Patterns, factors associated and morbidity burden of asthma in India

PubMed Central

Ram, Usha

2017-01-01

Background Asthma is a non-curable but preventable disease, responsible for higher morbidity worldwide. According to recent WHO report, nearly 235 million people are suffering from asthma leading to 383000 deaths in 2015. The burden of asthma morbidity is higher in developed countries and is increasing in developing countries. Objective The present study was aimed at studying the change in prevalence rate of asthma, associated risk factors and estimation of morbidity burden and avoidable cases of asthma in India. Methods The second round of Indian Human Development Survey (IHDS-II), 2011–12, was used for the study. For the present study, asthma was defines as ever diagnosed with asthma or having cough with short breath. Multiple-logistic regression was used to identify the possible risk factors associated with prevalence of reporting asthma. Population attributable fractions (PAFs) were computed to estimate the overall and risk factors specific burden of morbidity due to asthma using the extrapolated population of year 2015 using 2011 census. Results Overall prevalence rate of asthma increased from 41.9 (per 1000 population) in 2004–05 to 54.9 (per 1000 population) in 2011–12. The prevalence rate of reporting asthma was higher in poorer states compared to richer states, and also varied by sub-geographies, with higher prevalence rate in northern states of the country and lower rates in north-eastern states of the country. The odds of reporting asthma was higher for younger and older ages, individual with fewer years of schooling (OR: 1.41; 95% CI: 1.21–1.64) for individual with zero years of schooling compared to those with 11 or more years of schooling, individual from lower economic status, individual living in household using unclean fuels (OR:1.21; 95% CI: 1.08–1.34) and smokers (OR: 1.34; 95% CI: 1.17–1.55) compared to their counterparts. In the year 2015, the overall morbidity burden of asthma was estimated at nearly 65 million and more than 82

Factors associated with seeking treatment for postpartum morbidities in rural India

PubMed Central

Singh, Aditya; Kumar, Abhishek

2014-01-01

OBJECTIVES: To understand the prevalence of postpartum morbidities and factors associated with treatment-seeking behaviour among currently married women aged 15-49 residing in rural India. METHODS: We used data from the nationally representative District Level Household Survey from 2007-2008. Cross-tabulation was used to understand the differentials for the prevalence of postpartum morbidities and treatment-seeking behaviours across selected background characteristics. Two-level binary logistic regression was applied to understand the factors associated with treatment-seeking behaviour. RESULTS: Approximately 39.8% of rural women suffered from at least one of the six postpartum morbidities including high fever, lower abdominal pain, foul-smelling vaginal discharge, excessive bleeding, convulsions, and severe headache. Morbidities were more prevalent among poor, illiterate, Muslim, and high-parity women. About 55.1% of these rural women sought treatment/consultation for their problems. The odds of seeking treatment/consultation increased as economic status and years of schooling among both the woman and her husband increased. Poor, uneducated, unemployed, Hindu, and tribal women were less likely to seek treatment/consultation for postpartum morbidities than their counterparts were. The odds of seeking treatment/consultation decreased as the distance to the nearest private health facility increased. Most women visited a private hospital (46.3%) or a friend/family member’s home (20.8%) for treatment/consultation. Only a small percentage visited publicly funded health institutions such as a primary health centre (8.8%), community health centre (6.5%), health sub-centre (2.8%), or district hospital (13.1%). Rural women from the northeast region of India were 50% less likely to seek treatment/consultation than women from the central region were. CONCLUSIONS: Providing antenatal and delivery care, and ensuring nearby government healthcare facilities are available to

[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.

Factors associated with severe maternal morbidity in Kelantan, Malaysia: A comparative cross-sectional study.

PubMed

Norhayati, Mohd Noor; Nik Hazlina, Nik Hussain; Aniza, Abd Aziz; Sulaiman, Zaharah

2016-07-26

Knowledge on the factors associated with severe maternal morbidity enables a better understanding of the problem and serves as a foundation for the development of an effective preventive strategy. However, various definitions of severe maternal morbidity have been applied, leading to inconsistencies between studies. The objective of this study was to identify the sociodemographic characteristics, medical and gynaecological history, past and present obstetric performance and the provision of health care services as associated factors for severe maternal morbidity in Kelantan, Malaysia. A comparative cross-sectional study was conducted in two tertiary referral hospitals in 2014. Postpartum women with severe morbidity and without severe morbidity who fulfilled the inclusion and exclusion criteria were eligible as cases and controls, respectively. The study population included all postpartum women regardless of their age. Pregnancy at less than 22 weeks of gestation, more than 42 days after the termination of pregnancy and non-Malaysian citizens were excluded. Consecutive sampling was applied for the selection of cases and for each case identified, one unmatched control from the same hospital was selected using computer-based simple random sampling. Simple and multiple logistic regressions were performed using Stata Intercooled version 11.0. A total of 23,422 pregnant women were admitted to these hospitals in 2014 and 395 women with severe maternal morbidity were identified, of which 353 were eligible as cases. An age of 35 or more years old [Adj. OR (95 % CI): 2.6 (1.67, 4.07)], women with past pregnancy complications [Adj. OR (95 % CI): 1.7 (1.00, 2.79)], underwent caesarean section deliveries [Adj. OR (95 % CI): 6.8 (4.68, 10.01)], preterm delivery [Adj. OR (95 % CI): 3.4 (1.87, 6.32)] and referral to tertiary centres [Adj. OR (95 % CI): 2.7 (1.87, 3.97)] were significant associated factors for severe maternal morbidity. Our study suggests the enhanced

Risk Factors for Death and Major Morbidity in Guatemalan Children with Acute Bacterial Meningitis.

PubMed

Olson, Daniel; Lamb, Molly M; Gaensbauer, James T; Todd, James K; Halsey, Neal A; Asturias, Edwin J

2015-07-01

Acute bacterial meningitis (ABM) remains a significant cause of pediatric illness and death in low and middle income countries. Identifying severity risk factors and predictive scores may guide interventions to reduce poor outcomes. Data from a prospective surveillance study for ABM in children aged 0-59 months admitted to 3 referral hospitals in Guatemala City from 2000 to 2007 were analyzed. ABM was defined as positive cerebrospinal fluid (CSF) culture, positive latex agglutination or CSF white blood cell greater than 100 cells/mL. Univariate and multivariate analyses of risk factors at hospital admission that predicted major morbidity or death during hospitalization were performed, along with validation of the predictive Herson-Todd score (HTS). Of 809 children with ABM episodes, 221 (27.3%) survived with major morbidity and 192 (23.7%) died. Among 383 children with nonmissing data, the most significant multivariate predictors for death or major morbidity were seizure [odds ratio (OR), 101.5; P < 0.001], CSF glucose less than 20 mg/dL (OR, 5.3; P = 0.0004), symptom duration more than 3 days (OR, 3.7; P = 0.003) and coma (OR, 6.3; P = 0.004). Of 221 children with a HTS greater than 5, 204 (92%) died or suffered major morbidity (OR, 10.3; P < 0.0001). ABM is a cause of considerable morbidity and mortality in Guatemala. Several clinical risk factors and the composite HTS predicted death or major morbidity. These predictors could help clinicians in low and middle income country guide medical care for ABM and could contribute to the public health impact assessment in preventing meningitis with vaccines.

Risk Factors for Thirty-Day Morbidity and Mortality in Extradural Lumbar Spine Tumor Resection.

PubMed

Sarkiss, Christopher A; Hersh, Eliza H; Ladner, Travis R; Lee, Nathan; Kothari, Parth; Lakomkin, Nikita; Caridi, John M

2018-06-01

Epidural tumors in the lumbar spine represent a unique cohort of lesions with individual risks and challenges to resection. Knowledge of modifiable risk factors are important in minimizing postoperative complications. To determine the risk factors for 30-day morbidity and mortality in patients undergoing extradural lumbar tumor resection. A retrospective study of prospectively collected data using the American College of Surgeons National Quality Improvement Program database was performed. Adults who underwent laminectomy for excision of lumbar spine tumors between 2011 and 2014 were included in the study. Demographics and medical comorbidities were collected, along with morbidities and mortalities within 30 postoperative days. A multivariate binary logistic analysis of these clinical variables was performed to determine covariates of morbidity and mortality. The database search yielded 300 patients, of whom 118 (39.3%) were female. Overall, complications within 30 days of surgery occurred in 102 (34%) patients. Significant risk factors for morbidity included preoperative anemia (P < 0.0001), the need for preoperative blood transfusion (P = 0.034), preoperative hypoalbuminemia (P = 0.002), American Society of Anesthesiologists score 3 or 4 (P = 0.0002), and operative time >4 hours (P < 0.0001). Thirty-day mortality occurred in 15 (5%) patients and was independently associated with preoperative anemia (odds ratio 3.4, 95% confidence interval 1.8-6.5) and operative time >4 hours (odds ratio 2.6, 95% confidence interval 1.1-6.0). Excision of epidural lumbar spinal tumors carries a relatively high complication rate. This series reveals distinct risk factors that contribute to 30-day morbidity and mortality, which may be optimized preoperatively to improve surgical safety. Copyright © 2018 Elsevier Inc. All rights reserved.

Asthma Morbidity, Comorbidities, and Modifiable Factors Among Older Adults.

PubMed

Hsu, Joy; Chen, Jessica; Mirabelli, Maria C

Asthma morbidity is increased among older adults, especially older adult women. Interventions to improve asthma control in this population are not well described. The objective of this study was to identify risk factors (including modifiable factors) associated with asthma-related hospitalizations and emergency department or urgent care center visits (ED/UCV) among older adults. A secondary objective was to investigate sex differences in variables relevant to asthma control. Data were obtained from 14,076 older adults ≥65 years with active asthma participating in the 2006-2010 Behavioral Risk Factor Surveillance System Asthma Call-back Survey (a random-digit dialed survey) in 40 US states, the District of Columbia, and Puerto Rico, representative of >2.6 million persons. Weighted, adjusted logistic regression was conducted. One or more asthma-related hospitalizations in the past year were reported by 5.7% (95% confidence interval [95% CI] = 5.0% to 6.4%) of participants; 10.6% (95% CI = 9.7% to 11.5%) reported ≥1 asthma-related ED/UCV. Compared with older adults without asthma-related hospitalizations, adjusted odds were higher among those with ≥1 asthma-related hospitalization for chronic obstructive pulmonary disease (COPD), coronary artery disease, depression, cockroaches or mold in the home, and cost barriers to asthma-related health care or medication. All these factors, except for cockroaches, were associated with asthma-related ED/UCV. Compared with males, adjusted odds were higher among females for COPD, depression, obesity, and cost barriers to asthma-related health care or medication. Among older adults, asthma-related hospitalizations and ED/UCV were associated with clinical comorbidities, mold in the home, and financial barriers to asthma-related health care. Interventions addressing modifiable factors could reduce asthma morbidity among older adults. Published by Elsevier Inc.

Factors Influencing New RNs' Supervisory Performance in Long-Term Care Facilities.

PubMed

Prentice, Dawn; Boscart, Veronique; McGilton, Katherine S; Escrig, Astrid

2017-12-01

In long-term care facilities (LTCF), registered nurses (RNs) perform both clinical and supervisory roles as part of a team aiming to provide high-quality care to residents. The residents have several co-morbidities and complex care needs. Unfortunately, new RNs receive minimal preparation in gerontology and supervisory experience during their program, leading to low retention rates and affecting resident outcomes. This qualitative study explored factors that influence supervisory performance of new RNs in LTCF from the perspective of 24 participants from Ontario, Canada. Data were collected through individual interviews, followed by a directed content analysis. Three levels of influences were identified: personal influences, organizational influences, and external influences. Each level presented with sub-elements, further describing the factors that impact the supervisory performance of the new RN. To retain new RNs in LTC, organizations must provide additional gerontological education and mentoring for new RNs to flourish in their supervisory roles.

The Perspectives of Patients on Health-Care for Co-Morbid Diabetes and Chronic Kidney Disease: A Qualitative Study

PubMed Central

Lo, Clement; Ilic, Dragan; Teede, Helena; Cass, Alan; Fulcher, Greg; Gallagher, Martin; Johnson, Greg; Kerr, Peter G.; Mathew, Tim; Murphy, Kerry; Polkinghorne, Kevan; Walker, Rowan; Zoungas, Sophia

2016-01-01

Background Multi-morbidity due to diabetes and chronic kidney disease (CKD) remains challenging for current health-systems, which focus on single diseases. As a first step toward health-care improvement, we explored the perspectives of patients and their carers on factors influencing the health-care of those with co-morbid diabetes and CKD. Methods In this qualitative study participants with co-morbid diabetes and CKD were purposively recruited using maximal variation sampling from 4 major tertiary health-services from 2 of Australia’s largest cities. Separate focus groups were conducted for patients with CKD stages 3, 4 and 5. Findings were triangulated with semi-structured interviews of carers of patients. Discussions were transcribed verbatim and thematically analysed. Results Twelve focus groups with 58 participants and 8 semi-structured interviews of carers were conducted. Factors influencing health-care of co-morbid diabetes and CKD grouped into patient and health service level factors. Key patient level factors identified were patient self-management, socio-economic situation, and adverse experiences related to co-morbid diabetes and CKD and its treatment. Key health service level factors were prevention and awareness of co-morbid diabetes and CKD, poor continuity and coordination of care, patient and carer empowerment, access and poor recognition of psychological co-morbidity. Health-service level factors varied according to CKD stage with poor continuity and coordination of care and patient and carer empowerment emphasized by participants with CKD stage 4 and 5, and access and poor recognition of psychological co-morbidity emphasised by participants with CKD stage 5 and carers. Conclusions According to patients and their carers the health-care of co-morbid diabetes and CKD may be improved via a preventive, patient-centred health-care model which promotes self-management and that has good access, continuity and coordination of care and identifies and

Cardiovascular risk factors predictive for survival and morbidity-free survival in the oldest-old Framingham Heart Study participants.

PubMed

Terry, Dellara F; Pencina, Michael J; Vasan, Ramachandran S; Murabito, Joanne M; Wolf, Philip A; Hayes, Margaret Kelly; Levy, Daniel; D'Agostino, Ralph B; Benjamin, Emelia J

2005-11-01

To examine whether midlife cardiovascular risk factors predict survival and survival free of major comorbidities to the age of 85. Prospective community-based cohort study. Framingham Heart Study, Massachusetts. Two thousand five hundred thirty-one individuals (1,422 women) who attended at least two examinations between the ages of 40 and 50. Risk factors were classified at routine examinations performed between the ages of 40 and 50. Stepwise sex-adjusted logistic regression models predicting the outcomes of survival and survival free of morbidity to age 85 were selected from the following risk factors: systolic and diastolic blood pressure, total serum cholesterol, glucose intolerance, cigarette smoking, education, body mass index, physical activity index, pulse pressure, antihypertensive medication, and electrocardiographic left ventricular hypertrophy. More than one-third of the study sample survived to age 85, and 22% of the original study sample survived free of morbidity. Lower midlife blood pressure and total cholesterol levels, absence of glucose intolerance, nonsmoking status, higher educational attainment, and female sex predicted overall and morbidity-free survival. The predicted probability of survival to age 85 fell in the presence of accumulating risk factors: 37% for men with no risk factors to 2% with all five risk factors and 65% for women with no risk factors to 14% with all five risk factors. Lower levels of key cardiovascular risk factors in middle age predicted overall survival and major morbidity-free survival to age 85. Recognizing and modifying these factors may delay, if not prevent, age-related morbidity and mortality.

Early menarche and teenager pregnancy as risk factors for morbid obesity among reproductive-age women: A case-control study.

PubMed

Neves, Amanda Gonçalves; Kasawara, Karina Tamy; Godoy-Miranda, Ana Carolina; Oshika, Flávio Hideki; Chaim, Elinton Adami; Surita, Fernanda Garanhani

2017-10-01

The aim of this study was to evaluate potential risk factors, including non-communicable diseases, for morbid obesity in women between 20 and 49 years of age. We performed a case-control study with 110 morbidly obese women and 110 women with adequate weight who were matched by age and with a 1:1 case to control ratio. All women were between 20 to 49 years old and non-menopausal. Possible risk factors were evaluated through a self-report questionnaire assessing socio-demographic, obstetric and gynecological characteristics, presence of non-communicable diseases and habits. Multiple logistic regression was used to estimate the odds ratio with respective confidence intervals. Menarche under 12 years old, teenage pregnancy and lower educational level were shown to be risk factors for morbid obesity among women of reproductive age. Incidences of non-communicable diseases (diabetes, hypertension, dyslipidemia, liver disease, lung disease, thyroid dysfunction, and joint pain) were increased in women with morbid obesity. Early menarche, teenage pregnancy and low education level are risk factors for the occurrence of morbid obesity in women of reproductive age. Some non-communicable diseases were already more prevalent in women with morbid obesity even before 50 years of age.

Immigration and acculturation-related factors and asthma morbidity in Latino children.

PubMed

Koinis-Mitchell, Daphne; Sato, Amy F; Kopel, Sheryl J; McQuaid, Elizabeth L; Seifer, Ronald; Klein, Robert; Esteban, Cynthia; Lobato, Debra; Ortega, Alexander N; Canino, Glorisa; Fritz, Gregory K

2011-01-01

This article presents a summary of findings from asthma studies focusing on immigration and acculturation-related factors. A study examining associations between these processes, family cohesion and social support networks, and asthma morbidity in a sample of Dominican and Puerto Rican caregivers residing in the mainland U.S., is also described. Latino children with asthma (n = 232), ages 7-16 (49% female) and their caregivers completed interview-based questionnaires on immigration and acculturation-related processes, family characteristics, and asthma morbidity. The frequency of ED use due to asthma may be higher for children of caregivers born in Puerto Rico. Acculturative stress levels were higher for Puerto Rican born caregivers residing in the mainland U.S. Asthma-related educational and intervention programs for Latino children and families should be tailored to consider the effects that the immigration and acculturation experience can have on asthma management. Specific family-based supports focused on decreasing stress related to the acculturation process, and increasing social and family support around the asthma treatment process may help to reduce asthma morbidity in Latino children.

Factors affecting morbidity and mortality on-farm and on-station in the Ethiopian highland sheep.

PubMed

Bekele, T; Woldeab, T; Lahlou-Kassi, A; Sherington, J

1992-12-01

Factors affecting morbidity and mortality of the Ethiopian highland sheep were studied both on-farm and on-station at Debre Berhan between 1989 and 1990. Primary causes of infectious origin resulted in high proportional morbidity (88.4% on-farm) and mortality (72.9% on-farm and 71.8% on-station) rates. Nutritional and managemental factors were also responsible for mortalities in lambs. The most frequent secondary causes of morbidity and/or mortality were ectoparasites and nasal myiasis. Health management interventions on-station were not high enough to produce performance improvements above the on-farm levels. However, the occurrence of gastrointestinal parasites significantly (P < 0.05) differed between the two management systems. The frequency of some of the major causes of morbidity and mortality such as pneumonia, fasciolasis and enteritis were significantly (P < 0.01) affected by season and age of an animal. In order to alleviate the major health constraints identified in this study, a proper health management intervention involving vaccination, strategic anthelmintic treatment and feeding management are suggested.

Factors influencing warfarin control in Australia and Singapore.

PubMed

Bernaitis, Nijole; Ching, Chi Keong; Teo, Siew Chong; Chen, Liping; Badrick, Tony; Davey, Andrew K; Crilly, Julia; Anoopkumar-Dukie, Shailendra

2017-09-01

Warfarin is widely used for patients with non-valvular atrial fibrillation (NVAF). Variations in warfarin control, as measured by time in therapeutic range (TTR), have been reported across different regions and ethnicities, particularly between Western and Asian countries. However, there is limited data on comparative factors influencing warfarin control in Caucasian and Asian patients. Therefore, the aim of this study was to determine warfarin control and potential factors influencing this in patients with NVAF in Australia and Singapore. Retrospective data was collected for patients receiving warfarin for January to June 2014 in Australia and Singapore. TTR was calculated for individuals with mean patient TTR used for analysis. Possible influential factors on TTR were analysed including age, gender, concurrent co-morbidities, and concurrent medication. The mean TTR was significantly higher in Australia (82%) than Singapore (58%). At both sites, chronic kidney disease significantly lowered this TTR. Further factors influencing control were anaemia and age<60years in Australia, and vascular disease, CHA 2 DS 2 -VASc score of 6, and concurrent platelet inhibitor therapy in Singapore. Warfarin control was significantly higher in Australia compared to Singapore, however chronic kidney disease reduced control at both sites. The different levels of control in these two countries, together with patient factors further reducing control may impact on anticoagulant choice in these countries with better outcomes from warfarin in Australia compared to Singapore. Copyright © 2017 Elsevier Ltd. All rights reserved.

Risk factors for operative morbidity and mortality in gastric cancer patients undergoing total gastrectomy

PubMed Central

Gong, Dao-Jun; Miao, Chao-Feng; Bao, Qi; Jiang, Ming; Zhang, Li-Fang; Tong, Xiao-Tao; Chen, Li

2008-01-01

AIM: To study the risk factors for morbidity and mortality following total gastrectomy. METHODS: We retrospectively reviewed the records of 125 consecutive patients who underwent total gastrectomy for gastric cancer at the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2003 and March 2008. RESULTS: The overall morbidity rate was 20.8% (27 patients) and the mortality rate was 3.2% (4 patients). Morbidity rates were higher in patients aged over 60 [odds ratio (OR) 4.23 (95% confidence interval (CI) 1.09 to 12.05)], with preoperative comorbidity [with vs without, OR 1.25 (95% CI 1.13 to 8.12)], when the combined resection was performed [combined resection vs total gastrectomy only, OR 2.67 (95% CI 1.58 to 5.06)]. CONCLUSION: Age, preoperative comorbidity and combined resection were independently associated with the rate of morbidity after total gastrectomy for gastric cancer. PMID:19030212

Factors Predictive of 90-Day Morbidity, Readmission, and Costs in Patients Undergoing Pelvic Exenteration.

PubMed

Bogani, Giorgio; Signorelli, Mauro; Ditto, Antonino; Martinelli, Fabio; Casarin, Jvan; Mosca, Lavinia; Leone Roberti Maggiore, Umberto; Chiappa, Valentina; Lorusso, Domenica; Raspagliesi, Francesco

2018-06-01

Pelvic exenteration for recurrent gynecological malignancies is characterized by a high rate of severe complications. Factors predictive of morbidity, readmission, and cost were analyzed. Data of consecutive patients undergoing pelvic exenteration between January 2007 and December 2016 were prospectively evaluated. Fifty-eight patients were included in the analysis. Anterior, posterior, and total exenterations were executed in 39 (67%), 9 (16%), and 10 (17%) patients, respectively. Ten (15.5%) severe complications occurred: 8 (20.5%), 0 (0%), and 1 (10%) after anterior, posterior, and total exenterations, respectively. Radiotherapy dosage, time between radiotherapy and surgery, and previous administration of chemotherapy did not influence 90-day complications and readmission. At multivariable analysis, albumin levels less than 3.5 g/dL (odds ratio, 16.2 [95% confidence interval, 2.85-92.8]; P = 0.002) and history of deep vein thrombosis (odds ratio, 9.6 [95% confidence interval, 0.93-98.2]; P = 0.057) were associated with 90-day morbidity. Low albumin levels independently correlated with readmission (P = 0.011). The occurrence of 90-day postoperative complications and readmission increased costs of a median of +12,500 and +6000 euros, respectively (P < 0.05). Preoperative patient selection is a key point for the reduction of postoperative complications after pelvic exenteration. Further prospective studies are warranted to improve patient selection.

Immigration and Acculturation-Related Factors and Asthma Morbidity in Latino Children*

PubMed Central

Sato, Amy F.; Kopel, Sheryl J.; McQuaid, Elizabeth L.; Seifer, Ronald; Klein, Robert; Esteban, Cynthia; Lobato, Debra; Ortega, Alexander N.; Canino, Glorisa; Fritz, Gregory K.

2011-01-01

Objective This article presents a summary of findings from asthma studies focusing on immigration and acculturation-related factors. A study examining associations between these processes, family cohesion and social support networks, and asthma morbidity in a sample of Dominican and Puerto Rican caregivers residing in the mainland U.S., is also described. Methods Latino children with asthma (n = 232), ages 7–16 (49% female) and their caregivers completed interview-based questionnaires on immigration and acculturation-related processes, family characteristics, and asthma morbidity. Results The frequency of ED use due to asthma may be higher for children of caregivers born in Puerto Rico. Acculturative stress levels were higher for Puerto Rican born caregivers residing in the mainland U.S. Conclusion Asthma-related educational and intervention programs for Latino children and families should be tailored to consider the effects that the immigration and acculturation experience can have on asthma management. Specific family-based supports focused on decreasing stress related to the acculturation process, and increasing social and family support around the asthma treatment process may help to reduce asthma morbidity in Latino children. PMID:21745811

[Morbidity and mortality rates in relation to the "surgeon factor" after duodenopancreatectomy].

