causas de muerte obstétrica dependen de la región geográfica y de otros factores que incluyen la calidad de los servicios de salud. El objetivo de este estudio fue analizar las causas de morbilidad y mortalidad materna en las pacientes atendidas de 2011 a 2012. Métodos: se analizaron los datos de las pacientes en admisión hospitalaria, el diagnóstico y la severidad de la enfermedad, la presencia de comorbilidad y las complicaciones que ocurrieron durante el tratamiento y las causas de muerte de pacientes embarazadas o puérperas. Resultados: fueron atendidas 137 pacientes de las cuales 87 (63.5 %) requirieron ser hospitalizadas, 36 (41.3 %) presentaron criterios para complicación materna severa (CMS); la mayor parte de pacientes con CMS se encontraban en el puerperio postcesárea, Once pacientes fallecieron, cinco se consideraron muertes maternas indirectas y 6 muertes tardías. Conclusiones: las CMS y las muertes fueron más frecuentes en el puerperio. Las causas indirectas fueron las más frecuentes.

  10. Acute septic arthritis.

    PubMed

    Shirtliff, Mark E; Mader, Jon T

    2002-10-01

    Acute septic arthritis may develop as a result of hematogenous seeding, direct introduction, or extension from a contiguous focus of infection. The pathogenesis of acute septic arthritis is multifactorial and depends on the interaction of the host immune response and the adherence factors, toxins, and immunoavoidance strategies of the invading pathogen. Neisseria gonorrhoeae and Staphylococcus aureus are used in discussing the host-pathogen interaction in the pathogenesis of acute septic arthritis. While diagnosis rests on isolation of the bacterial species from synovial fluid samples, patient history, clinical presentation, laboratory findings, and imaging studies are also important. Acute nongonococcal septic arthritis is a medical emergency that can lead to significant morbidity and mortality. Therefore, prompt recognition, rapid and aggressive antimicrobial therapy, and surgical treatment are critical to ensuring a good prognosis. Even with prompt diagnosis and treatment, high mortality and morbidity rates still occur. In contrast, gonococcal arthritis is often successfully treated with antimicrobial therapy alone and demonstrates a very low rate of complications and an excellent prognosis for full return of normal joint function. In the case of prosthetic joint infections, the hardware must be eventually removed by a two-stage revision in order to cure the infection.

  11. Factors Affecting Morbidity in Solid Organ Injuries.

    PubMed

    Baygeldi, Serdar; Karakose, Oktay; Özcelik, Kazım Caglar; Pülat, Hüseyin; Damar, Sedat; Eken, Hüseyin; Zihni, İsmail; Çalta, Alpaslan Fedai; Baç, Bilsel

    2016-01-01

    Background and Aim. The aim of this study was to investigate the effects of demographic characteristics, biochemical parameters, amount of blood transfusion, and trauma scores on morbidity in patients with solid organ injury following trauma. Material and Method. One hundred nine patients with solid organ injury due to abdominal trauma during January 2005 and October 2015 were examined retrospectively in the General Surgery Department of Dicle University Medical Faculty. Patients' age, gender, trauma interval time, vital status (heart rate, arterial tension, and respiratory rate), hematocrit (HCT) value, serum area aminotransferase (ALT) and aspartate aminotransferase (AST) values, presence of free abdominal fluid in USG, trauma mechanism, extra-abdominal system injuries, injured solid organs and their number, degree of injury in abdominal CT, number of blood transfusions, duration of hospital stay, time of operation (for those undergoing operation), trauma scores (ISS, RTS, Glasgow coma scale, and TRISS), and causes of morbidity and mortality were examined. In posttraumatic follow-up period, intra-abdominal hematoma infection, emboli, catheter infection, and deep vein thrombosis were monitored as factors of morbidity. Results. One hundred nine patients were followed up and treated due to isolated solid organ injury following abdominal trauma. There were 81 males (74.3%) and 28 females (25.7%), and the mean age was 37.6 ± 18.28 (15-78) years. When examining the mechanism of abdominal trauma in patients, the following results were obtained: 58 (53.3%) traffic accidents (22 out-vehicle and 36 in-vehicle), 27 (24.7%) falling from a height, 14 (12.9%) assaults, 5 (4.5%) sharp object injuries, and 5 (4.5%) gunshot injuries. When evaluating 69 liver injuries scaled by CT the following was detected: 14 (20.3%) of grade I, 32 (46.4%) of grade II, 22 (31.8%) of grade III, and 1 (1.5%) of grade IV. In 63 spleen injuries scaled by CT the following was present: grade I in 21

  12. "Vicious circles": the development of morbid obesity.

    PubMed

    Owen-Smith, Amanda; Donovan, Jenny; Coast, Joanna

    2014-09-01

    Although there has been extensive research around the etiology of moderate obesity, there are still important questions relating to the development and lived experience of extreme obesity. We present a synthesis of data from two in-depth qualitative studies in which morbidly obese participants (N = 31) were able to explain the development of the condition in their own terms. We identified consistent themes in the two datasets, and undertook a detailed data synthesis. Particularly salient themes in the development of morbid obesity related to family structures and early socialization experiences, and the role of emotional distress was dominant in both initial weight gain and ongoing cycles of loss and regain. All informants accepted some responsibility for their health state, but identified a number of mitigating factors that limited personal culpability that were often related to the fulfillment of gendered social expectations.

  13. Mortality and cancer morbidity among cement workers.

    PubMed Central

    Jakobsson, K; Horstmann, V; Welinder, H

    1993-01-01

    OBJECTIVE--To explore associations between exposure to cement dust and cause specific mortality and tumour morbidity, especially gastrointestinal tumours. DESIGN--A retrospective cohort study. SUBJECTS AND SETTING--2400 men, employed for at least 12 months in two Swedish cement factories. MAIN OUTCOME MEASURES--Cause specific morality from death certificates (1952-86). Cancer morbidity from tumour registry information (1958-86). Standardised mortality rates (SMRs; national reference rates) and standardised morbidity incidence rates (SIRs; regional reference rates) were calculated. RESULTS--An increased risk of colorectal cancer was found > or = 15 years since the start of employment (SIR 1.6, 95% confidence interval (95% CI) 1.1-2.3), mainly due to an increased risk for tumours in the right part of the colon (SIR 2.7, 95% CI 1.4-4.8), but not in the left part (SIR 1.0, 95% CI 0.3-2.5). There was a numerical increase of rectal cancer (SIR 1.5, 95% CI 0.8-2.5). Exposure (duration of blue collar employment)-response relations were found for right sided colon cancer. After > or = 25 years of cement work, the risk was fourfold (SIR 4.3, 95% CI 1.7-8.9). There was no excess of stomach cancer or respiratory cancer. Neither total mortality nor cause specific mortality were significantly increased. CONCLUSIONS--Diverging risk patterns for tumours with different localisations within the large bowel were found in the morbidity study. Long term exposure to cement dust was a risk factor for right sided colon cancer. The mortality study did not show this risk. PMID:8457494

  14. Life Satisfaction and Morbidity among Postmenopausal Women

    PubMed Central

    Lukkala, Pyry S.; Honkanen, Risto J.; Rauma, Päivi H.; Williams, Lana J.; Quirk, Shae E.; Kröger, Heikki; Koivumaa-Honkanen, Heli

    2016-01-01

    Objective To investigate associations between morbidity and global life satisfaction in postmenopausal women taking into account type and number of diseases. Materials and Methods A total of 11,084 women (age range 57–66 years) from a population-based cohort of Finnish women (OSTPRE Study) responded to a postal enquiry in 1999. Life satisfaction was measured with a 4-item scale. Self-reported diseases diagnosed by a physician and categorized according to ICD-10 main classes were used as a measure of morbidity. Enquiry data on health and lifestyle were used as covariates in the multivariate logistic models. Results Morbidity was strongly associated with life dissatisfaction. Every additional disease increased the risk of life dissatisfaction by 21.1% (p < .001). The risk of dissatisfaction was strongest among women with mental disorders (OR = 5.26; 95%CI 3.84–7.20) and neurological disorders (OR = 3.62; 95%CI 2.60–5.02) compared to the healthy (each p < .001). Smoking, physical inactivity and marital status were also associated with life dissatisfaction (each p < .001) but their introduction to the multivariate model did not attenuate the pattern of associations. Conclusions Morbidity and life dissatisfaction have a disease-specific and dose-dependent relationship. Even if women with mental and neurological disorders have the highest risk for life dissatisfaction, monitoring life satisfaction among aging women regardless of disorders should be undertaken in order to intervene the joint adverse effects of poor health and poor well-being. PMID:26799838

  15. [Morbidity in the ghettos during the Holocaust].

    PubMed

    Shasha, Shaul M

    2002-04-01

    The environmental conditions and daily life in the ghettos of Europe during the holocaust are reviewed, and their effect on morbidity in different ghettos is scrutinized in an attempt to construct a typical morbidity profile. The outstanding characteristics were: crowding, shortage of basic necessities (such as food, clothing and medications), harsh environmental and sanitary conditions, inclement weather, poor personal hygiene, chronic undernutrition and malnutrition, physical and mental exhaustion. Morbidity was mainly due to infectious diseases, both endemic and epidemic outbreaks with high mortality, and high infestation rates of lice and other parasites. The dominant feature was "hunger disease" with its protean clinical expressions, endocine pathology, growth and development retardation in children, and amenorrhea and infertility among women of child-bearing age. Polyuria, nocturia and increased frequency of bowel movement were common. The typical presentation of a ghetto dweller was of extreme emaciation (a loss of up to 50% body weight); muscle weakness and skeletal abnormalities; pale, dry skin with excoriations; pedal edema; anxiety and nervousness; often goiter in children. Most of the inhabitants had some, or all, of those signs and symptoms (there were times when more than half the population was sick). This syndrome complex was termed "Ghetto Sickness" or "Ghetto Fatigue" (ghetto schwachkeit).

  16. Morbidity and mortality of diabetes with surgery.

    PubMed

    Chuah, L L; Papamargaritis, D; Pillai, D; Krishnamoorthy, A; le Roux, C W

    2013-03-01

    The prevalence of Type 2 diabetes mellitus (T2DM) has increased; as a result the number of patients with T2DM undergoing surgical procedures has also increased. This population is at high risk of macrovascular (cardiovascular disease, peripheral vascular disease) or microvascular (retinopathy, nephropathy or neuropathy) complications, both increasing their perioperative morbidity and mortality. Diabetes patients are more at risk of poor wound healing, respiratory infection, myocardial infarction, admission to intensive care, and increased hospital length of stay. This leads to increased inpatient costs. The outcome of perioperative glycaemia management remains a significant clinical problem without a universally accepted solution. The majority of evidence on morbidity and mortality of T2DM patients undergoing surgery comes from the setting of cardiac surgery; there was less evidence on noncardiac surgery and bariatric surgery. Bariatric surgery is increasingly performed in patients with severe obesity complicated by T2DM, but is distinguished from general surgery as it immediately improves the glucose homeostasis postoperatively. The improvements in glycaemia are thought to be independent of weight loss and this requires different postoperative management. Patients usually have to follow specific preoperative diets which lead to improvement in glycaemia immediately before surgery. Here we review the available data on the mortality and morbidity of patients with T2DM who underwent elective surgery (cardiac, non-cardiac and bariatric surgery) and the current knowledge of the impact that preoperative, intraoperative and postoperative glycaemic management has on operative outcomes.

  17. Maternal Competition in Women.

    PubMed

    Linney, Catherine; Korologou-Linden, Laurel; Campbell, Anne

    2017-03-01

    We examined maternal competition, an unexplored form of competition between women. Given women's high investment in offspring and mothers' key role in shaping their reproductive, social, and cultural success as adults, we might expect to see maternal competition between women as well as mate competition. Predictions about the effect of maternal characteristics (age, relationship status, educational background, number of children, investment in the mothering role) and child variables (age, sex) were drawn from evolutionary theory and sociological research. Mothers of primary school children (in two samples: N = 210 and 169) completed a series of questionnaires. A novel nine-item measure of maternal competitive behavior (MCQ) and two subscales assessing Covert (MCQ-C) and Face-to-Face (MCQ-FF) forms of competition were developed using confirmatory factor analysis. Competitiveness (MCQ score) was predicted by maternal investment, single motherhood, fewer children, and (marginally) child's older age. The effect of single motherhood (but not other predictors) was partially mediated by greater maternal investment. In response to a scenario of their child underperforming relative to their peers, a mother's competitive distress was a positive function of the importance she ascribed to their success and her estimation of her child's ability. Her competitive distress was highly correlated with the distress she attributed to a female friend, hinting at bidirectional dyadic effects. Qualitative responses indicated that nonspecific bragging and boasting about academic achievements were the most common irritants. Although 40% of women were angered or annoyed by such comments, less than 5% endorsed a direct hostile response. Instead, competitive mothers were conversationally shunned and rejected as friends. We suggest that the interdependence of mothers based on reciprocal childcare has supported a culture of egalitarianism that is violated by explicit competitiveness.

  18. Women at risk: Gender inequality and maternal health.

    PubMed

    Banda, Pamela C; Odimegwu, Clifford O; Ntoimo, Lorretta F C; Muchiri, Evans

    2017-04-01

    Gender inequality has been documented as a key driver of negative health outcomes, especially among women. However, studies have not clearly examined the role of gender inequality in maternal health in an African setting. Therefore, the authors of this study examined the role of gender inequality, indicated by lack of female autonomy, in exposing women to maternal health risk. Data were obtained from the 2007 Zambia Demographic and Health Survey on a weighted sample of 3,906 married or partnered women aged 15-49 years. Multivariable analyses revealed that low autonomy in household decision power was associated with maternal health risk (Odds Ratio (OR) = 1.52, p < .001). Autonomy interacted with household wealth showed that respondents who were in the wealthier households and had low autonomy in household decision power (OR = 2.03, p < .05) were more likely to be exposed to maternal health risk than their counterparts who had more autonomy. Efforts to lower women's exposure to maternal mortality and morbidity in Zambia should involve interventions to alter prevailing gender norms that limit women's active participation in decisions about their own health during pregnancy and delivery.

  19. Acute Decompensated Heart Failure

    PubMed Central

    Joseph, Susan M.; Cedars, Ari M.; Ewald, Gregory A.; Geltman, Edward M.; Mann, Douglas L.

    2009-01-01

    Hospitalizations for acute decompensated heart failure are increasing in the United States. Moreover, the prevalence of heart failure is increasing consequent to an increased number of older individuals, as well as to improvement in therapies for coronary artery disease and sudden cardiac death that have enabled patients to live longer with cardiovascular disease. The main treatment goals in the hospitalized patient with heart failure are to restore euvolemia and to minimize adverse events. Common in-hospital treatments include intravenous diuretics, vasodilators, and inotropic agents. Novel pharmaceutical agents have shown promise in the treatment of acute decompensated heart failure and may simplify the treatment and reduce the morbidity associated with the disease. This review summarizes the contemporary management of patients with acute decompensated heart failure. PMID:20069075

  20. Second Line Uterotonics and The Risk of Hemorrhage-Related Morbidity

    PubMed Central

    Butwick, Alexander J.; Carvalho, Brendan; Blumenfeld, Yair J; El-Sayed, Yasser Y.; Nelson, Lorene M; Bateman, Brian T.

    2015-01-01

    Objective Uterine atony is a leading cause of postpartum hemorrhage (PPH). Although most cases of PPH respond to first line therapy with uterine massage and oxytocin administration, second line uterotonics including methylergonovine and carboprost are integral for the management of refractory uterine atony. Despite their ubiquitous use, it is uncertain whether the risk of hemorrhage-related morbidity differs in women exposed to methylergonovine or carboprost at Cesarean delivery (CD). Study Design We performed a secondary analysis using the Maternal-Fetal Medicine Units Network Cesarean Registry. We identified women who underwent CD and received either methylergonovine or carboprost for refractory uterine atony. The primary outcome was hemorrhage-related morbidity defined as intraoperative or postoperative red blood cells transfusion or the need for additional surgical interventions including uterine artery ligation, hypogastric artery ligation, or peripartum hysterectomy for atony. We compared the risk of hemorrhage-related morbidity in those exposed to methylergonovine vs. carboprost. Propensity-score matching was used to account for potential confounders. Results The study cohort comprised 1,335 women; 870 (65.2%) women received methylergonovine and 465 (34.8%) women received carboprost. After accounting for potential confounders, the risk of hemorrhage-related morbidity was higher in the carboprost group than the methylergonovine group (RR = 1.7; 95% CI = 1.2 – 2.6). Conclusion In this propensity-score matched analysis, methylergonovine was associated with reduced risk of hemorrhage-related morbidity during CD compared to carboprost. Based on these results, methylergonovine may be a more effective second line uterotonic. PMID:25582104

  1. Maternal Obesity and its Short- and Long-Term Maternal and Infantile Effects

    PubMed Central

    Korkmaz, Levent; Baştuğ, Osman; Kurtoğlu, Selim

    2016-01-01

    Obesity, in childhood or in adulthood, remains to be a global health problem. The worldwide prevalence of obesity has increased in the last few decades, and consequently, the women of our time suffer more gestational problems than women in the past. The prevalence of obesity is greater in older women than in younger ones and in women with low educational level than in their counterparts with a higher level of education. Maternal obesity during pregnancy may increase congenital malformations and neonatal morbidity and mortality. Maternal obesity is associated with a decreased intention to breastfeed, decreased initiation of breastfeeding, and decreased duration of breastfeeding. We discuss the current epidemiological evidence for the association of maternal obesity with congenital structural neural tube and cardiac defects, fetal macrosomia that predisposes infants to birth injuries and to problems with physiological and metabolic transition, as well as potential for long-term complications secondary to prenatal and neonatal programming effects compounded by a reduction in sustained breastfeeding. PMID:26758575

  2. How much are Ecuadorians Willing to Pay to Reduce Maternal Mortality? Results from a Pilot Study on Contingent Valuation

    PubMed Central

    Roldós, María Isabel; Corso, Phaedra; Ingels, Justin

    2017-01-01

    Context: There is an established association between the provision of health care services and maternal mortality. In Ecuador, little is known if the societal value is greater than the resources expended in preventive medicine. Aims: The purpose of this research is to investigate Ecuadorians’ willingness to pay to prevent maternal death and disabilities due to complications of care during childbirth in the context of universal coverage. Methods and Materials: The study elicited a “contingent” market on morbidity and mortality outcomes, specific to Ecuador’s epidemiologic profiles between a hypothetical market that included a 50% reduction in the risk of maternal mortality from 100 to 50 per 100,000, and a market that included a 50% reduction in the risk of maternal morbidity from 4,000 to 2,000 per 100,000. Results: The average amount participants are willing to pay (WTP) to prevent maternal mortality in the context of universal coverage, was $176 a year (95% CI=$172, $179). The unadjusted mean WTP for a reduction in the maternal morbidity risk was $135 (95% CI=$132, $139). Translated into Value of statistical Life, participant´s from this study valued the prevention of one statistical maternal death at USD $352,000. Conclusion: Results suggest that the costs of maternal care do not outweigh the benefit of prevention, and that Ecuadorians are willing to pay a significant amount to reduce the risk of maternal mortality. Global Health Implications: Reduction of maternal mortality will remain an important global developmental goal in the upcoming years. Having a monetary approximation on the value of these losses may have important implications in the allotting financial and technical resources to reduce it. PMID:28058202

  3. Complexities and Perplexities: A Critical Appraisal of the Evidence for Soil-Transmitted Helminth Infection-Related Morbidity

    PubMed Central

    Nery, Susana V.; Doi, Suhail A.; Gray, Darren J.; Soares Magalhães, Ricardo J.; McCarthy, James S.; Traub, Rebecca J.; Andrews, Ross M.; Clements, Archie C. A.

    2016-01-01

    Background: Soil-transmitted helminths (STH) have acute and chronic manifestations, and can result in lifetime morbidity. Disease burden is difficult to quantify, yet quantitative evidence is required to justify large-scale deworming programmes. A recent Cochrane systematic review, which influences Global Burden of Disease (GBD) estimates for STH, has again called into question the evidence for deworming benefit on morbidity due to STH. In this narrative review, we investigate in detail what the shortfalls in evidence are. Methodology/Principal Findings: We systematically reviewed recent literature that used direct measures to investigate morbidity from STH and we critically appraised systematic reviews, particularly the most recent Cochrane systematic review investigating deworming impact on morbidity. We included six systematic reviews and meta-analyses, 36 literature reviews, 44 experimental or observational studies, and five case series. We highlight where evidence is insufficient and where research needs to be directed to strengthen morbidity evidence, ideally to prove benefits of deworming. Conclusions/Significance: Overall, the Cochrane systematic review and recent studies indicate major shortfalls in evidence for direct morbidity. However, it is questionable whether the systematic review methodology should be applied to STH due to heterogeneity of the prevalence of different species in each setting. Urgent investment in studies powered to detect direct morbidity effects due to STH is required. PMID:27196100

  4. Burden of cardiovascular morbidity and mortality following humanitarian emergencies: a systematic literature review

    PubMed Central

    Hayman, Kaitlin G.; Sharma, Davina; Wardlow, Robert D.; Singh, Sonal

    2016-01-01

    Background The global burden of cardiovascular mortality is increasing, as is the number of large-scale humanitarian emergencies. The interaction between these phenomena is not well understood. This review aims to clarify the relationship between humanitarian emergencies and cardiovascular morbidity and mortality. Methods With assistance from a research librarian, electronic databases (PubMed, Scopus, CINAHL, Global Health) were searched in January 2014. Findings were supplemented by reviewing citations of included trials. Observational studies reporting the effect of natural disasters and conflict events on cardiovascular morbidity and mortality in adults since 1997 were included. Studies without a comparison group were not included. Double-data extraction was utilized to abstract information on acute coronary syndrome (ACS), acute decompensated heart failure (ADHF), and cardiac death (SCD). Review Manager 5.0 was used to create figures for qualitative synthesis (Version 5.2, Copenhagen Denmark, The Nordic Cochrane Centre). Results The search retrieved 1697 unique records; 24 studies were included (17 studies of natural disasters, 7 studies of conflict). These studies involved 14,583 cardiac events. All studies utilized retrospective designs: 4 were population-based, 15 were single-center, and 5 were multicenter studies. 23 studies utilized historical controls in the primary analysis, and 1 utilized primarily geographical controls. Conflicts are associated with an increase in long-term morbidity from ACS; the short-term effects of conflict vary by study. Natural disasters exhibit heterogeneous effects including increased occurrence of ACS, ADHF, and SCD. Conclusions In certain settings, humanitarian emergencies are associated with increased cardiac morbidity and mortality that may persist for years following the event. Humanitarian aid organizations should consider morbidity from non-communicable disease when planning relief and recuperation projects. PMID

  5. Maternal Attitudes. Progress Report.

    ERIC Educational Resources Information Center

    Harnischfeger, Annegret; Wiley, David E.

    This paper discusses ways in which maternal attitudes may serve as mediating variables linking social class characteristics of the family to the socialization of children. Reference is made to the Family Problem Scale (Ernhart and Loevinger) which provides a psychological characterization of social class levels on five dimensions or subscales:…

  6. Maternity Leave in Taiwan

    ERIC Educational Resources Information Center

    Feng, Joyce Yen; Han, Wen-Jui

    2010-01-01

    Using the first nationally representative birth cohort study in Taiwan, this paper examines the role that maternity leave policy in Taiwan plays in the timing of mothers returning to work after giving birth, as well as the extent to which this timing is linked to the amount of time mothers spend with their children and their use of breast milk…

  7. Maternal Sexuality and Breastfeeding

    ERIC Educational Resources Information Center

    Bartlett, Alison

    2005-01-01

    In this paper I consider the ways in which lactation has been discussed as a form of maternal sexuality, and the implications this carries for our understanding of breastfeeding practices and sexuality. Drawing on knowledge constructed in the western world during the last half of the twentieth century, the paper identifies a shift between the…

  8. [Multiple pregnancies. Neonatal morbidity and mortality].

    PubMed

    Lenclen, R; Chassevent, J; Blanc, P; Hoenn, E; Olivier-Martin, M; Paupe, A; Philippe, H J

    1991-10-01

    The increase in the number of multiple pregnancies and the high incidence of prematurity in this type of pregnancy justifies a pediatric evaluation. A retrospective study (1985-1989) compared the perinatal and neonatal characteristics of children resulting from 14 multifetal (at least 3 fetuses) pregnancies, with a gestational age of less than 34 weeks, with 27 children resulting from monofetal pregnancies of the same duration. Neonatal morbidity and mortality appeared to be similar in both groups. Thus at this very early time of onset of labour (mean gestational age of 30 weeks), fetal multiplicity expressed itself neither by any particular neonatal pathology nor by malnutrition.

  9. The Aboriginal Maternal and Infant Health Service: a decade of achievement in the health of women and babies in NSW.

    PubMed

    Murphy, Elisabeth; Best, Elizabeth

    2012-06-01

    The Aboriginal Maternal and Infant Health Service was established to improve the health of Aboriginal women during pregnancy and decrease perinatal morbidity and mortality for Aboriginal babies. The Service is delivered through a continuity-of-care model, where midwives and Aboriginal Health Workers collaborate to provide a high quality maternity service that is culturally sensitive, women centred, based on primary health-care principles and provided in partnership with Aboriginal people. An evaluation of the Service found that the program is achieving its goals in relation to the provision of antenatal and postnatal care and has demonstrated improvements in perinatal morbidity and mortality rates.

  10. Maternal age and risk of labor and delivery complications.

    PubMed

    Cavazos-Rehg, Patricia A; Krauss, Melissa J; Spitznagel, Edward L; Bommarito, Kerry; Madden, Tessa; Olsen, Margaret A; Subramaniam, Harini; Peipert, Jeffrey F; Bierut, Laura Jean

    2015-06-01

    We utilized an updated nationally representative database to examine associations between maternal age and prevalence of maternal morbidity during complications of labor and delivery. We used hospital inpatient billing data from the 2009 United States Nationwide Inpatient Sample, part of the Healthcare Cost and Utilization Project. To determine whether the likelihood that maternal morbidity during complications of labor and delivery differed among age groups, separate logistic regression models were run for each complication. Age was the main independent variable of interest. In analyses that controlled for demographics and clinical confounders, we found that complications with the highest odds among women, 11-18 years of age, compared to 25-29 year old women, included preterm delivery, chorioamnionitis, endometritis, and mild preeclampsia. Pregnant women who were 15-19 years old had greater odds for severe preeclampsia, eclampsia, postpartum hemorrhage, poor fetal growth, and fetal distress. Pregnant women who were ≥35 years old had greater odds for preterm delivery, hypertension, superimposed preeclampsia, severe preeclampsia, and decreased risk for chorioamnionitis. Older women (≥40 years old) had increased odds for mild preeclampsia, fetal distress, and poor fetal growth. Our findings underscore the need for pregnant women to be aware of the risks associated with extremes of age so that they can watch for signs and symptoms of such complications.

  11. Air pollution and respiratory morbidity among adults in southern California

    SciTech Connect

    Ostro, B.D.; Lipsett, M.J.; Mann, J.K.; Krupnick, A.; Harrington, W. )

    1993-04-01

    This paper reports the results of an investigation of the acute effects of air pollution in 321 nonsmoking adults residing in Southern California. Previous epidemiologic investigations of effects of acute exposure to ozone have focused on groups who may not be representative of the general public, such as asthmatics or student nurses. For this study, participants recorded the daily incidence of several respiratory symptoms over a 6-month period between 1978 and 1979. The authors examined the impact of ambient concentrations of ozone, particulate sulfates, and other air pollutants on the incidence of respiratory morbidity, measured as either upper or lower respiratory tract symptoms. Using a logistic regression model, the authors found a significant association between the incidence of lower respiratory tract symptoms and 1-hour daily maximum ozone levels (odds ratio (OR) = 1.22, 95% confidence interval (Cl) 1.11-1.34, for a 10 parts per hundred million (pphm) change), 7-hour average ozone levels (OR = 1.32, 95% Cl 1.14-1.52), and ambient sulfates (OR = 1.30, 95% Cl 1.09-1.54, for a 10-micrograms/m3 change), but no association was found with coefficient of haze, a more general measure of particulates. The existence of a gas stove in the home was also associated with lower respiratory tract symptoms (OR = 1.23, 95% Cl 1.03-1.47). The effects of ozone were greater in the subpopulation without a residential air conditioner. In addition, ozone appears to have had a greater effect among individuals with a preexisting respiratory infection.

  12. Investigating financial incentives for maternal health: an introduction.

    PubMed

    Stanton, Mary Ellen; Higgs, Elizabeth S; Koblinsky, Marge

    2013-12-01

    Projection of current trends in maternal and neonatal mortality reduction shows that many countries will fall short of the UN Millennium Development Goal 4 and 5. Underutilization of maternal health services contributes to this poor progress toward reducing maternal and neonatal morbidity and mortality. Moreover, the quality of services continues to lag in many countries, with a negative effect on the health of women and their babies, including deterring women from seeking care. To enhance the use and provision of quality maternal care, countries and donors are increasingly using financial incentives. This paper introduces the JHPN Supplement, in which each paper reviews the evidence of the effectiveness of a specific financial incentive instrument with the aim of improving the use and quality of maternal healthcare and impact. The US Agency for International Development and the US National Institutes of Health convened a US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives on 24-25 April 2012 in Washington, DC. The Summit brought together leading global experts in finance, maternal health, and health systems from governments, academia, development organizations, and foundations to assess the evidence on whether financial incentives significantly and substantially increase provision, use and quality of maternal health services, and the contextual factors that impact the effectiveness of these incentives. Evidence review teams evaluated the multidisciplinary evidence of various financial mechanisms, including supply-side incentives (e.g. performance-based financing, user fees, and various insurance mechanisms) and demand-side incentives (e.g. conditional cash transfers, vouchers, user fee exemptions, and subsidies for care-seeking). At the Summit, the teams presented a synthesis of evidence and initial recommendations on practice, policy, and research for discussion. The Summit enabled structured

  13. Update: Acute Heart Failure (VII): Nonpharmacological Management of Acute Heart Failure.

    PubMed

    Plácido, Rui; Mebazaa, Alexandre

    2015-09-01

    Acute heart failure is a major and growing public health problem worldwide with high morbidity, mortality, and cost. Despite recent advances in pharmacological management, the prognosis of patients with acute decompensated heart failure remains poor. Consequently, nonpharmacological approaches are being developed and increasingly used. Such techniques may include several modalities of ventilation, ultrafiltration, mechanical circulatory support, myocardial revascularization, and surgical treatment, among others. This document reviews the nonpharmacological approach in acute heart failure, indications, and prognostic implications.

  14. Maternal healthcare in migrants: a systematic review.

    PubMed

    Almeida, Lígia Moreira; Caldas, José; Ayres-de-Campos, Diogo; Salcedo-Barrientos, Dora; Dias, Sónia

    2013-10-01

    Pregnancy is a period of increased vulnerability for migrant women, and access to healthcare, use and quality of care provided during this period are important aspects to characterize the support provided to this population. A systematic review of the scientific literature contained in the MEDLINE and SCOPUS databases was carried out, searching for population based studies published between 1990 and 2012 and reporting on maternal healthcare in immigrant populations. A total of 854 articles were retrieved and 30 publications met the inclusion criteria, being included in the final evaluation. The majority of studies point to a higher health risk profile in immigrants, with an increased incidence of co-morbidity in some populations, reduced access to health facilities particularly in illegal immigrants, poor communication between women and caregivers, a lower rate of obstetrical interventions, a higher incidence of stillbirth and early neonatal death, an increased risk of maternal death, and a higher incidence of postpartum depression. Incidences vary widely among different population groups. Some migrant populations are at a higher risk of serious complications during pregnancy, for reasons that include reduced access and use of healthcare facilities, as well as less optimal care, resulting in a higher incidence of adverse outcomes. Tackling these problems and achieving equality of care for all is a challenging aim for public healthcare services.

  15. Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993–2012

    PubMed Central

    Stoll, Barbara J.; Hansen, Nellie I.; Bell, Edward F.; Walsh, Michele C.; Carlo, Waldemar A.; Shankaran, Seetha; Laptook, Abbot R.; Sánchez, Pablo J.; Van Meurs, Krisa P.; Wyckoff, Myra; Das, Abhik; Hale, Ellen C.; Ball, M. Bethany; Newman, Nancy S.; Schibler, Kurt; Poindexter, Brenda B.; Kennedy, Kathleen A.; Cotten, C. Michael; Watterberg, Kristi L.; D’Angio, Carl T.; DeMauro, Sara B.; Truog, William E.; Devaskar, Uday; Higgins, Rosemary D.

    2016-01-01

    Importance Extremely preterm infants contribute disproportionately to neonatal morbidity and mortality. Objective To review 20-year trends in maternal/neonatal care, complications, and mortality among extremely preterm infants born at Neonatal Research Network centers. Design, Setting, Participants Prospective registry of 34,636 infants 22–28 weeks’ gestational age (GA) and 401–1500 gram birthweight born at 26 Network centers, 1993–2012. Exposure Extremely preterm birth. Main Outcomes Maternal/neonatal care, morbidities, and survival. Major morbidities, reported for infants who survived more than 12 hours, were: severe necrotizing enterocolitis, infection, bronchopulmonary dysplasia, severe intracranial hemorrhage, cystic periventricular leukomalacia, and/or severe retinopathy of prematurity. Regression models assessed yearly changes, adjusting for study center, race/ethnicity, GA, birthweight for GA, and sex. Results Use of antenatal corticosteroids increased from 1993 to 2012 (348/1431 [24%] to 1674/1919 [87%], p<0.001), as did cesarean delivery (625/1431 [44%] to 1227/1921 [64%], p<0.001). Delivery room intubation decreased from 1144/1433 (80%) in 1993 to 1253/1922 (65%) in 2012 (p<0.001). After increasing in the 1990s, postnatal steroid use declined to 141/1757 (8%) in 2004 (p<0.001), with no significant change thereafter. Although most infants were ventilated, continuous positive airway pressure without ventilation increased from 120/1666 (7%) in 2002 to 190/1756 (11%) in 2012 (p<0.001). Despite no improvement from 1993 to 2004, rates of late-onset sepsis declined between 2005 and 2012 for infants of each GA (median GA 26 weeks, 109/296 [37%] to 85/320 [27%], adjusted relative risk [aRR]: 0.93 [95% CI, 0.92–0.94]). Rates of other morbidities declined, but bronchopulmonary dysplasia increased between 2009 and 2012 for infants 26–27 weeks (26 weeks, 130/258 [50%] to 164/297 [55%], p<0.001). Survival increased between 2009 and 2012 for infants 23

  16. Maternal smoking and infant feeding: breastfeeding is better and safer.

    PubMed

    Dorea, Jose G

    2007-05-01

    The rise in smoking rates among young women has implications for children's health aggravated in lower social strata where infant morbidity and mortality rates are higher. The protection afforded by breastfeeding is beneficial to infants in rich and poor countries alike. Women (especially when young, uneducated, and unsupported) who are smokers constitute a risk group for abandoning breastfeeding; moreover, their bottle-fed newborns run a greater risk of morbidity and mortality. Bottle-feeding is attendant on maternal cigarette smoking. The advantages of breastfeeding over bottle-feeding are discussed with regard to systemic effects and the specific effects of cyanide (which can affect the iodine metabolism of infants) and nicotine derived from food and maternal smoking. Despite great strides in bans on smoking, public health policies should be designed to keep in perspective that breastfeeding is an effective tool to counterbalance the health disadvantages that under-privileged infants of smoking mothers face. This paper argues that infants born to smoking parents are better protected by breastfeeding than by formula feeding. Therefore, if public health policies cannot stop addicted mothers from smoking during pregnancy it is fundamental not to miss the chance of encouraging and supporting breastfeeding. The food and health inequalities of socially disadvantaged groups demand well crafted public-health policies to reduce the incidence of diseases and compress morbidity: these policies need to make it clear that breastfeeding is better and safer.