PubMed

Targarona, Javier; Pando, Elizabeth; Garatea, Rafael; Vavoulis, Alexandra; Montoya, Eduardo

2007-10-01

The present study was designed to determine whether the surgeon factor has an independent effect on morbidity and mortality rates after duodenopancreatectomy. Between October 2002 and December 2006, we performed a study of 119 patients who underwent duodenopancreatectomy. The surgeons were divided into 3 groups according to the number of interventions they performed each year: a low volume group (three Whipple procedures per year), a medium volume group (four to 10 Whipple procedures per year) and a high volume group (> 10 Whipple procedures per year). The morbidity rate was higher in the low volume group (82%) than in the high volume group (35%). Length of hospital stay was clearly longer in the low and medium volume groups (27 days, and 21 days) than in the high volume group (17 days). Comparison of the results of the 3 groups revealed that the group performing three or less interventions per year (low volume) had the highest mortality rate (47%), while the group performing more than 10 interventions per year (high volume) had a very low mortality rate (4%). We found that the volume-to-surgeon ratio was inversely proportional to morbidity, length of hospital stay, return to oral intake, and mortality rates. Therefore, increasing surgical volume could improve morbidity and mortality rates.

Antenatal risk factors associated with neonatal morbidity in large for gestational age infants: an international prospective cohort study.

PubMed

Vieira, Matias C; McCowan, Lesley Me; North, Robyn A; Myers, Jenny E; Walker, James J; Baker, Philip N; Dekker, Gustaaf A; Kenny, Louise C; Poston, Lucilla; Pasupathy, Dharmintra

2018-05-12

Large for gestational age (LGA) infants are associated with increased risk of neonatal morbidity and mortality, however most of them will not have adverse outcomes. Our aim was to identify antenatal clinical factors associated with neonatal morbidity in LGA infants. Nulliparous women from the Screening for Pregnancy Endpoints (SCOPE) study were included. We compared maternal and fetal factors between LGA infants (birthweight >90 th customized centile) with and without neonatal morbidity, defined as admission to neonatal intensive care unit or severe neonatal morbidity. Factors were selected based on a-priori hypotheses of association and included maternal demography, anthropometric measures and self-reported physical activity (15 and 20 weeks), fetal biometry (20 weeks), and clinical information. Multivariable logistic regression was used to identify risk factors. Stratified analyses were performed by maternal obesity and physical activity. Amongst term pregnancies, prevalence of LGA infants was 9.3% (491/5,255), with 11.8% (58/491) prevalence of neonatal morbidity. Random glucose at 20 weeks (OR 1.52; 95% CI1.17 to 1.97, per 1mmol/L increase) and no regular physical activity at 20 weeks (3.93; 1.75 to 8.83) were associated with increased risk of neonatal morbidity after adjustment for birthweight, gestational age at delivery and gestational diabetes. The increased risk associated with higher glucose levels was not evident in women with regular physical activity or without obesity. Regular physical activity in mid-pregnancy is associated with lower risk for neonatal morbidity in LGA infants and seems to offer protection against the increased risk associated with higher maternal glucose levels. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Placenta previa and maternal hemorrhagic morbidity.

PubMed

Gibbins, Karen J; Einerson, Brett D; Varner, Michael W; Silver, Robert M

2018-02-01

Placenta previa is associated with maternal hemorrhage, but most literature focuses on morbidity in the setting of placenta accreta. We aim to characterize maternal morbidity associated with previa and to define risk factors for hemorrhage. This is a secondary cohort analysis of the NICHD Maternal-Fetal Medicine Units Network Cesarean Section Registry. This analysis included all women undergoing primary Cesarean delivery without placenta accreta. About 496 women with previa were compared with 24,201 women without previa. Primary outcome was composite maternal hemorrhagic morbidity. Non-hemorrhagic morbidities and risk factors for hemorrhage were also evaluated. Maternal hemorrhagic morbidity was more common in women with previa (19 versus 7%, aRR 2.6, 95% CI 1.9-3.5). Atony requiring uterotonics (aRR 3.1, 95% CI 2.0-4.9), red blood cell transfusion (aRR 3.8, 95% CI 2.5-5.7), and hysterectomy (aRR 5.1, 95% CI 1.5-17.3) were also more common with previa. For women with previa, factors associated with maternal hemorrhage were pre-delivery anemia, thrombocytopenia, diabetes, magnesium use, and general anesthesia. Placenta previa is an independent risk factor for maternal hemorrhagic morbidity. Some risk factors are modifiable, but many are intrinsic to the clinical scenario.

[Prevalence and potential predictors of morbidity among Hungarian female physicians].

PubMed

Gyorffy, Zsuzsa; Adám, Szilvia; Kopp, Mária

2009-07-01

We explored the general health status of physicians in Hungary using a nationwide sample. Based on international and Hungarian literature, we hypothesised that the prevalence of psychiatric and somatic morbidity is higher among female physicians in Hungary compared to the normative population. The objective of our cross-sectional research was to study the morbidity of Hungarian female physicians as well as to analyse background factors. Data for this national study were collected from 408 female physicians. 818 white collar workers from a representative survey (Hungarostudy 2002) served as controls. The prevalence of chronic somatic morbidity and reproduction disorders among female physicians was significantly higher than that in the control group. The female physicians have more chronic diseases, and the somatic morbidity have been appeared earlier. Correlation analyses confirmed a significant relationship: the chronic morbidity associated with injurious to health, sleep disorders and higher levels of work-family conflict. We found that the prevalence of chronic somatic morbidity among female physicians was significantly higher than that in the respective control groups. The higher prevalence of somatic and mental morbidity of Hungarian female physicians has important consequences. This may influence health care systems and thus might lead increased morbidity and mortality of Hungarian population.

Low birth weight and fetal anaemia as risk factors for infant morbidity in rural Malawi.

PubMed

Kalanda, Boniface; Verhoeff, Francine; le Cessie, Saskia; Brabin, John

2009-06-01

Low birth weight (LBW) and fetal anaemia (FA) are common in malaria endemic areas. To investigate the incidence of infectious morbidity in infants in rural Malawi in relation to birth weight and fetal anaemia, a cohort of babies was followed for a year on the basis of LBW (<2500) and FA (cord haemoglobin < 12.5 g/dl). A matched group of normal birth weight (NBW), non-anaemic (NFA) new-borns were enrolled as controls. Morbidity episodes were recorded at 4-weekly intervals and at each extra visit made to a health centre with any illness. Infants in the NBW NFA group experienced an average of 1.15 (95% C.I. 0.99, 1.31), 1.04 (0.89, 1.19), 0.92 (0.73, 1.11) episodes per year of malaria, respiratory infection and diarrhoea respectively. Corresponding values for the LBW FA group were 0.83 (0.5, 1.16), 0.82 (0.5, 1.16) and 0.76 (0.33, 1.19). FA was not associated with a higher incidence of morbidity, but was significantly associated with a shorter time to first illness episode (p = 0.014). LBW was not a significant risk factor for higher morbidity incidence. LBW and FA were not significant risk factors for incidence of illness episodes in infants.

Colorectal cancer morbidity in Poland and Japan in the years 1999–2006 – a comparison

PubMed Central

Miśkiewicz, Marta; Mik, Michał; Dziki, Adam; Utada, Mai; Kempińska-Mirosławska, Bogumiła

2014-01-01

Introduction The frequency of colorectal cancer (CRC) is dependent on sex and age. The illness more often affects men than women, and a considerable increase in morbidity is noted after 65 years of age. The aim of the study was to assess the influence of various risk factors on CRC morbidity, statistical data from countries varied in cultural, socioeconomic and biological terms need to be studied. Poland and Japan can serve as examples of such contrasts. Material and methods The basis for the analysis of CRC morbidity was statistical data from Poland and Japan gathered in the period 1999–2006. They were expressed in absolute numbers and were related to the total morbidity, as well as morbidity according to sex and age. Results In the years 1999–2006, the total morbidity in Japan was on average 2.3 times higher than in Poland. The value was 2.5 times higher among men and 2.1 times among women when compared to Poland. In both countries morbidity is closely related to age and it reaches a peak between 65 and 74 years of age. Although the change in morbidity over the period was the same for Poland and Japan, there are considerable differences concerning the sex of the patients. Conclusions There is a substantial increase in CRC morbidity in both countries, especially among elderly people, which may point to the predominant influence of environmental factors and population aging in both countries. The much higher increase in morbidity among Polish men when compared to Polish women, not observed in the Japanese population, requires further study. PMID:25097579

Burns in Tanzania: morbidity and mortality, causes and risk factors: a review

PubMed Central

Outwater, Anne H; Ismail, Hawa; Mgalilwa, Lwidiko; Justin Temu, Mary; Mbembati, Naboth A

2013-01-01

Burn injuries in low and middle income countries still remain a significant health problem, even though numbers of burn injuries in high income countries have decreased showing that such events are not “accidents” but are usually preventable. WHO states that the vast majority (over 95%) of fire-related burns occur in low and middle income countries. Burn injuries are a major cause of prolonged hospital stays, disfigurement, disability, and death in Africa Region. Evidence shows that prevention strategies can work. However prevention strategies need to be tailored to the specific environment taking into account local risk factors and available resources. An examination of the patterns and causes of burns should allow site specific recommendations for interventions. This literature review, specific to the United Republic of Tanzania, was conducted by researching PubMed, SafetyLit, and African Journals on Line data bases for primary sources using key words plus morbidity>. Two sets of student data collected as part of Bachelor’s degree final dissertations at Muhimbili University of Health and Allied Sciences were used. In all, twenty two primary sources were found. Risk factors for burn morbidity in Tanzania are: 1/ a young age, especially years 1-3, 2/ home environment, especially around cooking fires, 3/ epilepsy, during seizures, and 4/ perceived inevitability of the incident. It was expected that ground level cooking fires would be found to be a risk factor, but several studies have shown non-significant results about raised cooking fires, types of fuel used, and cooking appliances. Risk factors for burn mortality are: being male, between 20-30 years of age, and being punished for alleged thieving by community mobs. An important factor in reducing burn morbidity, especially in children, is to educate people that burns are preventable in most cases and that most burns occur in the home around

Morbidity and mortality disparities among colonist and indigenous populations in the Ecuadorian Amazon.

PubMed

Kuang-Yao Pan, William; Erlien, Christine; Bilsborrow, Richard E

2010-02-01

Rural populations living in the northern Ecuadorian Amazon (NEA) experience the highest health burden of any region in the country. Two independent studies of colonist and indigenous groups living in the NEA are used to compare their morbidity and mortality experiences. Colonist data are from a probability sample of land plots in 1999, while indigenous data are from a representative sample of the five largest ethnicities (Quichua, Shuar, Huaorani, Cofan, Secoya) collected in 2001. Poisson regression was used to compare morbidity. Results indicate clear differences in health between populations. Indigenous groups had 30% higher probability of mortality and 63% higher incidence rate of all-cause morbidity compared to colonists. Vector-borne, chronic, gastrointestinal, and diseases of unknown origin were particularly high among indigenous groups. Factors associated with morbidity varied: morbidity rates were similar for the two youngest age groups (0-4 and 5-9), but indigenous people aged 15-39 and 40+ had almost double the morbidity compared to colonists; larger households, later months of data collection and less pollution were associated with less morbidity in both groups; better infrastructure access (electricity and roads) was generally associated with lower morbidity in both groups; and associations of land use were different by group with more cultivation of perennials and fewer annuals associated with less morbidity for colonists, but more for indigenous groups. These results demonstrate the health disparities that exist among indigenous and non-indigenous populations even when living in the same geographic region. Land use itself exemplifies the cultural and contextual differences that are evident in health, since land use decisions are related to broader demographic and economic factors that influence overall ecological and human health. Ongoing population-environment and/or environment-health research needs to recognize the broader factors involved when

Morbidity and mortality disparities among colonist and indigenous populations in the Ecuadorian Amazon

PubMed Central

Pan, William Kuang-Yao; Erlien, Christine; Bilsborrow, Richard E

2009-01-01

Rural populations living in the northern Ecuadorian Amazon (NEA) experience the highest health burden of any region in the country. Two independent studies of colonist and indigenous groups living in the NEA are used to compare their morbidity and mortality experiences. Colonist data are from a probability sample of land plots in 1999, while indigenous data are from a representative sample of the five largest ethnicities (Quichua, Shuar, Huaorani, Cofan, Secoya) collected in 2001. Poisson regression was used to compare morbidity. Results indicate clear differences in health between populations. Indigenous groups had 30% higher probability of mortality and 63% higher incidence rate of all-cause morbidity compared to colonists. Vector-borne, chronic, gastrointestinal, and diseases of unknown origin were particularly high among indigenous groups. Factors associated with morbidity varied: morbidity rates were similar for the two youngest age groups (0–4 and 5–9), but indigenous people aged 15–39 and 40+ had almost double the morbidity compared to colonists; larger households, later months of data collection and less pollution were associated with less morbidity in both groups; better infrastructure access (electricity and roads) was generally associated with lower morbidity in both groups; and associations of land use were different by group with more cultivation of perennials and fewer annuals associated with less morbidity for colonists, but more for indigenous groups. These results demonstrate the health disparities that exist among indigenous and non-indigenous populations even when living in the same geographic region. Land use itself exemplifies the cultural and contextual differences that are evident in health, since land use decisions are related to broader demographic and economic factors that influence overall ecological and human health. Ongoing population-environment and/or environment-health research needs to recognize the broader factors involved

The Influence of Co-Morbidity and Other Health Measures on Dental and Medical Care Use among Medicare beneficiaries 2002

PubMed Central

Chen, Haiyan; Moeller, John; Manski, Richard J.

2011-01-01

Objective To assess the impact of co-morbidity and other health measures on the use of dental and medical care services among the community-based Medicare population with data from the 2002 Medicare Current Beneficiary Survey. Methods A co-morbidity index is the main independent variable of our study. It includes oral cancer as a co-morbidity condition and was developed from Medicare claims data. The two outcome variables indicate whether a beneficiary had a dental visit during the year and whether the beneficiary had an inpatient hospital stay during the year. Logistic regressions estimated the relationship between the outcome variables and co-morbidity after controlling for other explanatory variables. Results High scores on the co-morbidity index, high numbers of self-reported physical limitations, and fair or poor self-reported health status were correlated with higher hospital use and lower dental care utilization. Similar results were found for other types of medical care including medical provider visits, outpatient care, and prescription drugs. A multiple imputation technique was used for the approximate 20% of the sample with missing claims, but the resulting co-morbidity index performed no differently than the index constructed without imputation. Conclusions Co-morbidities and other health status measures are theorized to play either a predisposing or need role in determining health care utilization. The study’s findings confirm the dominant role of these measures as predisposing factors limiting access to dental care for Medicare beneficiaries and as need factors producing higher levels of inpatient hospital and other medical care for Medicare beneficiaries. PMID:21972460

Cannabis and Depression: A Twin Model Approach to Co-morbidity.

PubMed

Smolkina, M; Morley, K I; Rijsdijk, F; Agrawal, A; Bergin, J E; Nelson, E C; Statham, D; Martin, N G; Lynskey, M T

2017-07-01

Cannabis use disorder (CUD) co-occurs with major depressive disorder (MDD) more frequently than would be expected by chance. However, studies to date have not produced a clear understanding of the mechanisms underlying this co-morbidity. Genetically informative studies can add valuable insight to this problem, as they allow the evaluation of competing models of co-morbidity. This study uses data from the Australian Twin Registry to compare 13 co-morbidity twin models initially proposed by Neale and Kendler (Am J Hum Genet 57:935-953, 1995). The analysis sample comprised 2410 male and female monozygotic and dizygotic twins (average age 32) who were assessed on CUD and MDD using the SSAGA-OZ interview. Data were analyzed in OpenMx. Of the 13 different co-morbidity models, two fit equally well: CUD causes MDD and Random Multiformity of CUD. Both fit substantially better than the Correlated Liabilities model. Although the current study cannot differentiate between them statistically, these models, in combination, suggest that CUD risk factors may causally influence the risk to develop MDD, but only when risk for CUD is high.

Assessing the influence of land use land cover pattern, socio economic factors and air quality status to predict morbidity on the basis of logistic based regression model

NASA Astrophysics Data System (ADS)

Dixit, A.; Singh, V. K.

2017-12-01

Recent studies conducted by World Health Organisation (WHO) estimated that 92 % of the total world population are living in places where the air quality level has exceeded the WHO standard limit for air quality. This is due to the change in Land Use Land Cover (LULC) pattern, socio economic drivers and anthropogenic heat emission caused by manmade activity. Thereby, many prevalent human respiratory diseases such as lung cancer, chronic obstructive pulmonary disease and emphysema have increased in recent times. In this study, a quantitative relationship is developed between land use (built-up land, water bodies, and vegetation), socio economic drivers and air quality parameters using logistic based regression model over 7 different cities of India for the winter season of 2012 to 2016. Different LULC, socio economic, industrial emission sources, meteorological condition and air quality level from the monitoring stations are taken to estimate the influence on morbidity of each city. Results of correlation are analyzed between land use variables and monthly concentration of pollutants. These values range from 0.63 to 0.76. Similarly, the correlation value between land use variable with socio economic and morbidity ranges from 0.57 to 0.73. The performance of model is improved from 67 % to 79 % in estimating morbidity for the year 2015 and 2016 due to the better availability of observed data.The study highlights the growing importance of incorporating socio-economic drivers with air quality data for evaluating morbidity rate for each city in comparison to just change in quantitative analysis of air quality.

Conscious knowledge influences decision-making differently in substance abusers with and without co-morbid antisocial personality disorder.

PubMed

Mellentin, Angelina I; Skøt, Lotte; Teasdale, Thomas W; Habekost, Thomas

2013-08-01

Decision-making impairment, as measured by the Iowa Gambling Task (IGT), is a consistent finding among individuals with substance use disorder (SUD). We studied how this impairment is influenced by co-morbid antisocial personality disorder (ASPD) and conscious knowledge of the task. Three groups were investigated: SUD individuals without co-morbid ASPD (n = 30), SUD individuals with co-morbid ASPD (n = 16), and healthy controls (n = 17). Both SUD and SUD+ASPD participants had poor overall IGT performance. A block-by-block analysis revealed that SUD participants exhibited slow but steady improvement across the IGT, whereas SUD+ASPD participants exhibited initial normal improvement, but dropped off during the last 40 trials. Conscious knowledge of the task was significantly correlated to performance for controls and SUD participants, but not for SUD+ASPD participants. Our findings suggest that decision-making proceeds differently in SUD and SUD+ASPD individuals due to differences in acquisition and application of conscious knowledge. © 2013 The Scandinavian Psychological Associations.

Morbidity and mortality according to age following gastrectomy for gastric cancer.

PubMed

Nelen, S D; Bosscha, K; Lemmens, V E P P; Hartgrink, H H; Verhoeven, R H A; de Wilt, J H W

2018-04-23

This study investigated age-related differences in surgically treated patients with gastric cancer, and aimed to identify factors associated with outcome. Data from the Dutch Upper Gastrointestinal Cancer Audit were used. All patients with non-cardia gastric cancer registered between 2011 and 2015 who underwent surgery were selected. Patients were analysed by age group (less than 70 years versus 70 years or more). Multivariable logistic regression was used to assess the influence of clinicopathological factors on morbidity and mortality. A total of 1109 patients younger than 70 years and 1206 aged 70 years or more were included. Patients aged at least 70 years had more perioperative or postoperative complications (41·2 versus 32·5 per cent; P < 0·001) and a higher 30-day mortality rate (7·9 versus 3·2 per cent; P < 0·001) than those younger than 70 years. In multivariable analysis, age 70 years or more was associated with a higher risk of complications (odds ratio 1·29, 95 per cent c.i. 1·05 to 1·59). Postoperative mortality was not significantly associated with age. In the entire cohort, morbidity and mortality were influenced most by ASA grade, neoadjuvant chemotherapy and type of resection. ASA grade, neoadjuvant chemotherapy and type of resection are independent predictors of morbidity and death in patients with gastric cancer, irrespective of age. © 2018 BJS Society Ltd Published by John Wiley & Sons Ltd.

[Morphological verification problems of Chernobyl factor influence on the prostate of coalminers of Donbas--liquidators of Chernobyl accident].

PubMed

Danylov, Iu V; Motkov, K V; Shevchenko, T I

2013-12-01

Problem of a diagnostic of Chernobyl factor influences on different organs and systems of Chernobyl accident liquidators are remain actually until now. Though morbidly background which development at unfavorable work conditions in underground coalminers prevents from objective identification features of Chernobyl factor influences. The qualitative and quantitative histological and immunohistochemical law of morphogenesis changes in prostate of Donbas's coalminer-non-liquidators Chernobyl accident in comparison with the group of Donbas's coalminers-liquidators Chernobyl accident which we were stationed non determined problem. This reason stipulates to development and practical use of mathematical model of morphogenesis of a prostatic gland changes.

Hope as determinant for psychiatric morbidity in family caregivers of advanced cancer patients.

PubMed

Rumpold, T; Schur, S; Amering, M; Ebert-Vogel, A; Kirchheiner, K; Masel, E; Watzke, H; Schrank, B

2017-05-01

Home care of advanced cancer patients often has adverse effects on physical and mental health of family caregivers. Little is known about the long-term effects of continuous caregiving on mental health as compared with the effects of bereavement. The objectives of this study were to describe the course of psychiatric morbidity in family caregivers over time, to identify the impact of the patients' death on caregivers, and to explore possible predictor variables for psychiatric morbidity. This multi-institutional, prospective study included 80 family caregivers of 80 advanced cancer patients for baseline and 9 months follow-up assessment. Possible psychiatric disorders (ie, depression, anxiety, posttraumatic stress disorder, and alcohol abuse/dependence) as well as potentially predictive factors (ie, sociodemographic factors, burden, hope, and coping mechanisms) were assessed. Follow-up assessment was conducted on average 9.2 months (±2.9) after baseline assessment. Prevalence rates of anxiety and posttraumatic stress disorder decreased significantly over time, whereas depression and alcoholism remained stable. Bereavement was experienced by 53% of caregivers in the follow-up period. The patients' death had no influence on psychiatric morbidity at follow-up. Predictors for the development of a psychiatric disorder varied according to condition, with hope and emotion-oriented coping identified as important influences, especially for anxiety and depression. Family caregivers with certain psychiatric disorders might need targeted psychosocial support to ensure their mental well-being and prevent long-term disability. Supporting hope and functional coping strategies early after the patient's diagnosis might limit development and extent of psychiatric morbidity. Copyright © 2016 John Wiley & Sons, Ltd.

[Influence of poor factors of airports on human health].

PubMed

Pochekaeva, E I

2008-01-01

The hygienic study conducted in Rostov-on-Don has shown that air transport and airports are important sources of physical and chemical pollution of the environment. Human health examinations served to illustrate the adverse impact of airports on the environmental and hygienic living conditions of the population. The performed studies provided the basis for purpose-oriented program to enhance the environment and to reduce morbidity rates in accordance with the National Environmental Hygiene Program. The developed algorithm of the assessment and reduction of a risk for diseases under the influence of poor factors associated with the activities of airports is designed to provide the authorities and concerned organizations with information, to make managerial decisions, and to work out health-improving measures.

[Morphological verification problems of Chernobyl factor influence on the testis of coal miners of Donbas-liquidators of Chernobyl accident].

PubMed

Danylov, Iu V; Motkov, K V; Shevchenko, T I

2013-01-01

Problem of a diagnostic of Chernobyl factor influences on different organs and systems of Chernobyl accident liquidators are remain actually until now. Though morbidly background which development at unfavorable work conditions in underground coalminers prevents from objective identification features of Chernobyl factor influences. The qualitative and quantitative histological and immunohistochemical law of morphogenesis changes in testis of Donbas's coalminer - non-liquidators Chernobyl accident in comparison with the group of Donbas's coalminers-liquidators Chernobyl accident, which we were stationed non determined problem. This reason stipulates to development and practical use of mathematical model of morphogenesis of a testis changes.

The role of prenatal care and social risk factors in the relationship between immigrant status and neonatal morbidity: a retrospective cohort study.

PubMed

Paz-Zulueta, María; Llorca, Javier; Sarabia-Lavín, Raquel; Bolumar, Francisco; Rioja, Luis; Delgado, Abraham; Santibáñez, Miguel

2015-01-01

Literature evaluating association between neonatal morbidity and immigrant status presents contradictory results. Poorer compliance with prenatal care and greater social risk factors among immigrants could play roles as major confounding variables, thus explaining contradictions. We examined whether prenatal care and social risk factors are confounding variables in the relationship between immigrant status and neonatal morbidity. Retrospective cohort study: 231 pregnant African immigrant women were recruited from 2007-2010 in northern Spain. A Spanish population sample was obtained by simple random sampling at 1:3 ratio. Immigrant status (Spanish, Sub-Saharan and Northern African), prenatal care (Kessner Index adequate, intermediate or inadequate), and social risk factors were treated as independent variables. Low birth weight (LBW < 2500 grams) and preterm birth (< 37 weeks) were collected as neonatal morbidity variables. Crude and adjusted odds ratios (OR) were estimated by unconditional logistic regression with 95% confidence intervals (95% CI). Positive associations between immigrant women and higher risk of neonatal morbidity were obtained. Crude OR for preterm births in Northern Africans with respect to nonimmigrants was 2.28 (95% CI: 1.04-5.00), and crude OR for LBW was 1.77 (95% CI: 0.74-4.22). However, after adjusting for prenatal care and social risk factors, associations became protective: adjusted OR for preterm birth = 0.42 (95% CI: 0.14-1.32); LBW = 0.48 (95% CI: 0.15-1.52). Poor compliance with prenatal care was the main independent risk factor associated with both preterm birth (adjusted OR inadequate care = 17.05; 95% CI: 3.92-74.24) and LBW (adjusted OR inadequate care = 6.25; 95% CI: 1.28-30.46). Social risk was an important independent risk factor associated with LBW (adjusted OR = 5.42; 95% CI: 1.58-18.62). Prenatal care and social risk factors were major confounding variables in the relationship between immigrant status and neonatal morbidity.

Surgery for hepatic hidatidosis. Risk factors and variables associated with postoperative morbidity. Overview of the existing evidence.

PubMed

Manterola, Carlos; Otzen, Tamara; Muñoz, Gloria; Alanis, Martín; Kruuse, Eileen; Figueroa, Gustavo

2017-12-01

There are few publications related to postoperative morbidity in hepatic hydatidosis and these have mixed results. The aim of this study was to determine risk and protective factors of postoperative morbidity in patients operated on for hepatic hydatidosis. A comprehensive review was made of the evidence, based on systematic reviews, clinical analyses and observational studies, obtained from the Trip Database, BVS, SciELO, Cochrane Central Register of Controlled Trials, WoS, MEDLINE, EMBASE, SCOPUS, EBSCOhost, IBECS, ePORTUGUESe, LILACS and WHOLIS. 1,087 related articles were identified; 69 fulfilled the selection criteria (2 systematic reviews, 3 clinical trials and 64 observational studies). Age, history of previous surgery for hepatic hydatidosis, location in the hepatic center, existence of biliary communications and evolutionary complications of the cyst were identified as risk factors, and radical surgical techniques as protective factors. Risk and protective factors were identified; however, the studies are few and the quality moderate to low. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Growth differentiation factor-15 predicts mortality and morbidity after cardiac resynchronization therapy.

PubMed

Foley, Paul W X; Stegemann, Berthold; Ng, Kelvin; Ramachandran, Sud; Proudler, Anthony; Frenneaux, Michael P; Ng, Leong L; Leyva, Francisco

2009-11-01

The aim of this study was to determine whether growth differentiation factor-15 (GDF-15) predicts mortality and morbidity after cardiac resynchronization therapy (CRT). Growth differentiation factor-15, a transforming growth factor-beta-related cytokine which is up-regulated in cardiomyocytes via multiple stress pathways, predicts mortality in patients with heart failure treated pharmacologically. Growth differentiation factor-15 was measured before and 360 days (median) after implantation in 158 patients with heart failure [age 68 +/- 11 years (mean +/- SD), left ventricular ejection fraction (LVEF) 23.1 +/- 9.8%, New York Class Association (NYHA) class III (n = 117) or IV (n = 41), and QRS 153.9 +/- 28.2 ms] undergoing CRT and followed up for a maximum of 5.4 years for events. In a stepwise Cox proportional hazards model with bootstrapping, adopting log GDF-15, log NT pro-BNP, LVEF, and NYHA class as independent variables, only log GDF-15 [hazard ratio (HR), 3.76; P = 0.0049] and log NT pro-BNP (HR, 2.12; P = 0.0171) remained in the final model. In the latter, the bias-corrected slope was 0.85, the optimism (O) was -0.06, and the c-statistic was 0.74, indicating excellent internal validity. In univariate analyses, log GDF-15 [HR, 5.31; 95% confidence interval (CI), 2.31-11.9; likelihood ratio (LR) chi(2) = 14.6; P < 0.0001], NT pro-BNP (HR, 2.79; 95% CI, 1.55-5.26; LR chi(2) = 10.4; P = 0.0004), and the combination of both biomarkers (HR, 7.03; 95% CI, 2.91-17.5; LR chi(2) = 19.1; P < 0.0001) emerged as significant predictors. The biomarker combination was associated with the highest LR chi(2) for all endpoints. Pre-implant GDF-15 is a strong predictor of mortality and morbidity after CRT, independent of NT pro-BNP. The predictive value of these analytes is enhanced by combined measurement.

Coagulation Profile as a Risk Factor for 30-Day Morbidity and Mortality Following Posterior Lumbar Fusion.

PubMed

Bronheim, Rachel S; Oermann, Eric K; Cho, Samuel K; Caridi, John M

2017-06-15

A retrospective cohort study. The aim of this study was to identify associations between abnormal coagulation profile and postoperative morbidity and mortality in patients undergoing posterior lumbar fusion (PLF). The literature suggests that abnormal coagulation profile is associated with postoperative complications, notably the need for blood transfusion. However, there is little research that directly addresses the influence of coagulation profile on postoperative complications following PLF. The American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP) was utilized to identify patients undergoing PLF between 2006 and 2013. Nine thousand two hundred ninety-five patients met inclusion criteria. Multivariate analysis was utilized to identify associations between abnormal coagulation profile and postoperative complications. Low platelet count was an independent risk factor for organ space surgical site infections (SSIs) [odds ratio (OR) = 6.0, P < 0.001], ventilation >48 hours (OR = 4.5, P = 0.002), Acute renal failure (OR = 5.8, P = 0.007), transfusion (OR = 1.6, P < 0.001), sepsis (OR = 2.2, P = 0.037), reoperation (OR = 2.5, P = 0.001), and death (OR = 3.7, P = 0.049). High partial thromboplastin time (PTT) was an independent risk factor for ventilation >48 hours (OR = 5.6, P = 0.002), cerebrovascular accident (CVA)/stroke with neurological deficit (OR = 5.1, P = 0.011), cardiac arrest (OR = 5.4, P = 0.030), transfusion (OR = 1.5, P = 0.020), and death (OR = 4.5, P = 0.050). High International Normalized Ration (INR) was an independent risk factor for pneumonia (OR = 8.7, P = 0.001), pulmonary embolism (OR = 5.6, P = 0.021), deep venous thrombosis/Thrombophlebitis (OR = 4.8, P = 0.011), septic shock (OR = 8.4, P = 0.048), and death (OR = 9.8, P = 0.034). Bleeding disorder was an

Tandem mass spectrometry determined maternal cortisone to cortisol ratio and psychiatric morbidity during pregnancy-interaction with birth weight.

PubMed

Hellgren, Charlotte; Edvinsson, Åsa; Olivier, Jocelien D; Fornes, Romina; Stener-Victorin, Elisabet; Ubhayasekera, S J Kumari A; Skalkidou, Alkistis; Bergquist, Jonas; Sundström-Poromaa, Inger

2016-07-01

Maternal serum cortisol has been suggested to be influenced by psychiatric morbidity, and may also influence fetal growth. However, several studies found equal cortisol levels in depressed and healthy pregnant women. Placental 11-β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) shields the fetus from maternal cortisol by conversion to cortisone, a function that may be compromised by maternal stress. We aimed to compare the serum ratio of cortisone to cortisol, in women with and without psychiatric morbidity during pregnancy. A secondary aim was to investigate whether fetal growth, approximated by infant birth weight, was associated with the cortisone to cortisol ratio. We performed tandem mass spectrometry analysis of serum cortisol and cortisone in late pregnancy in 94 women with antenatal psychiatric morbidity and 122 controls (cohort 1). We also compared the placental gene expression of HSD11B1 and 2 in another group of 69 women with psychiatric morbidity and 47 controls (cohort 2). There were no group differences in cortisol to cortisone ratio, absolute levels of cortisone and cortisol (cohort 1), or expression of HSD11B1 or 2 (cohort 2). However, cortisone to cortisol ratio was positively associated with birth weight in women with psychiatric morbidity, also after adjustment for gestational length, fetal sex, maternal height, smoking, SSRI use, and time of blood sampling (standardized β=0.35, p<0.001), with no association in the healthy controls Thus, the maternal serum cortisone to cortisol ratio does not seem to be affected by psychiatric morbidity, but psychiatric morbidity may increase fetal exposure to cortisol or other metabolic factors influencing fetal growth. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Central bank interest rate decisions, household indebtedness, and psychiatric morbidity and distress: Evidence from the UK.

PubMed

Boyce, Christopher J; Delaney, Liam; Ferguson, Eamonn; Wood, Alex M

2018-07-01

Central banks set economy-wide interest rates to meet exclusively economic objectives. There is a strong link between indebtedness and psychiatric morbidity at the individual level, with interest rates being an important factor determining ability to repay debt. However, no prior research has explored whether central bank interest rate changes directly influence mental health, nor whether this varies by levels of indebtedness. We use British data (N = 93,255) to explore whether the Bank of England base-rate affected how perceived burden of non-mortgage debt (low, medium, and high) influenced psychiatric morbidity. Psychiatric morbidity was measured using the General Health Questionnaire (GHQ-12). Our primary outcome measure was a binary indicator of "psychiatric caseness" (>3 on a 0-12 scale). We also used the GHQ-12 as a continuous measure of distress. When interest rates are high (low) there is an increased (decreased) risk of psychiatric morbidity only among those with a high debt burden (b = 0.026, p =  0.02). This result was robust to alternative explanations. Thus a 1 percentage point base-rate increase is associated with a 2.6% increase that someone with a high debt burden will experience psychiatric morbidity. Our study uses subjective indicators of debt burden. We were unable to determine the mechanism behind our effect. Changes in central bank interest rates to meet economic objectives pose a threat to mental health. Mental health support is needed for those in debt and central banks may need to consider how their decisions influence population mental health. Copyright © 2018. Published by Elsevier B.V.

Psychological morbidity and stress but not social factors influence level of fear of cancer recurrence in young women with early breast cancer: results of a cross-sectional study.

PubMed

Thewes, B; Bell, M L; Butow, P; Beith, J; Boyle, F; Friedlander, M; McLachlan, S A

2013-12-01

Fear of cancer recurrence (FCR) is a common problem amongst survivors. Past research has shown that young women with breast cancer are particularly vulnerable to FCR, yet few previous studies have specifically examined FCR in this subgroup. The aim of the study is to explore the relationship between FCR, psychological morbidity and social factors. A secondary aim was to explore the relationship between clinical levels of FCR and generalised anxiety disorder (GAD) and hypochondriasis. Two hundred eighteen breast cancer survivors (aged 18-45 years at diagnosis) diagnosed at least 1 year prior were recruited through seven metropolitan oncology clinics and two breast cancer consumer groups. Participants completed a web-based questionnaire, which assessed FCR, psychological functioning, generalised anxiety, hypochondriasis and items exploring past cancer-related experiences, attitudes to future childbearing, social support and correlates were identified using linear regression. Psychological morbidity scales measuring anxiety and psychological functioning and stressful life events were significantly associated with FCR in adjusted and unadjusted models (p < 0.0001). Past cancer experiences, children, social support and attitudes to childrearing were not associated with FCR. Among those with clinical levels of FCR (n = 152), 43% met screening criteria for hypochondriasis, and 36% met screening criteria for GAD. This study shows psychological morbidity is associated with FCR, but the majority of women with high levels of FCR do not also meet the criteria for a clinical level of GAD or hypochondriasis. Understanding the factors that make young women vulnerable to FCR is important to help guide the development of FCR-specific interventions for this subgroup. Copyright © 2013 John Wiley & Sons, Ltd.

Relative Risks of Contributing Factors to Morbidity and Mortality in Adults With Craniopharyngioma on Growth Hormone Replacement.

PubMed

Yuen, Kevin C J; Mattsson, Anders F; Burman, Pia; Erfurth, Eva-Marie; Camacho-Hubner, Cecilia; Fox, Janet L; Verhelst, Johan; Geffner, Mitchell E; Abs, Roger

2018-02-01

In adults, craniopharyngioma (CP) of either childhood-onset (CO-CP) or adult-onset (AO-CP) is associated with increased morbidity and mortality, but data on the relative risks (RRs) of contributing factors are lacking. To assess the RRs of factors contributing to morbidity and mortality in adults with CO-CP and AO-CP. Data on 1669 patients with CP from KIMS (Pfizer International Metabolic Database) were analyzed using univariate and multiple Poisson and Cox regression methods. When CO-CP and AO-CP groups were combined, history of stroke and hyperlipidemia increased cardiovascular risk, higher body mass index (BMI) and radiotherapy increased cerebrovascular risk, and increased waist circumference increased the risk of developing diabetes mellitus (DM). Compared with patients with CO-CP, patients with AO-CP had a threefold higher risk of tumor recurrence, whereas being female and previous radiotherapy exposure conferred lower risks. Radiotherapy and older age with every 10 years from disease onset conferred a 2.3- to 3.5-fold risk for developing new intracranial tumors, whereas older age, greater and/or increasing BMI, history of stroke, and lower insulinlike growth factor I (IGF-I) standard deviation score measured at last sampling before death were related to increased all-cause mortality. Compared with the general population, adults with CP had 9.3-, 8.1-, and 2.2-fold risks of developing DM, new intracranial tumors, and early death, respectively. Conventional factors that increase the risks of cardio- and cerebrovascular diseases and DM and risks for developing new intracranial tumors contributed to excess morbidity and mortality. In addition, lower serum IGF-I level measured from the last sample before death was inversely associated with mortality risk in patients with CP. Copyright © 2017 Endocrine Society

Risk factors for anastomotic leak and postoperative morbidity and mortality after elective right colectomy for cancer: results from a prospective, multicentric study of 1102 patients.

PubMed

Frasson, Matteo; Granero-Castro, Pablo; Ramos Rodríguez, José Luis; Flor-Lorente, Blas; Braithwaite, Mariela; Martí Martínez, Eva; Álvarez Pérez, Jose Antonio; Codina Cazador, Antonio; Espí, Alejandro; Garcia-Granero, Eduardo

2016-01-01

Studies focused on postoperative outcome after oncologic right colectomy are lacking. The main objective was to determine pre-/intraoperative risk factors for anastomotic leak after elective right colon resection for cancer. Secondary objectives were to determine risk factors for postoperative morbidity and mortality. Fifty-two hospitals participated in this prospective, observational study (September 2011-September 2012), including 1102 patients that underwent elective right colectomy. Forty-two pre-/intraoperative variables, related to patient, tumor, surgical procedure, and hospital, were analyzed as potential independent risk factors for anastomotic leak and postoperative morbidity and mortality. Anastomotic leak was diagnosed in 93 patients (8.4 %), and 72 (6.5 %) of them needed radiological or surgical intervention. Morbidity, mortality, and wound infection rates were 29.0, 2.6, and 13.4 %, respectively. Preoperative serum protein concentration was the only independent risk factor for anastomotic leak (p < 0.0001, OR 0.6 per g/dL). When considering only clinically relevant anastomotic leaks, stapled technique (p = 0.03, OR 2.1) and preoperative serum protein concentration (p = 0.004, OR 0.6 g/dL) were identified as the only two independent risk factors. Age and preoperative serum albumin concentration resulted to be risk factors for postoperative mortality. Male gender, pulmonary or hepatic disease, and open surgical approach were identified as risk factors for postoperative morbidity, while male gender, obesity, intraoperative complication, and end-to-end anastomosis were risk factors for wound infection. Preoperative nutritional status and the stapled anastomotic technique were the only independent risk factors for clinically relevant anastomotic leak after elective right colectomy for cancer. Age and preoperative nutritional status determined the mortality risk, while laparoscopic approach reduced postoperative morbidity.

A one-year community study of under-fives in rural Ethiopia: patterns of morbidity and public health risk factors.

PubMed

Muhe, L; Byass, P; Freij, L; Sandström, A; Wall, S

1995-03-01

A prospective weekly home surveillance study was undertaken to determine morbidity patterns within the Butajira Rural Health project in central Ethiopia. Overall prevalence of illness was 5.8% in 1216 person-years observed among rural Ethiopian children aged under 5 years. Acute respiratory infections (ARI) (prevalence 2.8%) and acute diarrhoea (2.4%) were the commonest conditions. Episodes of illness were distributed unequally among children, with a mean of 2.34 episodes per child. These included an average of 1.13 episodes of ARI (of which 0.16 had lower respiratory symptoms [ALRI]) and 1.17 episodes of acute diarrhoea. Sanitation factors were the principal risks for gastroenteritis, while living in rural areas predisposed children to ARI. Parental factors such as illiteracy were also linked to morbidity.

Reconstruction in oral malignancy: Factors affecting morbidity of various procedures

PubMed Central

Chakrabarti, Suvadip; Chakrabarti, Preeti Rihal; Desai, Sanjay M.; Agrawal, Deepak; Mehta, Dharmendra Y.; Pancholi, Mayank

2015-01-01

Aims and Objective: (1) To study the age and sex distribution of patient with oral malignancies. (2) To analyze various types of surgery performed. (3) Evaluation of reconstruction and factors affecting complications and its relation to the type of reconstruction. Materials and Methods: Cases of oral malignancies, undergoing surgery for the same in Sri Aurobindo Medical College and PG Institute, Indore from the period from October 1, 2012, to March 31, 2015. Results: Out of analysis of 111 cases of oral malignancy, 31 (27.9%) cases were in the fifth decade of life with male to female ratio 1.9:1. The commonest site of cancer was buccal mucosa. Forty-seven cases (43.2%) were in stage IVa. Diabetes was the most common co-morbidity reported, accounting for 53.9% of cases with reported morbidity. Tobacco chewing was the common entity in personal habits. All the cases underwent neck dissection along with resection of the primary. Hemimandibulectomy was the most preferred form of primary resection accounting for 53.15% (59 cases), followed by wide resection of primary 27% (30 cases). Pectoralis major myocutaneous (PMMC) flap only was the most common reconstruction across the study population. PMMC alone accounted for 38.7% (43 cases). The infection rate was 16.21%. PMMC alone accounted for 5 out of 18 (27.8%) of total infection rate, and 4.5% of the total study population. PMMC + deltopectoral accounted for 5 out of 18 (27.8%) of total infection rate, and 4.5% of the total study population. Conclusion: PMMC is a major workhorse for reconstruction with better functional outcome and acceptance among operated patients. PMID:26981469

Independent predictors of morbidity and mortality in blunt colon trauma.

PubMed

Ricciardi, R; Paterson, C A; Islam, S; Sweeney, W B; Baker, S P; Counihan, T C

2004-01-01

We sought to determine the impact of (1) grade of the colon injury, (2) the formation of an ostomy, and (3) associated injuries on outcomes such as morbidity and mortality after blunt colon injuries. We retrospectively reviewed 16,814 cases of blunt abdominal trauma. Patients with colonic injuries were selected and charts reviewed for demographic, clinical, and outcomes data. Injuries were grouped by the Colon Injury Scale (grades I-V). Independent risk factors of morbidity included spine and lung injuries, as well as increased age. A higher grade of colon injury trended toward a significant association with intra-abdominal complications. Independent risk factors of mortality included liver, heart, and lung injuries, as well as intracerebral blood and female gender. The grade of colon injury, the formation of an ostomy, and management of the colon trauma did not independently predict increased intra-abdominal complications, morbidity, or mortality. These results indicate that patients afflicted with blunt colon trauma experience a high rate of morbidity and mortality from associated injuries and or increased age. Treatment regimens directed at these factors will be most helpful in reducing the high morbidity and mortality after blunt colon trauma. Factors such as ostomy formation and management strategy are not associated with increased morbidity or mortality after blunt colon trauma.

Alberta Infant Motor Scale (AIMS) Performance of Greek Preterm Infants: Comparisons With Full-Term Infants of the Same Nationality and Impact of Prematurity-Related Morbidity Factors.

PubMed

Syrengelas, Dimitrios; Kalampoki, Vassiliki; Kleisiouni, Paraskevi; Manta, Vassiliki; Mellos, Stavros; Pons, Roser; Chrousos, George P; Siahanidou, Tania

2016-07-01

Only a few studies have been conducted with the objective of creating norms of the Alberta Infant Motor Scale (AIMS) for the assessment of gross motor development of preterm infants. The AIMS performance of preterm infants has been compared with that of the Canadian norms of full-term infants, but not with that of full-term infants of the same nationality. Moreover, the possible impact of prematurity-related morbidity factors on AIMS performance is unknown. The aims of this study were: (1) to evaluate AIMS trajectory in a large population of Greek preterm infants and create norms, (2) to compare it with the AIMS trajectory of Greek full-term infants, and (3) to examine the possible influence of neonatal morbidity on AIMS scores in the preterm sample. This was a cross-sectional study. Mean AIMS scores were compared, per month (1-19), between 403 preterm infants (≤32 weeks of age, corrected for prematurity) and 1,038 full-term infants. In preterm infants, the association of AIMS scores with respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH) of grade ≤III, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and sepsis was assessed by hierarchical regression analysis. Alberta Infant Motor Scale scores were significantly lower in preterm infants than in full-term infants. Mean AIMS scores in preterm infants were significantly associated with RDS (b=-1.93; 95% CI=-2.70, -1.16), IVH (b=-0.97; 95% CI=-1.69, -0.25), and ROP (b=-1.12; 95% CI=-1.99, -0.24) but not with BPD or sepsis in hierarchical regression analysis. Alberta Infant Motor Scale norms were created for Greek preterm infants. This study confirms that AIMS trajectories of preterm infants are below those of full-term infants of the same nationality. The influence of morbidity factors, including RDS, IVH, and ROP, should be taken into account when administering the AIMS in preterm infants. © 2016 American Physical Therapy Association.

High-grade extremity soft tissue sarcomas: factors predictive of local recurrence and its effect on morbidity and mortality.

PubMed

Eilber, Fritz C; Rosen, Gerald; Nelson, Scott D; Selch, Michael; Dorey, Frederick; Eckardt, Jeffery; Eilber, Frederick R

2003-02-01

To identify patient characteristics associated with the development of local recurrence and the effect of local recurrence on subsequent morbidity and mortality in patients with intermediate- to high-grade extremity soft tissue sarcomas. Numerous studies on extremity soft tissue sarcomas have consistently shown that presentation with locally recurrent disease is associated with the development of subsequent local recurrences and that large tumor size and high histologic grade are significant factors associated with decreased survival. However, the effect of local recurrence on patient survival remains unclear. From 1975 to 1997, 753 patients with intermediate- to high-grade extremity soft tissue sarcomas were treated at UCLA. Treatment outcomes and patient characteristics were analyzed to identify factors associated with both local recurrence and survival. Patients with locally recurrent disease were at a significantly increased risk of developing a subsequent local recurrence. Local recurrence was a morbid event requiring amputation in 38% of the cases. The development of a local recurrence was the most significant factor associated with decreased survival. Once a patient developed a local recurrence, he or she was about three times more likely to die of disease compared to similar patients who had not developed a local recurrence. Local recurrence in patients with intermediate- to high-grade extremity soft tissue sarcomas is associated with the development of subsequent local recurrences, a morbid event decreasing functional outcomes and the most significant factor associated with decreased survival. Although 85% to 90% of patients with high-grade extremity soft tissue sarcomas are treatable with a limb salvage approach, patients who develop a local recurrence need aggressive treatment and should be considered for trials of adjuvant systemic therapy.

Selection for inpatient rehabilitation after severe stroke: what factors influence rehabilitation assessor decision-making?