  17. Psychiatric Morbidity and Correlates in Postpartum Women in a Tertiary Care Hospital

    PubMed Central

    Kumar, Narendra; Nagaraj, Anil Kumar Mysore; Koudike, Umashree; Majgi, Sumanth Mallikarjuna

    2016-01-01

    Background: A range of psychological disorders occur in women in the postpartum period apart from the traditional blues, postpartum depression and psychosis. These include obsession of infanticide, PTSD, morbid preoccupations regarding child birth and disorders of mother-infant relationships, though they are under emphasized. Methods: it is a cross-sectional study conducted in the tertiary maternity care hospital. A total of 152 study subjects were interviewed on MINI (Mini International Neuropsychiatric Inventory) and GAF (Global Assessment of Functioning) within 2 weeks after delivery. Results: The psychiatric morbidity was seen in 67 (44%) of the study subjects. About 26% of subjects had Depressive disorder NOS. Obsessive harm to the child, Panic disorder, Social phobia were the other disorders identified. There were no cases of Mania, Bipolar disorder, psychosis, post traumatic stress disorder or substance use disorder diagnosed across the sample. The Global Assessment of Functioning (GAF) score averaged 87.8. Statistically significant association was seen to be present between psychiatric illness and number of previous still births and dead children before this delivery (P = 0.045). Conclusions: The study reveals that psychiatric co-morbidity is very common in the postpartum period and can be detected as early as first week after delivery. Social phobia identified as a common association is a new finding and needs further replication. It needs a larger sample with a prospective assessment to generalize the findings of our study. PMID:27570341

  18. Neuroendocrine regulation of maternal behavior.

    PubMed

    Bridges, Robert S

    2015-01-01

    The expression of maternal behavior in mammals is regulated by the developmental and experiential events over a female's lifetime. In this review the relationships between the endocrine and neural systems that play key roles in these developmental and experiential processes that affect both the establishment and maintenance of maternal care are presented. The involvement of the hormones estrogen, progesterone, and lactogens are discussed in the context of ligand, receptor, and gene activity in rodents and to a lesser extent in higher mammals. The roles of neuroendocrine factors, including oxytocin, vasopressin, classical neurotransmitters, and other neural gene products that regulate aspects of maternal care are set forth, and the interactions of hormones with central nervous system mediators of maternal behavior are discussed. The impact of prior developmental factors, including epigenetic events, and maternal experience on subsequent maternal care are assessed over the course of the female's lifespan. It is proposed that common neuroendocrine mechanisms underlie the regulation of maternal care in mammals.

  19. Fatigue, depression, maternal confidence, and maternal satisfaction during the first month postpartum: A comparison of Japanese mothers by age and parity.

    PubMed

    Mori, Emi; Tsuchiya, Miyako; Maehara, Kunie; Iwata, Hiroko; Sakajo, Akiko; Tamakoshi, Koji

    2017-02-01

    The aim of the study was to assess fatigue, depressive symptoms, and maternal confidence or satisfaction among older primiparae during the first month postpartum. The number of older Japanese primiparae has rapidly increased. Older primiparae are believed to be at high risk for puerperal morbidity. A multicentre prospective cohort study design was used. Data were examined from 2854 Japanese women who participated in a 6-month prospective cohort study conducted between May 2012 and September 2013. The women were classified into 4 groups based on maternal age and parity. All participants completed the Postnatal Accumulated Fatigue Scale, Japanese Edinburgh Postnatal Depression Scale, Postpartum Maternal Confidence Scale, and Postpartum Maternal Satisfaction Scale. Primiparae in all age groups were more severely fatigued and had a higher risk of postpartum depression than multiparous mothers during the first month postpartum. Older primiparae had significantly lower scores on maternal confidence and maternal satisfaction than the other 3 groups at 1 month postpartum. These findings suggest that postpartum nursing should focus on promoting adequate sleep, providing emotional support, and fostering the process of maternal role adaptation among older Japanese primiparae, particularly during the first postpartum month.

  20. [Functional status, morbidity, and mortality of centenarians].

    PubMed

    Arai, Yasumichi; Hirose, Nobuyoshi

    2013-01-01

    Prevention or postponement of age-related diseases and functional limitation is the key component of successful aging. We studied centenarians, a model for successful aging in terms of functional status and morbidities. Vast majority of centenarians had chronic disease such as hypertension (63.6%) , heart disease (28.8%) , stroke (15.9%) , fragile fracture (46.4%) , and few centenarians were free from any chronic diseases. Male centenarians had better physical function than female counterparts. Stroke and fragile fracture had negative impacts on their functional status, but hypertension was paradoxically associated with better physical function. When we looked at mortality beyond 100 years of age, physical function, but not morbidity profile had significant impact on their mortality. These results raised a notion that age-related frailty or diminution of functional reserve may be the major cause both for physical disability and poor prognosis of centenarians. Previous results from our study suggested that stability of energy homeostasis, in which neuroendocrine system has a key role, may be important to maintain physical function at the extreme old age.

  1. Morbidity markers for Schistosoma haematobium infection.

    PubMed

    Vennervald, B J; Reimert, C M; Ouma, J H; Kilama, W L; Deelder, A M; Hatz, C

    1994-01-01

    A description is given of a field study design, including pretreatment and short and long-term posttreatment measurements, which is conducted as a case-control study among school children in Kaloleni District, Kenya, and Kilosa District, Tanzania, including 500 school children from each endemic setting. The aim of the study is to evaluate eosinophil cationic protein (ECP) in urine as a marker for Schistosoma haematobium morbidity by comparing levels of ECP in urine with S. haematobium egg counts in urine, level of excreted S. haematobium egg antigen in urine, microhaematuria and urinary tract pathology assessed by ultrasonography. Initial results have been promising and are now subject to an extensive evaluation. Strong training components and transfer of technology are included in the project, thus contributing to the strengthening of the research capacity of the collaborating African institutions. Simple non-invasive assays for ECP and excreted S. haematobium egg antigen could provide new tools for evaluation of chemotherapy effects and morbidity in urinary schistosomiasis, helping to understand the dynamic process of posttreatment resolution and reappearance of pathological changes.

  2. [Diabetic co-morbidities: prevalences in Germany].

    PubMed

    Heller, T; Blum, M; Spraul, M; Wolf, G; Müller, U A

    2014-04-01

    In some patients with diabetes mellitus (DM) chronic hyperglycemia leads to microvascular complications in retina, kidney and nerves. Concerning missing data from Germany cited prevalence in German educational books and guidelines arise from other countries. This review demonstrates the prevalence of diabetic comorbidities in Germany. The largest investigation in Germany is the Disease-Management-Programm Nordrhein with more than 450.000 surveyed DM  patients. These researches show good comparability with most analyses respective to the prevalence of diabetic comorbidities in Germany. Patients with DM2 have a mean Hba1c of 7 % and patients with DM1 of 7.9 %. In patients with DM2 the prevalence of retinopathy is 11 %, nephropathy 10 % and neuropathy 20 %. Co-morbidities are more commonin patients with long diabetes duration and high HbA1c. In patients with DM1 the prevalence of retinopathy is 25 %, of nephropathy 15 % and neuropathy 27 %. The prevalence of diabetic co-morbidities in primary care in Germany is considerably lower as mentioned in educational books or guidelines. This positive development is reasonable through a better quality of care, nationwide early detection examinations and training programmes.

  3. Models for pulmonary lethality and morbidity after irradiation from internal and external sources

    SciTech Connect

    Scott, B.R.; Filipy, R.E.; Hahn, E.F.

    1989-05-01

    This report provides a hazard-function model for estimating the risk of death from radiation pneumonitis and/or pulmonary fibrosis following a light-water nuclear power accident. A similar model is also provided for estimating the prevalence of respiratory functional morbidity among those that survive death from acute effects. Hazard-function models for lethality and for morbidity were constructed using the cumulative hazard estimator H, which is related to the risk estimator R through the equation R = 1-exp(-H). The estimator H can be calculated using information provided in the report. The method of calculation depends on the exposure scenario. In general, the total normalized dose X for lethality or for morbidity is calculated. For lethality, X = 1 corresponds to a median lethal dose (LD/sub 50/); for morbidity, X = 1 corresponds to a median effective dose (ED/sub 50/). H is related to X by the equation H = 1n(2)X/sup V/, where V depends on the type of radiation (or radiations) involved. Contributions to X can arise from each of two main modes of exposure: (1) brief exposure of the lung, at a relatively high dose rate, to mainly external gammas, followed by (2) chronic internal alpha, and/or beta, and/or gamma irradiation of the lung. Equations are provided for calculating the contributions to X from both modes of exposure. 73 refs., 16 figs., 2 tabs.

  4. Application of WHO ‘Near-Miss’ Tool Indicates Good Quality of Maternal Care in Rural Healthcare Setting in Uttarakhand, Northern India

    PubMed Central

    Roy, Debabrata; Aggarwal, Pradeep; Nautiyal, Ruchira; Chaturvedi, Jaya; Kakkar, Rakesh

    2016-01-01

    Introduction Women who experienced and survived a severe health condition during pregnancy, childbirth or postpartum are considered as ‘near-miss’ or severe acute maternal morbidity (SAMM) cases. Women who survive life-threatening conditions arising from complications related to pregnancy and childbirth have many common aspects with those who die of such complications. Aim To evaluate health-care facility preparedness and perfor-mance in reducing severe maternal out comes at all levels of health care. Materials and Methods The present study was carried out over a period of 12 months under the Department of Community Medicine. The cross-sectional study included all the women (937) attending health-care facilities, at all levels of health care i.e. Primary, Secondary & Tertiary level in Doiwala block of Dehradun district. This study was conducted as per the WHO criteria for ‘near-miss’ by using probability sampling for random selection of health facilities. All eligible study subjects visiting health-care facilities during the study period were included, i.e. who were pregnant, in labour, or who had delivered or aborted up to 42 days ago. Results It was found that all women delivering at the THC received oxytocin to prevent postpartum haemorrhage. Treatment of severe post-partum haemorrhage by removal of retained products was significantly associated with levels of health care. Majority (94.73%) women who had eclampsia received magnesium sulfate as primary treatment. Conclusion Application of WHO ‘near-miss’ tool indicates good quality of maternal care in rural healthcare setting in Uttarakhand, North India. The women would have otherwise died due to obstetrics complications, had proper care not been provided to them in time. PMID:26894094

  5. Self Report Co-Morbidity and Health Related Quality of Life -- A Comparison with Record Based Co-Morbidity Measures

    ERIC Educational Resources Information Center

    Voaklander, Donald C.; Kelly, Karen D.; Jones, C. Allyson; Suarez-Almazor, Maria E.

    2004-01-01

    The purpose of this project was to compare three hospital-based measures of co-morbidity to patient self-report co-morbidity and to determine the relative proportion of outcome predicted by each of the co-morbidity measures in a population of individuals receiving major joint arthroplasty. Baseline measures using the SF-36 general health…

  6. Phenylketonuria and maternal phenylketonuria.

    PubMed

    Purnell, H

    2001-07-01

    Phenylketonuria is a genetic disease affecting 1:10,000 to 14,000 live births. In NSW there is an average of nine cases diagnosed each year (Dietitians Working Party 1996). This paper discusses the management of phenylketonuria, and in particular the value of breastfeeding, complemented with a low phenylalanine infant formula, in facilitating easier maintenance of satisfactory phenylalanine blood levels. The 'diet for life' approach to managing phenylketonuria is to avoid long-term neurological deficits and, in particular, the risk that maternal PKU, which is not under strict dietary control, will have adverse effects on infants born of mothers with the disease. There have been 31 successful pregnancies to 1997 managed by the Nutrition and Dietetics Department of The Children's Hospital at Westmead, Sydney. The Maternal PKU diet is presented with the case of a client with phenylketonuria who has achieved two normal pregnancies and breastfed her second child for six months.

  7. Maternal serum screening.

    PubMed Central

    Carroll, J. C.

    1994-01-01

    Maternal serum screening (MSS) measures three serum markers: alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol, from which the risk of fetal Down syndrome or open neural tube defect is calculated. Initially, 8% of women will have positive results. I present a protocol for investigating these women. Family physicians should be informed about MSS so they can give their patients information and guidance. PMID:7524838

  8. Cystitis - acute

    MedlinePlus

    Uncomplicated urinary tract infection; UTI - acute cystitis; Acute bladder infection; Acute bacterial cystitis ... cause. Menopause also increases the risk for a urinary tract infection. The following also increase your chances of having ...

  9. Naegele Forceps Delivery and Association between Morbidity and the Number of Forceps Traction Applications: A Retrospective Study

    PubMed Central

    Matsumoto, Naoki; Takenaka, Toshifumi; Ikeda, Nobuyuki; Yazaki, Satoshi; Sato, Yuichi

    2015-01-01

    Objective. To present the method of Naegele forceps delivery clinically practiced by the lead author, its success rate, and morbidity and to evaluate the relationship between morbidity and the number of forceps traction applications. Methods. Naegele forceps delivery was performed when the fetal head reached station +2 cm, the forceps were applied in the maternal pelvic application, and traction was slowly and gently performed. In the past two years, Naegele forceps delivery was attempted by the lead author in 87 cases, which were retrospectively reviewed. Results. The numbers of traction applications were one in 64.7% of cases, two in 24.7%, and three or more in 10.7%. The success rate was 100%. No severe morbidity was observed in mothers or neonates. Neonatal facial injury occurred most commonly in cases with fetal head malrotation, elevated numbers of traction applications, and maternal complications. Umbilical artery acidemia most commonly occurred in cases with nonreassuring fetal status. The significant crude odds ratio for three or more traction applications was 20 in cases with malrotation. Conclusion. Naegele forceps delivery has a high success rate, but multiple traction applications will sometimes be required, particularly in cases with malrotation. Malrotation and elevated numbers of traction applications may lead to neonatal head damage. PMID:26425369

  10. What we have learned regarding antibiotic therapy for the reduction of infant morbidity after preterm premature rupture of the membranes.

    PubMed

    Mercer, Brian M; Goldenberg, Robert L; Das, Anita F; Thurnau, Gary R; Bendon, Robert W; Miodovnik, Menachem; Ramsey, Risa D; Rabello, Yolanda A

    2003-06-01

    Preterm premature rupture of the membranes (pPROM) is responsible for approximately one third of the over 450,000 preterm births occurring in the United States annually. In this manuscript, we summarize the outcomes and analyses related to the National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network (NICHD-MFMU) network multicenter trial of antibiotics to reduce infant morbidity after pPROM. Based on evident reduction in gestational age dependent and infectious infant morbidity, we provide the rationale for aggressive intravenous and oral, broad spectrum Ampicillin/Amoxicillin, and Erythromycin therapy during conservative management of pPROM before 32 weeks' gestation. We further review the histopathologic correlates to pPROM, to antibiotic treatment, and to perinatal outcome, and discuss the relationships between maternal and neonatal cytokine levels intercellular adhesion molecule, and other clinical and plasma markers regarding perinatal morbidity. The use and limitations of ultrasound and vaginally collected amniotic fluid pulmonary maturity assessment are discussed.

  11. The effects of women's education on maternal health: Evidence from Peru.

    PubMed

    Weitzman, Abigail

    2017-03-06

    This article examines the causal effect of women's education on maternal health in Peru, a country where maternal mortality has declined by more than 70% in the last two and a half decades. To isolate the effects of education, the author employs an instrumented regression discontinuity that takes advantage of an exogenous source of variation-an amendment to compulsory schooling laws in 1993. The results indicate that extending women's years of schooling reduced the probability of several maternal health complications at last pregnancy/birth, sometimes by as much as 29%. Underlying these effects, increasing women's education is found to decrease the probability of short birth intervals and unwanted pregnancies (which may result in unsafe abortions) and to increase antenatal healthcare use, potentially owing to changes in women's cognitive skills, economic resources, and autonomy. These findings underscore the influential role of education in reducing maternal morbidity and highlight the contributions of women's education to population health and health transitions.

  12. Smoking and the compression of morbidity

    PubMed Central

    Nusselder, W; Looman, C; de Mheen, P J M.-v.; van de Mheen, H; Mackenbach, J

    2000-01-01

    OBJECTIVE—To examine whether eliminating smoking will lead to a reduction in the number of years lived with disability (that is, absolute compression of morbidity).
DESIGN—Multistate life table calculations based on the longitudinal GLOBE study (the Netherlands) combined with the Longitudinal Study of Aging (LSOA, United States of America).
SETTING—the Netherlands.
SUBJECTS—Dutch nationals aged 30-74 years living in the city of Eindhoven and surrounding municipalities (GLOBE) and United States citizens age 70 and over (LSOA).
MAIN OUTCOME MEASURES—Life expectancy with and without disability and total life expectancy at ages 30 and 70.
RESULTS—A non-smoking population on balance spends fewer years with disability than a mixed smoking-non-smoking population. Although non-smokers have lower mortality risks and thus are exposed to disability over a longer period of time, their lower incidence of disability and higher recovery from disability yield a net reduction of the length of time spent with disability (at age 30: −0.9 years in men and −1.1 years in women) and increases the length of time lived without disability (2.5 and 1.9 years, for men and women, respectively). These outcomes indicate that elimination of smoking will extend life and the period of disability free life, and will compress disability into a shorter period.
CONCLUSIONS—Eliminating smoking will not only extend life and result in an increase in the number of years lived without disability, but will also compress disability into a shorter period. This implies that the commonly found trade off between longer life and a longer period with disability does not apply. Interventions to discourage smoking should receive high priority.


Keywords: smoking; morbidity PMID:10890867

  13. Cancer mortality and morbidity among rubber workers.

    PubMed

    Monson, R R; Fine, L J

    1978-10-01

    Mortality and morbidity from cancer among a cohort of 13,570 white male rubber workers were examined. Each man worked for at least 5 years at the Akron, Ohio, plant of the B. F. Goodrich Company. The potential period of follow-up was from January 1, 1940 to June 30, 1976. Departmental work histories were based primarily on records maintained by Local no. 5, United Rubber Workers. The occurrence of cancer was measured by death certificates and by a survey of Akron-area hospital tumor registries from 1964 to 1974. Two types of analyses were made: 1) an external comparison of mortality rates of rubber workers versus rates of U.S. white males, and 2) an internal comparison of cancer morbidity rates among persons who were employed in various work areas of the plant. Excess cases of specific cancers (observed/expected numbers) among workers in specific work areas included: stomach and intestine: rubber making (30/14.4); lung: tire curing (31/14.1), fuel cells and/or deicers (46/29.1); bladder: chemical plant (6/2.4), and tire building (16/10.7); skin cancer: tire assembly (12/1.9); brain cancer: tire assembly (8/2.0); lymphatic cancer: tire building (8/3.2); and leukemia: calendering (8/2.2), tire curing (8/2.6), tire building (12/7.5), elevators (4/1.4), tubes (4/1.6), and rubber fabrics (4/1.1). Agents that may be responsible for these excesses were considered.

  14. Acute abdomen. Outcomes.

    PubMed

    Madonna, M B; Boswell, W C; Arensman, R M

    1997-05-01

    The outcome for children with common surgical conditions that cause an acute abdomen is discussed. These conditions include appendicitis, intussusception, malrotation, inflammatory bowel disease, intestinal obstructions, and nonorganic pain. Emphasis is placed on surgical intervention and disease processes that significantly affect outcome. The outcome of many of the diseases discussed is strongly influenced by the timing of diagnosis and treatment. These children should have prompt care and intervention to prevent morbidity and mortality. In addition, many children who present with common pediatric surgical emergencies have other medical conditions and are best treated in an environment that has a multidisciplinary team to handle their care and decrease the long-term complications.

  15. Maternal HIV Infection Influences the Microbiome of HIV Uninfected Infants

    PubMed Central

    Bender, Jeffrey M.; Li, Fan; Martelly, Shoria; Byrt, Erin; Rouzier, Vanessa; Leo, Marguerithe; Tobin, Nicole; Pannaraj, Pia S.; Adisetiyo, Helty; Rollie, Adrienne; Santiskulvong, Chintda; Wang, Shuang; Autran, Chloe; Bode, Lars; Fitzgerald, Daniel; Kuhn, Louise; Aldrovandi, Grace M.

    2017-01-01

    More than one million HIV-exposed, uninfected infants are born annually to HIV-positive mothers worldwide. This growing population of infants experiences twice the mortality of HIV-unexposed infants. We found that although there were very few differences seen in the microbiomes of mothers with and without HIV infection, maternal HIV infection was associated with changes in the microbiome of HIV-exposed, uninfected infants. Furthermore, we observed that human breast milk oligosaccharides were associated with the bacterial species in the infant microbiome. The disruption of the infant’s microbiome associated with maternal HIV infection may contribute to the increased morbidity and mortality of HIV-exposed, uninfected infants. PMID:27464748

  16. [Reducing maternal mortality in developing countries: theory and practice].

    PubMed

    Prual, A

    2004-01-01

    Chiefs of state attending the Millennium Summit (2000) set a goal of reducing maternal mortality by 75% before 2015. Based on knowledge of the epidemiology of maternal mortality/morbidity and on growing experience in the field, the international community defined a relatively low-cost program of evidence-based initiatives. However implementation of that program has been stymied by the reality that increasing geographical accessibility to a full range of quality emergency obstetric care of quality will require large investments of money and time. Increasing financial accessibility remains difficult given the low standard of living of populations and budget cutbacks by national governments. The problems facing women and health workers are mostly overlooked by public health policy. There is need for a multi-disciplinary approach with equal participation of specialists in public health, gyneco-obstetrics, anthropology, health care economics, political science and social and community mobilization.

  17. Changes in morbidity and medical care utilization after the recent economic crisis in the Republic of Korea.

    PubMed Central

    Kim, Hanjoong; Chung, Woo Jin; Song, Young Jong; Kang, Dae Ryong; Yi, Jee Jeon; Nam, Chung Mo

    2003-01-01

    OBJECTIVE: To examine and quantify the impact of the recent economic crisis on morbidity and medical care utilization in the Republic of Korea. METHODS: 22 675 people from 6791 households and 43 682 people from 12 283 households were questioned for two nationwide surveys that took place in 1995 and 1998, respectively. A separate sample pretest-posttest design was used and we conducted c2 test and logistic regression analysis after controlling for the maturation effect of the morbidity and medical care utilization. FINDINGS: The morbidity rates of chronic disease and acute disease increased significantly by 27.1% and 9.5%, respectively, whereas the utilization rates of outpatient and inpatient services decreased by 15.1% and 5.2%, respectively. In particular, the pace of decline in the utilization rate of outpatient services varied depending on the type of disease: morbidity rates for mental and behavioural disorders were 13.7%; for cardiovascular disease, 7.1%; and for injury, 31.6%. CONCLUSION: After the Republic of Korean economic crisis, the morbidity and medical care utilization rates changed significantly but the degree of change depended on the type of disease or service. The time-dependent relationship between the national economy and the morbidity and medical care utilization rates needs to be further investigated. PMID:14576888

  18. Maternally acquired runt disease.

    PubMed

    Beer, A E; Billingham, R E

    1973-01-19

    Without altering the structural integrity of the placenta by irradiation or drugs, we have shown that it is possible to immunize females both adoptively and actively against the paternally inherited transplantation antigens of their fetuses. Such immunization causes a high incidence of runt disease among the litters. Although the putative chimeric status of the affected offspring has yet to be confirmed, the results of our experiments support the thesis that runt disease is caused by the activities of "unwanted" immigrant lymphocytes from the maternal circulation. Our results suggest that immunologically activated cells are more likely to cross the placenta than normal cells and that this greater mobility may not be related to the immunologic specificity of the activated cells. Two factors may have contributed to the apparent failure of numerous previous attempts to demonstrate the capacity of transplantation immunity to affect the well-being of a fetus or, more correctly, its placenta, in the way that might be expected of a homograft. (i) Investigators were preoccupied with obtaining a classic type of rejection, in utero, analogous to the rejection of an orthotopic skin homograft. The birth of consistently healthy-looking litters, interpreted as a failure of the experiment, convinced the investigators of the efficacy of nature's solution of the homograft problem and there was no reason for them to suspect its possible limitations. Observation of the litters for several weeks might have uncovered the phenomenon of maternally induced runt disease. (ii) Most investigators resorted to hyperimmunization of the mothers. This would have facilitated the synthesis of protective isoantibodies capable of interfering with the expression of the potentially harmful cellular immune response (6). Ever since the abnormalities of runt disease were first described they have repeatedly been compared to those observed in patients with certain lymphomas (17). Various theories have been

  19. Maternal mortality in New York--Looking back, looking forward.

    PubMed

    Chazotte, Cynthia; D'Alton, Mary E

    2016-03-01

    New York City was ahead of its time in recognizing the issue of maternal death and the need for proper statistics. New York has also documented since the 1950s the enormous public health challenge of racial disparities in maternal mortality. This paper addresses the history of the first Safe Motherhood Initiative (SMI), a voluntary program in New York State to review reported cases of maternal deaths in hospitals. Review teams found that timely recognition and intervention in patients with serious morbidity could have prevented many of the deaths reviewed. Unfortunately the program was defunded by New York State. The paper then focuses on the revitalization of the SMI in 2013 to establish three safety bundles across the state to be used in the recognition and treatment of obstetric hemorrhage, severe hypertension in pregnancy, and the prevention of venous thromboembolism; and their introduction into 118 hospitals across the state. The paper concludes with a look to the future of the coordinated efforts needed by various organizations involved in women's healthcare in New York City and State to achieve the goal of a review of all maternal deaths in the state by a multidisciplinary team in a timely manner so that appropriate feedback to the clinical team can be given and care can be modified and improved as needed. It is the authors' opinion that we owe this type of review to the women of New York who entrust their care to us.

  20. Materno-infantilism, feminism and maternal health policy in Brazil.

    PubMed

    Diniz, Simone

    2012-06-01

    In the last days of 2011, President of Brazil Dilma Rousseff issued a provisional measure (or draft law) entitled "National Surveillance and Monitoring Registration System for the Prevention of Maternal Mortality" (MP 557), as part of a new maternal health programme. It was supposed to address the pressing issue of maternal morbidity and mortality in Brazil, but instead it caused an explosive controversy because it used terms such as nascituro (unborn child) and proposed the compulsory registration of every pregnancy. After intense protests by feminist and human rights groups that this law was unconstitutional, violated women's right to privacy and threatened our already limited reproductive rights, the measure was revised in January 2012, omitting "the unborn child" but not the mandatory registration of pregnancy. Unfortunately, neither version of the draft law addresses the two main problems with maternal health in Brazil: the over-medicalisation of childbirth and its adverse effects, and the need for safe, legal abortion. The content of this measure itself reflects the conflictive nature of public policies on reproductive health in Brazil and how they are shaped by close links between different levels of government and political parties, and religious and professional sectors.

  1. Tocolysis for acute preterm labor: does anything work.

    PubMed

    Haram, Kjell; Mortensen, Jan Helge Seglem; Morrison, John C

    2015-03-01

    The central rationale of tocolysis for preterm labor (PTL) is to delay delivery for at least 48 h to allow for transfer of the mother to a tertiary facility and for corticosteroids to induce surfactant production in fetal lungs. Beta-mimetics decrease the number of women in preterm labor giving birth within 48 h without reducing adverse neonatal outcomes. Calcium channel blockers inclusive of nifedipine decrease the adverse neonatal outcomes by significantly delaying delivery. Atosiban has the best maternal and fetal safety profile but does not seem to reduce neonatal complications. Magnesium sulfate is controversial as a tocolytic, but is valuable as a neuroprotective agent and for treatment of eclamptic seizures. Indomethacin may be a reasonable first choice for acute tocolytsis in gestational ages less than 32 weeks' gestation. Prolonged use (>48 h) should be avoided. Transdermal nitroglycerin can reduce neonatal morbidity and mortality as a result of decreased risk of birth before 28 weeks' gestation. Nifedipine may be a reasonable first choice because it is easy to administer and also of limited side effects relative to β2-mimetics. Tocolysis does not appear to significantly lengthen the gestational age beyond seven days.

  2. Acute Myocardial Infarction in the First Trimester of Pregnancy in a Great Grand Multiparous Woman with Poorly Controlled Chronic Hypertension

    PubMed Central

    Prasannan, Lakha; Blitz, Matthew J.; Rabin, Jill M.

    2016-01-01

    Introduction Acute myocardial infarction (MI) in pregnancy is a rare event, usually occurring late in gestation, either in the third trimester or in the puerperium. It is associated with significant maternal and fetal morbidity and mortality. Although diagnosis and management of MI in pregnancy has been discussed in the literature, management of pregnancy following an early antepartum MI, which may have more consequences for the fetus, has not received as much attention. Case A 38-year-old great grand multiparous woman presented to the emergency department complaining of acute onset chest pain. The patient had a history of chronic hypertension and was an active smoker. She was incidentally found to be 5 weeks pregnant. She was diagnosed with an acute MI, which was treated by primary percutaneous coronary intervention. Her subsequent pregnancy course was complicated by poorly controlled chronic hypertension, but she ultimately delivered a healthy newborn at 36 weeks of gestational age. Conclusion Good pregnancy outcomes are possible after early antepartum MI, especially with early diagnosis, appropriate treatment, and a multidisciplinary team approach to prenatal care. Delivery should occur in a tertiary referral center with experience managing high-risk obstetric patients with cardiac disease. PMID:27551581

  3. Maternal manifestation of Ballantyne's syndrome occurring concomitantly with the development of fetal congenital mesoblastic nephroma.

    PubMed

    Takahashi, Hironori; Matsubara, Shigeki; Kuwata, Tomoyuki; Ohkuchi, Akihide; Mukoda, Yukiko; Saito, Koyomi; Usui, Rie; Suzuki, Mitsuaki

    2014-04-01

    Various fetal or placental disorders cause Ballantyne's (mirror) syndrome. For the first time, we report a maternal manifestation of Ballantyne's syndrome occurring concomitantly with the development of fetal congenital mesoblastic nephroma (CMN). In a pregnant woman with a CMN fetus, lung edema, hypertension, hyperthyroidism, and high serum human chorionic gonadotrophin level occurred, all of which characterize maternal manifestation of Ballantyne's syndrome. The fetus and placenta were devoid of 'edema', lacking 'triple edema', and thus this condition was not diagnosed as Ballantyne's syndrome; however, we considered this condition as the maternal manifestation of Ballantyne's syndrome. We performed emergent cesarean section at 28 weeks. Delivery acutely ameliorated maternal symptoms. Tumor was resected and was confirmed as CMN. Maternal manifestations of Ballantyne's syndrome, such as lung edema and hypertension, can occur in a mother with fetal CMN even without fetal and/or placental edema. The clinical course of this patient may suggest an etiology of Ballantyne's syndrome.

  4. [Precautionary maternity leave in Tirol].

    PubMed

    Ludescher, K; Baumgartner, E; Roner, A; Brezinka, C

    1998-01-01

    Under Austrian law, precautionary maternity leave is a decree issued by the district public health physician. It forbids a pregnant woman to work and mandates immediate maternity leave. Regular maternity leave for all women employed in all jobs begins at 32 weeks of gestation. Women who work in workplaces deemed dangerous and women with a history of obstetric problems such as premature or growth-retarded babies from previous pregnancies are regularly 'sent' into precautionary maternity leave. The public health physicians of Tirol's nine administrative districts were interviewed and supplied data on precautionary maternity leave from their districts. In 100 women who attended the clinic for pregnancies at risk of the Obstetrics/Gynecology Department of Innsbruck University Hospital and who had already obtained precautionary maternity leave, the medical/administrative procedure was studied in each case and correlated with pregnancy outcome. The town district of Innsbruck and the district that comprises the suburbs of the provincial capital had the highest rates of precautionary maternity leave. The town district of Innsbruck had a rate of 24.3% of all pregnant women (employed and not employed) in precautionary maternity leave in 1997, whereas the whole province of Tirol had 13.4%. More than 80% of decrees for precautionary maternity leave are issued by district public health physicians on the basis of written recommendations from gynecologists. One third of women who are sent into precautionary maternity leave are issued the decree prior to 12 weeks of gestation - mostly cases of multiple pregnancies and women with previous miscarriages. The present system of precautionary maternity leave appears to work in the sense that most working pregnant women with risk factors are correctly identified - with most errors on the side of caution. As the system also helps employers - the employee's pay is paid from the federal family support fund and state insurance once she is in

  5. Ambient Temperature and Morbidity: A Review of Epidemiological Evidence

    PubMed Central

    Ye, Xiaofang; Wolff, Rodney; Yu, Weiwei; Vaneckova, Pavla; Pan, Xiaochuan

    2011-01-01

    Objective: In this paper, we review the epidemiological evidence on the relationship between ambient temperature and morbidity. We assessed the methodological issues in previous studies and proposed future research directions. Data sources and data extraction: We searched the PubMed database for epidemiological studies on ambient temperature and morbidity of noncommunicable diseases published in refereed English journals before 30 June 2010. Forty relevant studies were identified. Of these, 24 examined the relationship between ambient temperature and morbidity, 15 investigated the short-term effects of heat wave on morbidity, and 1 assessed both temperature and heat wave effects. Data synthesis: Descriptive and time-series studies were the two main research designs used to investigate the temperature–morbidity relationship. Measurements of temperature exposure and health outcomes used in these studies differed widely. The majority of studies reported a significant relationship between ambient temperature and total or cause-specific morbidities. However, there were some inconsistencies in the direction and magnitude of nonlinear lag effects. The lag effect of hot temperature on morbidity was shorter (several days) compared with that of cold temperature (up to a few weeks). The temperature–morbidity relationship may be confounded or modified by sociodemographic factors and air pollution. Conclusions: There is a significant short-term effect of ambient temperature on total and cause-specific morbidities. However, further research is needed to determine an appropriate temperature measure, consider a diverse range of morbidities, and to use consistent methodology to make different studies more comparable. PMID:21824855

  6. Factors associated with maternal death in an intensive care unit

    PubMed Central

    Saintrain, Suzanne Vieira; de Oliveira, Juliana Gomes Ramalho; Saintrain, Maria Vieira de Lima; Bruno, Zenilda Vieira; Borges, Juliana Lima Nogueira; Daher, Elizabeth De Francesco; da Silva Jr, Geraldo Bezerra

    2016-01-01

    Objective To identify factors associated with maternal death in patients admitted to an intensive care unit. Methods A cross-sectional study was conducted in a maternal intensive care unit. All medical records of patients admitted from January 2012 to December 2014 were reviewed. Pregnant and puerperal women were included; those with diagnoses of hydatidiform mole, ectopic pregnancy, or anembryonic pregnancy were excluded, as were patients admitted for non-obstetrical reasons. Death and hospital discharge were the outcomes subjected to comparative analysis. Results A total of 373 patients aged 13 to 45 years were included. The causes for admission to the intensive care unit were hypertensive disorders of pregnancy, followed by heart disease, respiratory failure, and sepsis; complications included acute kidney injury (24.1%), hypotension (15.5%), bleeding (10.2%), and sepsis (6.7%). A total of 28 patients died (7.5%). Causes of death were hemorrhagic shock, multiple organ failure, respiratory failure, and sepsis. The independent risk factors associated with death were acute kidney injury (odds ratio [OR] = 6.77), hypotension (OR = 15.08), and respiratory failure (OR = 3.65). Conclusion The frequency of deaths was low. Acute kidney injury, hypotension, and respiratory insufficiency were independent risk factors for maternal death. PMID:28099637

  7. [Schistosomiasis and acute appendicitis].

    PubMed

    Figueiredo, Jacinta; Santos, Ângela; Clemente, Horácio; Lourenço, Augusto; Costa, Sandra; Grácio, Maria Amélia; Belo, Silvana

    2014-01-01

    Acute appendicitis associated to Schistosoma haematobium and S. mansoni infection has been found in patients submitted to urgent appendectomy at the Hospital Américo Boavida in Luanda. Due to the high prevalence and morbidity caused by schistosomiasis (or bilharziasis) in the country, we suspect that the involvement of Schistosoma infection on appendicular pathology could be very frequent, in particular for those individuals more exposed to the parasite transmission. We report two clinical cases of acute appendicitis whose surgical specimens of the appendix revealed S. haematobium and S. mansoni eggs in histological samples. The reported patients live in endemic areas and have been exposed to schistosome during childhood, which may explain the infection's chronicity. Information of these clinical cases could be relevant, particularly for surgery specialists and clinical pathologists, due to the possibility of finding more patients with concurrent appendicitis and schistosomiasis.

  8. Atrial natriuretic factor in maternal and fetal sheep

    SciTech Connect

    Cheung, C.Y.; Gibbs, D.M.; Brace, R.A.

    1987-02-01

    To determine atrial natriuretic factor (ANF) concentrations in the circulation and body fluids of adult pregnant sheep and their fetuses, pregnant ewes were anesthetized with pentobarbital sodium, and the fetuses were exteriorized for sampling. ANF concentration, as measured by radioimmunoassay, was 47 +/- 6 (SE) pg/ml in maternal plasma, which was significantly higher than the 15 +/- 3 pg/ml in maternal urine. In the fetus, plasma ANF concentration was 265 +/- 49 pg/ml, 5.6 times that in maternal plasma. No umbilical arterial and venous difference in ANF concentration was observed. Fetal urine ANF concentration was significantly lower than that in fetal plasma, and was similar to that measured in amniotic and allantoic fluid. In chronically catheterized maternal and fetal sheep, fetal plasma ANF was again 5.1 times that in maternal plasma, and these levels were not different from those measured in acutely anesthetized animals. These results demonstrate that immunoreactive ANF is present in the fetal circulation at levels higher than those found in the mother. The low concentration of ANF in fetal urine suggests that ANF is probably metabolized and/or reabsorbed by the fetal kidney.

  9. Gender equality as a means to improve maternal and child health in Africa.

    PubMed

    Singh, Kavita; Bloom, Shelah; Brodish, Paul

    2015-01-01

    In this article we examine whether measures of gender equality, household decision making, and attitudes toward gender-based violence are associated with maternal and child health outcomes in Africa. We pooled Demographic and Health Surveys data from eight African countries and used multilevel logistic regression on two maternal health outcomes (low body mass index and facility delivery) and two child health outcomes (immunization status and treatment for an acute respiratory infection). We found protective associations between the gender equality measures and the outcomes studied, indicating that gender equality is a potential strategy to improve maternal and child health in Africa.

  10. Morbidity and mortality associated with mode of delivery for breech periviable deliveries

    PubMed Central

    TUCKER EDMONDS, Brownsyne; MCKENZIE, Fatima; MACHERAS, Michelle; SRINIVAS, Sindhu K.; LORCH, Scott A.

    2015-01-01

    Objective To estimate the odds of morbidity and mortality associated with cesarean compared to vaginal delivery for breech fetuses delivered from 23 to 24 6/7 weeks gestational age (GA). Study Design Retrospective cohort study of state-level maternal and infant hospital discharge data linked to vital statistics for breech deliveries occurring between 23 and 24 6/7 weeks gestation in California, Missouri and Pennsylvania from 2000–2009 (N=1854). Analyses were stratified by GA (23–23 6/7 vs. 24–24 6/7). Results Cesarean was performed for 46% (335) and 77% (856) of 23- and 24-week breech fetuses. In multivariable analyses, overall survival was greater for cesarean-born neonates (AOR=3.98 95% CI=2.24, 7.06; AOR=2.91, 95% CI=1.76, 4.81). When delivered for non-emergent indications, cesarean-born survivors were more than twice as likely to experience ‘Major Morbidity’ (IVH, BPD, NEC, asphyxia composite) (AOR 2.83, 95% CI=1.37, 5.84; AOR=2.07, 95% CI=1.11, 3.86 at 23 and 24 weeks). Among intubated neonates, despite a short-term survival advantage, there was no difference in survival to >6-month corrected age (AOR=1.77, 95% CI =0.83, 3.74; AOR=1.50, 95% CI=0.81, 2.76). There was no difference in survival for intubated 23-week neonates delivered by cesarean for non-emergent indications, nor cesarean-born neonates weighing <500g. Conclusion Cesarean increased overall survival and major morbidity for breech periviable neonates. However, among intubated neonates, despite a short-term survival advantage, there was no difference in 6-month survival. Also, cesarean did not increase survival for neonates weighing <500g. Patients and providers should explicitly discuss the trade-offs related to neonatal mortality and morbidity, maternal morbidity, and implications for future pregnancies. PMID:25747545

  11. Associations between life conditions and multi-morbidity in marginalized populations: the case of Palestinian refugees

    PubMed Central

    Hojeij, Safa; Elzein, Kareem; Chaaban, Jad; Seyfert, Karin

    2014-01-01

    Background: Evidence suggests that higher multi-morbidity rates among people with low socioeconomic status produces and maintains poverty. Our research explores the relationship between socioeconomic deprivation and multi-morbidity among Palestinian refugees in Lebanon, a marginalized and impoverished population. Methods: A representative sample of Palestinian refugees in Lebanon was surveyed, interviewing 2501 respondents (97% response rate). Multi-morbidity was measured by mental health, chronic and acute illnesses and disability. Multinomial logistic regression models assessed the association between indicators of poverty and multi-morbidities. Results: Findings showed that 14% of respondents never went to school, 41% of households reported water leakage and 10% suffered from severe food insecurity. Participants with an elementary education or less and those completing intermediate school were more than twice as likely to report two health problems than those with secondary education or more (OR: 2.60, CI: 1.73–3.91; OR: 2.47, CI: 1.62–3.77, respectively). Those living in households with water leakage were nearly twice as likely to have three or more health reports (OR = 1.88, CI = 1.45–2.44); this pattern was more pronounced for severely food insecure households (OR = 3.41, CI = 1.83–6.35). Conclusion: We identified a positive gradient between socioeconomic status and multi-morbidity within a refugee population. These findings reflect inequalities produced by the health and social systems in Lebanon, a problem expected to worsen following the massive influx of refugees from Syria. Ending legal discrimination and funding infrastructural, housing and health service improvements may counteract the effects of deprivation. Addressing this problem requires providing a decent livelihood for refugees in Lebanon. PMID:24994504

  12. Disability-Adjusted Life Years for Maternal, Neonatal, and Nutritional Disorders in Korea

    PubMed Central

    2016-01-01

    Maternal and child health is an important issue throughout the world. Given their impact on maternal and child health, nutritional issues need to be carefully addressed. Accordingly, the effect of maternal, child, and nutritional disorders on disability-adjusted life years (DALYs) should be calculated. The present study used DALYs to estimate the burden of disease of maternal, neonatal, and nutritional disorders in the Korean population in 2012. For this purpose, we used claim data of the Korean National Health Insurance Service, DisMod II, and death data of the Statistics Korea and adhered to incidence-based DALY estimation methodology. The total DALYs per 100,000 population were 376 in maternal disorders, 64 in neonatal disorders, and 58 in nutritional deficiencies. The leading causes of DALYs were abortion in maternal disorders, preterm birth complications in neonatal disorders, and iron-deficiency anemia in nutritional deficiencies. Our findings shed light on the considerable burden of maternal, neonatal, and nutritional conditions, emphasizing the need for health care policies that can reduce morbidity and mortality. PMID:27775256

  13. Using survival analysis to determine association between maternal pelvis height and antenatal fetal head descent in Ugandan mothers

    PubMed Central

    Munabi, Ian Guyton; Luboga, Samuel Abilemech; Mirembe, Florence

    2015-01-01

    Introduction Fetal head descent is used to demonstrate the maternal pelvis capacity to accommodate the fetal head. This is especially important in low resource settings that have high rates of childbirth related maternal deaths and morbidity. This study looked at maternal height and an additional measure, maternal pelvis height, from automotive engineering. The objective of the study was to determine the associations between maternal: height and pelvis height with the rate of fetal head descent in expectant Ugandan mothers. Methods This was a cross sectional study on 1265 singleton mothers attending antenatal clinics at five hospitals in various parts of Uganda. In addition to the routine antenatal examination, each mother had their pelvis height recorded following informed consent. Survival analysis was done using STATA 12. Results It was found that 27% of mothers had fetal head descent with an incident rate of 0.028 per week after the 25th week of pregnancy. Significant associations were observed between the rate of fetal head descent with: maternal height (Adj Haz ratio 0.93 P < 0.01) and maternal pelvis height (Adj Haz ratio 1.15 P < 0.01). Conclusion The significant associations observed between maternal: height and pelvis height with rate of fetal head descent, demonstrate a need for further study of maternal pelvis height as an additional decision support tool for screening mothers in low resource settings. PMID:26918071

  14. Ketorolac-associated renal morbidity: risk factors in cardiac surgical infants.

    PubMed

    Moffett, Brady S; Cabrera, Antonio

    2013-10-01

    We aimed to identify the risk factors for acute kidney injury in infants who have received ketorolac after a cardiac surgical procedure by identifying patients with a > or = 50% increase in serum creatinine from baseline and matching them by age with three controls that had < 50% increase in serum creatinine. Significant differences in primary surgical procedure, baseline serum creatinine, and concomitant aspirin use were noted. We conclude that the concomitant use of aspirin with ketorolac is associated with increased renal morbidity in young post-cardiac surgical infants.

  15. Effect of maternal exercises on biophysical fetal and maternal parameters: a transversal study

    PubMed Central

    dos Santos, Caroline Mombaque; dos Santos, Wendel Mombaque; Gallarreta, Francisco Maximiliano Pancich; Pigatto, Camila; Portela, Luiz Osório Cruz; de Morais, Edson Nunes

    2016-01-01

    ABSTRACT Objective To evaluate the acute effects of maternal and fetal hemodynamic responses in pregnant women submitted to fetal Doppler and an aerobic physical exercise test according to the degree of effort during the activity and the impact on the well-being. Methods Transversal study with low risk pregnant women, obtained by convenience sample with gestational age between 26 to 34 weeks. The participants carry out a progressive exercise test. Results After the exercise session, reduced resistance (p=0.02) and pulsatility indices (p=0.01) were identified in the umbilical artery; however, other Doppler parameters analyzed, in addition to cardiotocography and fetal biophysical profile did not achieve significant change. Maternal parameters obtained linear growth with activity, but it was not possible to establish a standard with the Borg scale, and oxygen saturation remained stable. Conclusion A short submaximal exercise had little effect on placental blood flow after exercise in pregnancies without complications, corroborating that healthy fetus maintains homeostasis even in situations that alter maternal hemodynamics. PMID:28076590

  16. Maternal Depression, Maternal Expressed Emotion, and Youth Psychopathology

    ERIC Educational Resources Information Center

    Tompson, Martha C.; Pierre, Claudette B.; Boger, Kathryn Dingman; McKowen, James W.; Chan, Priscilla T.; Freed, Rachel D.

    2010-01-01

    Across development, maternal depression has been found to be a risk factor for youth psychopathology generally and youth depression specifically. Maternal Expressed Emotion (EE) has been examined as a predictor of outcome among youth with depression. The present study explored the associations between youth psychopathology and two…

  17. Child Health, Maternal Marital and Socioeconomic Factors, and Maternal Health

    ERIC Educational Resources Information Center

    Garbarski, Dana; Witt, Whitney P.

    2013-01-01

    Although maternal socioeconomic status and health predict in part children's future health and socioeconomic prospects, it is possible that the intergenerational association flows in the other direction such that child health affects maternal outcomes. Previous research demonstrates that poor child health increases the risk of adverse maternal…

  18. Maternal ethanol ingestion: effect on maternal and neonatal glucose balance

    SciTech Connect

    Witek-Janusek, L.

    1986-08-01

    Liver glycogen availability in the newborn is of major importance for the maintenance of postnatal blood glucose levels. This study examined the effect of maternal ethanol ingestion on maternal and neonatal glucose balance in the rate. Female rats were placed on 1) the Lieber-DeCarli liquid ethanol diet, 2) an isocaloric liquid pair-diet, or 3) an ad libitum rat chow diet at 3 wk before mating and throughout gestation. Blood and livers were obtained from dams and rat pups on gestational days 21 and 22. The pups were studied up to 6 h in the fasted state and up to 24 h in the fed state. Maternal ethanol ingestion significantly decreased litter size, birth weight, and growth. A significantly higher mortality during the early postnatal period was seen in the prenatal ethanol exposed pups. Ethanol significantly decreased fed maternal liver glycogen stores but not maternal plasma glucose levels. The newborn rats from ethanol ingesting dams also had significantly decreased liver glycogen stores. Despite mobilizing their available glycogen, these prenatal ethanol exposed pups became hypoglycemic by 6 h postnatal. This was more marked in the fasted pups. Ethanol did not affect maternal nor neonatal plasma insulin levels. Thus maternal ethanol ingestion reduces maternal and neonatal liver glycogen stores and leads to postnatal hypoglycemia in the newborn rat.

  19. Family Centered Maternity Care

    PubMed Central

    Enkin, Murray W.

    1973-01-01

    Current practices of obstetrical care tend to hinder rather than facilitate family development and maturation. A program of family centred maternity care is described. Husbands are invited to prenatal visits, and are involved in intensive preparation for labor and delivery. Their presence and active participation in labor, delivery, and postpartum course are encouraged. This, along with a rooming-in policy for the baby, and the utilization of the postpartum period for an intensive training in parenthood, appears to produce a safe and satisfying obstetrical experience for the family. PMID:20468914

  20. [Morbidity and mortality of carotid endarterectomy].

    PubMed

    Rodríguez Pérez, A; Cabrera Morán, V; Abad Vázquez, C; Muñoz Falcón, L; Hernández Ruiz, A; Hermida Anllo, M; Cárdenes Romero, I

    1993-01-01

    In order to investigate the peroperative complications in carotid surgery, a cohort of 64 patients operated of carotid endarterectomy (EC) were evaluated. A total 78 EC were performed, 56 unilateral (EC-U) and 11 bilateral (EC-B). All the cases were managed in a similar manner regarding surgical technique, monitoring, anesthetic management and pre and postoperative care. A temporary shunt was inserted in 6 cases. The hospital mortality has been 0. We registered the following postoperative complications: arterial hypertension in 23.1 of EC-U and 18.2% of EC-B, cervical hematoma in 5.3% (EC-U) and 13.6% (EC-B), TIA in 5.3% (EC-U) and 4.5% (EC-B), stroke 1.7% (EC-U) and 4.5% (EC-B), vocal cord injury in 3.5% of EC-U and chest pain with angina in 1.7% of EC-U. A review of the mortality and morbidity in carotid surgery is done.

  1. Cancer morbidity in lamp manufacturing workers.

    PubMed

    Shannon, H S; Haines, T; Bernholz, C; Julian, J A; Verma, D K; Jamieson, E; Walsh, C

    1988-01-01

    A historical prospective study of cancer in lamp manufacturing workers in one plant was conducted. All men and women who worked for a total of at least 6 months and were employed at some time between 1960 and 1975 were included. Work histories were abstracted and subjects were divided according to whether they had worked in the coiling and wire drawing area (CWD). Cancer morbidity from 1964 to 1982 was ascertained via the provincial registry, and was compared with the site-specific incidence in Ontario, adjusting for age, sex and calendar period. Of particular interest were primary breast and gynecological cancers in women. The cancers of a priori concern were significantly increased in women in CWD, but not elsewhere in the plant. The excess was greatest in those with more than 5 yr exposure (in CWD) and more than 15 yr since first working in CWD, with eight cases of breast and gynecological cancers observed in this category compared with 2.67 expected. Only three cancers occurred in men in CWD. Environmental measurements had not been made in the past and little information was available on substances used in the 1940s and 1950s, the period when the women with the highest excess began employment. It is known that methylene chloride and trichlorethylene have been used, but not enough is known about the dates and patterns of use to draw any conclusions about their relationship with the increase in disease.

  2. [Sitting and cardiovascular morbidity and mortality].

    PubMed

    Shiyovich, Arthur; Shlyakhover, Vladimir; Katz, Amos

    2013-01-01

    Prolonged sitting and sedentary behavior comprises a major part of the modern lifestyle: at work, leisure (watching television, Internet) and commuting/traveling. Studies have shown that adults spend about half of their time at work and even more sitting. Similarly, a significant part of the leisure time is spent doing sedentary activities usually in front of a screen (TV or a computer). However, current recommendations focus on increasing moderate-to-vigorous physical activity with almost no recommendations relating to sedentary activities. Recent evidence from several research papers showed deleterious relationships of sedentary behavior with cardiovascular risk factors (e.g., obesity, type 2 diabetes mellitus and waist circumference). Furthermore, consistent independent associations have been observed between sitting time/sedentary behaviors and elevated all-cause and cardiovascular disease mortality risk. Generally, these associations have persisted following adjustment for physical activity. Recent emerging findings have shown that breaking up sedentary time potentially has a beneficial impact on cardiovascular health (independent of total sedentary time and moderate-to-vigorous intensity activity). In this article, we review the association between the time spent in various sedentary activities (occupational, leisure and commuting/transportation) and cardiovascular risk factors and cardiovascular morbidity and mortality. In addition, we review the suggested mechanisms that explain the empiric associations.

  3. The nature of unemployment morbidity. 2. Description

    PubMed Central

    Beale, Norman; Nethercott, Susan

    1988-01-01

    A longitudinal, controlled study on job loss and health using general practice records has concluded that unemployment morbidity among men made redundant can be identified as an increase in those episodes of illness which are associated with many consultations. The possibility that these episodes represent chronic ill health has been tested using the same data base. If chronic illnesses are defined as those requiring active management after one year, their incidence among unemployed men was over six times that among controls (P<0.001). Cardiovascular disorders were frequently detected in the unemployed men and several of the other chronic complaints they suffered may also have had a psychosomatic aetiology related to stress. The consequent workload in terms of consultations, investigations, referrals, outpatient attendances and drug therapy increased significantly after job loss. More frequent, short-lived illnesses showed continuing downward trends in study and control men. The results suggest that unskilled men face a serious health hazard if made redundant. Investigating and treating their chronic disabilities leads to an increased medical workload and must further burden the health service. PMID:3210181

  4. Maternal Employment and Adolescent Development.

    ERIC Educational Resources Information Center

    Montemayor, Raymond; Clayton, Mark D.

    1983-01-01

    The relationship between maternal employment and adolescent development is enormously complex, and no simple generalizations are possible. Many intervening variables alter the impact that maternal employment has on adolescent development. There is an urgent need to discover what impact this arrangement has on adolescent development. (CJ)

  5. Evolution of maternal effect senescence

    PubMed Central

    Moorad, Jacob A.; Nussey, Daniel H.

    2016-01-01

    Increased maternal age at reproduction is often associated with decreased offspring performance in numerous species of plants and animals (including humans). Current evolutionary theory considers such maternal effect senescence as part of a unified process of reproductive senescence, which is under identical age-specific selective pressures to fertility. We offer a novel theoretical perspective by combining William Hamilton’s evolutionary model for aging with a quantitative genetic model of indirect genetic effects. We demonstrate that fertility and maternal effect senescence are likely to experience different patterns of age-specific selection and thus can evolve to take divergent forms. Applied to neonatal survival, we find that selection for maternal effects is the product of age-specific fertility and Hamilton’s age-specific force of selection for fertility. Population genetic models show that senescence for these maternal effects can evolve in the absence of reproductive or actuarial senescence; this implies that maternal effect aging is a fundamentally distinct demographic manifestation of the evolution of aging. However, brief periods of increasingly beneficial maternal effects can evolve when fertility increases with age faster than cumulative survival declines. This is most likely to occur early in life. Our integration of theory provides a general framework with which to model, measure, and compare the evolutionary determinants of the social manifestations of aging. Extension of our maternal effects model to other ecological and social contexts could provide important insights into the drivers of the astonishing diversity of lifespans and aging patterns observed among species. PMID:26715745

  6. Global burden of influenza as a cause of cardiopulmonary morbidity and mortality.

    PubMed

    Fischer, William A; Gong, Michelle; Bhagwanjee, Satish; Sevransky, Jonathan

    2014-09-01

    Severe acute respiratory infections, including influenza, are a leading cause of cardiopulmonary morbidity and mortality worldwide. Until recently, the epidemiology of influenza was limited to resource-rich countries. Emerging epidemiological reports characterizing the 2009 H1N1 pandemic, however, suggest that influenza exerts an even greater toll in low-income, resource-constrained environments where it is the cause of 5% to 27% of all severe acute respiratory infections. The increased burden of disease in this setting is multifactorial and likely is the result of higher rates of comorbidities such as human immunodeficiency virus, decreased access to health care, including vaccinations and antiviral medications, and limited healthcare infrastructure, including oxygen therapy or critical care support. Improved global epidemiology of influenza is desperately needed to guide allocation of life-saving resources, including vaccines, antiviral medications, and direct the improvement of basic health care to mitigate the impact of influenza infection on the most vulnerable populations.

  7. Idiopathic Polyhydramnios: Severity and Perinatal Morbidity.

    PubMed

    Wiegand, Samantha L; Beamon, Carmen J; Chescheir, Nancy C; Stamilio, David

    2016-06-01

    Objective To estimate the association between the severity of idiopathic polyhydramnios and adverse outcomes. Study Design Retrospective cohort study of deliveries at one hospital from 2000 to 2012 with an amniotic fluid index (AFI) measurement ≥24 + 0 weeks' gestation. Pregnancies complicated by diabetes, multiples, or fetal anomalies were excluded. Exposure was the degree of polyhydramnios: normal (AFI 5-24 cm), mild (≥ 24-30 cm), and moderate-severe (> 30 cm). Primary outcomes were perinatal mortality, neonatal intensive care unit (NICU) admission, and postpartum hemorrhage. Results There were 10,536 pregnancies: 10,188 with a normal AFI, 274 mild (78.74%), and 74 moderate-severe polyhydramnios (21.26%). Adverse outcomes were increased with idiopathic polyhydramnios: NICU admission (adjusted odds ratio [AOR] 3.71, 95% confidence interval [CI] 2.77-4.99), postpartum hemorrhage (AOR 15.81, 95% CI 7.82-31.96), macrosomia (AOR 3.41, 95% CI 2.61-4.47), low 5-minute Apgar score (AOR 2.60, 95% CI 1.57-4.30), and cesarean (AOR 2.16, 95% CI 1.74-2.69). There were increasing odds of macrosomia (mild: AOR 3.19, 95% CI 2.36-4.32; moderate-severe: AOR 4.44, 95% CI 2.53-7.79) and low 5-minute Apgar score (mild: AOR 2.24, 95% CI 1.23-4.08; moderate-severe: AOR 3.93, 95% CI 1.62-9.55) with increasing severity of polyhydramnios. Conclusion Idiopathic polyhydramnios is independently associated with increased risks of morbidity. There appears to be a dose-response relationship for neonatal macrosomia and low 5-minute Apgar score risks.

  8. Acute pancreatitis as a model of SIRS.

    PubMed

    Bhatia, Madhav

    2009-01-01

    Acute pancreatitis is a common clinical condition. Excessive systemic inflammatory response syndrome (SIRS) in acute pancreatitis leads to distant organ damage and multiple organ dysfunction syndrome (MODS), which is the primary cause of morbidity and mortality in this condition. Development of in vivo experimental models of acute pancreatitis and associated systemic organ damage has enabled us to study the role played by inflammatory mediators in the pathogenesis of acute pancreatitis and associated systemic organ damage. Using these models, recent studies by us and other investigators have established the critical role played by inflammatory mediators such as TNF-a, IL-1b, IL-6, PAF, IL-10, CD40L, C5a, ICAM-1, chemokines, substance P and hydrogen sulfide in acute pancreatitis and the resultant MODS. This chapter intends to present an overview of different experimental animal models of acute pancreatitis and associated MODS and the role of inflammatory mediators in the pathogenesis of this condition.

  9. Maternal Health Phone Line: Saving Women in Papua New Guinea

    PubMed Central

    Watson, Amanda H.A.; Sabumei, Gaius; Mola, Glen; Iedema, Rick

    2015-01-01

    This paper presents the findings of a research project which has involved the establishment of a maternal health phone line in Milne Bay Province of Papua New Guinea (PNG). Mobile phones and landline phones are key information and communication technologies (ICTs). This research study uses the “ICTs for healthcare development” model to ascertain benefits and barriers to the successful implementation of the Childbirth Emergency Phone. PNG has a very high maternal mortality rate. The “three stages of delay” typology was developed by Thaddeus and Maine to determine factors that might delay provision of appropriate medical treatment and hence increase risk of maternal death. The “three stages of delay” typology has been utilised in various developing countries and also in the present study. Research undertaken has involved semi-structured interviews with health workers, both in rural settings and in the labour ward in Alotau. Additional data has been gathered through focus groups with health workers, analysis of notes made during phone calls, interviews with women and community leaders, observations and field visits. One hundred percent of interviewees (n = 42) said the project helped to solve communication barriers between rural health workers and Alotau Provincial Hospital. Specific examples in which the phone line has helped to create positive health outcomes will be outlined in the paper, drawn from research interviews. The Childbirth Emergency Phone project has shown itself to play a critical role in enabling healthcare workers to address life-threatening childbirth complications. The project shows potential for rollout across PNG; potentially reducing maternal morbidity and maternal mortality rates by overcoming communication challenges. PMID:25923199

  10. Maternal and Perinatal Outcomes of Twin Pregnancy in 23 Low- and Middle-Income Countries

    PubMed Central

    Vogel, Joshua P.; Torloni, Maria Regina; Seuc, Armando; Betrán, Ana Pilar; Widmer, Mariana; Souza, João Paulo; Merialdi, Mario

    2013-01-01

    Background Twin pregnancies in low- and middle-income countries (LMICs) pose a high risk to mothers and newborns due to inherent biological risks and scarcity of health resources. We conducted a secondary analysis of the WHO Global Survey dataset to analyze maternal and perinatal outcomes in twin pregnancies and factors associated with perinatal morbidity and mortality in twins. Methods We examined maternal and neonatal characteristics in twin deliveries in 23 LMICs and conducted multi-level logistic regression to determine the association between twins and adverse maternal and perinatal outcomes. Results 279,425 mothers gave birth to 276,187 (98.8%) singletons and 6,476 (1.2%) twins. Odds of severe adverse maternal outcomes (death, blood transfusion, ICU admission or hysterectomy) (AOR 1.85, 95% CI 1.60–2.14) and perinatal mortality (AOR 2.46, 95% CI 1.40–4.35) in twin pregnancies were higher, however early neonatal death (AOR 2.50, 95% CI 0.95–6.62) and stillbirth (AOR 1.22, 95% CI 0.58–2.57) did not reach significance. Amongst twins alone, maternal age <18, poor education and antenatal care, nulliparity, vaginal bleeding, non-cephalic presentations, birth weight discordance >15%, born second, preterm birth and low birthweight were associated with perinatal mortality. Marriage and caesarean section were protective. Conclusions Twin pregnancy is a significant risk factor for maternal and perinatal morbidity and mortality in low-resource settings; maternal risk and access to safe caesarean section may determine safest mode of delivery in LMICs. Improving obstetric care in twin pregnancies, particularly timely access to safe caesarean section, is required to reduce risk to mother and baby. PMID:23936446

  11. Towards elimination of maternal deaths: maternal deaths surveillance and response.

    PubMed

    Hounton, Sennen; De Bernis, Luc; Hussein, Julia; Graham, Wendy J; Danel, Isabella; Byass, Peter; Mason, Elizabeth M

    2013-01-02

    Current methods for estimating maternal mortality lack precision, and are not suitable for monitoring progress in the short run. In addition, national maternal mortality ratios (MMRs) alone do not provide useful information on where the greatest burden of mortality is located, who is concerned, what are the causes, and more importantly what sub-national variations occur. This paper discusses a maternal death surveillance and response (MDSR) system. MDSR systems are not yet established in most countries and have potential added value for policy making and accountability and can build on existing efforts to conduct maternal death reviews, verbal autopsies and confidential enquiries. Accountability at national and sub-national levels cannot rely on global, regional and national retrospective estimates periodically generated from academia or United Nations organizations but on routine counting, investigation, sub national data analysis, long term investments in vital registration and national health information systems. Establishing effective maternal death surveillance and response will help achieve MDG 5, improve quality of maternity care and eliminate maternal mortality (MMR ≤ 30 per 100,000 by 2030).

  12. Towards elimination of maternal deaths: maternal deaths surveillance and response

    PubMed Central

    2013-01-01

    Current methods for estimating maternal mortality lack precision, and are not suitable for monitoring progress in the short run. In addition, national maternal mortality ratios (MMRs) alone do not provide useful information on where the greatest burden of mortality is located, who is concerned, what are the causes, and more importantly what sub-national variations occur. This paper discusses a maternal death surveillance and response (MDSR) system. MDSR systems are not yet established in most countries and have potential added value for policy making and accountability and can build on existing efforts to conduct maternal death reviews, verbal autopsies and confidential enquiries. Accountability at national and sub-national levels cannot rely on global, regional and national retrospective estimates periodically generated from academia or United Nations organizations but on routine counting, investigation, sub national data analysis, long term investments in vital registration and national health information systems. Establishing effective maternal death surveillance and response will help achieve MDG 5, improve quality of maternity care and eliminate maternal mortality (MMR ≤ 30 per 100,000 by 2030). PMID:23279882

  13. Nutrition and maternal, neonatal, and child health.

    PubMed

    Christian, Parul; Mullany, Luke C; Hurley, Kristen M; Katz, Joanne; Black, Robert E

    2015-08-01

    This article reviews the central role of nutrition in advancing the maternal, newborn, and child health agenda with a focus on evidence for effective interventions generated using randomized controlled trials in low- and middle-income countries (LMIC). The 1000 days spanning from conception to 2 years of life are a critical period of time when nutritional needs must be ensured; failure to do so can lead to adverse impacts on short-term survival as well as long-term health and development [corrected]. The burden of maternal mortality continues to be high in many under-resourced settings; prenatal calcium supplementation in populations with low intakes can reduce the risk of pre-eclampsia and eclampsia morbidity and mortality and is recommended, and antenatal iron-folic acid use in many countries may reduce anemia, a condition that may be an underlying factor in postpartum hemorrhage. Sufficient evidence exists to promote multiple micronutrient supplementation during pregnancy to reduce fetal growth restriction and low birth weight. Early initiation of breastfeeding (within an hour), exclusive breastfeeding in the first 6 months of life, and vitamin A supplementation in the first few days of life in Asia (but not in Africa) reduce infant mortality. Biannual large-dose vitamin A supplements to children 6-59 months of age and zinc for treatment of diarrhea continue to be important strategies for improving child health and survival. Early nutrition and micronutrient status can influence child development but should be integrated with early responsive learning interventions. Future research is needed that goes beyond the 1000 days to ensure adequate preconceptional nutrition and health, with special emphasis on adolescents who contribute to a large proportion of first births in many LMIC. Thus, we make the case for integrating proven nutrition interventions with those for health in pregnant women, and with those for health and child development in neonates, infants, and

  14. [Latest advances in acute pancreatitis].

    PubMed

    de-Madaria, Enrique

    2015-09-01

    The present article analyses the main presentations on acute pancreatitis at Digestive Disease Week 2015. Arterial pseudoaneurysm is an uncommon complication of acute pancreatitis (incidence 0.7%) and mortality from this cause is currently anecdotal. Diabetes mellitus has little impact on the clinical course of acute pancreatitis, unlike cirrhosis, which doubles the risk of mortality. Intake of unsaturated fat could be associated with an increased severity of acute pancreatitis and is a confounding factor in studies evaluating the relationship between obesity and morbidity and mortality. PET-CT (positron emission tomography-computed tomography) could be a non-invasive tool to detect infection of collections in acute pancreatitis. Peripancreatic fat necrosis is less frequent than pancreatic fat necrosis and is associated with a better clinical course. If the clinical course is poor, increasing the calibre of the percutaneous drains used in the treatment of infected necrosis can avoid surgery in 20% of patients. The use of low molecular-weight heparin in moderate or severe pancreatitis could be associated with a better clinical course, specifically with a lower incidence of necrosis. In acute recurrent pancreatitis, simvastatin is a promising drug for prophylaxis of new episodes of acute pancreatitis. Nutritional support through a nasogastric tube does not improve clinical course compared with oral nutrition.

  15. Morbidly Adherent Placenta: Ultrasound Assessment and Supplemental Role of Magnetic Resonance Imaging.

    PubMed

    Shetty, Mahesh K; Dryden, Damla K

    2015-08-01

    Morbidly adherent placenta or placenta accreta is being increasingly encountered in obstetrical practice mainly owing to the increasing rates of cesarean delivery. This condition is associated with increased maternal morbidity and mortality resulting from postpartum hemorrhage. When unsuspected, outcomes can be catastrophic to the pregnant woman. Timely diagnosis during the antenatal period, on the contrary, allows for optimal planning of a multidisciplinary management approach and delivery at a tertiary care institution. A higher index of suspicion in those at greatest risk such as in women with placenta previa and with history of some prior cesarean deliveries should lead to diligent antenatal evaluation for possible placenta accreta. Management of invasive placenta implantation often involves cesarean delivery hysterectomies; uterus-sparing alternatives to manage this condition can be an option in selected cases. Ultrasound imaging remains the modality of choice for the diagnosis. This review article discusses the ultrasound image findings in placenta accreta, its limitations and pitfalls, and the supplemental role of magnetic resonance imaging in the imaging evaluation of placenta accreta.

  16. Perinatal morbidity and mortality in offspring of diabetic mothers in Qatif, Saudi Arabia.

    PubMed

    al-Dabbous, I A; Owa, J A; Nasserallah, Z A; al-Qurash, I S

    1996-04-01

    Diabetic mothers and their offspring were prospectively studied. Perinatal and neonatal morbidity and mortality data were analysed. Out of 11,677 deliveries in the hospital, 133 (1.14%) were delivered by diabetic mothers. They were made up of six (4.5%) stillbirths and 127 (95.5%) live births. Seventy-seven (57.9%), 55 (41.3%) and 1 (0.8%) were large, appropriate and small for gestational age, respectively. Hypoglycemia occurred in 49 (38.6%) of the 127 infants. Other associated problems were bacterial infections, congenital anomalies, birth trauma, preterm delivery, respiratory distress, polycythaemia and anaemia. Only 52 (39.1%) of the mothers received appropriate treatment for their diabetes during pregnancy. Poor maternal diabetic control resulted in high perinatal morbidity and mortality in the offspring. In order to improve the outcome in offspring of diabetic mothers in Qatif and probably Saudi Arabia as a whole, health education and improved care of the diabetic mothers during pregnancy urgently needed. This may be true of other developing countries where data on diabetes in pregnancy are scarce.

  17. [Contemporary features of occupational morbidity formation in major machinery enterprise].

    PubMed

    Kondrova, N S

    2010-01-01

    The author studied occupational morbidity among workers exposed to occupational hazards at major machinery enterprise in Bashkortostan Republic since 1997 to 2006, in reference to occupation, sex, age, length of service, type and conditions of work. The article covers hygienic evaluation of work conditions and their influence on occupational morbidity formation.