PubMed

Hakkennes, Sharon; Hill, Keith D; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

2013-01-01

This study aimed to identify factors that assessors considered important in decision-making regarding suitability for inpatient rehabilitation after acute severe stroke. Multi-site prospective observational cohort study. Consecutive acute, severe stroke patients and their assessors for inpatient rehabilitation. Rehabilitation assessors completed a questionnaire, rating the importance (10 point visual analogue scale) and direction (positive, negative or neutral) of 15 patient related and 2 organisational items potentially affecting their decision regarding patients' acceptance to rehabilitation. Of the 75 patients referred to rehabilitation and included in this study 61 (81.3%) were accepted for inpatient rehabilitation. The items considered to be most important in the decision to accept the patient for rehabilitation were pre-morbid cognition, pre-morbid mobility and pre-morbid communication. For those not accepted the most important items were current mobility, social support and current cognition. Factor analysis revealed 3 underlying factors, interpreted as post-stroke status, pre-morbid status, and social attributes, accounting for 61.8% of the total variance. All were independently associated with acceptance for rehabilitation (p < 0.05). This study highlights the importance of pre-morbid function and social factors in addition to post-stroke function in the decision making process for acceptance to rehabilitation following severe stroke. Future models for selection for rehabilitation should consider inclusion of these factors.

Cost and culture: Factors influencing worksite physical activity across three universities.

PubMed

Rinaldi-Miles, Anna I; Das, Bhibha M

2016-11-22

Physical inactivity is a leading cause of morbidity and mortality. Worksites provide an ideal environment for physical activity (PA) interventions. Colleges and universities are a unique work venue, with institutions of higher education of varying scope within every state of the United States and worldwide. To explore the institutional influences on worksite PA across multiple universities. Employees from two large, universities (Midwestern and Southern) and a mid-size, university (Midwestern) participated in exploratory research in March/April 2010 and 2013. The Nominal Group Technique (NGT) methodology and the Health Belief Model (HBM) were used to assess perceived influences on employees' engagement in worksite PA. The findings demonstrate that university employees experienced similar factors that influence PA as employees across the different institutions. Specifically, there was an interesting relationship between opportunities for PA and lack of a supportive work culture to promote it. Emphasis on immediate perceived threats to PA inactivity may improve the utility of the HBM for interventions within this context. Further, campus worksite interventions for employees should address barriers such as cost of campus recreation centers and administrative support for engaging in worksite PA as possible cues to action.

The morbidity and associated risk factors of cancer in chronic liver disease patients with diabetes mellitus: a multicenter field survey.

PubMed

Kawaguchi, Takumi; Kohjima, Motoyuki; Ichikawa, Tatsuki; Seike, Masataka; Ide, Yasushi; Mizuta, Toshihiko; Honda, Koichi; Nakao, Kazuhiko; Nakamuta, Makoto; Sata, Michio

2015-03-01

Diabetes mellitus is associated with various cancers; however, little is known of the relationship between cancer and diabetes in chronic liver disease (CLD) patients. The aim of this study is to investigate the morbidity and associated factors of cancer, including the use of anti-diabetics, in CLD patients with diabetes. We performed a multicenter survey in 2012 and 478 CLD patients with diabetes were enrolled (age 64.3 ± 12.1 years, female/male 187/291). A frequency analysis of cancer and antidiabetic use was performed. Independent factors for cancer were analyzed using logistic regression and decision-tree analysis. The morbidity of cancer was 33.3%. Hepatocellular carcinoma (HCC) and extra-hepatic cancer were diagnosed in 24.7 and 11.3% of enrolled patients, respectively. The frequency of antidiabetic use was 66.5%. Of prescribed antidiabetics, 39% were dipeptidyl-peptidase 4 inhibitors; however, their use was not significantly associated with cancer. In contrast, the use of exogenous insulin (OR 2.21; 95% CI 1.16-4.21, P = 0.0165) and sulfonylurea (OR 2.08; 95% CI 1.05-3.97, P = 0.0353) were independently associated with HCC and extra-hepatic cancer, respectively. In decision-tree analysis, exogenous insulin and sulfonylurea were also identified as a divergence factor for HCC and extra-hepatic cancer, respectively. We found a high morbidity of not only HCC, but also extra-hepatic cancer in CLD patients with diabetes. We also showed a possible association between the use of antidiabetics and the morbidity of cancer. Thus, a large-scale cohort study is needed to establish a therapeutic strategy for diabetes to suppress carcinogenesis in CLD patients.

Taking it one day at a time: African American women aging with HIV and co-morbidities.

PubMed

Warren-Jeanpiere, Lari; Dillaway, Heather; Hamilton, Pilar; Young, Mary; Goparaju, Lakshmi

2014-07-01

Self-managing HIV/AIDS presents challenges for anyone infected. These challenges may be further complicated for older HIV-infected African American women who acquired the disease at younger ages and now have co-morbidities. Little is known regarding how women's age identity, social responsibilities, co-morbidities, and romantic relationship status influence their HIV self-management. Five focus groups were conducted in Washington DC, with HIV-positive African American women aged 52-65. Topics included HIV and co-morbidity self-management, social support needs, medication adherence, and future plans for old age. A constant comparison approach was applied during data analysis. Co-morbidities, including diabetes and hypertension, were perceived to be more difficult to self-manage than HIV. This difficulty was not attributed to aging but to daily struggles such as lack of income and/or health insurance, an inflexible work schedule, and loneliness. Social responsibilities, including caring for family, positively impacted participants' ability to self-manage HIV by serving as motivation to stay healthy in order to continue to help family members. In contrast, inflexible work schedules negatively impacted women's ability to sustain medication adherence. Overall, this study demonstrates that HIV and co-morbidity self-management are inextricably linked. We can no longer afford to view engagement in HIV care as a single-disease issue and hope to attain optimal health and well-being in our HIV-affected populations. Optimal HIV self-management must be framed within a larger context that simultaneously addresses HIV and co-morbidities, while considering how social and cultural factors uniquely intersect to influence older African American women's self-management strategies.

[Morbidity from bilateral tubal ligation, via laparoscopy].

PubMed

Gorozpe Calvillo, J; García Luna, A; Manterola, D; Téllez Martínez, J; Vázquez Cuellar, G

1991-08-01

From January 1, 1987 January 30, 1990, 374 laparoscopic sterilizations using silastic rings (Falope), were carried out. Morbidity and main risk factors, were analyzed. More frequent surgical complications were: mesosalpinx rupture, and fallopian tube rupture in 22 cases (5.8%); abdominal wall emphysema, three cases (0.8%), uterine perforation, two cases (0.5%); other pelvic structures lesions, three cases (0.8%). Morbidity risk factors were: previous abdominal surgery, obesity, salpingitis, use of an uterine mobilizer in a puerperal uterus, and practice of tubal occlusion during the luteal phase of cycle, due to possibility of luteal phase pregnancy; therefore, if a risk factor is present, it is advisable to use other contraceptive technique.

Non-Alcoholic Steatohepatitis (NASH): Risk Factors in Morbidly Obese Patients

PubMed Central

Losekann, Alexandre; Weston, Antonio C.; de Mattos, Angelo A.; Tovo, Cristiane V.; de Carli, Luis A.; Espindola, Marilia B.; Pioner, Sergio R.; Coral, Gabriela P.

2015-01-01

The aim was to investigate the prevalence of non-alcoholic steatohepatitis (NASH) and risk factors for hepatic fibrosis in morbidly obese patients submitted to bariatric surgery. This retrospective study recruited all patients submitted to bariatric surgery from January 2007 to December 2012 at a reference attendance center of Southern Brazil. Clinical and biochemical data were studied as a function of the histological findings of liver biopsies done during the surgery. Steatosis was present in 226 (90.4%) and NASH in 176 (70.4%) cases. The diagnosis of cirrhosis was established in four cases (1.6%) and fibrosis in 108 (43.2%). Risk factors associated with NASH at multivariate analysis were alanine aminotransferase (ALT) >1.5 times the upper limit of normal (ULN); glucose ≥ 126 mg/dL and triglycerides ≥ 150 mg/dL. All patients with ALT ≥1.5 times the ULN had NASH. When the presence of fibrosis was analyzed, ALT > 1.5 times the ULN and triglycerides ≥ 150 mg/dL were risk factors, furthermore, there was an increase of 1% in the prevalence of fibrosis for each year of age increase. Not only steatosis, but NASH is a frequent finding in MO patients. In the present study, ALT ≥ 1.5 times the ULN identifies all patients with NASH, this finding needs to be further validated in other studies. Moreover, the presence of fibrosis was associated with ALT, triglycerides and age, identifying a subset of patients with more severe disease. PMID:26512661

Cultural aspects of morbid fears in Qatari women.

PubMed

el-Islam, M F

1994-05-01

The contents of morbid fears are patterned by cultural factors that decide the nature of the objects of the fears. Common factors in Western cultures do not obtain in local culture, which provides other objects for morbid fears in predisposed individuals. In the muslim community in Qatar, after-death fears dominated panic attacks, agoraphobia was rare, social phobias mirrored shame rather than guilt about failure to fulfil socially accepted norms of social behaviour, and obsessional fears revolved around fears of failure to control devil-induced impulses to harm self or others. Hypochondriacal fears of disease thrived because somatically oriented physicians colluded with somatizing patients in an endless search for presumed organic aetiology. Generalized anxiety fears were not encountered independently of other morbid fears.

Peritonitis in Rwanda: Epidemiology and risk factors for morbidity and mortality.

PubMed

Ndayizeye, Leonard; Ngarambe, Christian; Smart, Blair; Riviello, Robert; Majyambere, Jean Paul; Rickard, Jennifer

2016-12-01

Few studies discuss causes and outcomes of peritonitis in low-income settings. This study describes epidemiology of patients with peritonitis at a Rwandan referral hospital. Identification of risk factors associated with mortality and unplanned reoperation could improve management of peritonitis. Data were collected on demographics, clinical presentation, operative findings, and outcomes for all patients with peritonitis. Multivariate regression analysis identified factors associated with in-hospital mortality and unplanned reoperation. A total of 280 patients presented with peritonitis over a 6-month period. Causes of peritonitis were complications of intestinal obstruction (39%) and appendicitis (17%). Thirty-six (13%) patients required unplanned reoperation, and in-hospital mortality was 17%. Factors associated with increased odds of in-hospital mortality were unplanned reoperation (adjusted odds ratio 34.12), vasopressor use (adjusted odds ratio 24.91), abnormal white blood cell count (adjusted odds ratio 12.6), intensive care unit admission (adjusted odds ratio 9.06), and American Society of Anesthesiologist score ≥3 (adjusted odds ratio 7.80). Factors associated with increased odds of unplanned reoperation included typhoid perforation (adjusted odds ratio 5.92) and hypoxia on admission (adjusted odds ratio 3.82). Peritonitis in Rwanda presents with high morbidity and mortality. Minimizing delays in care is important, as many patients with intestinal obstruction present with features of peritonitis. A better understanding of patient care and management prior to arrival at the referral hospital is needed to identify areas for improvement at the health center and district hospital. Copyright © 2016 Elsevier Inc. All rights reserved.

Co-morbidities increase the risk of disability pension among MS patients: a population-based nationwide cohort study.

PubMed

Tinghög, Petter; Björkenstam, Charlotte; Carstensen, John; Jansson, Catarina; Glaser, Anna; Hillert, Jan; Alexanderson, Kristina

2014-06-03

Multiple sclerosis (MS) is a chronic and often disabling disease. In 2005, 62% of the MS patients in Sweden aged 16-65 years were on disability pension. The objective of this study is to investigate whether the presence of common co-morbidities increase MS patients' risk for disability pension. This population-based cohort study included 4 519 MS patients and 4 972 174 non-MS patients who in 2005 were aged 17-64 years, lived in Sweden, and were not on disability pension. Patients with MS were identified in the nationwide in- and outpatient registers, while four different registers were used to construct three sets of measures of musculoskeletal, mental, and cardiovascular disorders. Time-dependent proportional hazard models with a five-year follow up were performed, adjusting for socio-demographic factors. All studied disorders were elevated among MS patients, regardless of type of measure used. MS patients with mental disorders had a higher risk for disability pension than MS patients with no such co-morbidities. Moreover, mental disorders had a synergistic influence on MS patients' risk for disability pension. These findings were also confirmed when conducting sensitivity analyses. Musculoskeletal disorders appeared to increase MS patients' risk for disability pension. The results with regard to musculoskeletal disorders' synergistic influence on disability pension were however inconclusive. Cardiovascular co-morbidity had no significant influence on MS-patients' risk for disability pension. Co-morbidities, especially mental disorders, significantly contribute to MS patients' risk of disability pension, a finding of relevance for MS management and treatment.

[Natural factors influencing sleep].

PubMed

Jurkowski, Marek K; Bobek-Billewicz, Barbara

2007-01-01

Sleep is a universal phenomenon of human and animal lives, although the importance of sleep for homeo-stasis is still unknown. Sleep disturbances influence many behavioral and physiologic processes, leading to health complications including death. On the other hand, sleep improvement can beneficially influence the course of healing of many disorders and can be a prognostic of health recovery. The factors influencing sleep have different biological and chemical origins. They are classical hormones, hypothalamic releasing and inhibitory hormones, neuropeptides, peptides and others as cytokines, prostaglandins, oleamid, adenosine, nitric oxide. These factors regulate most physiologic processes and are likely elements integrating sleep with physiology and physiology with sleep in health and disorders.

Clinical profile, predisposing factors, and associated co-morbidities of children with cerebral palsy in South India

PubMed Central

Gowda, Vykuntaraju K.; Kumar, Anil; Shivappa, Sanjay K.; Srikanteswara, Praveen Kumar; Shivananda; Mahadeviah, M. S.; Govindraj, M.; Ramaswamy, Premalatha

2015-01-01

Introduction: Cerebral palsy (CP) is the most common physical disorder of children. Causes like jaundice and birth injury though are decreasing; complications resulting from the survival of low birth weight babies are replacing some of the older etiologies. Hence, this study was planned. Objectives: The objective was to study the clinical patterns, predisposing factors, and co-morbidities in children with CP. Materials and Methods: The present study is a hospital based prospective study conducted from January 2012 to January 2013 in children presenting to neurodevelopmental clinic at a tertiary care teaching hospital in India. Hundred cases with clinical features suggestive of CP were included in the study. Cases were evaluated by history, clinical examination, and necessary investigations. Results: Results of the study showed 81% of spastic, 12% of hypotonic, 5% of dystonic, and 2% of mixed CP cases. The mean age of presentation was 2 year, 2 month, and male to female ratio of 1:2. Pregnancy-induced hypertension (PIH) was the most common antenatal complication observed in 6%. Four percent had neonatal sepsis and 19% were born premature. Associated co-morbidities were mental retardation (55%), seizure disorder (46%), visual problems (26%), hearing problems (19%), and failure to thrive (47%). Discussion: Sex distribution observed in our study was male to female ratio of 1.2, which was comparable with a multicenter study in Europe. PIH was observed in 6% of cases, which was comparable with prior studies. Birth asphyxia was observed in 43% of cases. Eighty-one percent of the cases constituted a spastic variety of CP which was comparable to other studies. Conclusion: Perinatal asphyxia was the important etiological factor. We found preventable intranatal causes (60%) and antenatal causes (20%) forming a significant proportion. Co-morbidities were significantly observed in our study. PMID:26167210

The John Insall Award: Morbid obesity independently impacts complications, mortality, and resource use after TKA.

PubMed

D'Apuzzo, Michele R; Novicoff, Wendy M; Browne, James A

2015-01-01

higher risk of in-hospital death after primary TKA compared with nonobese patients (0.08% versus 0.02%; OR, 3.2; 95% CI, 2.0-5.2; p<0.001). Total hospital costs (USD 15,174 versus USD 14,715, p<0.001), length of stay (3.6 days versus 3.5 days, p<0.001), and rate of discharge to a facility (40% versus 30%, p<0.001) were all higher in morbidly obese patients. Morbid obesity appears to be independently associated with a higher risk for a small number of select in-hospital postoperative complications and mortality after matching for comorbid medical conditions linked to obesity. However, the independent impact of morbid obesity appears to be fairly modest, and morbid obesity did not appear to be an independent risk factor for many systemic complications. Continued research is necessary to identify the influence of associated comorbidities on early postoperative complications in morbidly obese patients after TKA. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Emergency gastric ulcer complications in elderly. Factors affecting the morbidity and mortality in relation to therapeutic approaches.

PubMed

Di Carlo, I; Toro, A; Sparatore, F; Primo, S; Barbagallo, F; Di Blasi, M

2006-08-01

In elderly the incidence of the emergency gastric ulcer complications, perforation and bleeding are increasing, with a difficult management of these patients for their concomitant diseases. The aim of this work is to analyze the therapeutical approach of emergency gastric ulcer complications in elderly patients, in order to establish the factors affecting the morbidity and mortality. Patients older than 70 years, presenting gastric ulcer, observed in a tertiary University Hospital from 1995 to 2003, have been considered for the present study. Two groups of diseases have been examined: ulcer perforation and bleeding ulcer. Age, sex, risk factors, comorbidity, methods of diagnosis, ulcer characteristics, treatment, morbidity, mortality, hospitalization time and follow-up have been considered in each group. Thirteen elderly patients with perforated gastric ulcer have been observed: 9 (69.2%) females and 4 (30.8%) males with a mean age of 80.5 years (range 70-90). Four patients were hospitalized in suburban hospital with an average time between the diagnosis and the surgery of 36 h, while the remnants were hospitalized directly in our Department with a medium waiting time of about 2 h. The surgical procedures were: simple closure with omentum patch in 11 cases (84.6%), and antrectomy in 2 cases (15.4%), in which the antrum was multiply perforated. Two patients presented an ulcer larger than 2 cm treated with simple suture and omental patch without morbidity and mortality. Three patients (23%) died postoperatively, due to septic shock, ventricular fibrillation and intraoperative massive haemorrhage, 2 of these patients came from other hospitals. Twenty-eight elderly patients with bleeding gastric ulcer have been observed during the same period: 13 (46.4%) females and 15 (53.6%) males with a mean age of 79.6 years (range 71-91). Except 2 patients submitted to endoscopic treatment both with adrenaline injection, all the remnant patients were managed with medical therapy

In vivo T cell depletion regulates resistance and morbidity in murine schistosomiasis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Phillips, S.M.; Linette, G.P.; Doughty, B.L.

1987-08-01

These studies assessed the roles of subpopulations of T lymphocytes in inducing and modulating resistance to schistosomiasis and thereby influencing subsequent morbidity. C57BL/6 mice were depleted in vivo of Lyt-1+, Lyt-2+, and L3T4+ cells by the daily administration of monoclonal antibodies. The development of protective immunity, induced by exposure to irradiated Schistosoma mansoni cercariae as expressed in depleted animals, was compared to that demonstrated in undepleted, normal, and congenitally athymic C57BL/6 mice. The development of morbidity was determined by spleen weight, portal pressure and reticuloendothelial system activity. The results indicated that depletion of specific subpopulations of T lymphocytes minimally affectedmore » the primary development of parasites; however, depletion strongly influenced the development of resistance to the parasite and subsequent morbidity due to infection. Depletion of T lymphocytes by anti-Lyt-1+ or anti-L3T4+ antibody decreased the development of resistance, antibody and delayed-type hypersensitivity directed against schistosome antigens. Morbidity due to disease was increased. Depletion of Lyt-2+ cells produced opposite changes with augmented resistance and reduced morbidity. Congenitally athymic mice developed minimal resistance and morbidity. Moreover, resistance was inversely related to the morbidity shown by a given animal. These studies indicate that the development of protective immunity to S. mansoni cercariae is regulated by discrete subpopulations of T lymphocytes. The feasibility of decreasing morbidity by increasing specific immunologically mediated resistance is suggested.« less

Effect of Esophagus Position on Surgical Difficulty and Postoperative Morbidities After Thoracoscopic Esophagectomy.

PubMed

Yoshida, Naoya; Baba, Yoshifumi; Shigaki, Hironobu; Shiraishi, Shinya; Harada, Kazuto; Watanabe, Masayuki; Iwatsuki, Masaaki; Kurashige, Junji; Sakamoto, Yasuo; Miyamoto, Yuji; Ishimoto, Takatsugu; Kosumi, Keisuke; Tokunaga, Ryuma; Yamashita, Yasuyuki; Baba, Hideo

2016-01-01

The objective include thoracoscopic esophagectomy for the deep-seated (left-sided) esophagus has several technical difficulties, which may affects the intraoperative or postoperative outcomes. However, no previous studies have focused on the correlation between the position of the esophagus and short-term outcome after thoracoscopic esophagectomy. Of 470 esophagectomies between April 2005 and April 2015 in Kumamoto University Hospital, 112 patients who underwent thoracoscopic esophagectomy for esophageal cancer were examined. The position of the esophagus was divided into 2 types: deep-seated esophagus or another type based on computed tomographic images in the supine position. In results, the deep-seated esophagus was associated with a longer operation time in the thorax and high incidence of severe morbidity of Clavien-Dindo classification ≥IIIb, pneumonia, and any pulmonary morbidity. The deep-seated esophagus was also an independent risk factor for severe morbidity (hazard ratio [HR] = 5.37, 95% CI: 1.307-22.03; P = 0.020), pneumonia (HR = 9.23, 95% CI: 2.150-39.60; P = 0.003), and any pulmonary morbidity (HR = 10.3, 95% CI: 2.714-38.78; P < 0.001). In conclusion, the position of the esophagus had a strong influence on the difficulty of thoracoscopic esophagectomy and the incidence of postoperative morbidities. Surgeons would be well advised to keep a careful watch perioperatively for patients with a deep-seated esophagus. Copyright © 2016 Elsevier Inc. All rights reserved.

Psychiatric morbidity and subsequent divorce: a couple-level register-based study in Finland.

PubMed

Metsä-Simola, Niina; Martikainen, Pekka; Monden, Christiaan W

2018-05-02

Studies that assess the role of mental health for the risk of divorce are scarce and mostly rely on individual-level data, although divorce is a couple-level phenomenon. Using data on couples, we examine the effects of both spouses' psychiatric morbidity on the risk of divorce, and whether socio-demographic factors affect these associations. We followed 96,222 Finnish married couples for 6 years using register-based data on both spouses and their household. New incidence of psychiatric morbidity and subsequent divorce was identified from dates of prescription medication purchases and hospital admissions, and dates of registered divorce. Socio-demographic factors were measured annually for both spouses and their household. The effect of incident psychiatric morbidity on divorce risk was analyzed using Cox regression. Psychiatric morbidity in men increased the age-adjusted risk of divorce more than twofold and in women nearly twofold. The risk of divorce was particularly pronounced immediately after new incidence of psychiatric morbidity, before settling to a persistently high level. Psychiatric morbidity in both spouses increased the risk of divorce almost threefold. Adjustment for socio-economic factors had little effect on these associations. Psychiatric morbidity is a persistent risk factor of divorce. The risk is larger when both spouses experience psychiatric morbidity compared to only one spouse. The findings are consistent with the idea that poor relationship quality and dissatisfaction in couples suffering from mental health problems have long-term consequences for marital stability. Treatment of psychiatric morbidity should not focus only on the individual but on couple-level dynamics.

Infant morbidity in an Indian slum birth cohort.

PubMed

Gladstone, B P; Muliyil, J P; Jaffar, S; Wheeler, J G; Le Fevre, A; Iturriza-Gomara, M; Gray, J J; Bose, A; Estes, M K; Brown, D W; Kang, G

2008-06-01

To establish incidence rates, clinic referrals, hospitalisations, mortality rates and baseline determinants of morbidity among infants in an Indian slum. A community-based birth cohort with twice-weekly surveillance. Vellore, South India. 452 newborns recruited over 18 months, followed through infancy. Incidence rates of gastrointestinal illness, respiratory illness, undifferentiated fever, other infections and non-infectious morbidity; rates of community-based diagnoses, clinic visits and hospitalisation; and rate ratios of baseline factors for morbidity. Infants experienced 12 episodes (95% confidence interval (CI) 11 to 13) of illness, spending about one fifth of their infancy with an illness. Respiratory and gastrointestinal symptoms were most common with incidence rates (95% CI) of 7.4 (6.9 to 7.9) and 3.6 (3.3 to 3.9) episodes per child-year. Factors independently associated with a higher incidence of respiratory and gastrointestinal illness were age (3-5 months), male sex, cold/wet season and household involved in beedi work. The rate (95% CI) of hospitalisation, mainly for respiratory and gastrointestinal illness, was 0.28 (0.22 to 0.35) per child-year. The morbidity burden due to respiratory and gastrointestinal illness is high in a South Indian urban slum, with children ill for approximately one fifth of infancy, mainly with respiratory and gastrointestinal illnesses. The risk factors identified were younger age, male sex, cold/wet season and household involvement in beedi work.