  18. Morbidity and Mortality Weekly Report. Volume 60, Number 23

    ERIC Educational Resources Information Center

    Centers for Disease Control and Prevention, 2011

    2011-01-01

    The "Morbidity and Mortality Weekly Report" ("MMWR") Series is prepared by the Centers for Disease Control and Prevention (CDC). Data presented by the Notifiable Disease Data Team and 122 Cities Mortality Data Team in the weekly "MMWR" are provisional, based on weekly reports to CDC by state health departments. This issue of "Morbidity and…

  19. Morbidity and Hospitalizations of Adults with Down Syndrome

    ERIC Educational Resources Information Center

    Tenenbaum, Ariel; Chavkin, Maor; Wexler, Isaiah D.; Korem, Maya; Merrick, Joav

    2012-01-01

    Over the last decade a significant increase in the life expectancy of people with Down syndrome (DS) has been observed, which has caused a higher incidence of morbidity as they age. However, there is a lack of literature regarding morbidity and hospitalization of adults with DS. Analysis of 297 hospitalizations of 120 adults with DS aged 18-73…

  20. Associations between poor living conditions and multi-morbidity among Syrian migrant agricultural workers in Lebanon

    PubMed Central

    Mikati, Diana; Hojeij, Safa; El Asmar, Khalil; Chaaya, Monique; Zurayk, Rami

    2016-01-01

    Background: Syrian migrant farmworkers are among the most marginalized populations in Lebanon, living in poverty, lacking basic legal protections and frequent targets of discrimination. These realities produce living conditions that undermine their basic health and wellbeing. This study explores associations between household living conditions and acute and chronic health problems among Syrian migrant agricultural workers in the Bekaa region of Lebanon. Methods: A survey was carried out in summer of 2011 with a sample of 290 migrant agriculture workers and members of their household living in a migrant farmworker camp. The survey assessed participants living conditions, assets and health conditions. Regression analyses were carried out to examine associations between multi-morbidity and quality of household and neighborhood living conditions. Results: The mean age for the population was 20 years. Forty-seven percent of participants reported health problems. Almost 20% reported either one acute or chronic illness, 15% reported two health problems and 13% reported three or more. The analysis showed a significant positive association between multi-morbidity and poor housing and infrastructure conditions among study participants. Conclusion: The situation for migrant communities in Lebanon has likely further deteriorated since the study was conducted, as hundreds of thousands of new migrants have entered Lebanon since the outbreak of the Syrian armed conflict in 2011. These findings should inspire multi-faceted community development initiatives that provide basic minimums of neighborhood infrastructure and housing quality for Syrian migrant informal settlements across Lebanon, safeguarding the health and wellbeing of community residents. PMID:27402635

  1. Birth Weight Independently Affects Morbidity and Mortality of Extremely Preterm Neonates

    PubMed Central

    Mamopoulos, Apostolos; Petousis, Stamatios; Tsimpanakos, John; Masouridou, Sophia; Kountourelli, Kelly; Margioula-Siarkou, Chrysoula; Papouli, Maria; Rousso, David

    2015-01-01

    Background Neonates born between 24 + 0 and 27 + 6 gestational weeks, widely known as extremely preterm neonates, present a category characterized by increased neonatal mortality and morbidity. Main objective of the present study is to analyze the effect of various epidemiological and pregnancy-related parameters on unfavorable neonatal mortality and morbidity outcomes. Methods A retrospective study was performed enrolling cases delivered during 2003 - 2008 in our department. Cases of neonatal death as well as pathological Apgar score (≤ 4 in the first and ≤ 7 in the fifth minute of life), need for emergency resuscitation, respiratory disease syndrome (RDS), neonatal asphyxia, intraventricular hemorrhage (IVH) and neonatal death were recorded for neonates of our analysis. A multivariate regression model was used to correlate these outcomes with gestational week at delivery, maternal age, parity, kind of gestation (singleton or multiple), intrauterine growth restriction (IUGR), birth weight (BW), preterm premature rupture of membranes (PPROM), mode of delivery (vaginal delivery or cesarean section) and antenatal use of corticosteroids. Results Out of 5,070 pregnancies delivered, 57 extremely preterm neonates were born (1.1%). Mean BW was 780.35 ± 176.0, RDS was observed in 93.0% (n = 53), resuscitation was needed in 54.4% (n = 31) while overall mortality rate was 52.6% (n = 30). BW was independently associated with neonatal death (P = 0.004), pathological Apgar score in the first (P = 0.05) and fifth minute of life (P = 0.04) as well as neonatal sepsis (P = 0.05). Conclusion BW at delivery is independently affecting neonatal mortality and morbidity parameters in extremely preterm neonates. PMID:26015815

  2. Morbidity in Pregnant Women Associated with Unverified Penicillin Allergies, Antibiotic Use, and Group B Streptococcus Infections

    PubMed Central

    Desai, Shilpa H; Kaplan, Michael S; Chen, Qiaoling; Macy, Eric M

    2017-01-01

    Context: The morbidity potentially associated with unverified penicillin allergy in pregnant women, with and without group B streptococcus (GBS) infections, is unknown. Penicillin allergy testing is safe during pregnancy but is done infrequently. Objective: To determine morbidity associated with antibiotic use in a large cohort of pregnant women, with and without an unverified history of penicillin allergy, and with and without GBS. Design: Retrospective. All pregnant women who delivered live infants in Kaiser Permanente Southern California between January 1, 2009, and December 31, 2014, were identified. Main Outcome Measures: Penicillin allergy status at delivery, delivery method, maternal and infant hospital utilization, peripartum antibiotic exposures, new antibiotic-associated adverse drug reactions, and new Clostridium difficile infections. Results: There were 170,379 unique women who had 201,316 pregnancies during the study period. There were 16,084 pregnancies in women with an active, but unverified, penicillin allergy at delivery. There were 42,524 pregnancies in GBS-positive women, and 3500 also had a penicillin allergy. Women with a penicillin allergy, with or without GBS, had significantly (about 10%) higher cesarean section rates and spent significantly more (about 0.1) days in the hospital after delivery. Among GBS-positive women, those with an unverified penicillin allergy were exposed to significantly more cefazolin, clindamycin, vancomycin, and gentamicin and had significantly higher rates of adverse drug reactions associated with all antibiotic use. Conclusions: Unverified penicillin allergy is associated with more hospital utilization and additional morbidity. Penicillin allergy testing of pregnant women with a history of penicillin allergy may help reduce these unwanted outcomes. PMID:28333608

  3. Fetal, Infant and Maternal Outcomes among Women with Prolapsed Membranes Admitted before 29 Weeks Gestation

    PubMed Central

    Robertson, Julie E.; Lisonkova, Sarka; Lee, Tang; De Silva, Dane A.; von Dadelszen, Peter; Synnes, Anne R.; Joseph, K. S.; Liston, Robert M.; Magee, Laura A.

    2016-01-01

    Background Few studies have examined fetal, infant and maternal mortality and morbidity among pregnant women at very early gestation with an open cervix and prolapsed membranes. We carried out a study describing the outcomes of women hospitalized with prolapsed membranes at 22–28 weeks’ gestation. Methods We prospectively recruited women with singleton pregnancies admitted at 22–28 weeks’ gestation to tertiary hospitals of the Canadian Perinatal Network between 2005 and 2009. Time-to-delivery, perinatal death, neonatal intensive care unit (NICU) admission, severe neonatal morbidity and severe maternal morbidity were compared between women admitted at 22–25 vs. 26–28 weeks gestation. Logistic regression was used to estimate adjusted odds ratios (AOR) and 95% confidence intervals. Results 129 women at 22–25 weeks gestation and 65 women at 26–28 weeks gestation were admitted to hospital and the median time-to-delivery was 4 days in both groups. Stillbirth rates were 12.4% vs 4.6% among women admitted at earlier vs later gestation (AOR 2.8, 95% CI 0.5–14.8), while perinatal death rates were 38.0% vs 6.1% (AOR 14.1, 95% CI 3.5–59.0), respectively. There were no significant differences in NICU admission and severe morbidity among live-born infants; 89.4% and 82.3% died or were admitted to NICU, (P value 0.18), and 53.9% vs 44.0% of NICU infants had severe neonatal morbidity (P value 0.28). Antibiotics, tocolysis and cerclage did not have a significant effect on perinatal death. Maternal death or severe maternal morbidity occurred in 8.5% and 6.2% of women admitted at 22–25 vs 26–28 weeks (AOR 1.2, 95% CI 0.4–4.2). Conclusion Perinatal mortality among women with prolapsed membranes at very early gestation is high, although significantly lower among those admitted at a relatively later gestational age. Rates of adverse maternal outcomes are also high. This information can be used to counsel women with prolapsed membranes at 22 to 28 weeks

  4. Acute Bronchitis

    MedlinePlus

    ... can also cause acute bronchitis. To diagnose acute bronchitis, your health care provider will ask about your symptoms and listen to your breathing. You may also have other tests. Treatments include rest, fluids, and aspirin (for adults) or ...

  5. Maternal and child health in Yushu, Qinghai Province, China

    PubMed Central

    2011-01-01

    Introduction Surmang, Qinghai Province is a rural nomadic Tibetan region in western China recently devastated by the 2010 Yushu earthquake; little information is available on access and coverage of maternal and child health services. Methods A cross-sectional household survey was conducted in August 2004. 402 women of reproductive age (15-50) were interviewed regarding their pregnancy history, access to and utilization of health care, and infant and child health care practices. Results Women's access to education was low at 15% for any formal schooling; adult female literacy was <20%. One third of women received any antenatal care during their last pregnancy. Institutional delivery and skilled birth attendance were <1%, and there were no reported cesarean deliveries. Birth was commonly attended by a female relative, and 8% of women delivered alone. Use of unsterilized instrument to cut the umbilical cord was nearly universal (94%), while coverage for tetanus toxoid immunization was only 14%. Traditional Tibetan healers were frequently sought for problems during pregnancy (70%), the postpartum period (87%), and for childhood illnesses (74%). Western medicine (61%) was preferred over Tibetan medicine (9%) for preventive antenatal care. The average time to reach a health facility was 4.3 hours. Postpartum infectious morbidity appeared to be high, but only 3% of women with postpartum problems received western medical care. 64% of recently pregnant women reported that they were very worried about dying in childbirth. The community reported 3 maternal deaths and 103 live births in the 19 months prior to the survey. Conclusions While China is on track to achieve national Millennium Development Goal targets for maternal and child health, women and children in Surmang suffer from substantial health inequities in access to antenatal, skilled birth and postpartum care. Institutional delivery, skilled attendance and cesarean delivery are virtually inaccessible, and

  6. Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety.

    PubMed

    Kendig, Susan; Keats, John P; Hoffman, M Camille; Kay, Lisa B; Miller, Emily S; Simas, Tiffany A Moore; Frieder, Ariela; Hackley, Barbara; Indman, Pec; Raines, Christena; Semenuk, Kisha; Wisner, Katherine L; Lemieux, Lauren A

    2017-04-06

    Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary work group to develop an evidence-based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow-up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation.

  7. Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety.

    PubMed

    Kendig, Susan; Keats, John P; Hoffman, M Camille; Kay, Lisa B; Miller, Emily S; Moore Simas, Tiffany A; Frieder, Ariela; Hackley, Barbara; Indman, Pec; Raines, Christena; Semenuk, Kisha; Wisner, Katherine L; Lemieux, Lauren A

    Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary workgroup to develop an evidence-based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow-up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation.

  8. Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety.

    PubMed

    Kendig, Susan; Keats, John P; Hoffman, M Camille; Kay, Lisa B; Miller, Emily S; Moore Simas, Tiffany A; Frieder, Ariela; Hackley, Barbara; Indman, Pec; Raines, Christena; Semenuk, Kisha; Wisner, Katherine L; Lemieux, Lauren A

    2017-03-01

    Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary workgroup to develop an evidence-based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow-up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation.

  9. Maternal Education and Immunization Status Among Children in Kenya.

    PubMed

    Onsomu, Elijah O; Abuya, Benta A; Okech, Irene N; Moore, DaKysha; Collins-McNeil, Janice

    2015-08-01

    Child morbidity and mortality due to infectious diseases continues to be a major threat and public health concern worldwide. Although global vaccination coverage reached 90 % for diphtheria, tetanus and pertussis (DTP3) across 129 countries, Kenya and other sub-Saharan countries continue to experience under-vaccination. The purpose of this study was to examine the association between maternal education and child immunization (12-23 months) in Kenya. This study used retrospective cross-sectional data from the 2008-2009 Kenya Demographic and Health Survey for women aged 15-49, who had children aged 12-23 months, and who answered questions about vaccination in the survey (n = 1,707). The majority of the children had received vaccinations, with 77 % for poliomyelitis, 74 % for measles, 94 % for tuberculosis, and 91 % for diphtheria, whooping cough (pertussis), and tetanus. After adjusting for other covariates, women with primary, secondary, and college/university education were between 2.21 (p < 0.01) and 9.10 (p < 0.001) times more likely to immunize their children than those who had less than a primary education. Maternal education is clearly crucial in ensuring good health outcomes among children, and integrating immunization knowledge with maternal and child health services is imperative. More research is needed to identify factors influencing immunization decisions among less-educated women in Kenya.

  10. Maternal health practices, beliefs and traditions in southeast Madagascar.

    PubMed

    Morris, Jessica L; Short, Samm; Robson, Laura; Andriatsihosena, Mamy Soafaly

    2014-09-01

    Contextualising maternal health in countries with high maternal mortality is vital for designing and implementing effective health interventions. A research project was therefore conducted to explore practices, beliefs and traditions around pregnancy, delivery and postpartum in southeast Madagascar. Interviews and focus groups were conducted with 256 pregnant women, mothers of young children, community members and stakeholders; transcripts were analysed to identify and explore predetermined and emerging themes. A questionnaire was also conducted with 373 women of reproductive age from randomly selected households. Data was analysed using STATA. Results confirmed high local rates of maternal mortality and morbidity and revealed a range of traditional health care practices and beliefs impacting on women's health seeking behaviours. The following socio-cultural barriers to health were identified: 1) lack of knowledge, 2) risky practices, 3) delays seeking biomedical care, and 4) family and community expectations. Recommendations include educational outreach and behaviour change communications targeted for women, their partners and family, increased engagement with traditional midwives and healers, and capacity building of formal health service providers.

  11. [Modern tendencies in co-morbid conditions].

    PubMed

    Ischeykin, K; Potyazhenko, M; Lyulka, N; Sokolyuk, N; Khaymenova, G

    2014-10-01

    The present manuscript reviews frequency of the concomitance of Ischaemic Heart Disease (IHD) with Chronic Obstructive Pulmonary Disease (COPD). The conclusion has been drawn, that quite a large group of patients (25.9%) suffers from pulmonary pathology concomitant with disorders of cardio-coronary system. 97 patients (84 male and 13 female) with concomitant IHD and COPD (steady cardiac angina FK II st.) have been admitted with acute pulmonary condition, and examined at the Department of Pulmonology at N.V. Sklifasovskiy Regional Teaching Hospital in Poltava. The patients were divided into 2 groups: patients in Group I (n=51) were receiving the basic therapy, according to the case management protocol for this type of disorders (β2-agonists, anticholinergic drugs, methylxantines, inhaler glucocorticoids, phosphodiesterase-4 inhibitors). Patients in the Group II (n=46), in addition to the basic protocol treatment were prescribed 4.2% L-Arginine (Tivortin) venous infusion therapy (100 ml QD for 6 days) with consequent change onto PO administration of 5-10 ml of the solution TID for 4 weeks. As a result, positive dynamics of regressing of clinical signs of COPD was apparent in both Groups after 10-12 days of the treatment. Clinical parameters, pulmonary, cardiac and indurance functions in patients of the Group II, who in addition to the basic treatment, were reciving L-Arginine were much better improved (p>0.05) than in Group I. The conducted study has allowed us to draw a conclusion, that including L-Arginine in the treatment protocol of COPD with concomitant IHD improves cardiohaemodynamics and allows for the better efficacy of respiratory pathology therapy. Addition of L-Arginine (Tivortin, "Yuriya-Farm", Kiev) to the complex therapy of COPD with concomitant IHD results in statistically significant improvement of clinical and instrumental test results, due to the drug's intihypoxic, antiagregational, membrane-stabilizing, antioxydant and vasodilating effect.

  12. Partnership Transitions and Maternal Parenting

    PubMed Central

    Beck, Audrey N.; Cooper, Carey E.; McLanahan, Sara; Brooks-Gunn, Jeanne

    2011-01-01

    We use data from the Fragile Families and Child Wellbeing Study (N = 1,975) to examine the association between mothers’ partnership changes and parenting behavior during the first five years of their children’s lives. We compare coresidential with dating transitions, and recent with more distal transitions. We also examine interactions between transitions and race/ethnicity, maternal education and family structure at birth. Findings indicate that both coresidential and dating transitions were associated with higher levels of maternal stress and harsh parenting; recent transitions had stronger associations than distal transitions. Maternal education significantly moderates these associations, with less educated mothers responding more negatively to instability in terms of maternal stress, and more educated mothers responding more negatively in terms of literacy activities. PMID:21423848

  13. Targeting asthma care in general practice using a morbidity index.

    PubMed Central

    Jones, K. P.; Charlton, I. H.; Middleton, M.; Preece, W. J.; Hill, A. P.

    1992-01-01

    OBJECTIVES--To evaluate a morbidity index as a postal surveillance tool in defining previously diagnosed asthmatic patients needing extra education or management; to determine the accuracy of a computerised asthma register in general practice. DESIGN--Postal questionnaire survey of asthmatic patients identified from a computer register. Questionnaire comprised three morbidity questions, two questions about current asthma status, and one about treatments. SETTING--Urban general practice of 8400 patients linked to academic unit. SUBJECTS--853 asthmatic patients of all ages. MAIN OUTCOME MEASURES--Numbers of patients with low, medium, and high morbidity; associations of these groups with age, asthma status, and drugs taken. RESULTS--Two mailings yielded 621 replies (73%); 28 patients (5%) had moved away, leaving 593 for analysis. Attempts were subsequently made to contact 20% sample of non-respondents. 234 respondents (40%) were in the "low morbidity" group, 149 (25%) in the "medium morbidity" group, and 210 (35%) in the "high morbidity" category. 53% of patients perceiving themselves as currently asthmatic (193/362) were in the high morbidity group, but 7% (11/153) who said they were no longer asthmatic and 8% (6/78) who did not believe they had ever been asthmatic were also in that group. High morbidity was also found in 10% (18/185) of those on no treatment, 38% (59/154) of those on bronchodilators alone, and 54% (119/220) of those on inhaled corticosteroids. 25 patients (4%) were wrongly identified as asthmatic; when combined with returns marked "gone away" this gave a disease register accuracy of 91%. CONCLUSIONS--This exercise identified subgroups of previously diagnosed asthmatic patients with high morbidity in general practice who might benefit from extra education and management and revealed some misclassification on the asthma disease register. PMID:1611335

  14. Maternal compared with paternal donor kidneys are associated with poorer graft outcomes after kidney transplantation.

    PubMed

    Lim, Wai H; McDonald, Stephen P; Coates, Patrick T; Chapman, Jeremy R; Russ, Graeme R; Wong, Germaine

    2016-03-01

    Noninherited maternal human leukocyte antigens may be less detrimental on allograft outcomes after kidney transplantation compared with noninherited paternal antigens, but this association in the era of modern immunosuppression remains unknown. Here we determine the association between parental donor kidneys, acute rejection, and graft failure in primary live-donor parental kidney transplant recipients using data from the Australia and New Zealand Dialysis and Transplant Registry between 1997 and 2012. Of the 1139 recipients followed for a median of 7.2 years (8588 person-years), 652 received kidneys from maternal donors. Compared with paternal donor kidneys, maternal donor kidneys were associated with a significantly increased risk of acute rejection (adjusted odds ratio 1.54; 95% confidence interval [CI], 1.14-2.07) and significant overall graft loss. The latter was confined to recipients who have experienced acute rejection (adjusted hazard ratio 1.60; 95%CI, 1.05-2.43) but not in those who did not experience acute rejection. Thus, our study suggests that recipients of maternal donor kidneys have a greater risk of rejection and graft loss. Hence, clinicians and patients should be cognizant of this association when determining which of the 2 parental donors is most suitable for transplantation.

  15. Scheduled cesarean delivery: maternal and neonatal risks in primiparous women in a community hospital setting.

    PubMed

    Quiroz, Lieschen H; Chang, Howard; Blomquist, Joan L; Okoh, Yvonne K; Handa, Victoria L

    2009-04-01

    We compared the short-term maternal and neonatal outcomes of women who deliver by cesarean without labor compared with women who deliver by cesarean after labor or by vaginal birth. This was a retrospective cohort study of women delivering a first baby from 1998 to 2002. Hospital discharge diagnostic coding identified unlabored cesarean deliveries (UCDs), labored cesarean deliveries (LCDs), and vaginal births (VBs). Medical records were abstracted and mode of delivery confirmed. The three outcomes of interest were maternal bleeding complications, maternal febrile morbidity, and neonatal respiratory complications. Using logistic regression for each outcome, we investigated whether mode of delivery was associated with the outcome, independent of other factors. The study groups included 513 UCDs, 261 LCDs, and 251 VBs. Compared with the UCD group, the adjusted odds of bleeding complications was higher in the LCD comparison group (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.21, 4.53) and the VB comparison group (OR 1.96; 95% CI 0.95, 4.02). The incidence of febrile morbidity was similar for both cesarean groups but lower in the VB group. Both comparison groups had lower odds of neonatal complications than the UCD group (OR for LCD comparison group 0.52; 95% CI 0.27, 0.95 and OR for VB comparison group 0.26; 95% CI 0.098, 0.59). Scheduled cesarean is associated with increased odds of neonatal respiratory complications but decreased odds of maternal bleeding complications.

  16. Changing picture of acute kidney injury in pregnancy: Study of 259 cases over a period of 33 years.

    PubMed

    Prakash, J; Pant, P; Prakash, S; Sivasankar, M; Vohra, R; Doley, P K; Pandey, L K; Singh, U

    2016-01-01

    The incidence of acute kidney injury (AKI) in pregnancy is declining in developing countries but still remains a major cause of maternal and fetal morbidity and mortality. The aim of the study was to analyze the changing trends in pregnancy related AKI (PR-AKI) over a period of thirty-three years. Clinical characteristics of PR-AKI with respect to incidence, etiology and fetal and maternal outcomes were compared in three study periods, namely 1982-1991,1992-2002 and 2003-2014. The incidence of PR-AKI decreased to 10.4% in 1992-2002, from 15.2% in 1982-1991, with declining trend continuing in 2003-2014 (4.68%).Postabortal AKI decreased to 1.49% in 2003-2014 from 9.4% in 1982-1991of total AKI cases. The AKI related to puerperal sepsis increased to 1.56% of all AKI cases in 2003-2014 from 1.4% in 1982-1991. Preeclampsia/eclampsia associated AKI decreased from 3.5% of total AKI cases in 1982-1991 to 0.54% in 2003-2014. Pregnancy associated - thrombotic microangiopathy and acute fatty liver of pregnancy were uncommon causes of AKI. Hyperemesis gravidarum associated AKI was not observed in our study. Incidence of renal cortical necrosis (RCN) decreased to 1.4% in 2003-2014 from 17% in 1982-1991.Maternal mortality reduced to 5.79% from initial high value 20% in 1982-1991. The progression of PR-AKI to ESRD decreased to1.4% in 2003-2014 from 6.15% in 1982-1991. The incidence of PR-AKI has decreased over last three decades, mainly due to decrease in incidence of postabortal AKI. Puerperal sepsis and obstetric hemorrhage were the major causes of PR-AKI followed by preeclampsia in late pregnancy. Maternal mortality and incidence and severity of RCN have significantly decreased in PR-AKI. The progression to CKD and ESRD has decreased in women with AKI in pregnancy in recent decade. However, the perinatal mortality did not change throughout study period.

  17. Changing picture of acute kidney injury in pregnancy: Study of 259 cases over a period of 33 years

    PubMed Central

    Prakash, J.; Pant, P.; Prakash, S.; Sivasankar, M.; Vohra, R.; Doley, P. K.; Pandey, L. K.; Singh, U.

    2016-01-01

    The incidence of acute kidney injury (AKI) in pregnancy is declining in developing countries but still remains a major cause of maternal and fetal morbidity and mortality. The aim of the study was to analyze the changing trends in pregnancy related AKI (PR-AKI) over a period of thirty-three years. Clinical characteristics of PR-AKI with respect to incidence, etiology and fetal and maternal outcomes were compared in three study periods, namely 1982-1991,1992-2002 and 2003-2014. The incidence of PR-AKI decreased to 10.4% in 1992-2002, from 15.2% in 1982-1991, with declining trend continuing in 2003-2014 (4.68%).Postabortal AKI decreased to 1.49% in 2003-2014 from 9.4% in 1982-1991of total AKI cases. The AKI related to puerperal sepsis increased to 1.56% of all AKI cases in 2003-2014 from 1.4% in 1982-1991. Preeclampsia/eclampsia associated AKI decreased from 3.5% of total AKI cases in 1982-1991 to 0.54% in 2003-2014. Pregnancy associated – thrombotic microangiopathy and acute fatty liver of pregnancy were uncommon causes of AKI. Hyperemesis gravidarum associated AKI was not observed in our study. Incidence of renal cortical necrosis (RCN) decreased to 1.4% in 2003-2014 from 17% in 1982-1991.Maternal mortality reduced to 5.79% from initial high value 20% in 1982-1991. The progression of PR-AKI to ESRD decreased to1.4% in 2003-2014 from 6.15% in 1982-1991. The incidence of PR-AKI has decreased over last three decades, mainly due to decrease in incidence of postabortal AKI. Puerperal sepsis and obstetric hemorrhage were the major causes of PR-AKI followed by preeclampsia in late pregnancy. Maternal mortality and incidence and severity of RCN have significantly decreased in PR-AKI. The progression to CKD and ESRD has decreased in women with AKI in pregnancy in recent decade. However, the perinatal mortality did not change throughout study period. PMID:27512298

  18. Maternal health in Third World.

    PubMed

    Rosenfield, A; Maine, D

    1987-03-21

    The authors are responding to a LANCET editorial that asserted that female education, rather than family planning, should be advocated for prevention of maternal deaths in sub-Saharan Africa. Family planning can prevent maternal deaths in 2 ways. The 1st is prevention of pregnancy among women at high risk of complicated pregnancy and delivery, including illegal abortion. The 2nd is simply prevention of pregnancy and, thus, exposure to complications. If only women who say they want no more children had no further births, an estimated 33% of maternal deaths in developing countries would be prevented. In reality, the effect of family planning might well be greater, since it plays an essential part in reducing mortality from illicitly induced abortion. Although improvement of education for Third World women will improve the quality of their lives, it is not likely to reduce maternal mortality. Once pregnant, 10-15% of women will have serious complicatons of pregnancy or delivery, no matter what the setting. The primary responsibility of health professionals is not socioeconomic development but prevention of maternal deaths resulting from lack of effective medical care. Interest in the issue is growing. In February, 1987, the World Bank, with the World Health Organization and the UN Fund for Population Activities, sponsored a meeting in Nairobi to launch the "Safe Motherhood Initiative." This initiative will contain a variety of activities. The authors hope that foremost will be those that act directly to prvent maternal deaths--prevention of unwanted pregnancies and early treatment of complications.

  19. Maternal immune transfer in mollusc.

    PubMed

    Wang, Lingling; Yue, Feng; Song, Xiaorui; Song, Linsheng

    2015-02-01

    Maternal immunity refers to the immunity transferred from mother to offspring via egg, playing an important role in protecting the offspring at early life stages and contributing a trans-generational effect on offspring's phenotype. Because fertilization is external in most of the molluscs, oocytes and early embryos are directly exposed to pathogens in the seawater, and thus maternal immunity could provide a better protection before full maturation of their immunological systems. Several innate immune factors including pattern recognition receptors (PRRs) like lectins, and immune effectors like lysozyme, lipopolysaccharide binding protein/bacterial permeability-increasing proteins (LBP/BPI) and antioxidant enzymes have been identified as maternally derived immune factors in mollusc eggs. Among these immune factors, some maternally derived lectins and antibacterial factors have been proved to endue mollusc eggs with effective defense ability against pathogen infection, while the roles of other factors still remain untested. The physiological condition of mollusc broodstock has a profound effect on their offspring fitness. Many other factors such as nutrients, pathogens, environment conditions and pollutants could exert considerable influence on the maternal transfer of immunity. The parent molluscs which have encountered an immune stimulation endow their offspring with a trans-generational immune capability to protect them against infections effectively. The knowledge on maternal transfer of immunity and the trans-generational immune effect could provide us with an ideal management strategy of mollusc broodstock to improve the immunity of offspring and to establish a disease-resistant family for a long-term improvement of cultured stocks.

  20. [Gyneco-obstetrical morbidity in the population of Santiago].

    PubMed

    Salinas, H; Kaempffer, A M; Walton, R; Bocaz, J; Hernández, E; Ramírez, R; Villaroel, R; Báez, M; Carmona, M; Castillo, P

    1988-01-01

    1607 women were interviewed about their gyneco-obstetrical health in a survey of 469 randomly selected households in the province of Santiago, Chile. The dependent variables correspond to the frequency of gynecologic or obstetrical morbidity and demand for medical attention in 2 weeks of April, 1987. Independent variables were age, educational status, and health insurance coverage. 125 of the households were headed by uninsured persons. The average woman was 34.4 years old. 43.1% had 8 years or less of education, 42.6% had 9.12 years, and 14.2% had 13 or more years. 21 new cases of acute obstetrical or gynecological disorders were reported, including 15 of vulvovaginitis, 3 abortions, 1 bartholinitis, 1 intrahepatic cholestasis of pregnancy, and 1 urinary tract infection. There were 55 cases of chronic disorders, including 12 benign ovarian lesions, 8 dysmenorrheas, 8 uterine dystropias, 10 cases of menstrual disturbances, 1 of infertility, 4 benign cervical lesions, 5 benign uterine lesions, 2 pelvic inflammations, 2 cervical cancers, 2 breast cancers, and 1 ovarian cancer. Among the 1607 women, 11 had consulted for family planning in the 2 weeks, 25 for pregnancy, 22 for gynecological conditions, and 9 for postpartum care. 58.3% of the women aged 15-49 used a contraceptive method. The proportions of users of oral contraceptives and IUDs respectively were 62.5% and 37.5% for women under 20, 60% and 40% for women 20-29, 27% and 61% for women 30-39, and 15.1% and 60.6% for women 40-49. 28.2% of women over 15 had had a Pap test in the past year. The proportions of different age groups having Pap tests ranged from 2.0% for women under 20 to 46.7% for women aged 30-39. 3 women in the sample households had died in the past year of gyneco-obstetric causes, 1 of complications of childbirth and 2 of cervical cancer.

  1. Maternity Leave in Taiwan

    PubMed Central

    Feng, Joyce Yen; Han, Wen-Jui

    2011-01-01

    Using the first nationally representative birth cohort study in Taiwan, this paper examines the role that maternity leave policy in Taiwan plays in the timing of mothers returning to work after giving birth, as well as the extent to which this timing is linked to the amount of time mothers spend with their children and their use of breast milk versus formula. We found that the time when mothers returned to work coincided with the duration of guaranteed leave. In particular, mothers with a labor pension plan resumed work significantly earlier than mothers with no pension plan, and mothers with no pension plan returned to work significantly later than those with pension plans. The short leave of absence guaranteed under existing policies translated into mothers spending less time with their children and being more likely to exclusively use formula by 6 months after birth. In contrast, mothers who resumed work later than 6 months after birth were more likely to have not worked before birth or to have quit their jobs during pregnancy. Implications and recommendations for parental leave policy in Taiwan are discussed. PMID:21603074

  2. Maternal critical care: what can we learn from patient experience? A qualitative study

    PubMed Central

    Hinton, Lisa; Locock, Louise; Knight, Marian

    2015-01-01

    Objective For every maternal death, nine women develop severe maternal morbidity. Many of those women will need care in an intensive care unit (ICU) or high dependency unit (HDU). Critical care in the context of pregnancy poses distinct issues for staff and patients, for example, with breastfeeding support and separation from the newborn. This study aimed to understand the experiences of women who experience a maternal near miss and require critical care after childbirth. Setting Women and some partners from across the UK were interviewed as part of a study of experiences of near-miss maternal morbidity. Design A qualitative study, using semistructured interviews. Participants A maximum variation sample was recruited of 35 women and 11 partners of women who had experienced a severe maternal illness, which without urgent medical attention would have led to her death. 18 of the women were admitted to ICU or HDU. Results The findings are presented in three themes: being in critical care; being a new mother in critical care; transfer and follow-up after critical care. The study highlights the shock of requiring critical care for new mothers and the gulf between their expectations of birth and what actually happened; the devastation of being separated from their baby, how valuable access to their newborn was, if possible, and the importance of breast feeding; the difficulties of transfer and the need for more support; the value of follow-up and outreach to this population of critical care patients. Conclusions While uncommon, critical illness in pregnancy can be devastating for new mothers and presents a challenge for critical care and maternity staff. This study provides insights into these challenges and recommendations for overcoming them drawn from patient experiences. PMID:25916486

  3. [Acute pancreatitis after bilateral laparoscopic adrenalectomy in patients with ectopic ACTH syndrome].

    PubMed

    Cougard, P; Peix, J L; Peschaud, F; Goudet, P

    2001-05-01

    Two cases of acute necrotizing pancreatitis after bilateral laparoscopic adrenalectomy were observed in patients with an ectopic ACTH syndrome. Two reasons may be suspected: the difficulty of dissection in such patients and the specific morbidity in relation to hypercorticism.

  4. Omental vein catheter thrombolysis for acute porto-mesenteric vein thrombosis.

    PubMed

    Fonseca, Annabelle L; Cleary, Muriel A; Cholewczynski, Walter; Sumpio, Bauer E; Atweh, Nabil A

    2013-05-01

    Mesenteric venous thrombosis (MVT) is an uncommon clinical condition with potential high morbidity. We report here a patient who presented with acute-onset MVT and bowel infarction, which was successfully ameliorated with intramesenteric vein thrombolytic therapy.

  5. Incorporating immunizations into routine obstetric care to facilitate Health Care Practitioners in implementing maternal immunization recommendations

    PubMed Central

    Webb, Heather; Street, Jackie; Marshall, Helen

    2014-01-01

    Immunization against pertussis, influenza, and rubella reduces morbidity and mortality in pregnant women and their offspring. Health care professionals (HCPs) caring for women perinatally are uniquely placed to reduce maternal vaccine preventable diseases (VPDs). Despite guidelines recommending immunization during the perinatal period, maternal vaccine uptake remains low. This qualitative study explored the role of obstetricians, general practitioners, and midwives in maternal vaccine uptake. Semi-structured interviews (n = 15) were conducted with perinatal HCPs at a tertiary maternity hospital in South Australia. HCPs were asked to reflect on their knowledge, beliefs, and practice relating to immunization advice and vaccine provision. Interviews were transcribed and coded using thematic analysis. Data collection and analysis was an iterative process, with collection ceasing with theoretical saturation. Participants unanimously supported maternal vaccination as an effective way of reducing risk of disease in this vulnerable population, however only rubella immunity detection and immunization is embedded in routine care. Among these professionals, delegation of responsibility for maternal immunization was unclear and knowledge about maternal immunization was variable. Influenza and pertussis vaccine prevention measures were not included in standard pregnancy record documentation, information provision to patients was “ad hoc” and vaccinations not offered on-site. The key finding was that the incorporation of maternal vaccinations into standard care through a structured process is an important facilitator for immunization uptake. Incorporating vaccine preventable disease management measures into routine obstetric care including incorporation into the Pregnancy Record would facilitate HCPs in implementing recommendations. Rubella prevention provides a useful “template” for other vaccines. PMID:24509790

  6. Understanding levels of morbidity and hospitalization in Kerala, India.

    PubMed Central

    Dilip, T. R.

    2002-01-01

    The prevalence of ailments and hospitalization in Kerala was examined using data from the 52 nd National Sample Survey Data on Health Care in Kerala in 1995-6. The survey included 24401 people from 4928 households. Age and seasonality had considerable effects on the morbidity of individuals. The burden of ill health was higher in rural areas than in urban areas. People who were more likely to have a better lifestyle had a higher level of morbidity and hospitalization. Regional differences were seen, with levels of morbidity and hospitalization higher in the comparatively developed regions of Southern Kerala than in Northern Kerala. Factors like physical accessibility of health care services and capacity to seek health care services could create artificial differences in morbidity and hospitalization among different subgroups of the population in Kerala. PMID:12378294

  7. Morbidity of obstructive sleep apnea in children: facts and theory.

    PubMed

    Gozal, D

    2001-01-01

    Sleep-disordered breathing (SDB) is a frequent, albeit underdiagnosed, problem in children. If left untreated, SDB may lead to substantial morbidities affecting multiple target organs and systems. This review provides a detailed and current description of the current status of our understanding of SDB-associated morbidity in children, and provides recommendations of future research directions necessary for increasing our knowledge and awareness on the short- and long-term consequences of SDB during childhood.

  8. Morbidity of Early Spine Surgery in the Multiply Injured Patient

    DTIC Science & Technology

    2014-07-31

    Rivera JD, Gre- nier ES, Lehman RA, et al. (2012) Spinal column injuries among Americans in the global war on terrorism. J Bone Joint Surg Am 94:e135...surgery for multiply injured patients with operative spinal injuries remains unknown. The purported benefits of early intervention must be weighed...morbidity of early surgery on military casualties. The objective is to compare surgical morbidity of early spinal surgery in multiply injured patients

  9. The influence of maternal care and overprotection on youth adrenocortical stress response: a multiphase growth curve analysis.

    PubMed

    Vergara-Lopez, Chrystal; Chaudoir, Stephenie; Bublitz, Margaret; O'Reilly Treter, Maggie; Stroud, Laura

    2016-11-01

    We examined the association between two dimensions of maternal parenting style (care and overprotection) and cortisol response to an acute laboratory-induced stressor in healthy youth. Forty-three participants completed the Parental Bonding Instrument and an adapted version of the Trier Social Stress Test-Child (TSST-C). Nine cortisol samples were collected to investigate heterogeneity in different phases of youth's stress response. Multiphase growth-curve modeling was utilized to create latent factors corresponding to individual differences in cortisol during baseline, reactivity, and recovery to the TSST-C. Youth report of maternal overprotection was associated with lower baseline cortisol levels, and a slower cortisol decline during recovery, controlling for maternal care, puberty, and gender. No additive or interactive effects involving maternal care emerged. These findings suggest that maternal overprotection may exert a unique and important influence on youth's stress response.