Challenges for co-morbid chronic illness care and policy in Australia: a qualitative study

PubMed Central

Jowsey, Tanisha; Jeon, Yun-Hee; Dugdale, Paul; Glasgow, Nicholas J; Kljakovic, Marjan; Usherwood, Tim

2009-01-01

Background In response to the escalating burden of chronic illness in Australia, recent health policies have emphasised the promotion of patient self-management and better preventive care. A notable omission from these policies is the acknowledgment that patients with chronic illness tend to have co-morbid conditions. Our objectives were: to identify the common challenges co-morbidity poses to patients and carers in their experiences of self-management; to detail the views and perceptions of health professionals about these challenges; and to discuss policy options to improve health care for people with co-morbid chronic illness. The method included semi-structured interviews and focus groups with 129 purposively sampled participants. Participants were people with Type 2 diabetes, chronic obstructive pulmonary disease and/or chronic heart failure as well as carers and health care professionals. Content analysis of the interview data was conducted using NVivo7 software. Results Patients and their carers found co-morbidity influenced their capacity to manage chronic illness in three ways. First, co-morbidity created barriers to patients acting on risk factors; second, it complicated the process of recognising the early symptoms of deterioration of each condition, and third, it complicated their capacity to manage medication. Conclusion Findings highlight challenges that patients with multiple chronic conditions face in relation to preventive care and self-management. Future clinical policy initiatives need to move away from single illness orientation toward strategies that meet the needs of people with co-morbid conditions and strengthen their capacity to self-manage. These patients will benefit directly from specialised education and services that cater to the needs of people with clusters of co-morbidities. PMID:19735576

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

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

PubMed

Norhayati, Mohd Noor; Surianti, Sukeri; Nik Hazlina, Nik Hussain

2015-01-01

To explore the experiences of women with severe maternal morbidity and their perception of the quality of health care. 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. Included a comprehensive search, appraisal of reports of qualitative studies, the classification of studies and the synthesis of findings. A literature search was conducted through nine databases for articles published between January 1980 and August 2013. 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. 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. 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.

Prevalence & factors associated with chronic obstetric morbidities in Nashik district, Maharashtra.

PubMed

Chauhan, Sanjay; Kulkarni, Ragini; Agarwal, Dinesh

2015-10-01

In India, community based data on chronic obstetric morbidities (COM) are scanty and largely derived from hospital records. The main aim of the study was to assess the community based prevalence and the factors associated with the defined COM--obstetric fistula, genital prolapse, chronic pelvic inflammatory disease (PID) and secondary infertility among women in Nashik district of Maharashtra State, India. The study was cross-sectional with self-reports followed by clinical and gynaecological examination. Six primary health centre areas in Nashik district were selected by systematic random sampling. Six months were spent on rapport development with the community following which household interviews were conducted among 1560 women and they were mobilized to attend health facility for clinical examination. Of the 1560 women interviewed at household level, 1167 women volunteered to undergo clinical examination giving a response rate of 75 per cent. The prevalence of defined COM among 1167 women was genital prolapse (7.1%), chronic PID (2.5%), secondary infertility (1.7%) and fistula (0.08%). Advancing age, illiteracy, high parity, conduction of deliveries by traditional birth attendants (TBAs) and obesity were significantly associated with the occurrence of genital prolapse. History of at least one abortion was significantly associated with secondary infertility. Chronic PID had no significant association with any of the socio-demographic or obstetric factors. The study findings provided an insight in the magnitude of community-based prevalence of COM and the factors associated with it. The results showed that COM were prevalent among women which could be addressed by interventions at personal, social and health services delivery level.

PSYCHIATRIC MORBIDITY AND PERSONALITY PROFILE IN DIVORCE SEEKING COUPLES

PubMed Central

Batra, Lalit; Gautam, Shiv

1995-01-01

To what extent psychiatric morbidity and personality factors contribute to marital disharmony and decision to divorce is still an unanswered question in Indian setting. This study was undertaken with aims to find out (1) the prevalence of psychiatric morbidity in persons seeking divorce; (2) the prevalence of psychiatric morbidity in persons who had good marital adjustment; (3) the nature of psychiatric morbidity observed in these subjects, and (4) the personality profile of these subjects. Fifty randomly selected divorce seeking couples (n=100) from the matrimonial court of Jaipur City and thirty couples with good marital adjustment (n=60) selected from the community were studied. Probable psychiatric cases identified by administering GHQ (Hindi version) were diagnosed according to ICD-10 and personality profile of all cases was studied by using 16 PF. High psychiatric morbidity (50%) was found among divorce seeking couples in comparison to control group (13%). There was a high prevalence of neurone disorders (22%) and mood disorders (16%) in experimental group. Schizophrenia and related disorders (10%) and substance abuse disorder (2%) were seen only in the experimental group. Specific personality factors related to divorce seeking individuals and persons with stable marriage have been identified. The implications of this study are highlighted. PMID:21743746

The influence of organizational factors on patient safety: Examining successful handoffs in health care.

PubMed

Richter, Jason P; McAlearney, Ann Scheck; Pennell, Michael L

2016-01-01

Although patient handoffs have been extensively studied, they continue to be problematic. Studies have shown poor handoffs are associated with increased costs, morbidity, and mortality. No prior research compared perceptions of management and clinical staff regarding handoffs. Our aims were (a) to determine whether perceptions of organizational factors that can influence patient safety are positively associated with perceptions of successful patient handoffs, (b) to identify organizational factors that have the greatest influence on perceptions of successful handoffs, and (c) to determine whether associations between perceptions of these factors and successful handoffs differ for management and clinical staff. A total of 515,637 respondents from 1,052 hospitals completed the Hospital Survey on Patient Safety Culture that assessed perceptions about organizational factors that influence patient safety. Using weighted least squares multiple regression, we tested seven organizational factors as predictors of successful handoffs. We fit three separate models using data collected from (a) all staff, (b) management only, and (c) clinical staff only. We found that perceived teamwork across units was the most significant predictor of perceived successful handoffs. Perceptions of staffing and management support for safety were also significantly associated with perceived successful handoffs for both management and clinical staff. For management respondents, perceptions of organizational learning or continuous improvement had a significant positive association with perceived successful handoffs, whereas the association was negative for clinical staff. Perceived communication openness had a significant association only among clinical staff. Hospitals should prioritize teamwork across units and strive to improve communication across the organization in efforts to improve handoffs. In addition, hospitals should ensure sufficient staffing and management support for patient safety

Factors influencing twins and zygosity.

PubMed

Hankins, Gary V D; Saade, George R

2005-01-01

Zygosity is influenced by many factors. Monozygotic twins occur spontaneously in approximately 1 in 250 births and are felt to increase twofold with ovulation induction techniques. Monozygotic twinning also increases in proportion to the number of blastocysts transferred during in vitro fertilisation. In contrast, dizygotic twinning appears to be influenced by race, genetic factors, maternal age, fertility enhancing drugs, folic acid supplementation, and maternal nutritional status.

Increase male genital diseases morbidity linked to informal electronic waste recycling in Guiyu, China.

PubMed

Xu, Xijin; Zhang, Yuling; Yekeen, Taofeek Akangbe; Li, Yan; Zhuang, Bingrong; Huo, Xia

2014-03-01

In recent years, occupational and environmental exposure to toxic pollutants has increasingly contributed to declining sperm quality and increasing morbidity of human male genital diseases. This study explored the effects of electronic waste (e-waste) environmental pollutions on male genital health in Guiyu, one of the largest e-waste recycling centers in the world. We collected outpatient case information from 2001 to 2009 in Guiyu and a control hospital and performed statistical analysis on male genital diseases morbidity (MGDM). The MGDM in Guiyu and the control hospital per thousand from 2004 to 2009 were 1.410/0.403 (2004), 0.539/0.385 (2005), 0.248/0.284 (2006), 0.485/0.195 (2007), 1.107/0.272 (2008), and 0.741/0.586 (2009) while the average total MGDM from 2004 to 2009 were 0.753 and 0.355 per thousand, respectively. Percentage of occurrence of epididymitis, impotence and prospermia, redundant prepuce, gonorrhea, urethritis, sexual function dysfunction, azoospermia, asthenospermia, and unknown etiology male sterility were higher in Guiyu (P < 0.05), whereas the frequency of prostatitis, condyloma accuminatum, and genital herpes were higher in the control (P < 0.05). Morbidity of male genital diseases was higher in Guiyu than in the control area. Male reproductive health may be threatened by e-waste environmental pollution in Guiyu, especially for diseases that could be influenced by environmental factors, and it may influence local population diathesis.

Factors Influencing Compliance and Health Seeking Behaviour for Hypertension in Mukono and Buikwe in Uganda: A Qualitative Study.

PubMed

Musinguzi, Geofrey; Anthierens, Sibyl; Nuwaha, Fred; Van Geertruyden, Jean-Pierre; Wanyenze, Rhoda K; Bastiaens, Hilde

2018-01-01

Hypertension is a global public health challenge and a leading risk factor for cardiovascular morbidity and mortality. Hypertension control rates are low worldwide, and delay in seeking care is associated with increased mortality. In a qualitative study, known hypertensive patients were interviewed to explore factors influencing compliance and health seeking behaviour (HSB). Data was analyzed following a semantic thematic analysis approach. Patients sought various channels of care for their hypertension. Self-medication and access to antihypertensive drugs with or without prescription were common as well as use of herbal remedies. Regular monitoring of blood pressure was not a common practice. Factors influencing HSB were related to health systems and the patient socioeconomic and structural environment. The main system issues were related to availability and attitudes of staff and shortage of supplies and medicines. The patient factors were related to awareness, perceived severity, perceived effectiveness of therapy, adverse effects, and perceived fears of lifelong dependence on medicines. The patient socioeconomic status played a role as did the marketing of traditional medicine. Patients seek varied channels of care for their hypertension. Strategies to address the multifactorial dimensions that affect HSB are needed to improve hypertension control in this population.

Hospital delivery volume, severe obstetrical morbidity, and failure to rescue.

PubMed

Friedman, Alexander M; Ananth, Cande V; Huang, Yongmei; D'Alton, Mary E; Wright, Jason D

2016-12-01

In the setting of persistently high risk for maternal death and severe obstetric morbidity, little is known about the relationship between hospital delivery volume and maternal outcomes. The objectives of this analysis were (1) to determine maternal risk for severe morbidity during delivery hospitalizations by hospital delivery volume in the United States and (2) to characterize, by hospital volume, the risk for death in the setting of severe obstetric morbidity, a concept known as failure to rescue. This cohort study evaluated 50,433,539 delivery hospitalizations across the United States from 1998-2010. The main outcome measures were (1) severe morbidity that was defined as a composite of any 1 of 15 diagnoses that are representative of acute organ injury and critical illness and (2) failure to rescue that was defined as death in the setting of severe morbidity. The prevalence of severe morbidity rose from 471.2-751.5 cases per 100,000 deliveries from 1998-2010, which was an increase of 59.5%. Failure to rescue was highest in 1998 (1.5%), decreased to 0.6% in 2007, and rose to 0.9% in 2010. In models that were adjusted for comorbid risk and hospital factors, both low and high annualized delivery volume were associated with increased risk for failure to rescue and severe morbidity. However, the relative importance of hospital volume for both outcomes compared with other factors was relatively small. Although low-and high-delivery volume are associated with increased risk for both failure to rescue and severe maternal morbidity, other factors, in particular characteristics of individual centers, may be more important in the determination of outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Gene-environment interplay in alcoholism and other substance abuse disorders: expressions of heritability and factors influencing vulnerability.

PubMed

Palomo, Tomas; Kostrzewa, R M; Beninger, R J; Archer, T

2004-01-01

Factors that confer predisposition and vulnerability for alcoholism and other substance abuse disorders may be described usefully within the gene-environment interplay framework. Thus, it is postulated that heritability provides a major contribution not only to alcohol but also to other substances of abuse. Studies of evoked potential amplitude reduction have provided a highly suitable and testable method for the assessment of both environmentally-determined and heritable characteristics pertaining to substance use and dependence. The different personal attributes that may co-exist with parental influence or exist in a shared, monozygotic relationship contribute to the final expression of addiction. In this connection, it appears that personality disorders are highly prevalent co-morbid conditions among addicted individuals, and, this co-morbidity is likely to be accounted for by multiple complex etiological relationships, not least in adolescent individuals. Co-morbidity associated with deficient executive functioning may be observed too in alcohol-related aggressiveness and crimes of violence. The successful intervention into alcohol dependence and craving brought about by baclofen in both human and animal studies elucidates glutamatergic mechanisms in alcoholism whereas the role of the dopamine transporter, in conjunction with both the noradrenergic and serotonergic transporters, are implicated in cocaine dependence and craving. The role of the cannabinoids in ontogeny through an influence upon the expression of key genes for the development of neurotransmitter systems must be considered. Finally, the particular form of behaviour/characteristic outcome due to childhood circumstance may lie with biological, gene-based determinants, for example individual characteristics of monoamine oxidase (MAO) activity levels, thereby rendering simple predictive measures both redundant and misguiding.

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.

Spatio-temporal heterogeneity of malaria morbidity in Ghana: Analysis of routine health facility data

PubMed Central

Malm, Keziah; Peprah, Nana Yaw; Silal, Sheetal P.

2018-01-01

Background Malaria incidence is largely influenced by vector abundance. Among the many interconnected factors relating to malaria transmission, weather conditions such as rainfall and temperature are known to create suitable environmental conditions that sustain reproduction and propagation of anopheles mosquitoes and malaria parasites. In Ghana, climatic conditions vary across the country. Understanding the heterogeneity of malaria morbidity using data sourced from a recently setup data repository for routine health facility data could support planning. Methods Monthly aggregated confirmed uncomplicated malaria cases from the District Health Information Management System and average monthly rainfall and temperature records obtained from the Ghana Meteorological Agency from 2008 to 2016 were analysed. Univariate time series models were fitted to the malaria, rainfall and temperature data series. After pre-whitening the morbidity data, cross correlation analyses were performed. Subsequently, transfer function models were developed for the relationship between malaria morbidity and rainfall and temperature. Results Malaria morbidity patterns vary across zones. In the Guinea savannah, morbidity peaks once in the year and twice in both the Transitional forest and Coastal savannah, following similar patterns of rainfall at the zonal level. While the effects of rainfall on malaria morbidity are delayed by a month in the Guinea savannah and Transitional Forest zones those of temperature are delayed by two months in the Transitional forest zone. In the Coastal savannah however, incidence of malaria is significantly associated with two months lead in rainfall and temperature. Conclusion Data captured on the District Health Information Management System has been used to demonstrate heterogeneity in the dynamics of malaria morbidity across the country. Timing of these variations could guide the deployment of interventions such as indoor residual spraying, Seasonal Malaria

Spatio-temporal heterogeneity of malaria morbidity in Ghana: Analysis of routine health facility data.

PubMed

Awine, Timothy; Malm, Keziah; Peprah, Nana Yaw; Silal, Sheetal P

2018-01-01

Malaria incidence is largely influenced by vector abundance. Among the many interconnected factors relating to malaria transmission, weather conditions such as rainfall and temperature are known to create suitable environmental conditions that sustain reproduction and propagation of anopheles mosquitoes and malaria parasites. In Ghana, climatic conditions vary across the country. Understanding the heterogeneity of malaria morbidity using data sourced from a recently setup data repository for routine health facility data could support planning. Monthly aggregated confirmed uncomplicated malaria cases from the District Health Information Management System and average monthly rainfall and temperature records obtained from the Ghana Meteorological Agency from 2008 to 2016 were analysed. Univariate time series models were fitted to the malaria, rainfall and temperature data series. After pre-whitening the morbidity data, cross correlation analyses were performed. Subsequently, transfer function models were developed for the relationship between malaria morbidity and rainfall and temperature. Malaria morbidity patterns vary across zones. In the Guinea savannah, morbidity peaks once in the year and twice in both the Transitional forest and Coastal savannah, following similar patterns of rainfall at the zonal level. While the effects of rainfall on malaria morbidity are delayed by a month in the Guinea savannah and Transitional Forest zones those of temperature are delayed by two months in the Transitional forest zone. In the Coastal savannah however, incidence of malaria is significantly associated with two months lead in rainfall and temperature. Data captured on the District Health Information Management System has been used to demonstrate heterogeneity in the dynamics of malaria morbidity across the country. Timing of these variations could guide the deployment of interventions such as indoor residual spraying, Seasonal Malaria Chemoprevention or vaccines to optimise

The morbidity and mortality outcomes of indigenous Australian peoples after isolated coronary artery bypass graft surgery: the influence of geographic remoteness.

PubMed

Prabhu, Anil; Tully, Phillip J; Bennetts, Jayme S; Tuble, Sigrid C; Baker, Robert A

2013-08-01

Though Indigenous Australian peoples reportedly have poorer survival outcome after cardiac surgery, few studies have jointly documented the experience of major morbidity, and considered the influence of patient geographic remoteness. From January 1998 to September 2008, major morbidity events and survival were recorded for 2748 consecutive patients undergoing coronary artery bypass graft surgery. Morbidity and survival analyses adjusted for propensity deciles based on patient ethnicity and age, sex, left ventricular ejection fraction, recent myocardial infarction, tobacco smoking, diabetes, renal disease and history of stroke. Sensitivity analyses controlled for the patient accessibility/remoteness index of Australia (ARIA). The 297 Indigenous Australian patients (10.8% of total) had greater odds for total morbidity (adjusted odds ratio = 1.55; 95% confidence interval [CI] 1.04-2.30) and prolonged ventilation (adjusted odds ratio = 2.08; 95% confidence interval [CI] 1.25-3.44) in analyses adjusted for propensity deciles and geographic remoteness. With a median follow-up of 7.5 years (interquartile range 5.2-10.2), Indigenous Australian patients were found to experience 30% greater mortality risk (unadjusted hazard ratio = 1.30; 95% CI: 1.03-1.64, p = 0.03). The effect size strengthened after adjustment for propensity score (adjusted hazard ratio = 1.49; 95% CI: 1.13-1.96, p = .004). Adjustment for ARIA categorisation strengthened the effect size (adjusted HR = 1.54 (95% CI: 1.11-2.13, p = .009). Indigenous Australian peoples were at greater risk for prolonged ventilation and combined morbidity outcome, and experienced poorer survival in the longer term. Higher mortality risk among Indigenous Australians was evident even after controlling for remoteness and accessibility to services. Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.

Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study.

PubMed

Montgomery, Anthony J; McGee, Hannah M; Shannon, William; Donohoe, John

2006-09-13

To understand why treatment referral rates for ESRF are lower in Ireland than in other European countries, an investigation of factors influencing general practitioner referral of patients developing ESRF was conducted. Randomly selected general practitioners (N = 51) were interviewed using 32 standardised written patient scenarios to elicit referral strategies. General practitioner referral levels and thresholds for patients developing end-stage renal disease; referral routes (nephrologist vs other physicians); influence of patient age, marital status and co-morbidity on referral. Referral levels varied widely with the full range of cases (0-32; median = 15) referred by different doctors after consideration of first laboratory results. Less than half (44%) of cases were referred to a nephrologist. Patient age (40 vs 70 years), marital status, co-morbidity (none vs rheumatoid arthritis) and general practitioner prior specialist renal training (yes or no) did not influence referral rates. Many patients were not referred to a specialist at creatinine levels of 129 micromol/l (47% not referred) or 250 micromol/l (45%). While all patients were referred at higher levels (350 and 480 micromol/l), referral to a nephrologist decreased in likelihood as scenarios became more complex; 28% at 129 micromol/l creatinine; 28% at 250 micromol/l; 18% at 350 micromol/l and 14% at 480 micromol/l. Referral levels and routes were not influenced by general practitioner age, sex or practice location. Most general practitioners had little current contact with chronic renal patients (mean number in practice = 0.7, s.d. = 1.3). The very divergent management patterns identified highlight the need for guidance to general practitioners on appropriate management of this serious condition.

Influence of arterial hypertension, type 2 diabetes and cardiovascular risk factors on ALS outcome: a population-based study.

PubMed

Moglia, Cristina; Calvo, Andrea; Canosa, Antonio; Bertuzzo, Davide; Cugnasco, Paolo; Solero, Luca; Grassano, Maurizio; Bersano, Enrica; Cammarosano, Stefania; Manera, Umberto; Pisano, Fabrizio; Mazzini, Letizia; Dalla Vecchia, Laura A; Mora, Gabriele; Chiò, Adriano

2017-11-01

To assess the prognostic influence of pre-morbid type 2 diabetes mellitus, arterial hypertension and cardiovascular (CV) risk profile on ALS phenotype and outcome in a population-based cohort of Italian patients. A total of 650 ALS patients from the Piemonte/Valle d'Aosta Register for ALS, incident in the 2007-2011 period, were recruited. Information about premorbid presence of type 2 diabetes mellitus, arterial hypertension was collected at the time of diagnosis. Patients' CV risk profile was calculated according to the Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice (JBS2). At the univariate analysis, the presence of pre-morbid arterial hypertension was associated with a higher age at onset of ALS and a shorter survival, and patients with a high CV risk profile had a worse prognosis than those with a low CV risk profile. The Cox multivariable analysis did not confirm such findings. Type 2 diabetes mellitus did not modify either the phenotype or the prognosis of ALS patients. This study performed on a large population-based cohort of ALS patients has demonstrated that arterial hypertension, type 2 diabetes and CV risk factors, calculated using the Framingham equation, do not influence ALS phenotype and prognosis.

Genetic and environmental influences on the co-morbidity between depression, panic disorder, agoraphobia, and social phobia: a twin study.

PubMed

Mosing, Miriam A; Gordon, Scott D; Medland, Sarah E; Statham, Dixie J; Nelson, Elliot C; Heath, Andrew C; Martin, Nicholas G; Wray, Naomi R

2009-01-01

Major depression (MD) and anxiety disorders such as panic disorder (PD), agoraphobia (AG), and social phobia (SP) are heritable and highly co-morbid. However, the relative importance of genetic and environmental etiology of the covariation between these disorders, particularly the relationship between PD and AG, is less clear. This study measured MD, PD, and AG in a population sample of 5,440 twin pairs and 1,245 single twins, about 45% of whom were also scored for SP. Prevalences, within individual co-morbidity and twin odds ratios for co-morbidity, are reported. A behavioral genetic analysis of the four disorders using the classical twin design was conducted. Odds ratios for MD, PD, AG, and SP in twins of individuals diagnosed with one of the four disorders were increased. Heritability estimates under a threshold-liability model for MD, PD, AG, and SP respectively were .33 (CI: 0.30-0.42), .38 (CI: 0.24-0.55), .48 (CI: 0.37-0.65), and .39 (CI: 0.16-0.65), with no evidence for any variance explained by the common environment shared by twins. We find that a common genetic factor explains a moderate proportion of variance in these four disorders. The genetic correlation between PD and AG was .83. MD, PD, AG, and SP strongly co-aggregate within families and common genetic factors explain a moderate proportion of variance in these four disorders. The high genetic correlation between PD and AG and the increased odds ratio for PD and AG in siblings of those with AG without PD suggests a common genetic etiology for PD and AG.

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

Impact of gender, co-morbidity and social factors on labour market affiliation after first admission for acute coronary syndrome. A cohort study of Danish patients 2001-2009.

PubMed

Osler, Merete; Mårtensson, Solvej; Prescott, Eva; Carlsen, Kathrine

2014-01-01

Over the last decades survival after acute coronary syndrome (ACS) has improved, leading to an increasing number of patients returning to work, but little is known about factors that may influence their labour market affiliation. This study examines the impact of gender, co-morbidity and socio-economic position on subsequent labour market affiliation and transition between various social services in patients admitted for the first time with ACS. From 2001 to 2009 all first-time hospitalisations for ACS were identified in the Danish National Patient Registry (n = 79,714). For this population, data on sick leave, unemployment and retirement were obtained from an administrative register covering all citizens. The 21,926 patients, aged 18-63 years, who had survived 30 days and were part of the workforce at the time of diagnosis were included in the analyses where subsequent transition between the above labour market states was examined using Kaplan-Meier estimates and Cox proportional hazards models. A total of 37% of patients were in work 30 days after first ACS diagnosis, while 55% were on sick leave and 8% were unemployed. Seventy-nine per cent returned to work once during follow-up. This probability was highest among males, those below 50 years, living with a partner, the highest educated, with higher occupations, having specific events (NSTEMI, and percutaneous coronary intervention) and with no co-morbidity. During five years follow-up, 43% retired due to disability or voluntary early pension. Female gender, low education, basic occupation, co-morbidity and having a severer event (invasive procedures) and receiving sickness benefits or being unemployed 30 days after admission were associated with increased probability of early retirement. About half of patients with first-time ACS stay in or return to work shortly after the event. Women, the socially disadvantaged, those with presumed severer events and co-morbidity have lower rates of return.

Maternal morbidity measurement tool pilot: study protocol.

PubMed

Say, Lale; Barreix, Maria; Chou, Doris; Tunçalp, Özge; Cottler, Sara; McCaw-Binns, Affette; Gichuhi, Gathari Ndirangu; Taulo, Frank; Hindin, Michelle

2016-06-09

While it is estimated that for every maternal death, 20-30 women suffer morbidity, these estimates are not based on standardized methods and measures. Lack of an agreed-upon definition, identification criteria, standardized assessment tools, and indicators has limited valid, routine, and comparable measurements of maternal morbidity. The World Health Organization (WHO) convened the Maternal Morbidity Working Group (MMWG) to develop standardized methods to improve estimates of maternal morbidity. To date, the MMWG has developed a definition and provided input into the development of a set of measurement tools. This protocol outlines the pilot test for measuring maternal morbidity in antenatal and postnatal clinical populations using these new tools. In each setting, the tools will be piloted on approximately 250 women receiving antenatal care (ANC) (at least 28 weeks pregnant) and 250 women receiving postpartum care (PPC) (at least 6 weeks postpartum). The tools will be administered by trained health care workers. Each tool has three modules as follows: 1. personal history - socio-economic information, and risk-factors (such as violence and substance abuse) 2. patient symptoms - WHO Disability Assessment Schedule (WHODAS) 12-item, and mental health questionnaires, General Anxiety Disorder, 7-item (GAD-7) and Personal Health Questionnaire, 9-item (PHQ-9) 3. physical examination - signs, laboratory tests and results. This pilot (planned for Jamaica, Kenya and Malawi) will allow for comparing the types of morbidities women experience between and across settings, and determine the feasibility, acceptability and utility of using a modified, streamlined tool for routine measurement and summary estimates of morbidity to inform resource allocation and service provision. As part of the post-2015 Sustainable Development Goals (SDGs) estimating and measuring maternal morbidity will be essential to ensure appropriate resources are allocated to address its impact and improve

The association between gender and pediatric respiratory morbidity.

PubMed

Ben-Shmuel, Atar; Sheiner, Eyal; Wainstock, Tamar; Landau, Daniella; Vaknin, Flear; Walfisch, Asnat

2018-06-26

To evaluate the association between newborn gender and the risk for later pediatric respiratory morbidity. A population based cohort analysis was performed by comparing the risk of long-term respiratory morbidity (until 18 years of age) according to gender. Respiratory morbidity included hospitalizations involving pneumonia, asthma, bronchitis, bronchiolitis, upper respiratory tract infection (URTI), influenza, and bronchiectasis. Deliveries occurred between the years 1991 and 2014 in a tertiary medical center. Kaplan-Meier survival curves were constructed to compare cumulative respiratory morbidity. A Cox proportional hazards model controlled for confounders. During the study period 240 953 newborns met the inclusion criteria. Among them, 118 113 were females (49.0%) and 122 840 were males (51.0%). During the 18 years of follow-up, 13 719 (5.7%) different newborns were hospitalized with respiratory related morbidity. Males had significantly higher rates of respiratory morbidity as compared with females (6.4% vs 4.9% respectively, P < 0.001, OR 1.32, 95% CI 1.28-1.37). Specifically, pneumonia, bronchitis, asthma, bronchiolitis, and URTI were significantly more common in males. Males exhibited higher total cumulative respiratory morbidity (log rank P < 0.001), as well as higher cumulative morbidity in several sub-categories. These sub-categories included pneumonia, bronchitis, asthma, bronchiolitis, and URTI (P < 0.05 in all). The Cox regression model demonstrated male gender to be an independent risk factor for pediatric respiratory morbidity while adjusting for gestational age, birthweight, and other confounders (HR 1.29, 95% CI 1.25-1.34, P < 0.001). Males are at an increased risk for pediatric respiratory morbidity, independent of obstetrical characteristics such as gestational age and birthweight. © 2018 Wiley Periodicals, Inc.

Choice of treatment modalities was not influenced by pain, severity or co-morbidity in patients with knee osteoarthritis.

PubMed

Jamtvedt, Gro; Dahm, Kristin Thuve; Holm, Inger; Odegaard-Jensen, Jan; Flottorp, Signe

2010-03-01

Patients with knee osteoarthritis (OA) are commonly treated by physiotherapists in primary care. The physiotherapists use different treatment modalities. In a previous study, we identified variation in the use of transcutaneous electrical nerve stimulation (TENS), low level laser or acupuncture, massage and weight reduction advice for patients with knee OA. The purpose of this study was to examine factors that might explain variation in treatment modalities for patients with knee OA. Practising physiotherapists prospectively collected data for one patient with knee osteoarthritis each through 12 treatment sessions.We chose to examine factors that might explain variation in the choice of treatment modalities supported by high or moderate quality evidence, and modalities which were frequently used but which were not supported by evidence from systematic reviews. Experienced clinicians proposed factors that they thought might explain the variation in the choice of these specific treatments. We used these factors in explanatory analyses. Using TENS, low level laser or acupuncture was significantly associated with having searched databases to help answer clinical questions in the last six months (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.08-3.42). Not having Internet access at work and using more than four treatment modalities were significant determinants for giving massage (OR = 0.36, 95% CI = 0.19-0.68 and OR = 8.92, 95% CI = 4.37-18.21, respectively). Being a female therapist significantly increased the odds for providing weight reduction advice (OR = 3.60, 95% CI = 1.12-11.57). No patient characteristics, such as age, pain or co-morbidity, were significantly associated with variation in practice. Factors related to patient characteristics, such as pain severity and co-morbidity, did not seem to explain variation in treatment modalities for patients with knee OA. Variation was associated with the following factors: physiotherapists having Internet

Morbidly Adherent Placenta: Interprofessional Management Strategies for the Intrapartum Period.

PubMed

Baird, Suzanne McMurtry; Troiano, Nan H; Kennedy, Margaret Betsy Babb

"Morbidly adherent placenta" is a term that describes the continuum of placenta accreta, increta, and percreta. The incidence of this type of abnormal placentation has increased significantly over recent decades. The reason is probably multifactorial but, partly, because of factors such as the increasing number of cesarean births. Women at greatest risk are those who have myometrial damage caused by a previous cesarean birth, with either anterior or posterior placenta previa overlying the uterine scar. This condition poses significant risks of morbidity and/or mortality to the pregnant woman and her fetus. A multidisciplinary approach to care throughout pregnancy is essential. This article describes the classification of morbidly adherent placenta, risk factors, methods of diagnosis, potential maternal and fetal complications, and intrapartum clinical management strategies to optimize outcomes.

Risk Factors for Postoperative Respiratory Mortality and Morbidity in Patients Undergoing Coronary Artery Bypass Grafting

PubMed Central

Rajaei, Samira; Dabbagh, Ali

2012-01-01

ABSTRACT Nowadays, coronary artery bypass grafting (CABG) is considered to be one of the most common surgical procedures. This procedure has been the main topic in many clinical research studies, which have assessed the effect of the procedure on patients’ outcomes. Like other surgical procedures, this procedure is also accompanied by a number of unwanted complications, including those of the respiratory system. Since the respiratory system plays an integral role in defining the clinical outcome of patients, improvements in studies that can assess and predict clinical outcomes of the respiratory system, assume greater importance. There are a number of predictive models which can assess patients in the preoperative period and introduce a number of risk factors, which could be considered as prognostic factors for patients undergoing CABG. The respiratory system is among the clinical systems that are assessed in many prediction scoring systems. This review assesses the main studies which have evaluated the possible risk factors for postoperative respiratory mortality and morbidity, in patients undergoing CABG. PMID:24223339

Influencing factors for port-site hernias after single-incision laparoscopy.

PubMed

Buckley, F P; Vassaur, H E; Jupiter, D C; Crosby, J H; Wheeless, C J; Vassaur, J L

2016-10-01

Single-incision laparoscopic surgery (SILS) has been demonstrated to be a feasible alternative to multiport laparoscopy, but concerns over port-site incisional hernias have not been well addressed. A retrospective study was performed to determine the rate of port-site hernias as well as influencing risk factors for developing this complication. A review of all consecutive patients who underwent SILS over 4 years was conducted using electronic medical records in a multi-specialty integrated healthcare system. Statistical evaluation included descriptive analysis of demographics in addition to bivariate and multivariate analyses of potential risk factors, which were age, gender, BMI, procedure, existing insertion-site hernia, wound infection, tobacco use, steroid use, and diabetes. 787 patients who underwent SILS without conversion to open were reviewed. There were 454 cholecystectomies, 189 appendectomies, 72 colectomies, 21 fundoplications, 15 transabdominal inguinal herniorrhaphies, and 36 other surgeries. Cases included 532 (67.6 %) women, and among all patients mean age was 44.65 (±19.05) years and mean BMI of 28.04 (±6). Of these, 50 (6.35 %) patients were documented as developing port-site incisional hernias by a health care provider or by incidental imaging. Of the risk factors analyzed, insertion-site hernia, age, and BMI were significant. Multivariate analysis indicated that both preexisting hernia and BMI were significant risk factors (p value = 0.00212; p value = 0.0307). Morbidly obese patients had the highest incidence of incisional hernias at 18.18 % (p value = 0.02). When selecting patients for SILS, surgeons should consider the presence of an umbilical hernia, increased age and obesity as risk factors for developing a port-site hernia.

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

Male gender preference, female gender disadvantage as risk factors for psychological morbidity in Pakistani women of childbearing age - a life course perspective

PubMed Central

2011-01-01

Background In Pakistan, preference for boys over girls is deeply culturally embedded. From birth, many women experience gendered disadvantages; less access to scarce resources, poorer health care, higher child mortality, limited education, less employment outside of the home and circumscribed autonomy. The prevalence of psychological morbidity is exceptionally high among women. We hypothesise that, among women of childbearing age, gender disadvantage is an independent risk factor for psychological morbidity Methods A cross-sectional catchment area survey of 525 women aged 18 to 35 years living in Islamabad and Rawalpindi. The effect of gender disadvantage was assessed as a latent variable using structural equation modelling. Indicators were parental gender preference, low parental care, parental overprotection, limited education, early age at marriage, marital dissatisfaction and low autonomy. Psychological morbidity was assessed using the 20 item Self Reporting Questionnaire (SRQ). Results Gender disadvantage was independently predictive of psychological morbidity. Among married women, socio-economic status did not predict psychological morbidity, and the effect of education was mediated through gender disadvantage rather than socioeconomic status (SES). The women's own preference for a male child was strongly predicted by their perceptions of having been disadvantaged by their gender in their families of origin. Conclusions The high prevalence of psychological morbidity among women in Pakistan is concerning given recently reported strong associations with low birth weight and infant stunting. Social action, public policies and legislation are indicated to reduce culturally embedded preferences. Neglect of these fundamentals will entrench consequent inequities including gender bias in access to education, a key millennium development goal. PMID:21958069

Tuberculosis-diabetes co-morbidity is characterized by heightened systemic levels of circulating angiogenic factors

PubMed Central

Kumar, Nathella Pavan; Moideen, Kadar; Sivakumar, Shanmugam; Menon, Pradeep A; Viswanathan, Vijay; Kornfeld, Hardy; Babu, Subash

2016-01-01

Background Tuberculosis-diabetes co-morbidity (TB-DM) is characterized by increased inflammation with elevated circulating levels of inflammatory cytokines and other factors. Circulating angiogenic factors are intricately involved in the angiogenesis-inflammation nexus. Methods To study the association of angiogenic factors with TB-DM, we examined the systemic levels of VEGF-A, VEGF-C, VEGF-D, VEGF-R1, VEGF-R2, VEGF-R3 in individuals with either TB-DM (n=44) or TB alone (n=44). Results Circulating levels of VEGF-A, C, D, R1, R2 and R3 were significantly higher in TB-DM compared to TB individuals. Moreover, the levels of VEGF-A, C, R2 and/or R3 were significantly higher in TB-DM with bilateral or cavitary disease or with hemoptysis, suggesing an association with both disease severity and adverse clinical presentation. The levels of these factors also exhibited a significant positive relationship with bacterial burdens and HbA1c levels. In addition, VEGF-A, C and R2 levels were signifantly higher (at 2 months of treatment) in culture positive compared to culture negative TB-DM individuals. Finally, the circulating levels of VEGF-A, C, D, R1, R2 and R3 were significantly reduced following successful chemotherapy at 6 months. Conclusion Our data demonstrate that TB-DM is associated with heightened levels of circulating angiogenic factors, possibly reflecting both dysregulated angiogenesis and exaggerated inflammation. PMID:27717783

Simultaneous Prediction of New Morbidity, Mortality, and Survival Without New Morbidity From Pediatric Intensive Care: A New Paradigm for Outcomes Assessment.

PubMed

Pollack, Murray M; Holubkov, Richard; Funai, Tomohiko; Berger, John T; Clark, Amy E; Meert, Kathleen; Berg, Robert A; Carcillo, Joseph; Wessel, David L; Moler, Frank; Dalton, Heidi; Newth, Christopher J L; Shanley, Thomas; Harrison, Rick E; Doctor, Allan; Jenkins, Tammara L; Tamburro, Robert; Dean, J Michael

2015-08-01

Assessments of care including quality assessments adjusted for physiological status should include the development of new morbidities as well as mortalities. We hypothesized that morbidity, like mortality, is associated with physiological dysfunction and could be predicted simultaneously with mortality. Prospective cohort study from December 4, 2011, to April 7, 2013. General and cardiac/cardiovascular PICUs at seven sites. Randomly selected PICU patients from their first PICU admission. None. Among 10,078 admissions, the unadjusted morbidity rates (measured with the Functional Status Scale and defined as an increase of ≥ 3 from preillness to hospital discharge) were 4.6% (site range, 2.6-7.7%) and unadjusted mortality rates were 2.7% (site range, 1.3-5.0%). Morbidity and mortality were significantly (p < 0.001) associated with physiological instability (measured with the Pediatric Risk of Mortality III score) in dichotomous (survival and death) and trichotomous (survival without new morbidity, survival with new morbidity, and death) models without covariate adjustments. Morbidity risk increased with increasing Pediatric Risk of Mortality III scores and then decreased at the highest Pediatric Risk of Mortality III values as potential morbidities became mortalities. The trichotomous model with covariate adjustments included age, admission source, diagnostic factors, baseline Functional Status Scale, and the Pediatric Risk of Mortality III score. The three-level goodness-of-fit test indicated satisfactory performance for the derivation and validation sets (p > 0.20). Predictive ability assessed with the volume under the surface was 0.50 ± 0.019 (derivation) and 0.50 ± 0.034 (validation) (vs chance performance = 0.17). Site-level standardized morbidity ratios were more variable than standardized mortality ratios. New morbidities were associated with physiological status and can be modeled simultaneously with mortality. Trichotomous outcome models including

Simultaneous Prediction of New Morbidity, Mortality, and Survival without New Morbidity from Pediatric Intensive Care: A New Paradigm for Outcomes Assessment

PubMed Central

Pollack, Murray M.; Holubkov, Richard; Funai, Tomohiko; Berger, John T.; Clark, Amy E.; Meert, Kathleen; Berg, Robert A.; Carcillo, Joseph; Wessel, David L.; Moler, Frank; Dalton, Heidi; Newth, Christopher J. L.; Shanley, Thomas; Harrison, Rick E.; Doctor, Allan; Jenkins, Tammara L.; Tamburro, Robert; Dean, J. Michael

2015-01-01

Objective Assessments of care including quality assessments adjusted for physiological status should include the development of new morbidities as well as mortalities. We hypothesized that morbidity, like mortality, is associated with physiological dysfunction and could be predicted simultaneously with mortality. Design Prospective cohort study from December 4, 2011 to April 7, 2013. Setting and Patients General and cardiac/cardiovascular pediatric intensive care units at 7 sites. Measurements and Main Results Among 10,078 admissions, the unadjusted morbidity rates (measured with the Functional Status Scale (FSS), and defined as an increase of ≥ 3 from pre-illness to hospital discharge) were 4.6% (site range 2.6% to 7.7%) and unadjusted mortality rates were 2.7% (site range 1.3% – 5.0%). Morbidity and mortality were significantly (p<0.001) associated with physiological instability (measured with the PRISM III score) in dichotomous (survival, death) and trichotomous (survival without new morbidity, survival with new morbidity, death) models without covariate adjustments. Morbidity risk increased with increasing PRISM III scores and then decreased at the highest PRISM III values as potential morbidities became mortalities. The trichotomous model with covariate adjustments included age, admission source, diagnostic factors, baseline FSS and the PRISM III score. The three-level goodness of fit test indicated satisfactory performance for the derivation and validation sets (p>0.20). Predictive ability assessed with the volume under the surface (VUS) was 0.50 ± 0.019 (derivation) and 0.50 ± 0.034 (validation) (versus chance performance = 0.17). Site-level standardized morbidity ratios were more variable than standardized mortality ratios. Conclusions New morbidities were associated with physiological status and can be modeled simultaneously with mortality. Trichotomous outcome models including both morbidity and mortality based on physiological status are suitable

Phonological Awareness: Factors of Influence

ERIC Educational Resources Information Center

Frohlich, Linda Paulina; Petermann, Franz; Metz, Dorothee

2013-01-01

Early child development is influenced by various genetic and environmental factors. This study aims to identify factors that affect the phonological awareness of preschool and first grade children. Based on a sample of 330 German-speaking children (mean age = 6.2 years) the following domains were evaluated: Parent factors, birth and pregnancy,…

Geographic Variation in Morbidity and Mortality of Cerebrovascular Diseases in Korea during 2011-2015.

PubMed

Lee, Juyeon; Bahk, Jinwook; Kim, Ikhan; Kim, Yeon-Yong; Yun, Sung-Cheol; Kang, Hee-Yeon; Lee, Jeehye; Park, Jong Heon; Shin, Soon-Ae; Khang, Young-Ho

2018-03-01

Little is known about within-country variation in morbidity and mortality of cerebrovascular diseases (CVDs). Geographic differences in CVD morbidity and mortality have yet to be properly examined. This study examined geographic variation in morbidity and mortality of CVD, neighborhood factors for CVD morbidity and mortality, and the association between CVD morbidity and mortality across the 245 local districts in Korea during 2011-2015. District-level health care utilization and mortality data were obtained to estimate age-standardized CVD morbidity and mortality. The bivariate Pearson correlation was used to examine the linear relationship between district-level CVD morbidity and mortality Z-scores. Simple linear regression and multivariate analyses were conducted to investigate the associations of area characteristics with CVD morbidity, mortality, and discrepancies between morbidity and mortality. Substantial variation was found in CVD morbidity and mortality across the country, with 1074.9 excess CVD inpatients and 73.8 excess CVD deaths per 100,000 between the districts with the lowest and highest CVD morbidity and mortality, respectively. Higher rates of CVD admissions and deaths were clustered in the noncapital regions. A moderate geographic correlation between CVD morbidity and mortality was found (Pearson correlation coefficient = .62 for both genders). Neighborhood level indicators for socioeconomic disadvantages, undersupply of health care resources, and unhealthy behaviors were positively associated with CVD morbidity and mortality and the relative standing of CVD mortality vis-à-vis morbidity. Policy actions targeting life-course socioeconomic conditions, equitable distribution of health care resources, and behavioral risk factors may help reduce geographic differences in CVD morbidity and mortality in Korea. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Factors Influencing Compliance and Health Seeking Behaviour for Hypertension in Mukono and Buikwe in Uganda: A Qualitative Study

PubMed Central

Anthierens, Sibyl; Nuwaha, Fred; Van Geertruyden, Jean-Pierre; Wanyenze, Rhoda K.; Bastiaens, Hilde

2018-01-01

Background and Methods Hypertension is a global public health challenge and a leading risk factor for cardiovascular morbidity and mortality. Hypertension control rates are low worldwide, and delay in seeking care is associated with increased mortality. Methods In a qualitative study, known hypertensive patients were interviewed to explore factors influencing compliance and health seeking behaviour (HSB). Data was analyzed following a semantic thematic analysis approach. Results Patients sought various channels of care for their hypertension. Self-medication and access to antihypertensive drugs with or without prescription were common as well as use of herbal remedies. Regular monitoring of blood pressure was not a common practice. Factors influencing HSB were related to health systems and the patient socioeconomic and structural environment. The main system issues were related to availability and attitudes of staff and shortage of supplies and medicines. The patient factors were related to awareness, perceived severity, perceived effectiveness of therapy, adverse effects, and perceived fears of lifelong dependence on medicines. The patient socioeconomic status played a role as did the marketing of traditional medicine. Conclusion Patients seek varied channels of care for their hypertension. Strategies to address the multifactorial dimensions that affect HSB are needed to improve hypertension control in this population. PMID:29854433

Morbid obesity increases risk of morbidity and reoperation in resection of benign cranial nerve neoplasms.

PubMed

Murphy, Meghan E; McCutcheon, Brandon A; Kerezoudis, Panagiotis; Porter, Amanda; Rinaldo, Lorenzo; Shepherd, Daniel; Rayan, Tarek; Maloney, Patrick R; Carter, Bob S; Bydon, Mohamad; Gompel, Jamie J Van; Link, Michael J

2016-09-01

Obesity has been associated with increased risk for postoperative CSF leak in patients with benign cranial nerve tumors. Other measures of postoperative morbidity associated with obesity have not been well characterized. Patients enrolled in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) from 2007 to 2013 with a diagnosis code of a benign neoplasm of a cranial nerve were included. The primary outcome of postoperative morbidity was analyzed as well as secondary outcomes of readmission and reoperation. The main covariate of interest was body mass index (BMI). A total of 561 patients underwent surgery for a benign cranial nerve neoplasm between 2007 and 2013. Readmission data, available for 2012-2013(n=353), revealed hydrocephalus, facial nerve injury, or CSF leak requiring readmission or reoperation occurred in 0.85%, 1.42%, and 3.12%, respectively. Composite morbidity included wound complications, infection, respiratory insufficiency, transfusion requirement, stroke, venous thromboembolism, coma and cardiac arrest. On multivariable analysis patients with class I (BMI 30-34.9) and II (BMI 35-39.9) obesity showed trends towards increasing return to operating room, though not significant, but there was no trend for composite complications in class I and II obesity patients. However, class III obesity, BMI≥40, was associated with increased odds of composite morbidity (OR 4.40, 95% CI 1.24-15.88) and return to the operating room (OR 5.97, 95% CI 1.20-29.6) relative to patients with a normal BMI, 18.5-25. Obesity is an independent and important risk factor for composite morbidity in resection of benign cranial nerve neoplasms, and as such, merits discussion during preoperative counseling. Copyright © 2016 Elsevier B.V. All rights reserved.

Autoimmunity and autoimmune co-morbidities in psoriasis.

PubMed

Furue, Kazuhisa; Ito, Takamichi; Tsuji, Gaku; Kadono, Takafumi; Nakahara, Takeshi; Furue, Masutaka

2018-05-01

Psoriasis is characterized by widespread scaly erythematous plaques that cause significant physical and psychological burdens for the affected individuals. Accelerated inflammation driven by the tumour necrosis factor-α/interleukin-23/interleukin-17 axis is now known to be the major mechanism in the development of psoriasis. In addition, psoriasis has an autoimmune nature that manifests as autoreactive T cells and is co-morbid with other autoimmune diseases, such as autoimmune bullous diseases, vitiligo, alopecia and thyroiditis. In this article, we review the recent topics on autoimmunity and autoimmune co-morbidities in psoriasis. © 2018 John Wiley & Sons Ltd.

Factors influencing participation in cardiac rehabilitation programmes after referral and initial attendance: qualitative systematic review and meta-synthesis.

PubMed

Clark, Alexander M; King-Shier, Kathryn M; Spaling, Melisa A; Duncan, Amanda S; Stone, James A; Jaglal, Susan B; Thompson, David R; Angus, Jan E

2013-10-01

Greater participation in cardiac rehabilitation improves morbidity and mortality in people with coronary heart disease, but little is understood of patients' decisions to participate. To develop interventions aimed at increasing completion of programmes, we conducted a qualitative systematic review and meta-synthesis to explore the complex factors and processes influencing participation in cardiac rehabilitation programmes after referral and initial access. To be included in the review, studies had to contain a qualitative research component, population specific data on programme participation in adults >18 years, and be published ≥1995 as full articles or theses. Ten databases were searched (31 October 2011) using 100+ search terms. Of 2264 citations identified, 62 studies were included involving: 1646 patients (57% female; mean age 64.2), 143 caregivers, and 79 professionals. Patients' participation was most strongly influenced by perceptions of the nature, suitability and scheduling of programmes, social comparisons made possible by programmes, and the degree to which programmes, providers, and programme users met expectations. Women's experiences of these factors rendered them less likely to complete. Comparatively, perceptions of programme benefits had little influence on participation. Factors reducing participation in programmes are varied but amenable to intervention. Participation should be viewed as a 'consumer behaviour' and interventions should mobilize family support, promote 'patient friendly' scheduling, and actively harness the social, identity-related, and experiential aspects of participation.