  10. Adoption, ART, and a re-conception of the maternal body: toward embodied maternity.

    PubMed

    Brakman, Sarah-Vaughan; Scholz, Sally J

    2006-01-01

    We criticize a view of maternity that equates the natural with the genetic and biological and show how such a practice overdetermines the maternal body and the maternal experience for women who are mothers through adoption and ART (Assisted Reproductive Technologies). As an alternative, we propose a new framework designed to rethink maternal bodies through the lens of feminist embodiment. Feminist embodied maternity, as we call it, stresses the particularity of experience through subjective embodiment. A feminist embodied maternity emphasizes the physical relations of the subjective lived-body rather than the genetic or biological connections. Instead of universalizing claims about the maternal body, embodied maternity looks to communicable experiences and empathetic understanding.

  11. Acute kidney injury in the elderly.

    PubMed

    Rosner, Mitchell H

    2013-08-01

    Most patients who develop acute kidney injury (AKI) are older than 65 years. Specific structural and functional changes that occur in the aging kidney predispose the elderly patient to AKI. This risk is further compounded by comorbid conditions, polypharmacy, and the need for invasive procedures. When AKI does occur, it is associated with significant morbidity and mortality. Although morbidity and mortality increases with advancing age, many elderly patients can survive AKI and do well. Thus, decision making should be thoughtful and individualized, and not dependent on age. Whenever possible, preventive approaches should be pursued to lessen the burden of AKI.

  12. Fetal Fatty Acid Oxidation Disorders, Their Effect on Maternal Health and Neonatal Outcome: Impact of Expanded Newborn Screening on Their Diagnosis and Management

    PubMed Central

    SHEKHAWAT, PREM S.; MATERN, DIETRICH; STRAUSS, ARNOLD W.

    2013-01-01

    Mitochondrial fatty acid oxidation disorders (FAOD) are recessively inherited errors of metabolism. Newborns with FAOD typically present with hypoketotic hypoglycemia, metabolic acidosis, hepatic failure, and cardiomyopathy. Late presentations include episodic myopathy, neuropathy, retinopathy, and arrhythmias. Sudden unexpected death can occur at any age and can be confused with sudden infant death syndrome. Some FAOD are associated with intrauterine growth restriction, prematurity, and pregnancy complications in the heterozygous mother, such as severe preeclampsia, acute fatty liver of pregnancy (AFLP), or hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Maternal pregnancy complications occur primarily in mothers carrying a fetus with long-chain L-3-hydroxyacyl CoA dehydrogenase deficiency or general tri-functional protein deficiencies. FAOD as a group represent the most common inborn errors of metabolism, and presymptomatic diagnosis of FAOD is the key to reduce morbidity and avoid mortality. The application of tandem mass spectrometry to newborn screening provides an effective means to identify most FAOD patients presymptomatically. At the beginning of 2005, 36 state newborn screening programs have mandated or adopted this technology resulting in a marked increase in the number of asymptomatic neonates with FAOD diagnosed. To ensure the long-term benefits of such screening programs, pediatricians and other health care providers must be educated about these disorders and their treatment. PMID:15817498

  13. [Congenital atrioventricular block and maternal autoimmune diseases].

    PubMed

    Herreman, G; Sauvaget, F; Généreau, T; Galezowski, N

    1990-01-01

    Congenital heart block is rare; it is acquired in utero, definitive and, more often than not, complete. It can be diagnosed by the appearance of fetal bradycardia around the 23rd week of gestation, during ultrasonographic monitoring of pregnancy. Heart block is usually associated with the presence of anti-Ro and/or anti-La antibodies in the mother's serum. These maternal immunological abnormalities can be isolated or associated with an autoimmune disease, usually systemic lupus erythematosus, but also Sjögren's syndrome, or more rarely still, an as yet unclassified connective tissue disease. Anti-Ro and anti-La antibodies cross the placental barrier and react with a fetal heart, leading to acute fetal myocarditis by the 17th week of gestation. When severe, it is lethal, otherwise it can result in degeneration and endocardial fibroelastosis, disrupting conduction and leading to congenital heart block. The ideal treatment would be prevention with corticosteroids. When the mother is Ro or La antibody-positive before pregnancy, elimination of these circulating antibodies can be attempted by treatment with 0.5 mg/kg body wt/d of prednisolone for 3 months. If the treatment is successful, corticotherapy can be prescribed early in the pregnancy to try to protect the fetus. However, there is not always a relationship between maternal anti-Ro antibodies and fetal heart block. If the Ro/La antibody-positive woman is already pregnant, but before her 17th week, it is possible to prescribe dexamethasone, which crosses the placenta and remains active, sometimes in association with plasmapheresis.

  14. Evidence from community level inputs to improve quality of care for maternal and newborn health: interventions and findings

    PubMed Central

    2014-01-01

    Annually around 40 million mothers give birth at home without any trained health worker. Consequently, most of the maternal and neonatal mortalities occur at the community level due to lack of good quality care during labour and birth. Interventions delivered at the community level have not only been advocated to improve access and coverage of essential interventions but also to reduce the existing disparities and reaching the hard to reach. In this paper, we have reviewed the effectiveness of care delivered through community level inputs for improving maternal and newborn health outcomes. We considered all available systematic reviews published before May 2013 on the pre-defined community level interventions and report findings from 43 systematic reviews. Findings suggest that home visitation significantly improved antenatal care, tetanus immunization coverage, referral and early initiation of breast feeding with reductions in antenatal hospital admission, cesarean-section rates birth, maternal morbidity, neonatal mortality and perinatal mortality. Task shifting to midwives and community health workers has shown to significantly improve immunization uptake and breast feeding initiation with reductions in antenatal hospitalization, episiotomy, instrumental delivery and hospital stay. Training of traditional birth attendants as a part of community based intervention package has significant impact on referrals, early breast feeding, maternal morbidity, neonatal mortality, and perinatal mortality. Formation of community based support groups decreased maternal morbidity, neonatal mortality, perinatal mortality with improved referrals and early breast feeding rates. At community level, home visitation, community mobilization and training of community health workers and traditional birth attendants have the maximum potential to improve a range of maternal and newborn health outcomes. There is lack of data to establish effectiveness of outreach services, mass media

  15. Heat- and cold-stress effects on cardiovascular mortality and morbidity among urban and rural populations in the Czech Republic

    NASA Astrophysics Data System (ADS)

    Urban, Aleš; Davídkovová, Hana; Kyselý, Jan

    2013-04-01

    Several studies have examined heat- and cold-related cardiovascular (CVD) mortality in the Czech Republic. Much less is understood about heat- and cold-related CVD morbidity and possible regional differences. This study compares heat- and cold-stress effects on excess CVD mortality and morbidity in the city of Prague and a rural region of southern Bohemia over 16-year period (1994-2009). Population size and age structure are similar in the two regions. Excess mortality (number of deaths) and morbidity (number of hospital admissions) were determined as differences between observed and expected daily values, the latter being adjusted for long-term changes, annual and weekly cycles, and epidemics of influenza/acute respiratory infections. Several methods for identifying days and spells of days with heat and cold stress are applied, including Physiologically Equivalent Temperature (PET) and the Universal Thermal Climate Index (UTCI). Generally higher relative excess CVD mortality on warm days was identified in Prague, while on cold days we found higher excess CVD mortality in the rural region of southern Bohemia. In contrast to mortality, weak excess CVD morbidity was observed for both warm and cold days. The differences between Prague and the rural region of southern Bohemia indicate a possible influence of urban heat island effect in Prague together with other factors such as long- and short-term exposure to air pollution, different lifestyle, or different population, which may result in differing vulnerability to heat and cold stress.

  16. Heat- and cold-stress effects on cardiovascular mortality and morbidity among urban and rural populations in the Czech Republic

    NASA Astrophysics Data System (ADS)

    Urban, Aleš; Davídkovová, Hana; Kyselý, Jan

    2014-08-01

    Several studies have examined the relationship of high and low air temperatures to cardiovascular mortality in the Czech Republic. Much less is understood about heat-/cold-related cardiovascular morbidity and possible regional differences. This paper compares the effects of warm and cold days on excess mortality and morbidity for cardiovascular diseases (CVDs) in the city of Prague and a rural region of southern Bohemia during 1994-2009. Population size and age structure are similar in the two regions. The results are evaluated for selected population groups (men and women). Excess mortality (number of deaths) and morbidity (number of hospital admissions) were determined as differences between observed and expected daily values, the latter being adjusted for long-term changes, annual and weekly cycles, and epidemics of influenza/acute respiratory infections. Generally higher relative excess CVD mortality on warm days than on cold days was identified in both regions. In contrast to mortality, weak excess CVD morbidity was observed for both warm and cold days. Different responses of individual CVDs to heat versus cold stress may be caused by the different nature of each CVD and different physiological processes induced by heat or cold stress. The slight differences between Prague and southern Bohemia in response to heat versus cold stress suggest the possible influence of environmental and socioeconomic factors such as the effects of urban heat island and exposure to air pollution, lifestyle differences, and divergence in population structure, which may result in differing vulnerability of urban versus rural population to temperature extremes.

  17. Heat- and cold-stress effects on cardiovascular mortality and morbidity among urban and rural populations in the Czech Republic.

    PubMed

    Urban, Aleš; Davídkovová, Hana; Kyselý, Jan

    2014-08-01

    Several studies have examined the relationship of high and low air temperatures to cardiovascular mortality in the Czech Republic. Much less is understood about heat-/cold-related cardiovascular morbidity and possible regional differences. This paper compares the effects of warm and cold days on excess mortality and morbidity for cardiovascular diseases (CVDs) in the city of Prague and a rural region of southern Bohemia during 1994-2009. Population size and age structure are similar in the two regions. The results are evaluated for selected population groups (men and women). Excess mortality (number of deaths) and morbidity (number of hospital admissions) were determined as differences between observed and expected daily values, the latter being adjusted for long-term changes, annual and weekly cycles, and epidemics of influenza/acute respiratory infections. Generally higher relative excess CVD mortality on warm days than on cold days was identified in both regions. In contrast to mortality, weak excess CVD morbidity was observed for both warm and cold days. Different responses of individual CVDs to heat versus cold stress may be caused by the different nature of each CVD and different physiological processes induced by heat or cold stress. The slight differences between Prague and southern Bohemia in response to heat versus cold stress suggest the possible influence of environmental and socioeconomic factors such as the effects of urban heat island and exposure to air pollution, lifestyle differences, and divergence in population structure, which may result in differing vulnerability of urban versus rural population to temperature extremes.

  18. Diarrhoea morbidity patterns in Central Region of Ghana

    PubMed Central

    Asamoah, Alexander; Ameme, Donne Kofi; Sackey, Samuel Oko; Nyarko, Kofi Mensah; Afari, Edwin Andrew

    2016-01-01

    Introduction Diarrhoea diseases remain a major public health threat with nearly 1.7 billion cases annually worldwide occurring in all age groups. In Ghana diarrhoea kills about 14,000 children under five years annually. We therefore analysed data to determine the morbidity pattern of diarrhoea diseases in the Central Region of Ghana. Methods Health facility morbidity data was reviewed from 2008-2012. Monthly data on diarrhoeal diseases were extracted from District Health Information Management System database by sex, age group and districts. Data for bloody diarrhoea were extracted from monthly surveillance report forms. Data was analysed descriptively and expressed as frequencies and proportionate morbidity rates (pmr). Aberrations were determined using C2 threshold. Results The total cases of all morbidity from 2008 to 2012 were 7,642,431. Diarrhoea diseases formed 4% (306854/7642431) of total morbidity. Children under one year (pmr= 8.4%) and males (pmr= 4.4%) were the most affected. Bloody diarrhea formed 2.2% (6835/306854) of diarrhoea cases with 0.7 %(45/6835) laboratory confirmed. Diarrhoea cases peaked from January to March throughout the study period with highest frequency 9.3% (28511/306854) in June. The mean monthly distribution of diarrhoea cases was 25571.17±1389.91. Poorest districts had significantly lower odds of getting bloody diarrhoea than non-poorest districts OR = 0.73 (95%CI = 0.70-0.77). Conclusion Diarrhoea characterized 4% of total morbidity presenting at health facilities in the region from 2008 to 2012. The diarrhoea morbidity rate decreased with increased age. Diarrhoea was higher among non poorest districts. The rate was highest in the month of June over the five year period. Bloody diarrhoea cases were mostly untested. We recommended that stool samples should be taken for laboratory testing for bloody diarrhoea cases. PMID:28149442

  19. Predictors of Urinary Morbidity in Cs-131 Prostate Brachytherapy Implants

    SciTech Connect

    Smith, Ryan P.; Jones, Heather A.; Beriwal, Sushil; Gokhale, Abhay; Benoit, Ronald

    2011-11-01

    Purpose: Cesium-131 is a newer radioisotope being used in prostate brachytherapy (PB). This study was conducted to determine the predictors of urinary morbidity with Cs-131 PB. Methods and Materials: A cohort of 159 patients underwent PB with Cs-131 at our institution and were followed by using Expanded Prostate Cancer Index Composite (EPIC) surveys to determine urinary morbidity over time. EPIC scores were obtained preoperatively and postoperatively at 2 and 4 weeks, and 3 and 6 months. Different factors were evaluated to determine their individual effect on urinary morbidity, including patient characteristics, disease characteristics, treatment, and dosimetry. Multivariate analysis of covariance was carried out to identify baseline determinants affecting urinary morbidity. Factors contributing to the need for postoperative catheterization were also studied and reported. Results: At 2 weeks, patient age, dose to 90% of the organ (D90), bladder neck maximum dose (D{sub max}), and external beam radiation therapy (EBRT) predicted for worse function. At 4 weeks, age and EBRT continued to predict for worse function. At the 3-month mark, better preoperative urinary function, preoperative alpha blockers, bladder neck D{sub max}, and EBRT predicted for worse urinary morbidity. At 6 months, better preoperative urinary function, preoperative alpha blockers, bladder neck D{sub max}, and EBRT were predictive of increased urinary problems. High bladder neck D{sub max} and poor preoperative urinary function predicted for the need for catheterization. Conclusions: The use of EBRT plus Cs-131 PB predicts for worse urinary toxicity at all time points studied. Patients should be cautioned about this. Age was a consistent predictor of worsened morbidity immediately following Cs-131 PB, while bladder D{sub max} was the only consistent dosimetric predictor. Paradoxically, patients with better preoperative urinary function had worse urinary morbidity at 3 and 6 months, consistent with

  20. Acute Diagnosis and Management of Stroke Presenting Dizziness or Vertigo.

    PubMed

    Lee, Seung-Han; Kim, Ji-Soo

    2015-08-01

    Stroke involving the brainstem and cerebellum frequently presents acute vestibular syndrome. Although vascular vertigo is known to usually accompany other neurologic symptoms and signs, isolated vertigo from small infarcts involving the cerebellum or brainstem has been increasingly recognized. Bedside neuro-otologic examination can reliably differentiate acute vestibular syndrome due to stroke from more benign inner ear disease. Sometimes acute isolated audiovestibular loss may herald impending infarction in the territory of the anterior inferior cerebellar artery. Accurate identification of isolated vascular vertigo is very important because misdiagnosis of acute stroke may result in significant morbidity and mortality.

  1. Global Reduction in HIV-related Maternal Mortality: ART as a Key Strategy.

    PubMed

    Salihu, Hamisu M

    2015-01-01

    Dr. Holtz and colleagues present a synthesis of evidence from published studies over the previous decade on the collective impact of HIV-targeted interventions on maternal mortality. Amongst an assortment of interventions [that include antiretroviral therapy (ART), micronutrients (multivitamins, vitamin A and selenium), and antibiotics], only ART reduced maternal mortality among HIV-infected pregnant and post-partum mothers. These findings have fundamental and global strategic implications. They are also timely since they provide the evidence that ART reduces HIV-related maternal mortality, and by further enhancing access to ART in HIV-challenged and poor regions of the world, significant improvement in maternal morbidity and mortality indices could be attained. The paper bears good tidings and sound scientific proof that the financial investment made globally by government and non-governmental organizations and agencies to reduce the global burden of HIV/AIDS primarily by making ART more accessible to regions of the world most affected by the epidemic is beginning to show beneficial effects not only in terms of numerical reductions in the rates of new cases of HIV/AIDS among women, but also in maternal mortality levels.

  2. Improving access to maternity services: an overview of cash transfer and voucher schemes in South Asia.

    PubMed

    Jehan, Kate; Sidney, Kristi; Smith, Helen; de Costa, Ayesha

    2012-06-01

    In Nepal, India, Bangladesh and Pakistan, policy focused on improving access to maternity services has led to measures to reduce cost barriers impeding women's access to care. Specifically, these include cash transfer or voucher schemes designed to stimulate demand for services, including antenatal, delivery and post-partum care. In spite of their popularity, however, little is known about the impact or effectiveness of these schemes. This paper provides an overview of five major interventions: the Aama (Mothers') Programme (cash transfer element) in Nepal; the Janani Suraksha Yojana (Safe Motherhood Scheme) in India; the Chiranjeevi Yojana (Scheme for Long Life) in India; the Maternal Health Voucher Scheme in Bangladesh and the Sehat (Health) Voucher Scheme in Pakistan. It reviews the aims, rationale, implementation challenges, known outcomes, potential and limitations of each scheme based on current available data. Increased use of maternal health services has been reported since the schemes began, though evidence of improvements in maternal health outcomes has not been established due to a lack of controlled studies. Areas for improvement in these schemes, identified in this review, include the need for more efficient operational management, clear guidelines, financial transparency, plans for sustainability, evidence of equity and, above all, proven impact on quality of care and maternal mortality and morbidity.

  3. Maternal Exposure to Polybrominated and Polychlorinated Biphenyls: Infant Birth Weight and Gestational Age

    PubMed Central

    Givens, Marjory L.; Small, Chanley M.; Terrell, Metrecia L.; Cameron, Lorraine L.; Blanck, Heidi Michels; Tolbert, Paige E.; Rubin, Carol; Henderson, Alden K.; Marcus, Michele

    2007-01-01

    Understanding the influence of maternal exposures on gestational age and birth weight is essential given that pre-term and/or low birth weight infants are at risk for increased mortality and morbidity. We performed a retrospective analysis of a cohort exposed to polybrominated biphenyls (PBB) through accidental contamination of cattle feed and polychlorinated biphenyls (PCB) through residual contamination in the geographic region. Our study population consisted of 444 mothers and their 899 infants born between 1975 and 1997. Using restricted maximum likelihood estimation, no significant association was found between estimated maternal serum PBB at conception or enrollment PCB levels and gestational age or infant birth weight in unadjusted models or in models that adjusted for maternal age, smoking, parity, infant gender, and decade of birth. For enrollment maternal serum PBB, no association was observed for gestational age. However, a negative association with high levels of enrollment maternal serum PBB and birth weight was suggested. We also examined the birth weight and gestational age among offspring of women with the highest (10%) PBB or PCB exposure, and observed no significant association. Because brominated compounds are currently used in consumer products and therefore, are increasingly prevalent in the environment, additional research is needed to better understand the potential relationship between in utero exposure to brominated compounds and adverse health outcomes. PMID:17617441

  4. Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery

    PubMed Central

    Bydon, Mohamad; Abt, Nicholas B.; Macki, Mohamed; Brem, Henry; Huang, Judy; Bydon, Ali; Tamargo, Rafael J.

    2014-01-01

    Background: Preoperative anemia may affect postoperative mortality and morbidity following elective cranial operations. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to identify elective cranial neurosurgical cases (2006-2012). Morbidity was defined as wound infection, systemic infection, cardiac, respiratory, renal, neurologic, and thromboembolic events, and unplanned returns to the operating room. For 30-day postoperative mortality and morbidity, adjusted odds ratios (ORs) were estimated with multivariable logistic regression. Results: Of 8015 patients who underwent elective cranial neurosurgery, 1710 patients (21.4%) were anemic. Anemic patients had an increased 30-day mortality of 4.1% versus 1.3% in non-anemic patients (P < 0.001) and an increased 30-day morbidity rate of 25.9% versus 14.14% in non-anemic patients (P < 0.001). The 30-day morbidity rates for all patients undergoing cranial procedures were stratified by diagnosis: 26.5% aneurysm, 24.7% sellar tumor, 19.7% extra-axial tumor, 14.8% intra-axial tumor, 14.4% arteriovenous malformation, and 5.6% pain. Following multivariable regression, the 30-day mortality in anemic patients was threefold higher than in non-anemic patients (4.1% vs 1.3%; OR = 2.77; 95% CI: 1.65-4.66). The odds of postoperative morbidity in anemic patients were significantly higher than in non-anemic patients (OR = 1.29; 95% CI: 1.03-1.61). There was a significant difference in postoperative morbidity event odds with a hematocrit level above (OR = 1.07; 95% CI: 0.78-1.48) and below (OR = 2.30; 95% CI: 1.55-3.42) 33% [hemoglobin (Hgb) 11 g/dl]. Conclusions: Preoperative anemia in elective cranial neurosurgery was independently associated with an increased risk of 30-day postoperative mortality and morbidity when compared to non-anemic patients. A hematocrit level below 33% (Hgb 11 g/dl) was associated with a significant increase in postoperative morbidity. PMID

  5. Hospital morbidity in the Fiji islands with special reference to the saccharine disease.

    PubMed

    Sorokin, M

    1975-08-23

    The concept of the excessive consumption of carbohydrates as a cause of many diseases of civilisation has previously been proposed under the name of the 'saccharine disease'. A review of the hospital morbidity figures for these diseases in a divisional hospital in the Fiji Islands is presented. The hospital serves a population comprised of Indians and Fijians, suggesting comparison with the province of Natal, South Africa. Indians have a higher incidence of diabetes melitus, myocardial infarction, duodenal ulcer, acute appendicitis, gallstones, renal stones and eclampsia. Their diets differ mainly in the higher consumption of refined fibre-depleted carbohydrates, and it is suggested that the association is compatible with the concept of the "saccharine disease".

  6. [Myocardial infarct morbidity among men and women in Krasnoyarsk from the viewpoint of age].

    PubMed

    Ivanov, A G

    1986-01-01

    A comparative analysis of the time course of age-related acute myocardial infarction incidence rates among men and women was based upon the results of an epidemiological study in Krasnoyarsk. Myocardial infarction incidence rates in men aged 20 to 69 (general as well as primary and secondary infarction incidence) were twice as high as in women of the same age. The time course of primary and secondary myocardial infarction incidence had common regularities. Under 60, incidence rates in men were higher than in women, over 60 just the opposite. Incidence rates in younger age groups were higher than in older age groups. No growth in the general morbidity of myocardial infarction was established in the period of the study. However its significant growth in men aged 50 to 59 ("rejuvenation" of myocardial infarction) was revealed.

  7. MORBIDITY AND SURVIVAL PROBABILITY IN BURN PATIENTS IN MODERN BURN CARE

    PubMed Central

    Jeschke, Marc G.; Pinto, Ruxandra; Kraft, Robert; Nathens, Avery B.; Finnerty, Celeste C.; Gamelli, Richard L.; Gibran, Nicole S.; Klein, Matthew B.; Arnoldo, Brett D.; Tompkins, Ronald G.; Herndon, David N.

    2014-01-01

    Objective Characterizing burn sizes that are associated with an increased risk of mortality and morbidity is critical because it would allow identifying patients who might derive the greatest benefit from individualized, experimental, or innovative therapies. Although scores have been established to predict mortality, few data addressing other outcomes exist. The objective of this study was to determine burn sizes that are associated with increased mortality and morbidity after burn. Design and Patients Burn patients were prospectively enrolled as part of the multicenter prospective cohort study, Inflammation and the Host Response to Injury Glue Grant, with the following inclusion criteria: 0–99 years of age, admission within 96 hours after injury, and >20% total body surface area burns requiring at least one surgical intervention. Setting Six major burn centers in North America. Measurements and Main Results Burn size cutoff values were determined for mortality, burn wound infection (at least two infections), sepsis (as defined by ABA sepsis criteria), pneumonia, acute respiratory distress syndrome, and multiple organ failure (DENVER2 score >3) for both children (<16 years) and adults (16–65 years). Five-hundred seventy-three patients were enrolled, of which 226 patients were children. Twenty-three patients were older than 65 years and were excluded from the cutoff analysis. In children, the cutoff burn size for mortality, sepsis, infection, and multiple organ failure was approximately 60% total body surface area burned. In adults, the cutoff for these outcomes was lower, at approximately 40% total body surface area burned. Conclusions In the modern burn care setting, adults with over 40% total body surface area burned and children with over 60% total body surface area burned are at high risk for morbidity and mortality, even in highly specialized centers. PMID:25559438

  8. Morbidity and Mortality of Malaria during Monsoon Flood of 2011: South East Asia Experience

    PubMed Central

    MEMON, Muhammad Sadik; SOLANGI, Shamsuddin; LAKHO, Shabana; ARAIN, Zain Islam; NAZ, Farukh; ZAKI, Madiha

    2014-01-01

    Abstract Background Malaria is the second most frequent clinically suspected disease entity after acute respiratory tract infection in developing countries. Active malarial transmission occurs throughout the year, while aggressive out bursts of disease are seen mainly during and after the ‘monsoon’ season. This study aimed to determine the morbidity and mortality associated with malaria during flood at Isra University Hospital, Hyderabad. Methods This prospective observational study was done at Isra University Hospital Hyderabad during monsoon flooding from July 2011 to October 2011. All 883 patients presented with symptoms of malaria (fever, headache, and vomiting) were evaluated and diagnostic tool ICT-MP was used for the detection of malaria parasite among them. Results Seventy four (8.38%) patients diagnosed for malaria. The mean age and SD was 30.11 ± 1.67 years. Overall mortality due to malaria observed (18.9%). Mortality rate significantly observed high in pregnant women (0.005) and in those patients who developed complications such as, pneumonia (P = 0.04), renal failure (P = 0.04), Unconsciousness (P = 0.001), and Septicemia (P = 0.001). Conclusion A Significant increase in the morbidity and mortality in patients with malaria after flood noticed. The probability of getting poor outcome is also associated when patient develop complications. PMID:26060676

  9. Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit

    PubMed Central

    Özbilgin, Şule; Hancı, Volkan; Ömür, Dilek; Özbilgin, Mücahit; Tosun, Mine; Yurtlu, Serhan; Küçükgüçlü, Semih; Arkan, Atalay

    2016-01-01

    Abstract The aim was to evaluate the nutritional situation of patients admitted to the Postoperative Acute Care Unit using classic methods of objective anthropometry, systemic evaluation methods, and Nutrition Risk in Critically Ill (NUTRIC) score, and to compare them as a predictor of morbidity and mortality. At admission to the postoperative care unit, patients undergoing various surgeries were assessed for the following items: Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Nutritional Risk Screening (NRS)-2002, Mini Nutritional Assessment (MNA), Charlson comorbidity index (CCI), and NUTRIC score, anthropometric measurements, serum total protein, serum albumin, and lymphocyte count. Patients were monitored for postoperative complications until death or discharge. Correlation of complications with these parameters was also analyzed. A total of 152 patients were included in the study. In this study a positive correlation was determined between mortality and NRS-2002, SGA, CCI, Acute Physiology and Chronic Health Evaluation , Sepsis-related Organ Failure Assessment, and NUTRIC score, whereas a negative correlation was determined between mortality and NRI. There was a correlation between NUTRIC score and pneumonia, development of atrial fibrillation, delirium, renal failure, inotrope use, and duration of mechanical ventilation. In our study group of postoperative patients, MNA had no predictive properties for any complication, whereas SGA had no predictive properties for any complications other than duration of hospital stay and mortality. The NUTRIC score is an important indicator of mortality and morbidity in postoperative surgical patients. NRI correlated with many postoperative complications, and though SGA and NRS were correlated with mortality, they were not correlated with the majority of complications. MNA was determined not to have any correlation with any complication, mortality, and duration of hospital stay in our patient group. PMID

  10. Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit.

    PubMed

    Özbilgin, Şule; Hanc, Volkan; Ömür, Dilek; Özbilgin, Mücahit; Tosun, Mine; Yurtlu, Serhan; Küçükgüçlü, Semih; Arkan, Atalay

    2016-10-01

    The aim was to evaluate the nutritional situation of patients admitted to the Postoperative Acute Care Unit using classic methods of objective anthropometry, systemic evaluation methods, and Nutrition Risk in Critically Ill (NUTRIC) score, and to compare them as a predictor of morbidity and mortality.At admission to the postoperative care unit, patients undergoing various surgeries were assessed for the following items: Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Nutritional Risk Screening (NRS)-2002, Mini Nutritional Assessment (MNA), Charlson comorbidity index (CCI), and NUTRIC score, anthropometric measurements, serum total protein, serum albumin, and lymphocyte count. Patients were monitored for postoperative complications until death or discharge. Correlation of complications with these parameters was also analyzed.A total of 152 patients were included in the study. In this study a positive correlation was determined between mortality and NRS-2002, SGA, CCI, Acute Physiology and Chronic Health Evaluation , Sepsis-related Organ Failure Assessment, and NUTRIC score, whereas a negative correlation was determined between mortality and NRI. There was a correlation between NUTRIC score and pneumonia, development of atrial fibrillation, delirium, renal failure, inotrope use, and duration of mechanical ventilation. In our study group of postoperative patients, MNA had no predictive properties for any complication, whereas SGA had no predictive properties for any complications other than duration of hospital stay and mortality.The NUTRIC score is an important indicator of mortality and morbidity in postoperative surgical patients. NRI correlated with many postoperative complications, and though SGA and NRS were correlated with mortality, they were not correlated with the majority of complications. MNA was determined not to have any correlation with any complication, mortality, and duration of hospital stay in our patient group.

  11. Effects of Elevated Circulating Cortisol Concentrations on Maternal Behavior in Common Marmoset Monkeys (Callithrix jacchus)

    PubMed Central

    Saltzman, Wendy; Abbott, David H.

    2009-01-01

    Summary Both acute and chronic stress can impair maternal behavior and increase rates of infant abuse in several species. The mechanisms inducing these effects are unknown, but experimental manipulation of circulating corticosterone levels alters maternal behavior in rats, and circulating or excreted cortisol concentrations have been found to correlate either positively or negatively with maternal behavior in humans and nonhuman primates. In this study, therefore, we experimentally tested the hypothesis that both acute and chronic treatment with exogenous glucocorticoids would alter maternal behavior in a primate, the common marmoset (Callithrix jacchus). Multiparous females, approximately 3−5 weeks postpartum, received daily injections of either cortisol (hydrocortisone sodium succinate and hydrocortisone acetate; N = 7) or vehicle (N = 7) for 8 days, and maternal behavior was characterized under baseline conditions as well as during exposure to a noise stressor. Cortisol treatment successfully elevated both morning and afternoon plasma cortisol concentrations and suppressed circulating levels of adrenocorticotropic hormone. In home-cage observations, cortisol-treated females carried their infants significantly less than control mothers, and in noise-stressor tests, several hours after the first cortisol or vehicle treatment, cortisol-treated mothers inspected their infants significantly more often than controls. Aggression towards infants was infrequent and mild, and did not differ between treatment groups. These findings provide the first experimental evidence that cortisol elevations can alter maternal behavior in primates. As these effects were limited in scope, however, they suggest that other stress-responsive hormones or neuropeptides may additionally play a role in mediating the effects of stress on maternal behavior. PMID:19362777

  12. Gender Differences in Respiratory Morbidity and Mortality of Preterm Neonates

    PubMed Central

    Townsel, Courtney Denise; Emmer, Sawyer F.; Campbell, Winston A.; Hussain, Naveed

    2017-01-01

    For the past century, researchers have underscored the “disadvantage” observed in respiratory morbidity and mortality of male newborns. In this contemporary review, we examine gender differences in preterm infant respiratory morbidity and mortality specifically appraising differences in the very low birth weight (VLBW) population as well as the late preterm (LPT) population. In the era of postnatal surfactant and antenatal corticosteroids, the gender gap in neonatal outcomes has not narrowed. Structural, physiologic, and hormonal sex differences may be at the root of this disparity. Further exploration into the origin of gender differences in respiratory morbidity and neonatal mortality will shape future therapies. These therapies may need to be gender specific to close the gender gap. PMID:28194395

  13. Prenatal Maternal Stress Programs Infant Stress Regulation

    ERIC Educational Resources Information Center

    Davis, Elysia Poggi; Glynn, Laura M.; Waffarn, Feizal; Sandman, Curt A.

    2011-01-01

    Objective: Prenatal exposure to inappropriate levels of glucocorticoids (GCs) and maternal stress are putative mechanisms for the fetal programming of later health outcomes. The current investigation examined the influence of prenatal maternal cortisol and maternal psychosocial stress on infant physiological and behavioral responses to stress.…

  14. Maternal and child nutrition in Sub-Saharan Africa: challenges and interventions.

    PubMed

    Lartey, Anna

    2008-02-01

    Women of child-bearing age (especially pregnant and lactating women), infants and young children are in the most nutritionally-vulnerable stages of the life cycle. Maternal malnutrition is a major predisposing factor for morbidity and mortality among African women. The causes include inadequate food intake, poor nutritional quality of diets, frequent infections and short inter-pregnancy intervals. Evidence for maternal malnutrition is provided by the fact that between 5 and 20% of African women have a low BMI as a result of chronic hunger. Across the continent the prevalence of anaemia ranges from 21 to 80%, with similarly high values for both vitamin A and Zn deficiency levels. Another challenge is the high rates of HIV infection, which compromise maternal nutritional status. The consequences of poor maternal nutritional status are reflected in low pregnancy weight gain and high infant and maternal morbidity and mortality. Suboptimal infant feeding practices, poor quality of complementary foods, frequent infections and micronutrient deficiencies have largely contributed to the high mortality among infants and young children in the region. Feeding children whose mothers are infected with HIV continues to remain an issue requiring urgent attention. There are successful interventions to improve the nutrition of mothers, infants and young children, which will be addressed. Interventions to improve the nutrition of infants and young children, particularly in relation to the improvement of micronutrient intakes of young children, will be discussed. The recent release by WHO of new international growth standards for assessing the growth and nutritional status of children provides the tool for early detection of growth faltering and for appropriate intervention.

  15. [Acute respiratory distress syndrome].

    PubMed

    Matĕjovic, M; Novák, I; Srámek, V; Rokyta, R; Hora, P; Nalos, M

    1999-04-26

    Acute respiratory distress syndrome (ARDS) is the general term used for severe acute respiratory failure of diverse aetiology. It is associated with a high morbidity, mortality (50-70%), and financial costs. Regardless of aetiology, the basic pathogenesis of ARDS is a systemic inflammatory response leading to a diffuse inflammatory process that involves both lungs, thus causing diffuse alveolar and endothelial damage with increased pulmonary capillary permeability and excessive extravascular lung water accumulation. ARDS is commonly associated with sepsis and multiple organ failure. The clinical picture involves progressive hypoxaemia, radiographic evidence of pulmonary oedema, decreased lung compliance and pulmonary hypertension. Despite the scientific and technological progress in critical care medicine, there is no specific ARDS therapy available at the moment and its management remains supportive. Therapeutic goals include resolution of underlying conditions, maintenance of acceptable gas exchange and tissue oxygenation and prevention of iatrogenic lung injury. Many new specific therapeutic strategies have been developed, however, most of them require further scientific evaluation. The paper reviews definition, basic pathogenesis and pathophysiology of ARDS and discusses current concepts of therapeutic possibilities of ARDS.

  16. Acute Kidney Injury

    PubMed Central

    Zuk, Anna; Bonventre, Joseph V.