Obsessive–compulsive disorder: subclassification based on co-morbidity

PubMed Central

Nestadt, G.; Di, C. Z.; Riddle, M. A.; Grados, M. A.; Greenberg, B. D.; Fyer, A. J.; McCracken, J. T.; Rauch, S. L.; Murphy, D. L.; Rasmussen, S. A.; Cullen, B.; Pinto, A.; Knowles, J. A.; Piacentini, J.; Pauls, D. L.; Bienvenu, O. J.; Wang, Y.; Liang, K. Y.; Samuels, J. F.; Roche, K. Bandeen

2011-01-01

Background Obsessive–compulsive disorder (OCD) is probably an etiologically heterogeneous condition. Many patients manifest other psychiatric syndromes. This study investigated the relationship between OCD and co-morbid conditions to identify subtypes. Method Seven hundred and six individuals with OCD were assessed in the OCD Collaborative Genetics Study (OCGS). Multi-level latent class analysis was conducted based on the presence of eight co-morbid psychiatric conditions [generalized anxiety disorder (GAD), major depression, panic disorder (PD), separation anxiety disorder (SAD), tics, mania, somatization disorders (Som) and grooming disorders (GrD)]. The relationship of the derived classes to specific clinical characteristics was investigated. Results Two and three classes of OCD syndromes emerge from the analyses. The two-class solution describes lesser and greater co-morbidity classes and the more descriptive three-class solution is characterized by: (1) an OCD simplex class, in which major depressive disorder (MDD) is the most frequent additional disorder; (2) an OCD co-morbid tic-related class, in which tics are prominent and affective syndromes are considerably rarer; and (3) an OCD co-morbid affective-related class in which PD and affective syndromes are highly represented. The OCD co-morbid tic-related class is predominantly male and characterized by high conscientiousness. The OCD co-morbid affective-related class is predominantly female, has a young age at onset, obsessive–compulsive personality disorder (OCPD) features, high scores on the ‘taboo’ factor of OCD symptoms, and low conscientiousness. Conclusions OCD can be classified into three classes based on co-morbidity. Membership within a class is differentially associated with other clinical characteristics. These classes, if replicated, should have important implications for research and clinical endeavors. PMID:19046474

Measles outbreaks in displaced populations: a review of transmission, morbidity and mortality associated factors.

PubMed

Kouadio, Isidore K; Kamigaki, Taro; Oshitani, Hitoshi

2010-03-19

Measles is a highly contagious infectious disease with a significant public health impact especially among displaced populations due to their characteristic mass population displacement, high population density in camps and low measles vaccination coverage among children. While the fatality rate in stable populations is generally around 2%, evidence shows that it is usually high among populations displaced by disasters. In recent years, refugees and internally displaced persons have been increasing. Our study aims to define the epidemiological characteristics and risk factors associated with measles outbreaks in displaced populations. We reviewed literature in the PubMed database, and selected articles for our analysis that quantitatively described measles outbreaks. A total of nine articles describing 11 measles outbreak studies were selected. The outbreaks occurred between 1979 and 2005 in Asia and Africa, mostly during post-conflict situations. Seven of eight outbreaks were associated with poor vaccination status (vaccination coverage; 17-57%), while one was predominantly due to one-dose vaccine coverage. The age of cases ranged from 1 month to 39 years. Children aged 6 months to 5 years were the most common target group for vaccination; however, 1622 cases (51.0% of the total cases) were older than 5 years of age. Higher case-fatality rates (>5%) were reported for five outbreaks. Consistent factors associated with measles transmission, morbidity and mortality were vaccination status, living conditions, movements of refugees, nutritional status and effectiveness of control measures including vaccination campaigns, surveillance and security situations in affected zones. No fatalities were reported in two outbreaks during which a combination of active and passive surveillance was employed. Measles patterns have varied over time among populations displaced by natural and man-made disasters. Appropriate risk assessment and surveillance strategies are essential

Ureaplasma-associated prenatal, perinatal, and neonatal morbidities.

PubMed

Silwedel, Christine; Speer, Christian P; Glaser, Kirsten

2017-11-01

Ureaplasma species (spp.) have been acknowledged as major causative pathogens in chorioamnionitis and prematurity, but may also contribute to key morbidities in preterm infants. Several epidemiological and experimental data indicate an association of neonatal Ureaplasma colonization and/or infection with bronchopulmonary dysplasia. Furthermore, a potential causal relation with other inflammation-induced morbidities, such as intraventricular hemorrhage, white matter injury, necrotizing enterocolitis, and retinopathy of prematurity, has been debated. Areas covered: This review will summarize current knowledge on the role of Ureaplasma spp. in prenatal, perinatal, and neonatal morbidities, while furthermore examining mutual underlying mechanisms. We try to elaborate who is at particular risk of Ureaplasma-induced inflammation and subsequent secondary morbidities. Expert commentary: Most likely by complex interactions with immunological processes, Ureaplasma spp. can induce pro-inflammation, but may also downregulate the immune system. Tissue damage, possibly causing the above mentioned complications, is likely to result from both ways: either directly cytokine-associated, or due to a higher host vulnerability to secondary impact factors. These events are very likely to begin in prenatal stages, with the most immature preterm infants being most susceptible and at highest risk.

The Dubai Community Psychiatric Survey. IV. Life events, chronic difficulties and psychiatric morbidity.

PubMed

Bebbington, P; Hamdi, E; Ghubash, R

1998-10-01

The relationship between life events, chronic social difficulties and psychiatric morbidity was investigated in 297 women selected at random as part of the Dubai Community Psychiatric Survey. The PSE-ID-CATEGO system was used to identify psychiatric cases, based on an Index of Definition level of 5 or more. Life events in the 6-month period prior to illness or interview were elicited through the Life Events and Difficulties Schedule. Chronic difficulties were explored through direct questioning based on a list of possible problems. The study demonstrates a significant excess of marked and moderately threatening life events in acute cases of psychiatric disorder (50%) compared to chronic cases (16.7%) and non-cases (27.9%). The association was particularly marked for events in the 3-month period before the onset. Around 33% of psychiatric morbidity may be attributed to marked and moderately threatening life events. Rates for mild events were similar in the three groups of subjects. Subjects experiencing chronic social difficulties included a significantly higher proportion of cases (33.3%) than those who did not experience such difficulties (9.1%). The effect of chronic social difficulties was more pronounced than, and independent of, the effects of life events. There were no interactions between life events and vulnerability factors in their effect on psychiatric morbidity, although numbers were small. The results suggest that the overall influence of life events and chronic difficulties on psychiatric morbidity is commensurate with that in Western societies, despite the different coping traditions of Islam.

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

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.

Predictors of Urinary Morbidity in Cs-131 Prostate Brachytherapy Implants

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smith, Ryan P., E-mail: smithrp@upmc.edu; Jones, Heather A.; Beriwal, Sushil

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 covariancemore » 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

Maternal morbidity in Butajira and Wukro districts, North and South central Ethiopia.

PubMed

Mekonnen, Alemayehu; Mahmoud, Emebet; Fantahun, Mesganaw; Hagos, Seifu; Assegid, Meselech

2013-10-01

Worldwide, for every woman that dies of maternal causes, there are at least 20 more women who suffer from infection, disabilities and injuries relating to pregnancy and childbirth. To determine the magnitude and the role of socio-economic, demographic and reproductive factors on the occurrence of maternal morbidity in the study population. During the months of January to February 2012, a community based cross sectional survey was conducted to assess magnitude and factors affecting maternal morbidity in selected kebeles of Wukro and Butajira districts, Tigray and Southern Nation Nationalities and People's (SNNP) regions respectively, Ethiopia. A total of 4949 women who had deliveries in the two years preceding the survey were included. Following description of variables under the study, bivariate and Multivariable statistics were used to see the relationship between different factors and maternal morbidity. A total of 688 (14.2%) women reported that they had at least one form of morbidity. The three most frequent reported maternal morbidity during antenatal period were severe headache 89 (17.2%), lower abdominal pain (15.1%) and excessive vomiting (11.4%). Of the 220 women who reported to have morbidity during labor and delivery, prolonged labor (more than 24 hours) was accounted for 89 (40.5%) followed by hemorrhage and premature rapture of membranes in 74 (33.6%) and 23 (10.5%) of the cases respectively. Lower proportion of maternal morbidity was reported in Wukro than Butajira district [AOR (95% CI) = 0.17 (0.12, 0.25)]. Poorest and poor women were more likely to report to be sick [AOR (95% CI) = 1.79 (1.10, 2.91)] and [AOR (95% CI) = 1.65 (1.10, 2.47)] respectively. Women with parity of 5-6 and > or = 7 children respectively were also more likely to be morbid [AOR (95% CI) = 1.52 (1.11, 2.09)] and [AOR (95% CI) = 2.01 (1.38, 2.91)]. Women who had facility delivery were found more likely to have reported maternal morbidity with [AOR (95% CI) = 3.73 (2.96, 4

Morbidity in ≤1500-Gram Births in Spain, 1993-2011: Study of a Sample of 1200 Cases

PubMed Central

Gómez Esteban, Concepción; Sánchez Carrión, Juan J.; García Selgas, Fernando J.; Segovia Guisado, José M.

2017-01-01

Background and Objective. Preterm birth has a major impact on growth, and very preterm birth is associated with disabilities in numerous developmental domains. This article describes and quantifies morbidities in a sample of 1200 ≤1500-g births in Spain between 1993 and 2011 based on parent information, and it highlights several variables that influence these morbidities. Methods. Multiple method surveys using computer-assisted telephones interviewing and computer-assisted web interviewing methods. Sample design was intentional. Most subjects were contacted via their referral hospitals. Data collection was done from April 2013 to June 2014. Prior to the survey, extensive qualitative fieldwork was conducted, including nonparticipant observation in neonatal units and the design and analysis of discussion groups and interviews with professionals and families, including preterm adolescents. Results. A total of 44.2% of the sample were experiencing morbidity (mean: 1.788 morbidities per child). The most prevalent types were learning difficulties (34.4%) and attention deficit/hyperactivity disorder (31.5%). The most influential variables were male gender, age, lower birthweight, private hospital admission for birth, scarcity of health resources in the family’s residential area, non-Spanish maternal birthplace, and emotional distress in the primary carer. Conclusions. Overall, the total percentage of very low birth weight children with morbidities has decreased moderately between 1993 and 2011, thanks to major socio-sanitary improvements during this period. Biological and medical variables, rather than family factors, explain more accurately the presence of morbidities in children with birth weight ≤1500 g. PMID:28989948

Prevalence & factors associated with chronic obstetric morbidities in Nashik district, Maharashtra, India

PubMed Central

Chauhan, Sanjay; Kulkarni, Ragini; Agarwal, Dinesh

2015-01-01

Background & objectives: In India, community based data on chronic obstetric morbidities (COM) are scanty and largely derived from hospital records. The main aim of the study was to assess the community based prevalence and the factors associated with the defined COM - obstetric fistula, genital prolapse, chronic pelvic inflammatory disease (PID) and secondary infertility among women in Nashik district of Maharashtra State, India. Methods: The study was cross-sectional with self-reports followed by clinical and gynaecological examination. Six primary health centre areas in Nashik district were selected by systematic random sampling. Six months were spent on rapport development with the community following which household interviews were conducted among 1560 women and they were mobilized to attend health facility for clinical examination. Results: Of the 1560 women interviewed at household level, 1167 women volunteered to undergo clinical examination giving a response rate of 75 per cent. The prevalence of defined COM among 1167 women was genital prolapse (7.1%), chronic PID (2.5%), secondary infertility (1.7%) and fistula (0.08%). Advancing age, illiteracy, high parity, conduction of deliveries by traditional birth attendants (TBAs) and obesity were significantly associated with the occurrence of genital prolapse. History of at least one abortion was significantly associated with secondary infertility. Chronic PID had no significant association with any of the socio-demographic or obstetric factors. Interpretation & conclusions: The study findings provided an insight in the magnitude of community-based prevalence of COM and the factors associated with it. The results showed that COM were prevalent among women which could be addressed by interventions at personal, social and health services delivery level. PMID:26609041

Factors associated with self-esteem in persons with morbid obesity and in persons with chronic obstructive pulmonary disease: a cross-sectional study.

PubMed

Bonsaksen, Tore; Fagermoen, May Solveig; Lerdal, Anners

2015-01-01

Living with chronic illnesses can be stressful and may negatively impact persons' self-esteem. Personal factors, like self-efficacy and illness perceptions, and also factors related to the environment, activity, and participation may be associated with self-esteem in chronic illness populations. This cross-sectional comparative study explored sociodemographic variables, work, physical activity, illness perceptions, and general self-efficacy in relation to self-esteem in persons with morbid obesity and in persons with chronic obstructive pulmonary disease (COPD). The study had a cross-sectional design. A total of 223 eligible participants were recruited from patient education courses, and data were collected at baseline. Self-esteem was measured with The Rosenberg self-esteem scale; the general self-efficacy scale was used to measure self-efficacy, and brief illness perception questionnaire was also used. This is an instrument assessing cognitions about the illness and emotional responses towards it. Multivariate linear regression was used in the statistical analyses. In obese participants (n = 134), higher self-esteem was associated with lower emotional response, a shorter timeline, and higher general self-efficacy. In COPD participants (n = 89), higher self-esteem was associated with higher general self-efficacy. The independent variables accounted for 42.9% (morbid obesity) and 49.4% (COPD) of the self-esteem variance. In participants in both illness groups, higher self-efficacy was associated with increased self-esteem. A shorter timeline and lower emotional response to illness was related to higher self-esteem only for the obese participants. The results indicate that believing in one's capacity to cope with everyday challenges is important for self-esteem in persons with morbid obesity and in persons with COPD, whereas illness perceptions related to the duration of illness and the coping with emotions also is important for self-esteem in persons with morbid

Factors that Influence Participation in Online Learning

ERIC Educational Resources Information Center

Vonderwell, Selma; Zachariah, Sajit

2005-01-01

This study explored what factors influenced learner participation in two sections of a graduate online course at a Midwestern university. Findings indicated that online learner participation and patterns of participation are influenced by the following factors: technology and interface characteristics, content area experience, student roles and…

A scoping review of biopsychosocial risk factors and co-morbidities for common spinal disorders.

PubMed

Green, Bart N; Johnson, Claire D; Haldeman, Scott; Griffith, Erin; Clay, Michael B; Kane, Edward J; Castellote, Juan M; Rajasekaran, Shanmuganathan; Smuck, Matthew; Hurwitz, Eric L; Randhawa, Kristi; Yu, Hainan; Nordin, Margareta

2018-01-01

The purpose of this review was to identify risk factors, prognostic factors, and comorbidities associated with common spinal disorders. A scoping review of the literature of common spinal disorders was performed through September 2016. To identify search terms, we developed 3 terminology groups for case definitions: 1) spinal pain of unknown origin, 2) spinal syndromes, and 3) spinal pathology. We used a comprehensive strategy to search PubMed for meta-analyses and systematic reviews of case-control studies, cohort studies, and randomized controlled trials for risk and prognostic factors and cross-sectional studies describing associations and comorbidities. Of 3,453 candidate papers, 145 met study criteria and were included in this review. Risk factors were reported for group 1: non-specific low back pain (smoking, overweight/obesity, negative recovery expectations), non-specific neck pain (high job demands, monotonous work); group 2: degenerative spinal disease (workers' compensation claim, degenerative scoliosis), and group 3: spinal tuberculosis (age, imprisonment, previous history of tuberculosis), spinal cord injury (age, accidental injury), vertebral fracture from osteoporosis (type 1 diabetes, certain medications, smoking), and neural tube defects (folic acid deficit, anti-convulsant medications, chlorine, influenza, maternal obesity). A range of comorbidities was identified for spinal disorders. Many associated factors for common spinal disorders identified in this study are modifiable. The most common spinal disorders are co-morbid with general health conditions, but there is a lack of clarity in the literature differentiating which conditions are merely comorbid versus ones that are risk factors. Modifiable risk factors present opportunities for policy, research, and public health prevention efforts on both the individual patient and community levels. Further research into prevention interventions for spinal disorders is needed to address this gap in the

A scoping review of biopsychosocial risk factors and co-morbidities for common spinal disorders

PubMed Central

Smuck, Matthew; Hurwitz, Eric L.; Randhawa, Kristi; Yu, Hainan; Nordin, Margareta

2018-01-01

Objective The purpose of this review was to identify risk factors, prognostic factors, and comorbidities associated with common spinal disorders. Methods A scoping review of the literature of common spinal disorders was performed through September 2016. To identify search terms, we developed 3 terminology groups for case definitions: 1) spinal pain of unknown origin, 2) spinal syndromes, and 3) spinal pathology. We used a comprehensive strategy to search PubMed for meta-analyses and systematic reviews of case-control studies, cohort studies, and randomized controlled trials for risk and prognostic factors and cross-sectional studies describing associations and comorbidities. Results Of 3,453 candidate papers, 145 met study criteria and were included in this review. Risk factors were reported for group 1: non-specific low back pain (smoking, overweight/obesity, negative recovery expectations), non-specific neck pain (high job demands, monotonous work); group 2: degenerative spinal disease (workers’ compensation claim, degenerative scoliosis), and group 3: spinal tuberculosis (age, imprisonment, previous history of tuberculosis), spinal cord injury (age, accidental injury), vertebral fracture from osteoporosis (type 1 diabetes, certain medications, smoking), and neural tube defects (folic acid deficit, anti-convulsant medications, chlorine, influenza, maternal obesity). A range of comorbidities was identified for spinal disorders. Conclusion Many associated factors for common spinal disorders identified in this study are modifiable. The most common spinal disorders are co-morbid with general health conditions, but there is a lack of clarity in the literature differentiating which conditions are merely comorbid versus ones that are risk factors. Modifiable risk factors present opportunities for policy, research, and public health prevention efforts on both the individual patient and community levels. Further research into prevention interventions for spinal

Burnout, psychological morbidity, job stress, and job satisfaction in Chinese neurologists.

PubMed

Zhou, Xinyu; Pu, Juncai; Zhong, Xiaoni; Zhu, Dan; Yin, Dinghong; Yang, Lining; Zhang, Yuqing; Fu, Yuying; Wang, Haiyang; Xie, Peng

2017-05-02

To investigate the prevalence of and personal and professional characteristics associated with burnout, psychological morbidity, job stress, and job satisfaction in Chinese neurologists. The China Neurologist Association conducted a national cross-sectional study from September 2014 to March 2015. A questionnaire including the Maslach Burnout Inventory, the 12-item General Health Questionnaire, the Consultants' Mental Health Questionnaire, and questions assessing personal and professional characteristics, career satisfaction, and current doctor-patient relationships was administered. A total of 693 directors of neurology departments and 6,111 neurologists in 30 Chinese provinces returned surveys. Overall, 53.2% of responding neurologists experienced burnout, 37.8% had psychological morbidity, 50.7% had high levels of job stress, 25.7% had low levels of job satisfaction, 76.9% had poor doctor-patient relationships, and 58.1% regretted becoming a doctor. Factors independently associated with burnout were lower income, more hours worked per week, more nights on call per month, working in public hospitals, psychological morbidity, high levels of job stress, low levels of job satisfaction, and poor doctor-patient relationships. Factors independently associated with psychological morbidity included lower income, more nights on call per month, working in enterprise-owned hospitals, burnout, high levels of job stress, and low levels of job satisfaction. Burnout and psychological morbidity are common in Chinese neurologists. Burnout is the single greatest predictor of neurologists' psychological morbidity, high job stress, and low job satisfaction. © 2017 American Academy of Neurology.

The influence of the risk factor on the abdominal complications in colon injury management.

PubMed

Torba, M; Gjata, A; Buci, S; Bushi, G; Zenelaj, A; Kajo, I; Koceku, S; Kagjini, K; Subashi, K

2015-01-01

The management of colon injuries has distinctly evolved over the last three decades. However, trauma surgeons often find themselves in a dilemma, whether to perform a diversion or to perform a primary repair. The purpose of this study is to evaluate risk factors in colon injury management and their influence on abdominal complications. This is a prospective study conducted at a national level I trauma center in Tirana, Albania from January 2009 to December 2012. The data with respect to demographics, physiological risk factors, intraoperative findings, and surgical procedures were collected. Colonic injury-related morbidity and mortality were analyzed. Multivariate logistic regression analysis was performed by assessing the influence of risk factors on abdominal complications. Of the 157 patients treated with colon injury, was performed a primary repair in 107 (68.15%) of the patients and a diversion in the remaining 50 (31.85%). The mean PATI was 18.6, while 37 (23.6%) of patients had PATI greater than 25. The complications and their frequencies according to the surgical technique used (primay repair vs diversion respectively) includes: wound infections (9.3% vs 50%), anastomotic leak (1.8% vs 8.7%), and intra-abdominal abscess (1.8% vs 6.5%). The multivariate analysis identified two independent risk factors for abdominal complications: transfusions of 4 units of blood within the first 24 hours (OR = 1.2 95% CI (1.03 - 1.57) p =0.02), and diversion (OR = 9.6, 95% CI 4.4 - 21.3, p<0.001). Blood transfusions of more than 4 units within the first 24 hours and diversion during the management of destructive colon injuries are both independent risk factors for abdominal complications. The socioeconomic impact and the need for a subsequent operation in colostomy patients are strong reasons to consider primary repair in the management of colon injuries.

Liberal perioperative fluid administration is an independent risk factor for morbidity and is associated with longer hospital stay after rectal cancer surgery.

PubMed

Boland, M R; Reynolds, I; McCawley, N; Galvin, E; El-Masry, S; Deasy, J; McNamara, D A

2017-02-01

INTRODUCTION Recent studies have advocated the use of perioperative fluid restriction in patients undergoing major abdominal surgery as part of an enhanced recovery protocol. Series reported to date include a heterogenous group of high- and low-risk procedures but few studies have focused on rectal cancer surgery alone. The aim of this study was to assess the effects of perioperative fluid volumes on outcomes in patients undergoing elective rectal cancer resection. METHODS A prospectively maintained database of patients with rectal cancer who underwent elective surgery over a 2-year period was reviewed. Total volume of fluid received intraoperatively was calculated, as well as blood products required in the perioperative period. The primary outcome was postoperative morbidity (Clavien-Dindo grade I-IV) and the secondary outcomes were length of stay and major morbidity (Clavien-Dindo grade III-IV). RESULTS Over a 2-year period (2012-2013), 120 patients underwent elective surgery with curative intent for rectal cancer. Median total intraoperative fluid volume received was 3680ml (range 1200-9670ml); 65/120 (54.1%) had any complications, with 20/120 (16.6%) classified as major (Clavien-Dindo grade III-IV). Intraoperative volume >3500ml was an independent risk factor for the development of postoperative all-cause morbidity (P=0.02) and was associated with major morbidity (P=0.09). Intraoperative fluid volumes also correlated with length of hospital stay (Pearson's correlation coefficient 0.33; P<0.01). CONCLUSIONS Intraoperative fluid infusion volumes in excess of 3500ml are associated with increased morbidity and length of stay in patients undergoing elective surgery for rectal cancer.

Influence of FTO rs9939609 polymorphism on appetite, ghrelin, leptin, IL6, TNFα levels, and food intake of women with morbid obesity.

PubMed

Magno, Fernanda Cristina Carvalho Mattos; Guaraná, Helena Chrispim; Fonseca, Ana Carolina Proença; Cabello, Giselda Maria Kalil; Carneiro, João Régis Ivar; Pedrosa, Aline Pereira; Ximenes, Ana Carolina; Rosado, Eliane Lopes

2018-01-01

The fat mass and obesity-related ( FTO ) gene has a strong relationship with obesity, extreme obesity and inflammatory state, and may also be associated with food intake regulation. The aim of the present study was to evaluate the influence of the rs9939609 single-nucleotide polymorphism of the FTO gene on appetite, ghrelin, leptin, interleukin 6 (IL6), tumor necrosis factor α (TNFα) levels and food intake of morbidly obese women. The study comprised 70 women, aged between 20 and 48 years, from Rio de Janeiro, Brazil. The participants were selected according to the body mass index between 40 and 60 kg/m 2 . Anthropometric and biochemical data were measured during fasting. Hormones and inflammatory data were measured before and after the participants ate an isocaloric meal. Dietary records were calculated and analyzed using a nutritional assessment program. Visual analog scales were used for behaviors of the sensations of appetite and food preferences. The FTO rs9939609 variant was genotyped using real-time polymerase chain reaction. Participants with the AA genotype had lower values of ghrelin and IL6 and higher values of leptin than those with TT and TA in the postprandial period. Comparing the plasma concentrations of ghrelin, insulin, IL6 and TNFα intragenotypes, it was observed that those with TT had decreased leptin and increased IL6 at the postprandial period. Subjects with TA showed increased postprandial IL6, and those with AA had decreased postprandial ghrelin. There was no difference in TNFα intra- and intergenotypes. The postprandial sensations of hunger were lower in AA than those with TT. There were differences between genotypes regarding ingested grams of protein by weight, cholesterol, B3, B5, B6 and B12 vitamins, and selenium potassium and sodium minerals. These findings suggest that genetics may exert an influence on physiologic factors and might alter eating behavior.