    2016-01-01

    Acute kidney injury (AKI) is a global public health concern associated with high morbidity, mortality, and healthcare costs. Other than dialysis, no therapeutic interventions reliably improve survival, limit injury, or speed recovery. Despite recognized shortcomings of in vivo animal models, the underlying pathophysiology of AKI and its consequence, chronic kidney disease (CKD), is rich with biological targets. We review recent findings relating to the renal vasculature and cellular stress responses, primarily the intersection of the unfolded protein response, mitochondrial dysfunction, autophagy, and the innate immune response. Maladaptive repair mechanisms that persist following the acute phase promote inflammation and fibrosis in the chronic phase. Here macrophages, growth-arrested tubular epithelial cells, the endothelium, and surrounding pericytes are key players in the progression to chronic disease. Better understanding of these complex interacting pathophysiological mechanisms, their relative importance in humans, and the utility of biomarkers will lead to therapeutic strategies to prevent and treat AKI or impede progression to CKD or end-stage renal disease (ESRD). PMID:26768243

  17. Evaluation of Maternal Health Service Indicators in Urban Slum of Bangladesh

    PubMed Central

    Jolly, Saira Parveen; Rahman, Mahfuzar; Afsana, Kaosar; Yunus, Fakir Md; Chowdhury, Ahmed M. R.

    2016-01-01

    Background A continuous influx of poor people to urban slums poses a challenge to Bangladesh’s health system as it has failed to tackle maternal morbidity and mortality. BRAC is the largest non-governmental organisation in Bangladesh. BRAC has been working to reduce maternal, neonatal and under-five children morbidity and mortality of slum dwellers in cities. BRAC has been doing this work for a decade through a programme called MANOSHI. This programme provides door-to-door services to its beneficiaries through community health workers (CHWs) and normal delivery service through its delivery and maternity centres. BRAC started the ‘MANOSHI’ programme in Narayanganj City Corporation during 2011 to address maternal, neonatal and child health problems facing slum dwellers. We investigated the existing maternal health-service indicators in the slums of Narayanganj City Corporation and compared the findings with a non-intervention area. Methods This cross-sectional study was conducted during 2012, in 47 slums of Narayanganj City Corporation as intervention and 10 slums of Narsingdi Sadar Municipality as comparison area. A total of 1206 married women, aged 15–49 years, with a pregnancy outcome in the previous year were included for interview. Data on socio-demographic characteristics, reproductive and maternal health-care practices like use of contraceptive methods, antenatal care (ANC), delivery care, postnatal care (PNC) were collected through a structured questionnaire. The chi-square test, Student t test, Mann Whitney U-test, factor analysis and log-binominal test were performed by using STATA statistical software for analysing data. Results The activities of BRAC CHWs significantly improved four or more ANC (47% vs. 21%; p<0.000) and PNC (48% vs. 39%; p<0.01) coverage in the intervention slums compared to comparison slums. Still, about half of the deliveries in both areas were attended at home by unskilled birth attendants, of which a very few received PNC

  18. Spatiotemporally-Resolved Air Exchange Rate as a Modifier of Acute Air Pollution-Related Morbidity

    EPA Science Inventory

    The National Exposure Research Laboratory (NERL) Human Exposure and Atmospheric Sciences Division (HEASD) conducts research in support of EPA mission to protect human health and the environment. HEASD research program supports Goal 1 (Clean Air) and Goal 4 (Healthy People) of EP...

  19. Maternal Pharmacokinetics and Fetal Disposition of (±)-Citalopram during Mouse Pregnancy

    PubMed Central

    2016-01-01

    While selective-serotonin reuptake inhibitor (SSRI) antidepressants are commonly prescribed in the treatment of depression, their use during pregnancy leads to fetal drug exposures. According to recent reports, such exposures could affect fetal development and long-term offspring health. A central question is how pregnancy-induced physical and physiological changes in mothers, fetuses, and the placenta influence fetal SSRI exposures during gestation. In this study, we examined the effects of gestational stage on the maternal pharmacokinetics and fetal disposition of the SSRI (±)-citalopram (CIT) in a mouse model. We determined the maternal and fetal CIT serum concentration–time profiles following acute maternal administration on gestational days (GD)14 and GD18, as well as the fetal brain drug disposition. The results show that pregnancy affects the pharmacokinetics of CIT and that maternal drug clearance increases as gestation progresses. The data further show that CIT and its primary metabolite desmethylcitalopram (DCIT) readily cross the placenta into the fetal compartment, and fetal exposure to CIT exceeds that of the mother during gestation 2 h after maternal administration. Enzymatic activity assays revealed that fetal drug metabolic capacity develops in late gestation, resulting in elevated circulating and brain concentrations of DCIT at embryonic day (E)18. Fetal exposure to the SSRI CIT in murine pregnancy is therefore influenced by both maternal gestational stage and embryonic development, suggesting potential time-dependent effects on fetal brain development. PMID:26765210

  20. Acute Pancreatitis and Pregnancy

    MedlinePlus

    ... Pancreatitis Acute Pancreatitis and Pregnancy Acute Pancreatitis and Pregnancy Timothy Gardner, MD Acute pancreatitis is defined as ... pancreatitis in pregnancy. Reasons for Acute Pancreatitis and Pregnancy While acute pancreatitis is responsible for almost 1 ...

  1. [Current problems of occupational morbidity on the railway transport].

    PubMed

    Pankova, V B; Kameneva, E A; Artemenkov, Iu M; Glebova, G M

    2006-01-01

    The paper discusses the present working conditions on railway transport, by using the results of employee rating, characterizes railway services showing the greatest magnitude of adverse and dangerous factors of working conditions. It also characterizes occupational morbidity in railway transport workers over 5 years (1999-2003) and by hazards problems of occupational morbidity and by basic services: locomotive, wagon, and track ones. The paper also presents the rates of disability due to occupational diseases, characterizes the priorities of prevention of occupational diseases on the railway transport.

  2. Co-morbid anxiety and depression among pulmonary tuberculosis patients.

    PubMed

    Aamir, Siddiqua; Aisha

    2010-10-01

    The need to recognize and manage psychiatric co-morbidity in tuberculosis (TB) patients in primary care settings in order to improve adherence to the treatment is now well documented. Pulmonary TB patients at the District TB Control Office and TB Centre in Haripur from December 2007 to March 2008 were evalute in order to assess the frequency of anxiety and depression and continuation of treatment. Forty seven out of 65 (72%) TB patients had severe/moderate level of anxiety and depression according to Hospital Anxiety and Depression Scale (HADS). Fourteen (22%) TB patients with co-morbid anxiety and depression showed multi drug-resistance (MDR-TB).

  3. Oxytocin and Maternal Brain Plasticity

    ERIC Educational Resources Information Center

    Kim, Sohye; Strathearn, Lane

    2016-01-01

    Although dramatic postnatal changes in maternal behavior have long been noted, we are only now beginning to understand the neurobiological mechanisms that support this transition. The present paper synthesizes growing insights from both animal and human research to provide an overview of the plasticity of the mother's brain, with a particular…

  4. Multigenerational effects of maternal undernutrition.

    PubMed

    Einstein, Francine H

    2014-06-03

    Intrauterine exposure to reduced nutrient availability can have major effects in determining susceptibility to chronic disease later in life. Martínez et al. (2014) demonstrate multigenerational effects of poor maternal nutrition and evidence of germline transmission through alterations in DNA methylation.

  5. The microbiology of the acute dental abscess.

    PubMed

    Robertson, D; Smith, A J

    2009-02-01

    The acute dental abscess is frequently underestimated in terms of its morbidity and mortality. The risk of potential serious consequences arising from the spread of a dental abscess is still relevant today with many hospital admissions for dental sepsis. The acute dental abscess is usually polymicrobial comprising facultative anaerobes, such as viridans group streptococci and the Streptococcus anginosus group, with predominantly strict anaerobes, such as anaerobic cocci, Prevotella and Fusobacterium species. The use of non-culture techniques has expanded our insight into the microbial diversity of the causative agents, identifying such organisms as Treponema species and anaerobic Gram-positive rods such as Bulleidia extructa, Cryptobacterium curtum and Mogibacterium timidum. Despite some reports of increasing antimicrobial resistance in isolates from acute dental infection, the vast majority of localized dental abscesses respond to surgical treatment, with antimicrobials limited to spreading and severe infections. The microbiology and treatment of the acute localized abscess and severe spreading odontogenic infections are reviewed.

  6. Acute scurvy during treatment with interleukin-2.

    PubMed

    Alexandrescu, D T; Dasanu, C A; Kauffman, C L

    2009-10-01

    The association of vitamin C deficiency with nutritional factors is commonly recognized. However, an acute form of scurvy can occur in patients with an acute systemic inflammatory response, which is produced by sepsis, medications, cancer or acute inflammation. The frequency of acute hypovitaminosis C in hospitalized patients is higher than previously recognized. We report the occurrence of acute signs and symptoms of scurvy (perifollicular petechiae, erythema, gingivitis and bleeding) in a patient hospitalized for treatment of metastatic renal-cell carcinoma with high-dose interleukin-2. Concomitantly, serum vitamin C levels decreased to below normal. Better diets and longer lifespan may result a lower frequency of acute scurvy and a higher frequency of scurvy associated with systemic inflammatory responses. Therefore, increased awareness of this condition can lead to early recognition of the cutaneous signs of acute scurvy in hospitalized patients with acute illnesses or in receipt of biological agents, and prevent subsequent morbidity such as bleeding, anaemia, impaired immune defences, oedema or neurological symptoms.

  7. Experiences of the quality of care of women with near-miss maternal morbidities in the UK

    PubMed Central

    Hinton, L; Locock, L; Knight, M

    2014-01-01

    We undertook a qualitative interview study of women's and their partners’ experiences of severe pregnancy complications. Across the care pathway, women identified a number of examples of good practice that made an important difference to their recovery. There were some areas where women felt the quality of care could be improved, for example during points of transition between higher level and routine care or from hospital to the community. Longer-term support and counselling were felt to be particularly valuable, and yet not always universally available. These results emphasise the importance of integrated quality care across the whole patient pathway. PMID:25236629

  8. Pancreaticoatmospheric fistula following severe acute necrotising pancreatitis

    PubMed Central

    Simoneau, Eve; Chughtai, Talat; Razek, Tarek; Deckelbaum, Dan L

    2014-01-01

    Severe acute necrotising pancreatitis is associated with numerous local and systemic complications. Abdominal compartment syndrome requiring urgent decompressive laparotomy is a potential complication of this disease process and is associated with increased morbidity and mortality. We describe the case of a pancreaticoatmospheric fistula following decompressive laparotomy in a patient with severe acute necrotising pancreatitis. While this fistula was managed successfully using the current standard of care for pancreatic fistulas, the wound care for in this patient with drainage of the fistula through an open abdomen, is a significant challenge. PMID:25519860

  9. Applying the Maternal Near Miss Approach for the Evaluation of Quality of Obstetric Care: A Worked Example from a Multicenter Surveillance Study

    PubMed Central

    Haddad, Samira Maerrawi; Souza, Joao Paulo; Sousa, Maria Helena; Parpinelli, Mary Angela; Costa, Maria Laura; Pacagnella, Rodolfo C.; Brum, Ione R.; Moraes Filho, Olímpio B.; Feitosa, Francisco E.; Menezes, Carlos A.; Guanabara, Everardo M.; Moreira, Joaquim L.; Peret, Frederico A.; Schmaltz, Luiza E.; Katz, Leila; Lima, Antonio C. Barbosa; Amorim, Melania M.; Martins, Marilia G.; Nascimento, Denis J.; Paiva, Cláudio S.; Rohloff, Roger D.; Costa, Sergio M.; Luz, Adriana G.; Lobato, Gustavo; Cordioli, Eduardo; Peraçoli, Jose C.; Maia Filho, Nelson L.; Quintana, Silvana M.; Lotufo, Fátima A.; Aquino, Márcia M.; Mattar, Rosiane

    2014-01-01

    Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P < 0.001), delays related to quality of medical care (P = 0.012), absence of blood derivatives (P = 0.013), difficulties of communication between health services (P = 0.004), and any delay during the whole process (P = 0.039). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care. PMID:25147830

  10. Links between maternal health and NCDs.

    PubMed

    Kapur, Anil

    2015-01-01

    Non-communicable diseases (NCDs) and maternal health are closely linked. NCDs such as diabetes, obesity and hypertension have a significant adverse impact on maternal health and pregnancy outcomes, and through the mechanism of intrauterine programming maternal health impacts the burden of NCDs in future generations. The cycle of vulnerability to NCDs is repeated with increasing risk accumulation in subsequent generations. This article discusses the impact, interlinkages and advocates for integration of services for maternal and child health, NCD care and prevention and health promotion to sustainably improve maternal health as well address the rising burden of NCDs.

  11. Maternal dexamethasone and EEG hyperactivity in preterm fetal sheep

    PubMed Central

    Davidson, Joanne O; Quaedackers, Josine S L T; George, Sherly A; Gunn, Alistair Jan; Bennet, Laura

    2011-01-01

    Abstract Maternal treatment with synthetic corticosteroids such as dexamethasone (DEX) significantly reduces neonatal morbidity and mortality, but its effects on the fetal brain remain unclear. In this study we evaluated the effects of DEX on EEG activity in preterm fetal sheep. Ewes at 103 days gestation received two intramuscular injections of DEX (12 mg, n = 8) or saline vehicle (n = 7) 24 h apart. Fetal EEG activity was recorded from 6 h before until 120 h after the first injection (DEX-1). DEX-1 was associated with a marked transient rise in total EEG power, maximal at 12 h (P < 0.001), with a relative increase in delta and reduced theta, alpha and beta activity, resolving by 24 h. Continuous EEG records showed a shift to larger but less frequent transient waveforms (P < 0.001). Unexpectedly, evolving epileptiform activity, consistent with electrographic and clinical seizures, developed from 178 ± 44 min after DEX-1. Similar but smaller changes were seen after the second injection. Following the injections, total power returned to control values, but the proportion of alpha activity progressively increased vs. controls (P < 0.001), with reduced interburst interval duration and number (P < 0.001). No histological neural injury or microglial activation was seen. In summary, exposure to maternal dexamethasone was associated with dramatic, evolving low-frequency hyperactivity on fetal cortical EEG recordings, followed by sustained changes consistent with maturation of fetal sleep architecture. We postulate that these effects may contribute to improved neonatal outcomes. PMID:21646408

  12. Plasmodium vivax malaria associated with acute post infectious glomerulonephritis.

    PubMed

    Kanodia, Kamal V; Vanikar, Aruna V; Kute, Vivek Balkrishna; Trivedi, Hargovind L

    2013-08-01

    Malaria remains a major health problem in many parts of the world leading to high morbidity and mortality related to renal dysfunction and relapsing nature of Plasmodium vivax malaria. Acute renal failure occurs commonly in Plasmodium falciparum malaria, although its rare occurrences have been reported in P. vivax malaria also. We reported a rare case of P. vivax malaria monoinfection associated with acute post infectious glomerulonephritis.

  13. Maternal use of selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn.

    PubMed

    Alwan, S; Bandoli, G; Chambers, C D

    2016-07-01

    Use of selective serotonin reuptake inhibitors (SSRIs) in late pregnancy has been associated with persistent pulmonary hypertension of the newborn (PPHN), a rare condition with substantial infant mortality and morbidity. Although the increase in absolute risk is small on a population level, it may be of concern to many patients. It remains unclear the extent to which the increased risks reported for PPHN are explained by the underlying maternal illness rather than the use of SSRIs.

  14. [Acute pancreatitis].

    PubMed

    Hecker, M; Mayer, K; Askevold, I; Collet, P; Weigand, M A; Krombach, G A; Padberg, W; Hecker, A

    2014-03-01

    Acute pancreatitis is a potentially fatal disease with individually differing expression of systemic involvement. For this reason early diagnosis with subsequent risk stratification is essential in the clinical management of this frequent gastroenterological disorder. Severe forms of acute pancreatitis occur in approximately 20 % of cases often requiring intensive care monitoring and interdisciplinary therapeutic approaches. In the acute phase adequate fluid replacement and sufficient analgesic therapy is of major therapeutic importance. Concerning the administration of antibiotics and the nutritional support of patients with acute pancreatitis a change in paradigms could be observed in recent years. Furthermore, endoscopic, radiological or surgical interventions can be necessary depending on the severity of the disease and potential complications.

  15. Bronchitis - acute

    MedlinePlus

    ... to breathe. Other symptoms of bronchitis are a cough and coughing up mucus. Acute means the symptoms ... diagnosed with chronic bronchitis, you must have a cough with mucus on most days for at least ...

  16. Acute Bronchitis

    MedlinePlus

    ... bronchitis? Acute bronchitis is inflammation of your bronchial tree. The bronchial tree consists of tubes that carry air into your ... weeks or months. This happens because the bronchial tree takes a while to heal. A lasting cough ...

  17. Maternal responsiveness and maternal selectivity in domestic sheep and goats: the two facets of maternal attachment.

    PubMed

    Poindron, Pascal; Lévy, Frédéric; Keller, Matthieu

    2007-01-01

    Sheep and goats rapidly establish an exclusive relationship with their neonate following contact with it during a sensitive period of maternal responsiveness induced by the physiological events occurring at parturition. The data concerning the sensory, physiological, and neurobiological factors involved in the activation of both maternal responsiveness and the establishment of selective nursing indicates that these processes are activated simultaneously by the combined action of two main factors, the prepartum rise in circulating estrogen and the vaginocervical stimulation (VCS) caused by fetus expulsion. On the one hand, these two factors act on a neural network including the main olfactory system (MOB), the medial preoptic area (MPOA), and the paraventricular nucleus of the hypothalamus (PVN) to induce maternal responsiveness towards any neonate. The intracerebral release of oxytocin (OT) from the PVN, and the triggering of olfactory attraction for amniotic fluid (AF) are key elements in this process. On the other hand, VCS at birth also sets the MOB ready to memorize the individual odor of the neonate, through the release of peptides and neurotransmitters (noradrenaline and acetylcholine). In addition to the MOB, the network involved in recognition mainly includes the medial and cortical amygdala. Across consolidation processes, reorganization occurs in the network engaged in lamb recognition. Whether this memorization may be potentiated by other sensory cues is not known. The identification of the chemosensory compounds involved in the attraction for AF and in the recognition of the neonate is important for understanding the mechanisms of maternal attachment.

  18. Maternal control of early embryogenesis in mammals

    PubMed Central

    Zhang, Kun; Smith, George W.

    2015-01-01

    Oocyte quality is a critical factor limiting the efficiency of assisted reproductive technologies (ART) and pregnancy success in farm animals and humans. ART success is diminished with increased maternal age, suggesting a close link between poor oocyte quality and ovarian-aging. However, the regulation of oocyte quality remains poorly understood. Oocyte quality is functionally linked to ART success because the maternal-to-embryonic transition is dependent on stored maternal factors, which are accumulated in oocytes during oocyte development and growth. The maternal-to-embryonic transition consists of critical developmental processes including maternal RNA depletion and embryonic genome activation. In recent years, key maternal proteins encoded by maternal-effect genes have been determined, primarily using genetically modified mouse models. These proteins are implicated in various aspects of early embryonic development including maternal mRNA degradation, epigenetic reprogramming, signal transduction, protein translation and initiation of embryonic genome activation. Species differences exist in number of cell divisions encompassing the maternal-to-embryonic transition and maternal-effect genes controlling this developmental window. Perturbations of maternal control result in decreased oocyte quality, some of which are associated with ovarian aging. PMID:25695370

  19. Maternal smoking in pregnancy and its influence on childhood asthma

    PubMed Central

    2016-01-01

    Maternal smoking in pregnancy (MSP) is a large modifiable risk factor for pregnancy related mortality and morbidity and also the most important known modifiable risk factor for asthma. This review summarises the effects of MSP throughout infancy, childhood and adolescence with regards to asthma (development and severity). Firstly, the direct damage caused by nicotine on fetal lung development, fetal growth and neuronal differentiation is discussed, as well as the indirect effects of nicotine on placental functioning. Secondly, the effects of MSP on later immune functioning resulting in increased infection rate are summarised and details are given on the effects of MSP modulating airway hyperreactivity, reducing lung function and therefore increasing asthma morbidity. Furthermore, epigenetic effects are increasingly being recognised. These can also result in transgenerational detrimental effects induced by cigarette smoke. In summary, the causal relationship between MSP and asthma development is well documented and presents a major health problem for generations to come. The high prevalence of MSP is alarming and epigenetic effects of nicotine on immune functioning potentiate this danger. A considerable part of the increase in asthma prevalence worldwide is due to MSP. PMID:27730206

  20. Maternal smoking in pregnancy and its influence on childhood asthma.

    PubMed

    Zacharasiewicz, Angela

    2016-07-01

    Maternal smoking in pregnancy (MSP) is a large modifiable risk factor for pregnancy related mortality and morbidity and also the most important known modifiable risk factor for asthma. This review summarises the effects of MSP throughout infancy, childhood and adolescence with regards to asthma (development and severity). Firstly, the direct damage caused by nicotine on fetal lung development, fetal growth and neuronal differentiation is discussed, as well as the indirect effects of nicotine on placental functioning. Secondly, the effects of MSP on later immune functioning resulting in increased infection rate are summarised and details are given on the effects of MSP modulating airway hyperreactivity, reducing lung function and therefore increasing asthma morbidity. Furthermore, epigenetic effects are increasingly being recognised. These can also result in transgenerational detrimental effects induced by cigarette smoke. In summary, the causal relationship between MSP and asthma development is well documented and presents a major health problem for generations to come. The high prevalence of MSP is alarming and epigenetic effects of nicotine on immune functioning potentiate this danger. A considerable part of the increase in asthma prevalence worldwide is due to MSP.

  1. Socioeconomic and Demographic Factors Influencing Feeding Practices, Morbidity Status, and Dietary Intakes of Children Aged 7-24 Months in Rural Uganda.

    PubMed

    Isingoma, Barugahara Evyline; Samuel, Mbugua; Edward, Karuri; Maina, Gakenia Wamuyu

    2017-01-01

    The objective of this study was to analyze the nutritional and morbidity patterns of children aged 7-24 months in relationship to household socioeconomic and demographic characteristics. Structured questionnaires and repeated 24-hour recalls were used to collect data. Maternal education and age influenced timing of complementary foods, dietary diversity score, meal frequency, and diarrhea incidences (p < .05). This resulted in 53%, 59%, 48%, 43%, and 22% of the study children having inadequate intake of energy, protein, vitamin A, iron, and zinc, respectively. Households need to be empowered to utilize available resources for improving nutrient intake and health among their children.

  2. Interleukin-17A Gene Expression in Morbidly Obese Women

    PubMed Central

    Zapata-Gonzalez, Fernando; Auguet, Teresa; Aragonès, Gemma; Guiu-Jurado, Esther; Berlanga, Alba; Martinez, Salomé; Martí, Andreu; Sabench, Fátima; Hernandez, Mercé; Aguilar, Carmen; Sirvent, Joan Josep; Jorba, Rosa; Del Castillo, Daniel; Richart, Cristóbal

    2015-01-01

    Data from recent studies conducted in rodent models and humans suggest that interleukin-17A (IL-17A) plays a role in the induction of inflammation in adipose tissue during obesity. The aim of this study was to assess the gene expression of IL-17A in adipose tissue of morbidly obese patients. We used RT-PCR to evaluate the expression of IL-17A and several adipo/cytokines in the visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) of 10 normal-weight control women (BMI < 25 kg/m2) and 30 morbidly obese women (MO, BMI > 40 kg/m2). We measured serum levels of IL-17A and adipo/cytokines in MO and normal weight women. IL-17A expression was significantly higher in VAT than in SAT in MO patients (p = 0.0127). It was very low in normal-weight controls in both VAT and SAT tissues. We found positive correlations between IL-17A and IL-6, lipocalin-2 and resistin in VAT of MO patients. The circulating level of IL-17A was higher in the normal-weight group than the MO patients (p = 0.032), and it was significantly related to adiponectin and TNFRII levels. In conclusion, IL-17A expression in VAT is increased in morbidly obese women, which suggests a link between obesity and innate immunity in low-grade chronic inflammation in morbidly obese women. PMID:26263971

  3. Morbidity and Mortality Weekly Report. Volume 60, Number 15

    ERIC Educational Resources Information Center

    Moolenaar, Ronald L., Ed.

    2011-01-01

    The "Morbidity and Mortality Weekly Report" ("MMWR") Series is prepared by the Centers for Disease Control and Prevention (CDC). Data presented by the Notifiable Disease Data Team and 122 Cities Mortality Data Team in the weekly "MMWR" are provisional, based on weekly reports to CDC by state health departments. This…

  4. Morbidity and Mortality Weekly Report. Volume 61, Number 33

    ERIC Educational Resources Information Center

    Moolenaar, Ronald L., Ed.

    2012-01-01

    The "Morbidity and Mortality Weekly Report" ("MMWR") Series is prepared by the Centers for Disease Control and Prevention (CDC). Data presented by the Notifiable Disease Data Team and 122 Cities Mortality Data Team in the weekly "MMWR" are provisional, based on weekly reports to CDC by state health departments. This…

  5. Morbidity and Mortality Weekly Report. Volume 61, Number 13

    ERIC Educational Resources Information Center

    Moolenaar, Ronald L., Ed.

    2012-01-01

    The "Morbidity and Mortality Weekly Report" ("MMWR") Series is prepared by the Centers for Disease Control and Prevention (CDC). Data presented by the Notifiable Disease Data Team and 122 Cities Mortality Data Team in the weekly "MMWR" are provisional, based on weekly reports to CDC by state health departments. This…

  6. Morbidity and Mortality Weekly Report. Volume 61, Number 17

    ERIC Educational Resources Information Center

    Moolenaar, Ronald L., Ed.

    2012-01-01

    The "Morbidity and Mortality Weekly Report" ("MMWR") Series is prepared by the Centers for Disease Control and Prevention (CDC). Data presented by the Notifiable Disease Data Team and 122 Cities Mortality Data Team in the weekly "MMWR" are provisional, based on weekly reports to CDC by state health departments. This…

  7. Morbidity in early Parkinson's disease and prior to diagnosis

    PubMed Central

    Frandsen, Rune; Kjellberg, Jakob; Ibsen, Rikke; Jennum, Poul

    2014-01-01

    Background Nonmotor symptoms are probably present prior to, early on, and following, a diagnosis of Parkinson's disease. Nonmotor symptoms may hold important information about the progression of Parkinson's disease. Objective To evaluated the total early and prediagnostic morbidities in the 3 years before a hospital contact leading to a diagnosis of Parkinson's disease. Methods Retrospective morbidity data from Danish National Patient Registry records (1997–2007) of 10,490 adult patients with a secondary care diagnosis of Parkinson's disease were compared with 42,505 control cases. Results Parkinson's disease was associated with significantly higher morbidity rates associated with conditions in the following categories: mental and psychiatric, nervous system, gastrointestinal, musculoskeletal system and connective tissue, genitourinary, abnormal clinical and laboratory findings, injury, poisoning and certain other external causes, and other factors influencing health status and contact with health services. It was negatively associated with neoplasm, cardiovascular, and respiratory diseases. Conclusions Patients with a diagnosis of Parkinson's disease present significant differences in morbidities early on, following, and prior to, their diagnosis, compared with healthy controls. PMID:24944873

  8. Morbid Obesity and the Transition from Welfare to Work

    ERIC Educational Resources Information Center

    Cawley, John; Danziger, Sheldon

    2005-01-01

    This paper utilizes a rich longitudinal data set--the Women's Employment Study (WES)--to investigate whether obesity, which is common among women of low socioeconomic status, is a barrier to employment and earnings for current and former welfare recipients. We find that former welfare recipients who are both White and morbidly obese have been less…

  9. Interleukin-17A Gene Expression in Morbidly Obese Women.

    PubMed

    Zapata-Gonzalez, Fernando; Auguet, Teresa; Aragonès, Gemma; Guiu-Jurado, Esther; Berlanga, Alba; Martinez, Salomé; Martí, Andreu; Sabench, Fátima; Hernandez, Mercé; Aguilar, Carmen; Sirvent, Joan Josep; Jorba, Rosa; Del Castillo, Daniel; Richart, Cristóbal

    2015-07-30

    Data from recent studies conducted in rodent models and humans suggest that interleukin-17A (IL-17A) plays a role in the induction of inflammation in adipose tissue during obesity. The aim of this study was to assess the gene expression of IL-17A in adipose tissue of morbidly obese patients. We used RT-PCR to evaluate the expression of IL-17A and several adipo/cytokines in the visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) of 10 normal-weight control women (BMI < 25 kg/m2) and 30 morbidly obese women (MO, BMI > 40 kg/m2). We measured serum levels of IL-17A and adipo/cytokines in MO and normal weight women. IL-17A expression was significantly higher in VAT than in SAT in MO patients (p = 0.0127). It was very low in normal-weight controls in both VAT and SAT tissues. We found positive correlations between IL-17A and IL-6, lipocalin-2 and resistin in VAT of MO patients. The circulating level of IL-17A was higher in the normal-weight group than the MO patients (p = 0.032), and it was significantly related to adiponectin and TNFRII levels. In conclusion, IL-17A expression in VAT is increased in morbidly obese women, which suggests a link between obesity and innate immunity in low-grade chronic inflammation in morbidly obese women.

  10. Morbidity and Mortality Weekly Report. Volume 61, Number 31

    ERIC Educational Resources Information Center

    Moolenaar, Ronald L., Ed.

    2012-01-01

    The "Morbidity and Mortality Weekly Report" ("MMWR") Series is prepared by the Centers for Disease Control and Prevention (CDC). Data presented by the Notifiable Disease Data Team and 122 Cities Mortality Data Team in the weekly "MMWR" are provisional, based on weekly reports to CDC by state health departments. This…

  11. Psychiatry Morbidity and Mortality Rounds: Implementation and Impact

    ERIC Educational Resources Information Center

    Goldman, Stuart; Demaso, David R.; Kemler, Beth

    2009-01-01

    Objective: This study assessed the implementation of psychiatry morbidity and mortality rounds (M&Ms) on the clinical and educational practice in a children's hospital. Methods: Attendees to monthly M&Ms between July 2005 and May 2007 included staff and trainees from psychiatry, psychology, nursing, and social work. Cases were selected based on a…

  12. Health and morbidity survey, Seychelles, 1956-57

    PubMed Central

    Spitz, A. J. W.

    1960-01-01

    Adequate knowledge of existing health and morbidity conditions is the basis for all planning of future health services. For this reason, a health and morbidity survey of the population of the Seychelles was carried out in 1956-57 under the joint auspices of the Seychelles Government and the World Health Organization. Statistical sampling methods were used and the information was obtained by the household interview method. Health, morbidity and relevant demographic data were thus disclosed for the first time for Seychelles. Basic information was obtained on: general morbidity of the population, including dental and nutritional status, malnutrition, incidence of intestinal diseases and other easily diagnosable conditions; growth and weight curves of children up to the age of 16; haemoglobin levels; erythrocyte sedimentation rates; general living conditions such as housing and overcrowding, social status and latrine arrangements; the connexion of soil pollution with the incidence of amoebiasis and helminthiasis; and lastly, the incidence of the sickle cell trait, eosinophilia and positive serological reactions to the Chediak test (for manifest or latent syphilis). The findings are presented with a minimum of remarks and interpretation. PMID:13833401

  13. Fetal and perinatal consequences of maternal obesity.

    PubMed

    Vasudevan, Chakrapani; Renfrew, Mary; McGuire, William

    2011-09-01

    In many industrialised countries, one in five women booking for antenatal care is obese. As well as affecting maternal health, maternal obesity may have important adverse consequences for fetal, neonatal and long-term health and well-being. Maternal obesity is associated with a higher risk of stillbirth, elective preterm birth and perinatal mortality. The incidence of severe birth defects, particularly neural tube and structural cardiac defects, appears to be higher in infants of obese mothers. Fetal macrosomia associated with maternal obesity and gestational diabetes predisposes infants to birth injuries, perinatal asphyxia and transitional problems such as neonatal respiratory distress and metabolic instability. Maternal obesity may also result in long-term health problems for offspring secondary to perinatal problems and to intrauterine and postnatal programming effects. Currently, the available interventions to prevent and treat maternal obesity are of limited proven utility and further research is needed to define the effects of maternal weight management interventions on fetal and neonatal outcomes.

  14. Maternal phobic anxiety and child anxiety.

    PubMed

    Bernstein, Gail A; Layne, Ann E; Egan, Elizabeth A; Nelson, Lara P

    2005-01-01

    The present study examined the relation between maternal anxiety symptoms and child anxiety symptoms and evaluated whether a reporting bias is associated with maternal anxiety. Fifty-seven mother-child pairs participated. All children had features or diagnoses of separation anxiety disorder (SAD), generalized anxiety disorder, and/or social phobia. Measures of maternal symptomatology and child anxiety were administered. Higher levels of maternal phobic anxiety on the Brief Symptom Inventory were significantly associated with higher levels of separation anxiety in children. After controlling for clinician rating of SAD severity, maternal phobic anxiety emerged as a significant predictor of maternal ratings of child separation anxiety, accounting for 19% of the variance. Phobic mothers endorsed levels of separation anxiety in their children that exceeded levels endorsed by clinicians, suggesting maternal overreporting.

  15. Maternal Characteristics Predicting Young Girls’ Disruptive Behavior

    PubMed Central

    van der Molen, Elsa; Hipwell, Alison E.; Vermeiren, Robert; Loeber, Rolf

    2011-01-01

    Little is known about the relative predictive utility of maternal characteristics and parenting skills on the development of girls’ disruptive behavior. The current study used five waves of parent and child-report data from the ongoing Pittsburgh Girls Study to examine these relationships in a sample of 1,942 girls from age 7 to 12 years. Multivariate Generalized Estimating Equation (GEE) analyses indicated that European American race, mother’s prenatal nicotine use, maternal depression, maternal conduct problems prior to age 15, and low maternal warmth explained unique variance. Maladaptive parenting partly mediated the effects of maternal depression and maternal conduct problems. Both current and early maternal risk factors have an impact on young girls’ disruptive behavior, providing support for the timing and focus of the prevention of girls’ disruptive behavior. PMID:21391016

  16. [Maternal mortality and perinatal mortality].

    PubMed

    Boutaleb, Y; Mesbahi, M; Lahlou, D; Aderdour, M

    1982-01-01

    94 maternal deaths and 1546 fetal and neonatal deaths were registered among 28,706 births at the CHU Averroes in Casablanca between 1978-80. 45% of women who deliver at the clinic are very poor and only 10% are relatively well off. Obstetrical antecedents were noted in 27% of the fetal deaths. 70% of the maternal deaths occurred in women aged 20-34. 32 maternal deaths occurred among 16,232 women with 1-2 children, 30 among 6514 women with 3-5 children, and 32 among 5960 women with 6-14 children. 11,027 of the 28,706 were primaparas. Perinatal mortality was 4.46% among primaparas, 8.24% among grand multiparas, and 4.1% among secondiparas. In 58 of the 94 cases of maternal mortality the woman was hospitalized after attempting delivery at home or in a village clinic. Among women with 1 or 2 children, hemorrhage was the cause of death in 8 cases, infection in 7 cases, eclampsia in 3 cases, thromboembolism in 2 cases, uterine inversion in 2 cases, pulmonary tuberculosis in 1 case, embolism in 5 cases, and other causes 1 case each. Among women with 3-5 children hemorrhage was the cause of death in 10 cases, septicemia in 3 cases, uterine rupture in 3 cases, eclampsia in 3 cases, uterine inversion in 2 cases, viral hepatitis in 2 cases, emboli in 2 cases, and other reasons 1 case each. Among grand multiparas hemorrhage was the cause of death in 11 cases, uterine rupture in 12 cases, peritonitis in 2 cases, eclampsia in 2 cases, emboli in 2 cases, and other causes 1 case each. 19 of the maternal deaths were judged to have been avoidable with better management. Prematurity and birth weight of 1000-2500 g associated or not with other pathology were found in 714 of 1546 perinatal deaths. Of 390 cases of death in utero with retention and maceration, 68 were caused by reno-vascular syndromes, 76 by maternal infections, 33 by maternal syphilis, 26 by fetal malformation, 18 by maternal diabetes, 10 by Rh incompatability, and 159 by indeterminate causes. In 795 cases of

  17. Global Morbidity and Mortality of Leptospirosis: A Systematic Review

    PubMed Central

    Calcagno, Juan; Kane, Michael; Torgerson, Paul; Martinez-Silveira, Martha S.; Stein, Claudia; Abela-Ridder, Bernadette; Ko, Albert I.

    2015-01-01

    Background Leptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis is a life-threatening disease and recognized as an important cause of pulmonary haemorrhage syndrome, the lack of global estimates for morbidity and mortality has contributed to its neglected disease status. Methodology/Principal Findings We conducted a systematic review of published morbidity and mortality studies and databases to extract information on disease incidence and case fatality ratios. Linear regression and Monte Carlo modelling were used to obtain age and gender-adjusted estimates of disease morbidity for countries and Global Burden of Disease (GBD) and WHO regions. We estimated mortality using models that incorporated age and gender-adjusted disease morbidity and case fatality ratios. The review identified 80 studies on disease incidence from 34 countries that met quality criteria. In certain regions, such as Africa, few quality assured studies were identified. The regression model, which incorporated country-specific variables of population structure, life expectancy at birth, distance from the equator, tropical island, and urbanization, accounted for a significant proportion (R2 = 0.60) of the variation in observed disease incidence. We estimate that there were annually 1.03 million cases (95% CI 434,000–1,750,000) and 58,900 deaths (95% CI 23,800–95,900) due to leptospirosis worldwide. A large proportion of cases (48%, 95% CI 40–61%) and deaths (42%, 95% CI 34–53%) were estimated to occur in adult males with age of 20–49 years. Highest estimates of disease morbidity and mortality were observed in GBD regions of South and Southeast Asia, Oceania, Caribbean, Andean, Central, and Tropical Latin America, and East Sub-Saharan Africa. Conclusions/Significance Leptospirosis is among the leading zoonotic causes of morbidity worldwide and

  18. Differential modulation of dibenzo[def,p]chrysene transplacental carcinogenesis: Maternal diets rich in indole-3-carbinol versus sulforaphane

    SciTech Connect

    Shorey, Lyndsey E.; Madeen, Erin P.; Atwell, Lauren L.; Ho, Emily; Löhr, Christiane V.; Pereira, Clifford B.; Dashwood, Roderick H.; Williams, David E.

    2013-07-01

    Cruciferous vegetable components have been documented to exhibit anticancer properties. Targets of action span multiple mechanisms deregulated during cancer progression, ranging from altered carcinogen metabolism to the restoration of epigenetic machinery. Furthermore, the developing fetus is highly susceptible to changes in nutritional status and to environmental toxicants. Thus, we have exploited a mouse model of transplacental carcinogenesis to assess the impact of maternal dietary supplementation on cancer risk in offspring. In this study, transplacental and lactational exposure to a maternal dose of 15 mg/Kg B.W. of dibenzo[def,p]chrysene (DBC) resulted in significant morbidity of offspring due to an aggressive T-cell lymphoblastic lymphoma. As in previous studies, indole-3-carbinol (I3C, feed to the dam at 100, 500 or 1000 ppm), derived from cruciferous vegetables, dose-dependently reduced lung tumor multiplicity and also increased offspring survival. Brussels sprout and broccoli sprout powders, selected for their relative abundance of I3C and the bioactive component sulforaphane (SFN), respectively, surprisingly enhanced DBC-induced morbidity and tumorigenesis when incorporated into the maternal diet at 10% wt/wt. Purified SFN, incorporated in the maternal diet at 400 ppm, also decreased the latency of DBC-dependent morbidity. Interestingly, I3C abrogated the effect of SFN when the two purified compounds were administered in equimolar combination (500 ppm I3C and 600 ppm SFN). SFN metabolites measured in the plasma of neonates positively correlated with exposure levels via the maternal diet but not with offspring mortality. These findings provide justification for further study of the safety and bioactivity of cruciferous vegetable phytochemicals at supplemental concentrations during the perinatal period. - Highlights: • Dietary supplementation may modulate cancer risk in a mouse model of lymphoma. • Cruciferous vegetables may not contain sufficient I3C

  19. Customized versus population-based birth weight charts for the detection of neonatal growth and perinatal morbidity in a cross-sectional study of term neonates.

    PubMed

    Carberry, Angela E; Raynes-Greenow, Camille H; Turner, Robin M; Jeffery, Heather E

    2013-10-15

    Customized birth weight charts that incorporate maternal characteristics are now being adopted into clinical practice. However, there is controversy surrounding the value of these charts in the prediction of growth and perinatal outcomes. The objective of this study was to assess the use of customized charts in predicting growth, defined by body fat percentage, and perinatal morbidity. A total of 581 term (≥37 weeks' gestation) neonates born in Sydney, Australia, in 2010 were included. Body fat percentage measurements were taken by using air displacement plethysmography. Objective composite measurements of perinatal morbidity were used to identify neonates who had poor outcomes; these data were extracted from medical records. The value of customized charts was assessed by calculating positive predictive values, negative predictive values, and odds ratios with 95% confidence intervals. Customized versus population-based charts did not improve the prediction of either low body fat percentage (59% vs. 66% positive predictive value and 87% vs. 89% negative predictive value, respectively) or high body fat percentage (48% vs. 53% positive predictive value and 90% vs. 89% negative predictive value, respectively). Customized charts were not better than population-based charts at predicting perinatal morbidity (for customized charts, odds ratio = 1.02, 95% confidence interval: 1.01, 1.04; for population-based charts, odds ratio = 1.03, 95% confidence interval: 1.01, 1.05) per percentile decrease in birth weight. Customized birth weight charts do not provide significant improvements over population-based charts in predicting neonatal growth and morbidity.

  20. Morbidity, Mortality, and Seasonality of Influenza Hospitalizations in Egypt, November 2007-November 2014

    PubMed Central

    Kandeel, Amr; Labib, Manal; Said, Mayar; El-Refai, Samir; El-Gohari, Amani; Talaat, Maha

    2016-01-01

    Background Influenza typically comprises a substantial portion of acute respiratory infections, a leading cause of mortality worldwide. However, influenza epidemiology data are lacking in Egypt. We describe seven years of Egypt’s influenza hospitalizations from a multi-site influenza surveillance system. Methods Syndromic case definitions identified individuals with severe acute respiratory infection (SARI) admitted to eight hospitals in Egypt. Standardized demographic and clinical data were collected. Nasopharyngeal and oropharyngeal swabs were tested for influenza using real-time reverse transcription polymerase chain reaction and typed as influenza A or B, and influenza A specimens subtyped. Results From November 2007–November 2014, 2,936/17,441 (17%) SARI cases were influenza-positive. Influenza-positive patients were more likely to be older, female, pregnant, and have chronic condition(s) (all p<0.05). Among them, 53 (2%) died, and death was associated with older age, five or more days from symptom onset to hospitalization, chronic condition(s), and influenza A (all p<0.05). An annual seasonal influenza pattern occurred from July–June. Each season, the proportion of the season’s influenza-positive cases peaked during November–May (19–41%). Conclusions In Egypt, influenza causes considerable morbidity and mortality and influenza SARI hospitalization patterns mirror those of the Northern Hemisphere. Additional assessment of influenza epidemiology in Egypt may better guide disease control activities and vaccine policy. PMID:27607330

  1. The Evolution of Multivariate Maternal Effects

    PubMed Central

    Kuijper, Bram; Johnstone, Rufus A.; Townley, Stuart

    2014-01-01

    There is a growing interest in predicting the social and ecological contexts that favor the evolution of maternal effects. Most predictions focus, however, on maternal effects that affect only a single character, whereas the evolution of maternal effects is poorly understood in the presence of suites of interacting traits. To overcome this, we simulate the evolution of multivariate maternal effects (captured by the matrix M) in a fluctuating environment. We find that the rate of environmental fluctuations has a substantial effect on the properties of M: in slowly changing environments, offspring are selected to have a multivariate phenotype roughly similar to the maternal phenotype, so that M is characterized by positive dominant eigenvalues; by contrast, rapidly changing environments favor Ms with dominant eigenvalues that are negative, as offspring favor a phenotype which substantially differs from the maternal phenotype. Moreover, when fluctuating selection on one maternal character is temporally delayed relative to selection on other traits, we find a striking pattern of cross-trait maternal effects in which maternal characters influence not only the same character in offspring, but also other offspring characters. Additionally, when selection on one character contains more stochastic noise relative to selection on other traits, large cross-trait maternal effects evolve from those maternal traits that experience the smallest amounts of noise. The presence of these cross-trait maternal effects shows that individual maternal effects cannot be studied in isolation, and that their study in a multivariate context may provide important insights about the nature of past selection. Our results call for more studies that measure multivariate maternal effects in wild populations. PMID:24722346

  2. Current Concepts of Maternal Nutrition

    PubMed Central

    Lowensohn, Richard I.; Stadler, Diane D.; Naze, Christie

    2016-01-01

    Background A nutrient-rich maternal diet before and during pregnancy is associated with improved fetal health, more appropriate birth weight, and increased rates of maternal and infant survival. Physicians need a better understanding of the role of diet in shaping fetal outcomes. Given this background, we reviewed and summarized articles on maternal nutrition found in MEDLINE since 1981, written in English, and limited to human subjects. For the Offspring Maternal diets high in sugar and fat lead to an increased incidence of metabolic syndrome, diabetes, and cardiovascular disease later in life. Folic acid should be supplemented prior to conception and continued through at least the first 28 days of fetal life to prevent neural tube defects, and vitamin C should be given to women who smoke to lower the incidence of asthma and wheezing in the children. Iodine deficiency is increasing, and iodine should be included in prenatal supplements. If the maternal hemoglobin is 7 g/dL or more, there is no evidence that iron supplementation is needed. Fish intake during pregnancy is protective against atopic outcomes, whereas high-meat diets contribute to elevated adult blood pressure and hypersecretion of cortisol. For the Mother Calcium supplementation lowers the risk of preeclampsia and hypertensive disease in pregnancy. Conclusions Given the limits of our current knowledge, a diet rich in whole grains, fruits, vegetables, and selected fish is desirable for the best outcomes. Diets high in sugar and fat lead to higher rates of diabetes, metabolic syndrome, and cardiovascular disease. Folic acid, iodine, and calcium in all pregnant women and vitamin C in smokers are the only supplements so far shown to be of value for routine use. The physician treating a pregnant woman should be ready to advise a healthy diet for the benefit of the fetus. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After participating in this activity, the

  3. Moderately elevated intracranial pressure after diffuse traumatic brain injury is associated with exacerbated neuronal pathology and behavioral morbidity in the rat

    PubMed Central

    Lafrenaye, Audrey D; Krahe, Thomas E; Povlishock, John T

    2014-01-01

    Traumatic brain injury (TBI)-induced elevated intracranial pressure (ICP) is correlated with ensuing morbidity/mortality in humans. This relationship is assumed to rely mostly on the recognition that extremely elevated ICP either indicates hematoma/contusions capable of precipitating herniation or alters cerebral perfusion pressure (CPP), which precipitates global ischemia. However, whether subischemic levels of elevated ICP without hematoma/contusion contribute to increased morbidity/mortality remains unknown. To address this knowledge gap, we utilized a model of moderate diffuse TBI in rats followed by either intraventricular ICP monitoring or manual ICP elevation to 20 mm Hg, in which CPP was above ischemic levels. The effects of ICP elevation after TBI on acute and chronic histopathology, as well as on behavioral morbidity, were evaluated. ICP elevation after TBI resulted in increased acute neuronal membrane perturbation and was also associated with reduced neuronal density at 4 weeks after injury. Somatosensory hypersensitivity was exacerbated by ICP elevation and was correlated to the observed neuronal loss. In conclusion, this study indicates that morbidity and increased neuronal damage/death associated with elevated ICP can occur without concurrent global ischemia. Therefore, understanding the pathologies associated with subischemic levels of elevated ICP could lead to the development of better therapeutic strategies for the treatment and management of TBI patients. PMID:25027309

  4. Association between pneumonia in acute stroke stage and 3-year mortality in patients with acute first-ever ischemic stroke.

    PubMed

    Yu, Yi-Jing; Weng, Wei-Chieh; Su, Feng-Chieh; Peng, Tsung-I; Chien, Yu-Yi; Wu, Chia-Lun; Lee, Kuang-Yung; Wei, Yi-Chia; Lin, Shun-Wen; Zhu, Jun-Xiao; Huang, Wen-Yi

    2016-11-01

    The influence of pneumonia in acute stroke stage on the clinical presentation and long-term outcomes of patients with acute ischemic stroke is still controversial. We investigate the influence of pneumonia in acute stroke stage on the 3-year outcomes of patients with acute first-ever ischemic stroke. Nine-hundred and thirty-four patients with acute first-ever ischemic stroke were enrolled and had been followed for 3years. Patients were divided into two groups according to whether pneumonia occurred during acute stroke stage or not. Clinical presentations, risk factors for stroke, laboratory data, co-morbidities, and outcomes were recorded. The result showed that a total of 100 patients (10.7%) had pneumonia in acute stroke stage. The prevalence of older age, atrial fibrillation was significantly higher in patients with pneumonia in acute stroke stage. Total anterior circulation syndrome and posterior circulation syndrome occurred more frequently among patients with pneumonia in acute stroke stage (P<0.001 and P=0.009, respectively). Multivariate Cox regression revealed that pneumonia in acute stroke stage is a significant predictor of 3-year mortality (hazard ratio=6.39, 95% confidence interval=4.03-10.11, P<0.001). In conclusion, pneumonia during the acute stroke stage is associated with increased risk of 3-year mortality. Interventions to prevent pneumonia in acute stroke stage might improve ischemic stroke outcome.

  5. Prenatal Screening Using Maternal Markers

    PubMed Central

    Cuckle, Howard

    2014-01-01

    Maternal markers are widely used to screen for fetal neural tube defects (NTDs), chromosomal abnormalities and cardiac defects. Some are beginning to broaden prenatal screening to include pregnancy complications such as pre-eclampsia. The methods initially developed for NTDs using a single marker have since been built upon to develop high performance multi-maker tests for chromosomal abnormalities. Although cell-free DNA testing is still too expensive to be considered for routine application in public health settings, it can be cost-effective when used in combination with existing multi-maker marker tests. The established screening methods can be readily applied in the first trimester to identify pregnancies at high risk of pre-eclampsia and offer prevention though aspirin treatment. Prenatal screening for fragile X syndrome might be adopted more widely if the test was to be framed as a form of maternal marker screening. PMID:26237388

  6. Maternal obesity and prenatal programming.

    PubMed

    Elshenawy, Summer; Simmons, Rebecca

    2016-11-05

    Obesity is a significant and increasing public health concern in the United States and worldwide. Clinical and epidemiological evidence clearly shows that genetic and environmental factors contribute to the increased susceptibility of humans to obesity and its associated comorbidities; the interplay of these factors is explained by the concept of epigenetics. The impact of maternal obesity goes beyond the newborn period; fetal programming during the critical window of pregnancy, can have long term detrimental effects on the offspring as well as future generations. Emerging evidence is uncovering a link between the clinical and molecular findings in the offspring with epigenetic changes in the setting of maternal obesity. Research targeted towards reducing the transgenerational propagation and developmental programming of obesity is vital in reducing the increasing rates of disease.

  7. Breech presentation: increasing maternal choice.

    PubMed

    Tiran, Denise

    2004-11-01

    Pregnant women with a third trimester breech presentation are almost invariably offered Caesarean section as the mode of delivery of first choice, especially when external version has failed to turn the fetus to cephalic. However, increasingly women are resorting to alternatives, to avoid either operative delivery or manipulative intervention in late pregnancy. This paper reviews some of the options for women with breech presentation, focusing especially on integrating these options into conventional maternity care.

  8. Maternal food restrictions during breastfeeding

    PubMed Central

    Jeong, Goun; Park, Sung Won; Lee, Yeon Kyung; Ko, Sun Young

    2017-01-01

    Purpose This study investigated self-food restriction during breastfeeding, reviewed the literature showing the effect of maternal diet on the health of breast-fed infants, and explored the validity of dietary restrictions. Methods Questionnaire data were collected from breastfeeding Korean mothers who visited the pediatric clinic of Cheil General Hospital & Women's Healthcare Center from July 2015 through August 2015. The survey included items assessing maternal age, number of children, maternal educational attainment, household income, degree of difficulty with self-food restriction, types of self-restricted foods, dietary customs during breastfeeding, and sources of information about breastfeeding. Results The questionnaire was completed by 145 mothers. More than a third (n=56, 39%) had discomfort from and usually avoided 4–5 types of food (mean, 4.92). Mothers younger than 40 years had more discomfort (odds ratio [OR], 12.762; P=0.017). Primiparas felt less discomfort than multiparas (OR, 0.436; P=0.036). Dietary practices were not influenced by maternal educational attainment or household income. The most common self-restricted foods were caffeine (n=131, 90.3%), spicy foods (n=124, 85.5%), raw foods (n=109, 75.2%), cold foods (n=100, 69%), and sikhye (traditional sweet Korean rice beverage) (n=100, 69%). Most mothers (n=122, 84.1%) avoided foods for vague reasons. Conclusion Most mothers restricted certain foods unnecessarily. Literature review identified no foods that mothers should absolutely avoid during breastfeeding unless the infant reacts negatively to the food. PMID:28392822

  9. Trajectories of parenting behavior and maternal depression.

    PubMed

    Azak, Schale; Raeder, Sabine

    2013-06-01

    This study investigated trajectories of maternal parenting behavior across the infants' first 18 months of life in relation to maternal depression. Furthermore, predictors of the quality of the mother-infant relationship at 18 months were examined. Participants consisted of three types of mother-infant dyads: mothers with comorbid depression and anxiety (n=19), mothers with depression (n=7) and nondepressed mothers (n=24). Maternal behaviors and the quality of relationship were rated on a global scale (NICHD) from video-taped mother-infant interactions. Maternal behaviors rated at six, 12 and 18 months were collapsed into a composite variable maternal style. The quality of the relationship captured as dyadic mutuality was rated at 18 months. Comorbid and depressed mothers showed lower quality in maternal style compared with the nondepressed mothers at six months. Over the follow-up the comorbid mothers were lower in maternal style compared to the nondepressed mothers, but the comorbid mothers increased significantly in maternal style despite elevated depression symptoms. Mean maternal style and infant cognitive skills predicted the quality in relationship at 18 months suggesting that the mother-toddler relationship depends on contributions from the mother and the child. Higher growth in maternal style despite of depression symptoms among comorbid mothers was interpreted against the background that the majority of the comorbid mother-infant dyads received several treatments.

  10. [The fibrinolytic treatment with urokinase of acute arterial thrombosis].

    PubMed

    Ballester, A; Donato di Paola, M; Saccà, A; Cappello, I; D'Addato, M

    1993-01-01

    We present our experiences on 86 patients with acute arterial thrombosis of the legs, undergoing a fibrinolytic treatment with urokinase. Results from the treatment are analyzed according to: the administration way (systemic, locoregional, intrathrombotic), the level of thrombosis (upper or lower legs), the associated morbidity and mortality.

  11. Socioeconomic inequities patterns of multi-morbidity in early adolescence

    PubMed Central

    2013-01-01

    Background Multi-morbidity such as cumulating mental health, behavioral, and school difficulties (consumptions of alcohol, tobacco, cannabis, and hard drugs, obesity, depressive symptoms, suicide attempts, involvement in violence, and low school performance) is common in early adolescence and can be favored by a number of socioeconomic factors (gender, age, nationality, family structure, parents’ education, father’ occupation, and income). This study assessed the concurrent roles of various socioeconomic factors in multi-morbidity defined as cumulated number of difficulties (CD) which has been partially documented. Methods Adolescents from middle schools in north-eastern France (N = 1,559) completed a questionnaire measuring socioeconomic characteristics and mental health, behavioral, and school difficulties. Data were analyzed using logistic regression models. Results Alcohol use affected 35.2% of subjects, tobacco use 11.2%, cannabis use 5.6%, hard drugs use 2.8%, obesity 10.6%, depressive symptoms 13.3%, suicide attempts 9.9%, involvement in violence 10.3%, and low school performance 8.2%. Insufficient income and non-intact families impacted most mental health, behavioral, and school difficulties with adjusted odds ratios (ORa) between 1.51 and 3.72. Being immigrant impacted illicit drugs use and low school performance (ORa 2.31-4.14); low parents’ education depressive symptoms (1.42) and school performance (3.32); and manual-worker/inactive offspring low school performance (2.56-3.05). Multi-morbidity was very common: CD0 44.1%, CD1 30.8%, CD2-3 18.4%, and CD ≥ 4 6.7%. Insufficient income, divorced/separated parents, reconstructed families, and single parents played impressive roles with strong ORa gradients (reaching 4.86) from CD1 to CD ≥ 4. Being European immigrant, low parents’ education, and low fathers’ occupations had significant gender-age-adjusted odds ratios for CD2-3 and CD ≥ 4, but these became non-significant when adjusted for

  12. Morbidity and mortality in ESRD patients on dialysis.

    PubMed

    Al Wakeel, Jamal S; Mitwalli, Ahmed H; Al Mohaya, S; Abu-Aisha, Hassan; Tarif, Nauman; Malik, Ghulam H; Hammad, D

    2002-01-01

    End-stage renal disease (ESRD), due to its high morbidity and mortality as well as social and financial implications, is a major public health problem. Outcome depends not only on different modalities of treatment like hemodialysis and peritoneal dialysis, but also on existing co-morbidities, age, duration on dialysis, supportive therapies and infection control strategies. Thus, a detailed study becomes necessary to improve health care delivery, provide medical care and to establish a geographical reference. The present study was undertaken to characterize the ESRD patients by their demographic and co-morbid conditions and relate this to the morbidity and mortality trends. The medical records of 110 ESRD patients seen over a five-year period (June 1995 to December 1999) in two tertiary-care hospitals in Riyadh, Saudi Arabia were studied retrospectively. There were 79 (64.5%) males and 31 (35.5%) females; their age ranged from 17 to 92 years (mean age 53.8 +/- 17.8 years). Diabetes was the commonest cause of ESRD seen in 26 (26.6%) followed by nephrosclerosis, unknown etiology, lupus nephritis, pyelonephritis and primary glomerulonephritis. Diabetes mellitus was the most prevalent co-morbidity seen during the study period and occurred in 65 patients (59%) followed by heart disease in 36 (32.7%), liver disease in 30 (27.3%), cerebrovascular accidents in 13 (11.8%) and neoplasm in 11 (10%). Seven (6.3%) patients only were smokers. Hemodialysis was the most frequent treatment choice as renal replacement therapy. Among the causes of hospitalization, cardiovascular conditions were the leading single cause (19.1%), followed by access related reasons and infections (11.5% each). The overall hospitalization rate was 11.2 days/year. The overall mortality rate was 8.07 deaths/year. The leading cause of death was cardiovascular in 15 (51.7%) followed by unknown/sudden death in eight (27.5%). Other causes of death included fluid overload, gastrointestinal hemorrhage, septicemia

  13. Maternal and child undernutrition and overweight in low-income and middle-income countries.

    PubMed

    Black, Robert E; Victora, Cesar G; Walker, Susan P; Bhutta, Zulfiqar A; Christian, Parul; de Onis, Mercedes; Ezzati, Majid; Grantham-McGregor, Sally; Katz, Joanne; Martorell, Reynaldo; Uauy, Ricardo

    2013-08-03

    Maternal and child malnutrition in low-income and middle-income countries encompasses both undernutrition and a growing problem with overweight and obesity. Low body-mass index, indicative of maternal undernutrition, has declined somewhat in the past two decades but continues to be prevalent in Asia and Africa. Prevalence of maternal overweight has had a steady increase since 1980 and exceeds that of underweight in all regions. Prevalence of stunting of linear growth of children younger than 5 years has decreased during the past two decades, but is higher in south Asia and sub-Saharan Africa than elsewhere and globally affected at least 165 million children in 2011; wasting affected at least 52 million children. Deficiencies of vitamin A and zinc result in deaths; deficiencies of iodine and iron, together with stunting, can contribute to children not reaching their developmental potential. Maternal undernutrition contributes to fetal growth restriction, which increases the risk of neonatal deaths and, for survivors, of stunting by 2 years of age. Suboptimum breastfeeding results in an increased risk for mortality in the first 2 years of life. We estimate that undernutrition in the aggregate--including fetal growth restriction, stunting, wasting, and deficiencies of vitamin A and zinc along with suboptimum breastfeeding--is a cause of 3·1 million child deaths annually or 45% of all child deaths in 2011. Maternal overweight and obesity result in increased maternal morbidity and infant mortality. Childhood overweight is becoming an increasingly important contributor to adult obesity, diabetes, and non-communicable diseases. The high present and future disease burden caused by malnutrition in women of reproductive age, pregnancy, and children in the first 2 years of life should lead to interventions focused on these groups.

  14. Emergency Surgery for Acute Complicated Diverticulitis

    PubMed Central

    Köckerling, Ferdinand

    2015-01-01

    Background The optimal treatment of acute complicated diverticulitis is a matter of debate and has undergone significant changes. Currently, the main focus of surgical treatment concepts is on controlling the emergency situation triggered by acute complicated sigmoid diverticulitis through interventional and minimally invasive measures. Methods This article presents the current data and recommendations on differentiated treatment of acute complicated sigmoid diverticulitis, which are also summarized in a decision tree. Results In general, resection of the diverticular sigmoid is needed to treat acute complicated sigmoid diverticulitis, because without resection the recurrence rate is too high at 40%. Since the morbidity and mortality rates associated with emergency resection are extremely high, resulting in the creation of a stoma, efforts are made to control the acute situation through interventional and laparoscopic measures. Therefore, pericolic and pelvic abscesses (Hinchey stages I, II) are eliminated through percutaneous or laparoscopic drainage. Likewise, laparoscopic lavage and drainage are performed for purulent and feculent peritonitis (Hinchey stages III, IV). After elimination of the acute septic situation, interval elective sigmoid resection is conducted. If emergency resection cannot be avoided, it is performed, while taking account of the patient's overall condition, with primary anastomosis and a protective stoma or as discontinuity resection using Hartmann's procedure. Conclusion Thanks to the progress made in interventional and laparoscopic treatment, differentiated concepts are now used to treat acute complicated sigmoid diverticulitis. PMID:26989380

  15. The Feto-Maternal Outcome of Preeclampsia with Severe Features and Eclampsia in Abakaliki, South-East Nigeria

    PubMed Central

    Ozonu, Nelson Chukwudi; Ezeonu, Paul Olisaemeka; Lawani, Lucky Osaheni; Obuna, Johnson Akuma; Onwe, Emeka Ogah

    2016-01-01

    Introduction Preeclampsia with severe features and eclampsia has remained a serious challenge in tropical obstetric practice. It is a major cause of maternal and perinatal morbidity and mortality in Nigeria. Aim This study was aimed at determining the prevalence, the risk factors and feto-maternal outcome of preeclampsia with severe features and eclampsia in Abakaliki. Materials and Methods This was a 5-year retrospective case-control study of preeclampsia with severe features and eclampsia at the Federal Teaching Hospital, Abakaliki. Case notes of preeclampsia with severe features and eclampsia between January 2008 and December, 2012 were retrieved. Similarly, the case file of next parturient that did not have any medical disease was included in the study. The cases and controls were selected at the ratio of 1:1. The data assessed were information on maternal age, parity, booking status, diagnosis, mode of delivery, complications, maternal and perinatal outcomes. Results A total of 13,750 deliveries were recorded within the study period. The prevalence of preeclampsia with severe features and eclampsia were 136(0.99%) and 104(0.76%) respectively. Preeclampsia with severe features and eclampsia was more common among adolescents, rural dwellers, poorly educated, unemployed, unbooked and nulliparous women. It was more associated with preterm delivery, caesarean section, low birth weight babies, maternal and perinatal mortality. Conclusion Preeclampsia with severe features and eclampsia is common among the adolescents, unbooked, rural, and low socio-economic group of women in this study. It has also contributed to high maternal and perinatal morbidity and mortality. There is need for policy makers to formulate policies toward female education, women empowerment and provision of social amenities in rural areas. These policies may reverse the current ugly trend in this environment. PMID:27790527

  16. Paternal and maternal influences on the psychological well-being of Chinese adolescents.

    PubMed

    Shek, D T

    1999-08-01

    Adolescents' (N = 378) perceptions of and satisfaction with parenting styles, perceived parent-adolescent conflict, perceived frequency of parent-adolescent communication and related feelings, perceived parent-adolescent relationship, and mental health were assessed with rating scales and structured interviews on 2 occasions separated by 1 year. Results showed that the questionnaire and interview measures at each time could be grouped into 2 stable factors: Paternal Parenthood Qualities (PPQ) and Maternal Parenthood Qualities (MPQ). Although both factors generally had significant concurrent and longitudinal correlations with adolescents' mental health, PPQ at Time 1-predicted changes in adolescent life satisfaction, hopelessness, self-esteem, purpose in life, and general psychiatric morbidity at Time 2, whereas MPQ at Time 1 did not predict those changes. Adolescents' mental health at Time 1 was found to predict changes in MPQ but not PPQ at Time 2. Relative to maternal qualities, paternal qualities were generally found to exert a stronger impact on adolescent psychological well-being.

  17. Does maternal autonomy influence feeding practices and infant growth in rural India?

    PubMed

    Shroff, Monal R; Griffiths, Paula L; Suchindran, Chirayath; Nagalla, Balakrishna; Vazir, Shahnaz; Bentley, Margaret E

    2011-08-01

    The high prevalence of child under-nutrition remains a profound challenge in the developing world. Maternal autonomy was examined as a determinant of breast feeding and infant growth in children 3-5 months of age. Cross-sectional baseline data on 600 mother-infant pairs were collected in 60 villages in rural Andhra Pradesh, India. The mothers were enrolled in a longitudinal randomized behavioral intervention trial. In addition to anthropometric and demographic measures, an autonomy questionnaire was administered to measure different dimensions of autonomy (e.g. decision-making, freedom of movement, financial autonomy, and acceptance of domestic violence). We conducted confirmatory factor analysis on maternal autonomy items and regression analyses on infant breast feeding and growth after adjusting for socioeconomic and demographic variables, and accounting for infant birth weight, infant morbidity, and maternal nutritional status. Results indicated that mothers with higher financial autonomy were more likely to breastfeed 3-5 month old infants. Mothers with higher participation in decision-making in households had infants that were less underweight and less wasted. These results suggest that improving maternal financial and decision-making autonomy could have a positive impact on infant feeding and growth outcomes.

  18. Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort

    PubMed Central

    Manktelow, Bradley N; Piedvache, Aurelie; Cuttini, Marina; Boyle, Elaine; van Heijst, Arno; Gadzinowski, Janusz; Van Reempts, Patrick; Huusom, Lene; Weber, Tom; Schmidt, Stephan; Barros, Henrique; Dillalo, Dominico; Toome, Liis; Norman, Mikael; Blondel, Beatrice; Bonet, Mercedes; Draper, Elisabeth S; Maier, Rolf F

    2016-01-01

    Objectives To evaluate the implementation of four high evidence practices for the care of very preterm infants to assess their use and impact in routine clinical practice and whether they constitute a driver for reducing mortality and neonatal morbidity. Design Prospective multinational population based observational study. Setting 19 regions from 11 European countries covering 850 000 annual births participating in the EPICE (Effective Perinatal Intensive Care in Europe for very preterm births) project. Participants 7336 infants born between 24+0 and 31+6 weeks’ gestation in 2011/12 without serious congenital anomalies and surviving to neonatal admission. Main outcome measures Combined use of four evidence based practices for infants born before 28 weeks’ gestation using an “all or none” approach: delivery in a maternity unit with appropriate level of neonatal care; administration of antenatal corticosteroids; prevention of hypothermia (temperature on admission to neonatal unit ≥36°C); surfactant used within two hours of birth or early nasal continuous positive airway pressure. Infant outcomes were in-hospital mortality, severe neonatal morbidity at discharge, and a composite measure of death or severe morbidity, or both. We modelled associations using risk ratios, with propensity score weighting to account for potential confounding bias. Analyses were adjusted for clustering within delivery hospital. Results Only 58.3% (n=4275) of infants received all evidence based practices for which they were eligible. Infants with low gestational age, growth restriction, low Apgar scores, and who were born on the day of maternal admission to hospital were less likely to receive evidence based care. After adjustment, evidence based care was associated with lower in-hospital mortality (risk ratio 0.72, 95% confidence interval 0.60 to 0.87) and in-hospital mortality or severe morbidity, or both (0.82, 0.73 to 0.92), corresponding to an estimated 18% decrease

  19. Reporting hospital adverse events using the Alfred Hospital's morbidity data.

    PubMed

    Carroll, Rhonda; McLean, Jenny; Walsh, Michael

    2003-01-01

    Hospital morbidity data were analysed to determine their usefulness for reporting adverse events. The entire ICD-10-AM classification system was reviewed in conjunction with the Australian Coding Standards to identify external cause codes and code prefixes associated with adverse events. For the 50,712 separations registered at The Alfred from July 2000-June 2001, 4,740 external cause codes were associated with adverse events. Place of occurrence code CY92.22 was considered the best indicator of the number of separations associated with adverse events. Approximately 4% of all separations were associated with adverse events occurring during an episode of care. Results suggest that hospital morbidity data are useful for monitoring adverse events at hospital level. Reliable reporting across the health care industry requires consistent reporting requirements at state and national levels and the adoption of standard code prefixes nationally.

  20. [MORBIDITY OF SUBMARINE CREW SAILORS IN LONG-DISTANCE CRUISES].

    PubMed

    Myznikov, I L; Burtsev, N N; Bondarenko N V; Khamidullina, A Ya

    2015-01-01

    Morbidity among the personnel of a Kola-based (beyond the Arctic circle) atomic (ASM) and diesel-powered (DSM) submarines in the course of long-distance cruises in different waters of the world ocean was studied. Statistics was collected from the reports of submarine medical officers since 1969. Levels and causes of morbidity were analyzed. According to the data of many years' observations, within the structure of primary diseases of military contractors on cruises the leading place has been occupied by respiratory disorders followed by skin and subcutaneous fat problems, and digestive diseases. Incidence of chronic diseases among ASM and DSM personnel was evaluated. The authors raise the issue of dental care quality provided to submariners.

  1. Family violence and maltreatment of women during the perinatal period: Associations with infant morbidity in Indian slum communities

    PubMed Central

    Silverman, Jay G.; Balaiah, Donta; Decker, Michele R.; Ritter, Julie; Naik, D.D.; Nair, Saritha; Saggurti, Niranjan; Raj, Anita

    2015-01-01

    Objectives To determine the prevalence of non-violent, gender-based forms of maltreatment of women by husbands and in-laws (i.e., gender-based household maltreatment; GBHM) during pregnancy and postpartum; to clarify the role of GBHM in compromising infant health, and whether this role extends beyond that previously observed for intimate partner violence (IPV). Methods Cross-sectional, quantitative data were collected from women (ages 15-35) seeking immunizations for their infants <6 months of age (N=1061) in urban health centers in Mumbai, India. Logistic regression models were constructed to assess associations between maternal abuse (perinatal IPV, in-law violence and GBHM) and recent infant morbidity (diarrhea, respiratory distress, fever, colic and vomiting). Results More than one in four women (28.4%) reported IPV during their recent pregnancy and/or during the postpartum period, 2.6% reported perinatal violence from in-laws, and 49.0% reported one or more forms of perinatal GBHM. In adjusted regression models that included all forms of family violence and maltreatment, perinatal GBHM remained significantly associated with infant morbidity (AORs 1.4-1.9); perinatal IPV and in-law violence ceased to predict infant morbidity in models including GBHM. Conclusions Findings indicate that non-violent expressions of gender inequity (e.g., nutritional deprivation, deprivation of sleep, blocking access to health care during pregnancy) are more strongly associated with poor infant health than physical or sexual violence from husbands or in-laws in urban India. These results strongly suggest the need to expand the conception of gender inequities beyond IPV to include non-violent forms of gendered mistreatment in considering their impact on infant health. PMID:26440937

  2. Maternal and Perinatal Outcomes of Exercise in Pregnant Women with Chronic Hypertension and/or Previous Preeclampsia: A Randomized Controlled Trial

    PubMed Central

    Kasawara, Karina Tamy; Burgos, Camila Schneider Gannuny; do Nascimento, Simony Lira; Ferreira, Néville Oliveira; Surita, Fernanda Garanhani; Pinto e Silva, João Luiz

    2013-01-01

    Objectives. To evaluate the association between physical exercise supervised in pregnant women with chronic hypertension and/or previous preeclampsia and maternal and neonatal outcomes. Method. Randomized controlled trial, which included 116 pregnant women with chronic hypertension and/or previous preeclampsia, considered risk of preeclampsia development. They were divided into two groups: study group that performed physical exercise with a stationary bicycle once a week, for 30 minutes; the intensity was controlled (heart rate 20% above resting values), under professional supervision and a control group that was not engaged in any physical exercise. The data was retrieved from medical charts. Significance level assumed was 5%. Results. Women from study group performed 9.24 ± 7.03 of physical exercise sessions. There were no differences between groups comparing type of delivery and maternal outcomes, including maternal morbidity and hospitalization in intensive unit care, and neonatal outcomes, including birth weight, adequacy of weight to gestational age, prematurity, Apgar scale at first and fifth minutes, hospitalization in intensive unit care, and neonatal morbidity. Conclusions. Physical exercise using a stationary bicycle in pregnant women with chronic hypertension and/or previous preeclampsia, once a week, under professional supervision, did not interfere in the delivery method and did not produce maternal and neonatal risks of the occurrence of morbidity. This trial is registered with ClinicalTrials.gov NCT01395342. PMID:23997960

  3. [Ankylosing spondylitis is associated with increased cardiovascular morbidity and mortality].

    PubMed

    Madsen, Ole Rintek; Lindhardsen, Jesper

    2011-05-23

    Ankylosing spondylitis is an inflammatory disorder primarily affecting the axial skeleton. The disease is associated with increased cardiovascular morbidity and mortality. Structural changes in the heart, and arteriosclerosis secondary to inflammation may be of importance. The role of traditional cardiovascular risk factors and of anti-inflammatory treatment is unclear. Tumor necrosis factor inhibitors seem to increase cholesterol levels. Evaluation of the cardiovascular risk in these patients should be considered. Cardiovascular risk factors should be managed according to ordinary guidelines.

  4. Poor compensatory hyperventilation in morbidly obese women at peak exercise.

    PubMed

    Zavorsky, Gerald S; Murias, Juan M; Kim, Do Jun; Gow, Jennifer; Christou, Nicolas V

    2007-11-15

    This study was designed to compare differences in pulmonary gas exchange at rest and at peak exercise in two groups of women: (1) physically active, non-obese women and (2) women with morbid obesity. Fourteen morbidly obese women (body mass index or BMI=49+/-7 kg/m2; peak oxygen consumption or VO2 peak=14+/-2 ml/(kg min)) and 14 physically active non-obese women (BMI=22+/-2 kg/m2; VO2 peak=50+/-6 ml/(kg min)) performed an incremental, ramped exercise test to exhaustion on a cycle ergometer. Arterial blood was sampled at rest and at peak exercise. At rest, the alveolar to arterial oxygen partial pressure difference was 3x higher in the obese women (14+/-10 mmHg) compared to non-obese women (5+/-4 mmHg). Arterial carbon dioxide pressure (PaCO2) was identical in both groups at rest (37+/-4 mmHg). Only the non-obese women showed a decrease in PaCO2 rest to peak exercise (-5+/-3 mmHg). The slope between heart rate and VO2 during exercise was higher in the morbidly obese compared to non-obese women indicating that for the same absolute increase in VO2 a larger increase in heart rate is needed, demonstrating poorer cardiac efficiency in obese women. In conclusion, morbidly obese women have poorer exercise capacity, cardiac efficiency, and compensatory hyperventilation at peak exercise, and poorer gas exchange at rest compared to physically active, non-obese women.

  5. The Role of Co-morbidities in Cardioprotection

    PubMed Central

    Sack, Michael; Murphy, Elizabeth

    2012-01-01

    Cardioprotective strategies such as pre and postconditioning result in a robust reduction in infarct size in young, healthy male animals. However there are data suggesting that the protection is diminished in animals with co-morbidities such as hypertension, hypercholesterolemia and diabetes. It is important to understand at a mechanistic level the reasons for these differences. The effects of sex and diseases need to be considered in design of cardioprotective interventions in animal studies and clinical trials. PMID:21821527

  6. Psychiatric morbidity among cocaine and heroin users in the community.

    PubMed

    Tortajada, Silvia; Herrero, Ma Jesús; Domingo-Salvany, Antònia; Molist, Gemma; Barrio, Gregorio; de la Fuente, Luís; Brugal, Ma Teresa

    2012-01-01

    Drug abuse is a serious public health problem. Moreover, co-occurring mental health and substance abuse disorders are common among drug users. This paper examines psychiatric disorders of young cocaine and heroin users using the World Mental Health Composite International Diagnostic Interview (WMH-CIDI). A cohort of 1266 young (18-30 years) current regular cocaine (705) and heroin (561) users were recruited outside the health services in Barcelona, Madrid and Seville, Spain. The WMH-CIDI was used to evaluate mental disorders; the Severity of Dependence Scale (SDS) measured the degree of dependence; and the Duke-UNC Functional Social Support Questionnaire (FSSQ) assessed social support, in a crosssectional study design. About 43% was diagnosed with a lifetime mental disorder. The most common diagnoses were depression (37.5%) and specific phobia (6.8%). During the last 12 months, prevalence rates were also slightly higher in heroin group (26.4%) than in cocaine cohort (21.7%). Every day cocaine consumption, having unstable living conditions and low social support were variables highly associated with psychiatric morbidity in cocaine cohort. In heroin cohort, earning money through illegal activities was associated with psychiatric morbidity, while the moderate use of alcohol acted as a protective factor for mental pathology. Morbidity was associated to having received psychiatric/psychological treatment during the last 12 months in both cohorts. This study has shown a relatively high prevalence of psychiatric morbidity in cocaine and heroin users recruited in non-clinical settings. Future studies examining differences between cocaine and heroin patterns of consumption associated with mental diseases are necessary.

  7. Maternal Depression and Parent Management Training Outcomes.

    PubMed

    Dempsey, Jack; McQuillin, Samuel; Butler, Ashley M; Axelrad, Marni E

    2016-09-01

    This study examines the impact of maternal depression on reductions in children's behavior problems severity following implementation of the Brief Behavioral Intervention-a brief, manualized parent management training treatment. The parents of 87 children aged 2-6 years of age received parent management training at a metropolitan hospital. Parents of participants completed measures of externalizing behavior and maternal depression. The association between pre-post treatment change in externalizing behavior and maternal depression was examined using an autoregressive cross-lagged model. Results showed that self-reported maternal depressive symptoms at pre-treatment negatively influenced the overall magnitude of reduction of reported externalizing behaviors in children following treatment. Results indicate that aspects of family functioning not specifically targeted by parent management training, such as maternal depression, significantly affect treatment outcomes. Clinicians providing parent management training may benefit from assessing for maternal depression and modifying treatment as indicated.

  8. Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation

    PubMed Central

    Shin, Rumi; Lee, Sang Mok; Sohn, Beonghoon; Lee, Dong Woon; Song, Inho; Chai, Young Jun; Lee, Hae Won; Ahn, Hye Seong; Jung, In Mok; Chung, Jung Kee

    2016-01-01

    Purpose An intestinal perforation is a rare condition, but has a high mortality rate, even after immediate surgical intervention. The clinical predictors of postoperative morbidity and mortality are still not well established, so this study attempted to identify risk factors for postoperative morbidity and mortality after surgery for an intestinal perforation. Methods We retrospectively analyzed the cases of 117 patients who underwent surgery for an intestinal perforation at a single institution in Korea from November 2008 to June 2014. Factors related with postoperative mortality at 1 month and other postoperative complications were investigated. Results The mean age of enrolled patients was 66.0 ± 15.8 years and 66% of the patients were male. Fifteen patients (13%) died within 1 month after surgical treatment. Univariate analysis indicated that patient-related factors associated with mortality were low systolic and diastolic blood pressure, low serum albumin, low serum protein, low total cholesterol, and high blood urea nitrogen; the surgery-related factor associated with mortality was feculent ascites. Multivariate analysis using a logistic regression indicated that low systolic blood pressure and feculent ascites independently increased the risk for mortality; postoperative complications were more likely in both females and those with low estimated glomerular filtration rates and elevated serum C-reactive protein levels. Conclusion Various factors were associated with postoperative clinical outcomes of patients with an intestinal perforation. Morbidity and mortality following an intestinal perforation were greater in patients with unstable initial vital signs, poor nutritional status, and feculent ascites. PMID:28119865

  9. Expiratory flow limitation in morbidly obese postoperative mechanically ventilated patients.

    PubMed

    Koutsoukou, A; Koulouris, N; Bekos, B; Sotiropoulou, C; Kosmas, E; Papadima, K; Roussos, C

    2004-10-01

    Although obesity promotes tidal expiratory flow limitation (EFL), with concurrent dynamic hyperinflation (DH), intrinsic PEEP (PEEPi) and risk of low lung volume injury, the prevalence and magnitude of EFL, DH and PEEPi have not yet been studied in mechanically ventilated morbidly obese subjects. In 15 postoperative mechanically ventilated morbidly obese subjects, we assessed the prevalence of EFL [using the negative expiratory pressure (NEP) technique], PEEPi, DH, respiratory mechanics, arterial oxygenation and PEEPi inequality index as well as the levels of PEEP required to abolish EFL. In supine position at zero PEEP, 10 patients exhibited EFL with a significantly higher PEEPi and DH and a significantly lower PEEPi inequality index than found in the five non-EFL (NEFL) subjects. Impaired gas exchange was found in all cases without significant differences between the EFL and NEFL subjects. Application of 7.5 +/- 2.5 cm H2O of PEEP (range: 4-16) abolished EFL with a reduction of PEEPi and DH and an increase in FRC and the PEEPi inequality index but no significant effect on gas exchange. The present study indicates that: (a) on zero PEEP, EFL is present in most postoperative mechanically ventilated morbidly obese subjects; (b) EFL (and concurrent risk of low lung volume injury) is abolished with appropriate levels of PEEP; and (c) impaired gas exchange is common in these patients, probably mainly due to atelectasis.

  10. Myocardial revascularisation in women: evaluation of hospital mortality and morbidity

    PubMed Central

    Cloin, E.C.W.; Noyez, L.

    2006-01-01

    Background Although women are reported to be at higher risk for mortality and morbidity after coronary artery bypass graft (CABG), there is no consensus in literature. Method Pre-, peri- and postoperative hospital data of 8578 patients undergoing an isolated myocardial revascularisation from January 1987 to December 2004 were analysed. Of these patients, 2083 (24.3%) were female. Results Female patients were significantly older (p=0.001), and risk factors as diabetes (p=0.001), hypertension (p=0.001), hyperlipidaemia (p=0.001) were significantly more prevalent than in men. The incidence of preoperative myocardial infarction (p=0.001) and triple-vessel disease (p=0.001) was lower, but the incidence of unstable angina (NYHA IV) (p=0.001) was significantly higher than in men. Significantly fewer women (p=0.04) received an arterial graft. Postoperatively, there was no significant difference in the registered morbidity, with the exception of a lower incidence of female patients with non-sinus rhythm (p=0.001) and a higher incidence of pulmonary problems (p=0.006). Hospital mortality was not significantly different between the genders: 3.5 vs. 3.4% (p=0.9). A preoperative myocardial infarction was identified as the only independent predictor for hospital mortality. Conclusion The preoperative profiles of women and men undergoing CABG are dissimilar. However, the incidences of hospital mortality, and morbidity were not statistically different. Female gender was not identified as predictor for death or adverse outcome. PMID:25696593

  11. Psychological Co-morbidity in Children with Specific Learning Disorders

    PubMed Central

    Sahoo, Manoj K.; Biswas, Haritha; Padhy, Susanta Kumar

    2015-01-01

    Children under 19 years of age constitute over 40% of India's population and information about their mental health needs is a national imperative. Children with specific learning disorders (SLDs) exhibit academic difficulties disproportionate to their intellectual capacities. Prevalence of SLD ranges from 2% to 10%. Dyslexia (developmental reading disorder) is the most common type, affecting 80% of all SLD. About 30% of learning disabled children have behavioral and emotional problems, which range from attention deficit hyperactivity disorder (most common) to depression, anxiety, suicide etc., to substance abuse (least common). Co-occurrence of such problems with SLD further adds to the academic difficulty. In such instances, diagnosis is difficult and tricky; improvement in academics demands comprehensive holistic treatment approach. SLD remains a large public health problem because of under-recognition, inadequate treatment and therefore merits greater effort to understand the co-morbidities, especially in the Indian population. As the literature is scarce regarding co-morbid conditions in learning disability in Indian scenario, the present study has tried to focus on Indian population. The educational concessions (recent most) given to such children by Central Board of Secondary Education, New Delhi are referred to. The issues to be addressed by the family physicians are: Low level of awareness among families and teachers, improper dissemination of accurate information about psychological problems, available help seeking avenues, need to develop service delivery models in rural and urban areas and focus on the integration of mental health and primary care keeping such co-morbidity in mind. PMID:25810984

  12. Psychosocial functioning of two groups of morbidly obese patients.

    PubMed

    Rosen, L W; Aniskiewicz, A S

    1983-01-01

    Fourteen morbidly obese women who were candidates for intestinal bypass surgery were compared in terms of psychosocial functioning and dietary behavior to 14 morbidly obese women who elected not to undergo the bypass procedure. Each patient underwent a psychiatric evaluation which included a developmental and dietary history, a mental status exam, and the administration of the MMPI. Diagnoses were based on the DSM-III multi-axial system. There was no difference between the bypass group and the non-bypass group on the Axis I diagnoses, however the bypass group did have a significantly higher frequency of Axis II diagnoses. The bypass group demonstrated significantly higher levels of psychosocial stressors (Axis IV) and lower levels of adaptive functioning (Axis V) when compared to the non-bypass group. The bypass patients also had a significantly higher frequency of past suicide attempts. On the MMPI, the bypass group had significantly higher elevations on scales 2 (depression), 4 (psychopathic deviate), 6 (paranoia), and 0 (social introversion). There were no significant differences between the groups in terms of dietary history and behavior, except that significantly fewer bypass patients could place a numerical estimate on their daily energy intake. These results were discussed in terms of their implications for the assessment and treatment of morbidly obese patients.

  13. Leg morbidity and function following fibular free flap harvest.

    PubMed

    Shpitzer, T; Neligan, P; Boyd, B; Gullane, P; Gur, E; Freeman, J

    1997-05-01

    Over a period of 3 years, 50 consecutive free fibular flaps for mandibular reconstruction were performed on 47 patients. In 38 patients (81%) a skin paddle was included with the flap to provide either mucosal lining or skin cover; in 9 patients (19%) bone alone was used. Thirty-one patients (66%) required a skin graft to close the donor defect in the leg. Donor leg morbidity and function were determined by patient questionnaire and by physical examination. Forty-one donor sites in 40 patients were available for long-term follow-up. The follow-up ranged from 4 to 39 months with an average of 17 months. Immediate postoperative infection occurred in the donor site of 1 patient (2%) and required additional surgery. There was no other immediate donor site complications when closure required skin grafting. Eleven patients (27%) had late donor site morbidity, consisting of motor weakness of the great toe in 5 patients, ankle instability and/or stiffness in 3 patients, donor site pain in 1 patient, and edema in 2 patients. All complications were graded as mild in severity by the patient and by the examiner. In this series, although most donor site defects required skin grafting, short- and long-term morbidity was minimal. After a short rehabilitation period, all patients were fully able to engage in all daily and recreational activities.

  14. Association between respiratory mechanics and autonomic function in morbid obesity.

    PubMed

    Sant' Anna, M; Carvalhal, R F; Carneiro, J R I; Lapa, M S; Zin, W A; Lugon, J R; Guimarães, F S

    2014-01-01

    This study aimed to investigate the association between respiratory mechanics and autonomic modulation in morbidly obese patients. We evaluated 10 morbidly obese subjects (BMI=52.9±11.2kg/m(2)), aged 23-58 years. Assessment of respiratory mechanics was done by the forced oscillation technique (FOT), and cardiovascular autonomic function was recorded by heart rate variability analysis (HRV). The Pearson correlation coefficient was used to test the associations between respiratory mechanics and HRV variables. There were associations between the standard deviation of all RR intervals (SDNN) and airway resistance (Rm) (r=-0.82; p=0.004), SDNN and respiratory system resistance (R0) (r=-0.79; p=0.006), root mean square of successive differences between adjacent normal RR intervals (rMSSD) and respiratory system resistance (R5) (r=-0.643; p=0.0451), rMSSD and R0 (r=-0.64; p=0.047), and rMSSD and Rm (r=-0.658; p=0.039). We concluded that the airway and respiratory system resistances are negatively associated with parasympathetic activity in patients with morbid obesity.

  15. Predicting neonatal morbidity after perinatal asphyxia: a scoring system.

    PubMed

    Portman, R J; Carter, B S; Gaylord, M S; Murphy, M G; Thieme, R E; Merenstein, G B

    1990-01-01

    Predicting immediate neonatal morbidity after perinatal asphyxia has been difficult. A review of asphyxiated neonates greater than or equal to 36 weeks' gestation admitted to The Children's Hospital Newborn Intensive Care Unit in 1983 was conducted to devise a scoring system that would rapidly predict organ dysfunction observed in the immediate neonatal period. Comparison of potential score components to morbidity by multiple regression analysis yielded significant association with abnormalities in fetal heart rate monitoring, the 5-minute Apgar score, and neonatal base deficit. A scoring system was devised whose sensitivity (93.8%) and specificity (81.3%) were more predictive than any of its individual components. Prospective analysis in a similar population in 1984 validated its ability to distinguish severe from moderate morbidity after asphyxia. Positive predictive value for the score in the combined study groups (n = 98) was 79% and the negative predictive value was 83%. The scoring system may offer a rapid and accurate prediction of organ dysfunction in the immediate neonatal period after asphyxia.

  16. Essential pre-pregnancy and pregnancy interventions for improved maternal, newborn and child health

    PubMed Central

    2014-01-01

    The statistics related to pregnancy and its outcomes are staggering: annually, an estimated 250000-280000 women die during childbirth. Unfortunately, a large number of women receive little or no care during or before pregnancy. At a period of critical vulnerability, interventions can be effectively delivered to improve the health of women and their newborns and also to make their pregnancy safe. This paper reviews the interventions that are most effective during preconception and pregnancy period and synergistically improve maternal and neonatal outcomes. Among pre-pregnancy interventions, family planning and advocating pregnancies at appropriate intervals; prevention and management of sexually transmitted infections including HIV; and peri-conceptual folic-acid supplementation have shown significant impact on reducing maternal and neonatal morbidity and mortality. During pregnancy, interventions including antenatal care visit model; iron and folic acid supplementation; tetanus Immunisation; prevention and management of malaria; prevention and management of HIV and PMTCT; calcium for hypertension; anti-Platelet agents (low dose aspirin) for prevention of Pre-eclampsia; anti-hypertensives for treating severe hypertension; management of pregnancy-induced hypertension/eclampsia; external cephalic version for breech presentation at term (>36 weeks); management of preterm, premature rupture of membranes; management of unintended pregnancy; and home visits for women and children across the continuum of care have shown maximum impact on reducing the burden of maternal and newborn morbidity and mortality. All of the interventions summarized in this paper have the potential to improve maternal mortality rates and also contribute to better health care practices during preconception and periconception period. PMID:25178042

  17. Evaluation of Maternal Complications in Severe Preeclampsia in a University Hospital in Tirana

    PubMed Central

    Ndoni, Eriseida; Hoxhallari, Redi; Bimbashi, Astrit

    2016-01-01

    BACKGROUND: Preeclampsia is a hypertensive multisystem disorder of pregnancy that complicates up to 10% of pregnancies worldwide and is one of the leading causes of maternal and perinatal morbidity and mortality. AIM: To evaluate maternal complications associated with severe preeclampsia. METHODS: This is a retrospective cross-sectional study conducted in the UHOG “Koço Gliozheni”, in Tirana. Primary outcomes evaluated: maternal death, eclampsia, stroke, HELLP syndrome, and pulmonary edema. Secondary outcomes: renal failure, admission in ICU, caesarean section, placental abruption, and postpartum hemorrhage. Fisher’s exact test and Chi-squared test were used as statistical methods. RESULTS: In women with severe preeclampsia we found higher rates of complications comparing to the group with preeclampsia. Eclampsia (1.5% vs. 7.1%, P < 0.001), HELLP syndrome (2.4% vs. 11.0%; P < 0.001), stroke (0.5% vs 1.9%, P = 0.105) pulmonary edema (0.25% vs. 1.3%, P = 0.0035), renal failure (0.9% vs. 2.6%, P = 0.107), admission in ICU (19.5% vs. 71.4%, P = 0.007), caesarean section rates (55.5% vs. 77%, P = 0.508), placental abruption (4.3% vs. 7.8%, P = 0.103) and severe postpartum hemorrhage (3.2% vs. 3.9%, P = 0.628). CONCLUSION: Severe preeclampsia is associated with high rates of maternal severe morbidity and early diagnosis and timely intervention can prevent life treating complications. PMID:27275340

  18. Cardiac Arrhythmias and Abnormal Electrocardiograms After Acute Stroke.

    PubMed

    Ruthirago, Doungporn; Julayanont, Parunyou; Tantrachoti, Pakpoom; Kim, Jongyeol; Nugent, Kenneth

    2016-01-01

    Cardiac arrhythmias and electrocardiogram (ECG) abnormalities occur frequently but are often underrecognized after strokes. Acute ischemic and hemorrhagic strokes in some particular area of brain can disrupt central autonomic control of the heart, precipitating cardiac arrhythmias, ECG abnormalities, myocardial injury and sometimes sudden death. Identification of high-risk patients after acute stroke is important to arrange appropriate cardiac monitoring and effective management of arrhythmias, and to prevent cardiac morbidity and mortality. More studies are needed to better clarify pathogenesis, localization of areas associated with arrhythmias and practical management of arrhythmias and abnormal ECGs after acute stroke.

  19. [The systemic inflammatory response syndrome correction in acute destructive pancreatitis].

    PubMed

    Agapov, M A; Khoreva, M V; Gorskiĭ, V A

    2011-01-01

    Acute pancreatitis is a disease of variable severity. In which some patients experience mild, self-limited attacks while others manifest a severe, highly morbid, and frequently lethal attack. The exact mechanisms by which diverse etiological factors induce an attack are still unclear. Recent studies have established the role played by inflammatory mediators in the pathogenesis of acute pancreatitis. In our research we have estimated influence of not steroid anti-inflammatory preparation on synthesis pro-and anti-inflammatory Cytokines at healthy donors and at patients with Acute pancreatitis.

  20. The Neuroendocrinology of Primate Maternal Behavior

    PubMed Central

    Saltzman, Wendy; Maestripieri, Dario

    2010-01-01

    In nonhuman primates and humans, similar to other mammals, hormones are not strictly necessary for the expression of maternal behavior, but nevertheless influence variation in maternal responsiveness and parental behavior both within and between individuals. A growing number of correlational and experimental studies have indicated that high circulating estrogen concentrations during pregnancy increase maternal motivation and responsiveness to infant stimuli, while effects of prepartum or postpartum estrogens and progestogens on maternal behavior are less clear. Prolactin is thought to play a role in promoting paternal and alloparental care in primates, but little is known about the relationship between this hormone and maternal behavior. High circulating cortisol levels appear to enhance arousal and responsiveness to infant stimuli in young, relatively inexperienced female primates, but interfere with the expression of maternal behavior in older and more experienced mothers. Among neuropeptides and neurotransmitters, preliminary evidence indicates that oxytocin and endogenous opioids affect maternal attachment to infants, including maintenance of contact, grooming, and responses to separation. Brain serotonin affects anxiety and impulsivity, which in turn may affect maternal behaviors such as infant retrieval or rejection of infants’ attempts to make contact with the mother. Although our understanding of the neuroendocrine correlates of primate maternal behavior has grown substantially in the last two decades, very little is known about the mechanisms underlying these effects, e.g., the extent to which these mechanisms may involve changes in perception, emotion, or cognition. PMID:20888383

  1. The protective effect of thymoquinone against sepsis syndrome morbidity and mortality in mice.

    PubMed

    Alkharfy, Khalid M; Al-Daghri, Nasser M; Al-Attas, Omar S; Alokail, Majed S

    2011-02-01

    Sepsis and septic shock are life threatening complications and most common cause of death in intensive care units. Thymoquinone, a constituent of Nigella sativa (black seed), holds exceptional promise as an anti-cancer and anti-inflammatory agent. No evidence has been published, however, whether this compound has a protective effect from sepsis-related morbidity, mortality and associated organ dysfunction. To examine this, two sets of mice (n=12 per group), with parallel control groups, were acutely treated with thymoquinone intraperitoneal injections of 1.0 and 2.0mg/kg body weight, and were subsequently challenged with endotoxin Gram-negative bacteria (LPS O111:B4). In another set of experiments, thymoquinone was administered at doses of 0.75 and 1.0mg/kg/day for three consecutive days prior to sepsis induction with live Escherichia coli. Survival of various groups was computed, and renal, hepatic and sepsis markers were quantified. Thymoquinone reduced mortality by 80-90% and improved both renal and hepatic biomarker profiles. The concentrations of IL-1α with 0.75 mg/kg thymoquinone dose was 310.8 ± 70.93 and 428.3 ± 71.32 pg/ml in the 1mg/kg group as opposed to controls (1187.0 ± 278.64 pg/ ml; P<0.05). Likewise, IL-10 levels decreased significantly with 0.75 mg/kg thymoquinone treatment compared to controls (2885.0 ± 553.98 vs. 5505.2 ± 333.96 pg/ml; P<0.01). Mice treated with thymoquinone also exhibited relatively lower levels of TNF-α and IL-2 (P values=0.1817 and 0.0851, respectively). This study gives strength to the potential clinical relevance of thymoquinone in sepsis-related morbidity and mortality reduction and suggests that human studies should be performed.

  2. Acute Pancreatitis

    PubMed Central

    Geokas, Michael C.

    1972-01-01

    For many decades two types of acute pancreatitis have been recognized: the edematous or interstitial and the hemorrhagic or necrotic. In most cases acute pancreatitis is associated with alcoholism or biliary tract disease. Elevated serum or urinary α-amylase is the most important finding in diagnosis. The presence of methemalbumin in serum and in peritoneal or pleural fluid supports the diagnosis of the hemorrhagic form of the disease in patients with a history and enzyme studies suggestive of pancreatitis. There is no characteristic clinical picture in acute pancreatitis, and its complications are legion. Pancreatic pseudocyst is probably the most common and pancreatic abscess is the most serious complication. The pathogenetic principle is autodigestion, but the precise sequence of biochemical events is unclear, especially the mode of trypsinogen activation and the role of lysosomal hydrolases. A host of metabolic derangements have been identified in acute pancreatitis, involving lipid, glucose, calcium and magnesium metabolism and changes of the blood clotting mechanism, to name but a few. Medical treatment includes intestinal decompression, analgesics, correction of hypovolemia and other supportive and protective measures. Surgical exploration is advisable in selected cases, when the diagnosis is in doubt, and is considered imperative in the presence of certain complications, especially pancreatic abscess. PMID:4559467

  3. Evidence from Maternity Leave Expansions of the Impact of Maternal Care on Early Child Development

    ERIC Educational Resources Information Center

    Baker, Michael; Milligan, Kevin

    2010-01-01

    We study the impact of maternal care on early child development using an expansion in Canadian maternity leave entitlements. Following the leave expansion, mothers who took leave spent 48-58 percent more time not working in their children's first year of life. This extra maternal care primarily crowded out home-based care by unlicensed…

  4. Maternal and Child Anxiety: Do Attachment Beliefs or Children's Perceptions of Maternal Control Mediate Their Association?

    ERIC Educational Resources Information Center

    Costa, Natalie M.; Weems, Carl F.

    2005-01-01

    This study tested a model of the association between maternal and child anxiety that views mother and child attachment beliefs and children's perceptions of maternal control as mediators of the association. The study was conducted with mothers and their children aged 6 to 17 (N = 88). Maternal anxiety was significantly associated with child…

  5. Maternal and Adolescent Temperament as Predictors of Maternal Affective Behavior during Mother-Adolescent Interactions

    ERIC Educational Resources Information Center

    Davenport, Emily; Yap, Marie B. H.; Simmons, Julian G.; Sheeber, Lisa B.; Allen, Nicholas B.

    2011-01-01

    This study examined maternal and early adolescent temperament dimensions as predictors of maternal emotional behavior during mother-adolescent interactions. The sample comprised 151 early adolescents (aged 11-13) and their mothers (aged 29-57). Adolescent- and mother-reports of adolescent temperament and self-reports of maternal temperament were…

  6. Second-Trimester Amniotic Fluid Corticotropin-Releasing Hormone and Urocortin in Relation to Maternal Stress and Fetal Growth in Human Pregnancy.

    PubMed

    La Marca-Ghaemmaghami, Pearl; Dainese, Sara M; Stalla, Günter; Haller, Marina; Zimmermann, Roland; Ehlert, Ulrike

    2017-03-27

    This study explored the association between the acute psychobiological stress response, chronic social overload and amniotic fluid corticotropin corticotropin-releasing hormone (CRH) and urocortin (UCN) in 34 healthy, second-trimester pregnant women undergoing amniocentesis. The study further examined the predictive value of second-trimester amniotic fluid CRH and UCN for fetal growth and neonatal birth outcome. The amniocentesis served as a naturalistic stressor, during which maternal state anxiety and salivary cortisol was measured repeatedly and an aliquot of amniotic fluid was collected. The pregnant women additionally completed a questionnaire on chronic social overload. Fetal growth parameters were obtained at amniocentesis using fetal ultrasound biometry and at birth from medical records. The statistical analyses revealed that the acute maternal psychobiological stress response was unassociated with the amniotic fluid peptides, but that maternal chronic overload and amniotic CRH were positively correlated. Moreover, amniotic CRH was negatively associated with fetal size at amniocentesis and positively with growth in size from amniocentesis to birth. Hardly any studies have previously explored whether acute maternal psychological stress influences fetoplacental CRH or UCN levels significantly. Our findings suggest that 1) chronic, but not acute maternal stress may affect fetoplacental CRH secretion and that 2) CRH is complexly involved in fetal growth processes as previously shown in animals.

  7. Maternal miscarriage history and risk of anencephaly.

    PubMed

    Blanco-Muñoz, Julia; Lacasaña, Marina; Borja-Aburto, Victor Hugo

    2006-05-01

    Women with a history of reproductive loss may be at an increased risk of having an unfavourable outcome in subsequent pregnancies. Using data from a matched case-control study based on the record of the Epidemiological Surveillance System of Neural Tube Defects, we evaluated the association between history of maternal reproductive loss and the risk of anencephaly in three Mexican states. Mothers of 157 cases of anencephaly and 151 controls born during the period March 2000 to February 2001, were interviewed about their reproductive history and other additional factors, including socio-economic characteristics, prenatal care, use of tobacco and alcohol, presence of chronic diseases, acute illnesses and fever during the periconceptional period, and consumption of multivitamins and medicines during this period; mothers who reported no prior pregnancies were excluded from the analysis; 58 matched case-control pairs were used for the analysis. After adjusting for potential confounders, women with a history of miscarriage in previous pregnancies had 4.58 times more risk of having a child with anencephaly, than those who did not have this history; OR = 4.58, [95% CI 1.22, 17.23]. Our results suggest that a history of previous miscarriages is a risk indicator for anencephaly in future gestations. This does not necessarily mean that the miscarriage itself is the cause, but that common mechanisms could be involved in the aetiology of both events. Thus, women who have had histories of reproductive losses, especially miscarriages, should be a priority group for the primary and secondary prevention of neural tube defects.

  8. Organ protection possibilities in acute heart failure.

    PubMed

    Montero-Pérez-Barquero, M; Morales-Rull, J L

    2016-04-01

    Unlike chronic heart failure (HF), the treatment for acute HF has not changed over the last decade. The drugs employed have shown their ability to control symptoms but have not achieved organ protection or managed to reduce medium to long-term morbidity and mortality. Advances in our understanding of the pathophysiology of acute HF suggest that treatment should be directed not only towards correcting the haemodynamic disorders and achieving symptomatic relief but also towards preventing organ damage, thereby counteracting myocardial remodelling and cardiac and extracardiac disorders. Compounds that exert vasodilatory and anti-inflammatory action in the acute phase of HF and can stop cell death, thereby boosting repair mechanisms, could have an essential role in organ protection.

  9. Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery.

    PubMed

    Sherrod, Brandon A; Rocque, Brandon G

    2017-04-01

    OBJECTIVE Morbidity associated with surgical site infection (SSI) following nonshunt pediatric neurosurgical procedures is poorly understood. The purpose of this study was to analyze acute morbidity and mortality associated with SSI after nonshunt pediatric neurosurgery using a nationwide cohort. METHODS The authors reviewed data from the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) 2012-2014 database, including all neurosurgical procedures performed on pediatric patients. Procedures were categorized by Current Procedural Terminology (CPT) codes. CSF shunts were excluded. Deep and superficial SSIs occurring within 30 days of an index procedure were identified. Deep SSIs included deep wound infections, intracranial abscesses, meningitis, osteomyelitis, and ventriculitis. The following outcomes occurring within 30 days of an index procedure were analyzed, along with postoperative time to complication development: sepsis, wound disruption, length of postoperative stay, readmission, reoperation, and death. RESULTS A total of 251 procedures associated with a 30-day SSI were identified (2.7% of 9296 procedures). Superficial SSIs were more common than deep SSIs (57.4% versus 42.6%). Deep SSIs occurred more frequently after epilepsy or intracranial tumor procedures. Superficial SSIs occurred more frequently after skin lesion, spine, Chiari decompression, craniofacial, and myelomeningocele closure procedures. The mean (± SD) postoperative length of stay for patients with any SSI was 9.6 ± 14.8 days (median 4 days). Post-SSI outcomes significantly associated with previous SSI included wound disruption (12.4%), sepsis (15.5%), readmission (36.7%), and reoperation (43.4%) (p < 0.001 for each). Post-SSI sepsis rates (6.3% vs 28.0% for superficial versus deep SSI, respectively; p < 0.001), wound disruption rates (4.9% vs 22.4%, p < 0.001), and reoperation rates (23.6% vs 70.1%, p < 0.001) were significantly greater for patients

  10. Management of Acute Aortic Syndrome and Chronic Aortic Dissection

    SciTech Connect

    Nordon, Ian M. Hinchliffe, Robert J.; Loftus, Ian M.; Morgan, Robert A.; Thompson, Matt M.

    2011-10-15

    Acute aortic syndrome (AAS) describes several life-threatening aortic pathologies. These include intramural hematoma, penetrating aortic ulcer, and acute aortic dissection (AAD). Advances in both imaging and endovascular treatment have led to an increase in diagnosis and improved management of these often catastrophic pathologies. Patients, who were previously consigned to medical management or high-risk open surgical repair, can now be offered minimally invasive solutions with reduced morbidity and mortality. Information from the International Registry of Acute Aortic Dissection (IRAD) database demonstrates how in selected patients with complicated AAD the 30-day mortality from open surgery is 17% and endovascular stenting is 6%. Despite these improvements in perioperative deaths, the risks of stroke and paraplegia remain with endovascular treatment (combined outcome risk 4%). The pathophysiology of each aspect of AAS is described. The best imaging techniques and the evolving role of endovascular techniques in the definitive management of AAS are discussed incorporating strategies to reduce perioperative morbidity.

  11. Marathon Maternity Oral History Project

    PubMed Central

    Orkin, Aaron; Newbery, Sarah

    2014-01-01

    Abstract Objective To explore how birthing and maternity care are understood and valued in a rural community. Design Oral history research. Setting The rural community of Marathon, Ont, with a population of approximately 3500. Participants A purposive selection of mothers, grandmothers, nurses, physicians, and community leaders in the Marathon medical catchment area. Methods Interviews were conducted with a purposive sample, employing an oral history research methodology. Interviews were conducted non-anonymously in order to preserve the identity and personhood of participants. Interview transcripts were edited into short narratives. Oral histories offer perspectives and information not revealed in other quantitative or qualitative research methodologies. Narratives re-personalize and humanize medical research by offering researchers and practitioners the opportunity to bear witness to the personal stories affected through medical decision making. Main findings Eleven stand-alone narratives, published in this issue of Canadian Family Physician, form the project’s findings. Similar to a literary text or short story, they are intended for personal reflection and interpretation by the reader. Presenting the results of these interviews as narratives requires the reader to participate in the research exercise and take part in listening to these women’s voices. The project’s narratives will be accessible to readers from academic and non-academic backgrounds and will interest readers in medicine and allied health professions, medical humanities, community development, gender studies, social anthropology and history, and literature. Conclusion Sharing personal birthing experiences might inspire others to reevaluate and reconsider birthing practices and services in other communities. Where local m