Stigma and psychiatric morbidity among mothers of children with epilepsy in Zambia

PubMed Central

Elafros, Melissa A.; Sakubita-Simasiku, Claire; Atadzhanov, Masharip; Haworth, Alan; Chomba, Elwyn; Birbeck, Gretchen L.

2013-01-01

Background Epilepsy-associated stigma contributes substantially to the social, medical, and economic burden of disease for people with epilepsy (PWE), but little is known about its impact on caregivers of PWE. Methods To better understand stigma experienced by caregivers of PWE, factors that influence caregiver stigma, and the effect of stigma on a caregiver's psychologic well being, we interviewed 100 caregivers of children with epilepsy in Zambia. Questions assessed maternal knowledge, attitudes, and practices related to epilepsy, maternal stigma, mother's proxy report of child stigma, and maternal psychiatric morbidity. Results Of 100 mothers, 39 (39%) indicated that their child was stigmatized because of his or her epilepsy. Maternal proxy report of child stigma was highly correlated with maternal stigma (OR: 5.4, p=0.04), seizure frequency (p=0.03) and seizure severity (p=0.01). One in five of 100 mothers (20%) reported feeling stigmatized because of their child's epilepsy. Higher maternal stigma was associated with lower familial and community support (ORs: 65.2 and 34.7, respectively; both p<0.0001) as well as higher psychiatric morbidity (OR: 1.2; p=0.002). Formal education and epilepsy knowledge were associated with decreased maternal stigma (ORs: 0.8 and 0.7, respectively; both p<0.001). Conclusions One in five mothers of PWE feel stigmatized because of their child's epilepsy. As maternal stigma is associated with psychiatric morbidity, educating caregivers about epilepsy and screening for anxiety and depression are warranted. PMID:24214528

Sociodemographic status and self-reported BMI-related morbidity in Koreans.

PubMed

Lee, Kayoung

2010-03-01

This study examined whether the relationship between body mass index (BMI) and the morbidity of chronic diseases differs by marital status, education, and income level. From a nationally representative sample of 5,526 adults from the third Korean National Health and Nutrition Examination Survey (2005), data regarding measured height and weight to classify BMI category (< 23, 23-24.9, > or = 25), self-reported sociodemographics (marital status, education, income, age, sex, and residence area), health behaviors (smoking, alcohol use, exercise, sleep, stress perception, and depression), and morbidity from at least one chronic disease were collected. Education, income, and marital status were significantly associated with morbidity regardless of adjustment for BMI and health behaviors. After adjusting for BMI, other sociodemographic factors, and health behaviors, the odds ratio (95% confidence interval) of morbidity was 2.9 (2.4-3.7) for those in the married group and 2.9 (2.1-4.0) for those in the separated/divorced/widowed group, 2.0 (1.6-2.5) for those in the lowest education group, and 1.3 (1.2-1.6) for those in the lowest income group. When the BMI category and sociodemographic factors were combined, the odds ratios were elevated for those in the combination group with higher BMI and lower sociodemographic position. Korean subjects who were married, in the lowest education group, or in the lowest income level had a higher risk of morbidity in relation to BMI.

The Psychosocial Factors Related to Obesity: A Study Among Overweight, Obese, and Morbidly Obese Women in India

PubMed Central

Agrawal, Praween; Gupta, Kamla; Mishra, Vinod; Agrawal, Sutapa

2015-01-01

Psychosocial factors among overweight, obese, and morbidly obese women in Delhi, India were examined. A follow-up survey was conducted of 325 ever-married women aged 20–54 years, systematically selected from 1998–99 National Family Health Survey samples, who were re-interviewed after 4 years in 2003. Information on day-to-day problems, body image dissatisfaction, sexual dissatisfaction, and stigma and discrimination were collected and anthropometric measurements were obtained from women to compute their current body mass index. Three out of four overweight women (BMI between 25 and 29.9 kg/m2) were not happy with their body image, compared to four out of five obese women (BMI of 30 kg/m2 or greater), and almost all (95 percent) morbidly obese women (BMI of 35 kg/m2 or greater) (p < .0001). It was found that morbidly obese and obese women were five times (adjusted odds ratio [aOR] 5.29, 95% confidence interval [CI] 2.02–13.81, p < .001) and two times (aOR 2.30, 95% CI 1.20–4.42, p < .001), respectively, as likely to report day-to-day problems; twelve times (aOR 11.88, 95% CI 2.62–53.87, p < .001) and three times, respectively, as likely (aOR 2.92, 95% CI 1.45–5.88, p = .001) to report dissatisfaction with body image; and nine times (aOR 9.41, 95% CI 2.96–29.94, p < .001) and three times (aOR 2.93, 95% CI 1.03–8.37, p = .001), respectively, as likely to report stigma and discrimination as overweight women. PMID:25905678

Factors That Influence Language Growth.

ERIC Educational Resources Information Center

McCarthy, Dorothea, Ed.; And Others

This booklet contains four articles that discuss factors influencing language growth. The first, "The Child's Equipment for Language Growth" by Charlotte Wells, examines what the child needs for language learning, how the child uses his equipment for language growth, and what school factors facilitate the child's use of his equipment for language…

Prevalence of cardiovascular morbidities in Myanmar.

PubMed

Zaw, Ko Ko; Nwe, Nwe; Hlaing, Su Su

2017-02-15

Cardiovascular diseases (CVDs) are now in a rising trend in South East Asia including Myanmar due to increase in major cardiovascular risk factors in both urban and rural areas, such as smoking, obesity and diabetes mellitus. It is necessary to determine CVD morbidities in Myanmar for planning of prevention and control activities for CVDs. The cross-sectional household survey was conducted in 2012 with 600 people aged 40 years and above in four townships (Kyauk-Tan, Mawlamyaing, Pathein and Pyay) and used face-to-face interview with standard questionnaire [Rose Angina Questionnaire and Questionnaire by European Cardiovascular Indicators Surveillance Set (EUROCISS) Research Group] to determine the level of reported CVD morbidities in adult population. Age of the study population ranged from 40 to 99 years with the mean age of 56 years. Seventy-one percent of the study population was women. Nine percent of the study population have suffered from angina according to Rose Angina Questionnaire. Prevalence of possible heart attack, stroke and heart failure was 7.5, 1.5 and 2.8%. Prevalence of hypertension was 51%. The CVD morbidities are high. There is a need for strengthening prevention and control activities of CVDs.

PTSD Trajectory, Co-morbidity, and Utilization of Mental Health Services among National Guard Forces

DTIC Science & Technology

2011-10-01

constructed a survey for initial data collection as well as subsequent waves that contains modules on (1) risk or protective factors for psychological ...morbidity over the life course (general traumas, psychological resources, life and family concerns), (2) mental health (depression, PTSD, emotional...protective factors for psychological morbidity among National Guard force members, (b) mental health, and (c) service utilization patterns among

Lifestyle factors and co-morbidities associated with obesity and overweight in Nkonkobe Municipality of the Eastern Cape, South Africa.

PubMed

Otang-Mbeng, Wilfred; Otunola, Gloria Aderonke; Afolayan, Anthony Jide

2017-05-25

Obesity is a global epidemic that affects 500 million people worldwide and is predicted to increase to one billion people by 2030. The prevalence of obesity is increasing across populations in South Africa. However, questions still remain surrounding the predisposing factors and obesity-related health problems especially in the rural areas. This study evaluated several lifestyle factors such as dietary habits, physical activity, smoking, alcohol intake, co-morbidities and their association with the prevalence of obesity and overweight in Nkonkobe Municipality of the Eastern Cape. A cross-sectional, population-based survey was conducted among 118 residents in four rural/sub-urban townships of the study area. Measurements including weight, height, body mass index (BMI), physical activity and dietary habits were determined using a validated questionnaire. The overall prevalence of obesity and overweight was 38 and 19%, respectively. The highest prevalence of obesity (70%) was observed among those who do not undertake any physical activity. Close to half (48.48%) of the respondents who eat fast foods always were obese, and 30.30% were overweight; when combined, the prevalence for obesity is 78.78%. A negative association with obesity was observed among regular smokers (26.92%) and consumers of alcohol (4.00%). Arthritis, hypertension and tuberculosis were co-morbidities significantly (P < 0.05) associated with obesity in the study area. The findings of this study reveal that lack of physical activity, overindulgence on fast and fried foods, low fruit and vegetable consumption as well as arthritis, hypertension and tuberculosis were significant risk factors of obesity in Nkonkobe Municipality.

Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions.

PubMed

Davenport, Daniel L; Henderson, William G; Mosca, Cecilia L; Khuri, Shukri F; Mentzer, Robert M

2007-12-01

Since the Institute of Medicine patient safety reports, a number of survey-based measures of organizational climate safety factors (OCSFs) have been developed. The goal of this study was to measure the impact of OCSFs on risk-adjusted surgical morbidity and mortality. Surveys were administered to staff on general/vascular surgery services during a year. Surveys included multiitem scales measuring OCSFs. Additionally, perceived levels of communication and collaboration with coworkers were assessed. The National Surgical Quality Improvement Program was used to assess risk-adjusted morbidity and mortality. Correlations between outcomes and OCSFs were calculated and between outcomes and communication/collaboration with attending and resident doctors, nurses, and other providers. Fifty-two sites participated in the survey: 44 Veterans Affairs and 8 academic medical centers. A total of 6,083 surveys were returned, for a response rate of 52%. The OCSF measures of teamwork climate, safety climate, working conditions, recognition of stress effects, job satisfaction, and burnout demonstrated internal validity but did not correlate with risk-adjusted outcomes. Reported levels of communication/collaboration with attending and resident doctors correlated with risk-adjusted morbidity. Survey-based teamwork, safety climate, and working conditions scales are not confirmed to measure organizational factors that influence risk-adjusted surgical outcomes. Reported communication/collaboration with attending and resident doctors on surgical services influenced patient morbidity. This suggests the importance of doctors' coordination and decision-making roles on surgical teams in providing high-quality and safe care. We propose risk-adjusted morbidity as an effective measure of surgical patient safety.

Treatment of Morbidity with Atypical Chest Pain

PubMed Central

Cott, Arthur

1987-01-01

The appropriate management of atypical chest pain requires an integration of medical and behavioural treatments. Unnecessary medicalization can increase morbidity. A sensitivity to the behavioural factors contributing to symptoms and disability may reduce both. The purpose of this paper is to provide physicians with a cognitive-behavioural perspective of the nature of morbidity and disability associated with chronic chest discomfort; some strategies for detecting heretofore unsuspected disability associated with chronic chest pain and related discomfort in patients with organic findings (both cardiac and non-cardiac), as well those with no identifiable disease process or organic cause; and some simple behavioural and cognitive-behavioural therapeutic techniques for treating and preventing such problems. PMID:21263912

Factors influencing children's food choice.

PubMed

Koivisto Hursti, U K

1999-04-01

Although food habits are not stable and unchanging during a person's lifetime, a base for healthy food habits can be created in early childhood. Children's food habits can be assumed to be influenced by their parents' food habits and choices. The aim of this article is to review factors influencing food choice in children as well as in adults. The results demonstrate that the development of children's food habits is influenced by a multitude of factors. Parents play an important role in the formation of food habits and preferences of young children. They can influence their children's food choice by making specific foods available, by acting as models for their children and by their behaviour in specific situations. Children tend to be afraid of new foods and do not readily accept them. However, experience is known to enhance preference, and earlier experiences of a particular food are the major determinants of the development of children's food acceptance patterns. Thus, parents should be encouraged to make healthy foods easily available to the child and serve these foods in positive mealtime situations in order to help their child to develop healthy food habits.

Factors influencing children's food choice.

PubMed

Hursti, Ulla-Kaisa Koivisto

1999-01-01

Although food habits arc not stable and unchanging during a person's lifetime, a base for healthy food habits can be created in early childhood. Children's food habits can be assumed to be influenced by their parents' food habits and choices. The aim of this article is to review factors influencing food choice in children as well as in adults. The results demonstrate that the development of children's food habits is influenced by a multitude of factors. Parents play an important role in the formation of food habits and preferences of young children. They can influence their children's food choice by making specific foods available, by acting as models for their children and by their behaviour in specific situations. Children tend to be afraid of new foods and do not readily accept them. However, experience is known to enhance preference, and earlier experiences of a particular food are the major determinants of the development of children's food acceptance patterns. Thus, parents should be encouraged to make healthy foods easily available to the child and serve these foods in positive mealtime situations in order to help their child to develop healthy food habits.

[Morbidity of textile industry workers in Kaunas].

PubMed

Ustinaviciene, Rūta; Piesine, Loreta

2007-01-01

According to the Department of Statistics at the beginning of 2003, 551 textile industry and garment enterprises operated in Lithuania. The purpose of the study was to evaluate morbidity among workers in textile industry enterprises in Kaunas and analyze the data obtained in relation to sex, age, profession, and occupational health hazards. A sick-leave-based case-control study was conducted in the units of four textile enterprises where 1842 workers were employed. Data were categorized in relation to sex, profession, and kind of sickness. Age was grouped in the following way: under 29 years, 30-39 years, 40-49 years, and over 50 years. In the period of survey, 1482 cases of sick leave were reported in the enterprises where 1842 workers were employed. The main cause of absence because of sickness was respiratory diseases--37.3% (30.27 cases per 100 workers), nursing took the second place--17.0% (13.76 cases per 100 workers). Accidents and injuries made up 9.3% (7.5 cases per 100 workers), musculoskeletal and connective tissue disorders--7.9% (6.4 cases per 100 workers). Data were analyzed using statistical programs SPSS 97, Epi-Info 6.0. Main morbidities reported included respiratory diseases (37.3%), nursing (17.0%), accidents and injuries (9.3%), musculoskeletal and connective tissue disorders (7.9%). The incidence of morbidity among workers engaged in workplace where occupational risk factors exceeded hygienic standards was higher. The rate of morbidity also increased with age and sex; morbidity among women was 1.5 higher than among men.

A descriptive model of preventability in maternal morbidity and mortality.

PubMed

Geller, S E; Cox, S M; Kilpatrick, S J

2006-02-01

To develop a descriptive model of preventability for maternal morbidity and mortality that can be used in quality assurance and morbidity and mortality review processes. This descriptive study was part of a larger case-control study conducted at the University of Illinois at Chicago in which maternal deaths were cases and women with severe maternal morbidity served as controls. Morbidities and mortalities were classified by a team of clinicians as preventable or not preventable. Qualitative analysis of data was conducted to identify and categorize different types of preventable events. Of 237 women, there were 79 women with preventable events attributable to provider or system factors. The most common types of preventable events were inadequate diagnosis/recognition of high-risk (54.4%), treatment (38.0%), and documentation (30.7%). A descriptive model was illustrated that can be used to categorize preventable events in maternal morbidity and mortality and can be incorporated into quality assurance and clinical case review to enhance the monitoring of hospital-based obstetric care and to decrease medical error.

Factors associated with childhood ocular morbidity and blindness in three ecological regions of Nepal: Nepal pediatric ocular disease study.

PubMed

Adhikari, Srijana; Shrestha, Mohan Krishna; Adhikari, Kamala; Maharjan, Nhukesh; Shrestha, Ujjowala Devi

2014-10-23

Nepal Pediatric Ocular Diseases Study is a three year longitudinal population based study. Here we present the baseline survey report which aims to investigate various risk factors associated with childhood ocular morbidity and blindness in three ecological regions of Nepal. This baseline survey is a population based cross sectional study. The investigation was conducted in a district from each of the following regions: Terai, Hill and Mountain. The Village Development Committees (VDCs) from each district were selected by random sampling. Three Community health workers were given training on vision screening and identification of abnormal ocular signs in children. They conducted a house to house survey in their respected districts examining the children and gathering a standardized set of data variables. Children with abnormal vision or ocular signs were then further examined by pediatric ophthalmologists. A total of 10950 children aged 0-10 years (5403 from Terai, 3204 from the hills, 2343 from the mountains) were enrolled in the study. However 681 (6.2%) were non responders. The male to female ratio was 1.03. The overall prevalence of ocular morbidity was 3.7% (95% CI of 3.4%-4%) and blindness was 0.07% (95% CI of 0.02%-0.12%). Ocular morbidity was more prevalent in the mountain region whereas blindness was more prevalent in the Terai region.Children from the Terai region were more likely to suffer from congenital ocular anomalies compared to the other regions. Children whose mother smoked, drank alcohol, or was illiterate were significantly afflicted with ocular diseases (p < 0.05). In addition,a higher prevalence of ocular disease was related to children with past medical history of systemic illnesses, abnormal postnatal period or missing childhood vaccinations. Blindness was more prevalent in children who suffered from a systemic illness. Females and under-nourished children were more likely to have ocular morbidity and blindness. It was found that

Risk factors for hospital morbidity and mortality after the Norwood procedure: A report from the Pediatric Heart Network Single Ventricle Reconstruction trial.

PubMed

Tabbutt, Sarah; Ghanayem, Nancy; Ravishankar, Chitra; Sleeper, Lynn A; Cooper, David S; Frank, Deborah U; Lu, Minmin; Pizarro, Christian; Frommelt, Peter; Goldberg, Caren S; Graham, Eric M; Krawczeski, Catherine Dent; Lai, Wyman W; Lewis, Alan; Kirsh, Joel A; Mahony, Lynn; Ohye, Richard G; Simsic, Janet; Lodge, Andrew J; Spurrier, Ellen; Stylianou, Mario; Laussen, Peter

2012-10-01

We sought to identify risk factors for mortality and morbidity during the Norwood hospitalization in newborn infants with hypoplastic left heart syndrome and other single right ventricle anomalies enrolled in the Single Ventricle Reconstruction trial. Potential predictors for outcome included patient- and procedure-related variables and center volume and surgeon volume. Outcome variables occurring during the Norwood procedure and before hospital discharge or stage II procedure included mortality, end-organ complications, length of ventilation, and hospital length of stay. Univariate and multivariable Cox regression analyses were performed with bootstrapping to estimate reliability for mortality. Analysis included 549 subjects prospectively enrolled from 15 centers; 30-day and hospital mortality were 11.5% (63/549) and 16.0% (88/549), respectively. Independent risk factors for both 30-day and hospital mortality included lower birth weight, genetic abnormality, extracorporeal membrane oxygenation (ECMO) and open sternum on the day of the Norwood procedure. In addition, longer duration of deep hypothermic circulatory arrest was a risk factor for 30-day mortality. Shunt type at the end of the Norwood procedure was not a significant risk factor for 30-day or hospital mortality. Independent risk factors for postoperative renal failure (n = 46), sepsis (n = 93), increased length of ventilation, and hospital length of stay among survivors included genetic abnormality, lower center/surgeon volume, open sternum, and post-Norwood operations. Innate patient factors, ECMO, open sternum, and lower center/surgeon volume are important risk factors for postoperative mortality and/or morbidity during the Norwood hospitalization. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

A one-year community study of under-fives in rural Ethiopia: health and behavioural determinants of morbidity.

PubMed

Muhe, L; Byass, P; Freij, L; Sandström, A; Wall, S

1996-07-01

Based on a one-year weekly home surveillance study, morbidity patterns of 1,304 children under five years of age in a rural Ethiopian community were measured, together with nutritional and health behavioural determinants. Using Poisson regression models, the study showed that nutritional and health care factors make a significant impact on under-five morbidity. Gastroenteritis was particularly associated with child care factors, while acute respiratory infections were particularly associated with nutritional factors. Lack of immunization, low birthweight and pre-term delivery (more than one month early) were not found to have any independent effect on morbidity. Breast feeding was universal, but the introduction of supplementary foods was found to protect from excess morbidity. The study concludes by discussing possible applications of the results in intervention programmes.

[Aging and influence of inversion of the CD4:CD8 ratio in the incidence of co-morbidities and mortality in a cohort of patients infected with human immunodeficiency virus].

PubMed

Cervero, Miguel; Torres, Rafael; Agud, Jose Luis; Pastor, Susana; Jusdado, Juan José

2016-03-04

It has been postulated that the inversion of the CD4:CD8 ratio as a hallmark of immunosenescence can be an independent factor that can herald the risk of co-morbidities. We studied the influence of aging and inversion of the CD4:CD8 ratio in the incidence of comorbidities and mortality in the cohort of Hosptital Severo Ochoa. We analyzed the differences in the incidence rates of age-adjusted morbidities and evaluated the inversion of the CD4:CD8 ratio as predictor of mortality and development of comorbidities. Age was associated with an increased incidence rate of diabetes mellitus, fractures, COPD and non-AIDS malignancies. We found an increased incidence rate of non-AIDS clinical events (OR 2.25; 95% CI 1.025-4.94) and AIDS events (OR 3.48; 95% CI 1.58-7.64) in individuals with CD4:CD8 ratio<0.7. Moreover, patients with a CD4:CD8 ratio<0.7 ratio had a higher risk of mortality (OR 5.96; 95% CI 0.73 to 48.40). It is important to detect and prevent non-AIDS comorbidities in the presence of a CD4:CD8 ratio<0.7. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

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

The impact of occupational stress factors on temporary work disability related to arterial hypertension and its complications.

PubMed

Lazaridis, Konstantinos; Jovanović, Jovica; Jovanović, Jovana; Šarac, Ivana; Jovanović, Stefan

2017-06-01

To determine which specific groups of occupational stress factors influence the duration of temporary work disability related to arterial hypertension and joint complications/co-morbidities. Workers (n = 1398; 1009 in the exposed group, 389 in the control group) with arterial hypertension who worked at one workplace for a minimum of 10 years were divided into 10 subgroups, depending on the presence of joint complications/co-morbidities. The intensity of seven groups of occupational stress factors, the total score of Occupational Stress Index (OSI) and the average number of lost working days during 1 year were analysed. The number of lost working days due to arterial hypertension and joint complications/co-morbidities was significantly higher in the exposed group. In all subgroups of the exposed group there was a high correlation between the number of lost working days and the total OSI score. Specific occupational stress factors were associated with specific complications: High Demands with chronic myocardial infarction, Strictness with cerebral haemorrhage, Conflict/Uncertainty with cerebral infarction, Extrinsic Time Pressure with acute myocardial infarction, and Avoidance/Symbolic Aversiveness with non-insulin-dependent diabetes. There are specific groups of occupational stress factors which can influence the duration of work disability associated with certain complications and co-morbidities of arterial hypertension.

Factors Influencing Effective Writing.

ERIC Educational Resources Information Center

Muccino, Mary Ann; And Others

Focusing on procedures and strategies suitable for teaching writing to students in grades 4, 6, and 8, this paper examines the factors that have been shown through research to influence effective writing. The paper divides the research examined into the categories of metacognition; socially-based writing strategies; theory-tested approaches to…

An analysis of predictors of morbidity after stab wounds of the pancreas in 78 consecutive injuries

PubMed Central

Kotze, UK; Sayed, R; Navsaria, PH; Nicol, AJ

2014-01-01

Introduction Penetrating injuries of the pancreas may result in serious complications. This study assessed the factors influencing morbidity after stab wounds of the pancreas. Methods A retrospective univariate cohort analysis was carried out of 78 patients (74 men) with a median age of 26 years (range: 16–62 years) with stab wounds of the pancreas between 1982 and 2011. Results The median revised trauma score (RTS) was 7.8 (range: 2.0–7.8). Injuries involved the body (n=36), tail (n=24), head/uncinate process (n=16) and neck (n=2) of the pancreas. All 78 patients underwent a laparotomy. Sixty-five patients had AAST (American Association for the Surgery of Trauma) grade I or II pancreatic injuries and thirteen had grade III, IV or V injuries. Eight patients (10.3%) had an initial damage control operation. Sixty-nine patients (84.6%) had drainage of the pancreas only, six had a distal pancreatectomy and one had a pancreaticoduodenectomy. Most pancreas related complications occurred in patients with AAST grade III injuries; eight patients (10.2%) developed a pancreatic fistula. Four patients (5.1%) died. Grade of pancreatic injury (AAST grade I–II vs grade III–V injuries, p<0.001), RTS (odds ratio [OR]: 5.01, 95% confidence interval [CI]: 1.46–17.19, p<0.007), presence of shock on admission (OR: 3.31, 95% CI: 1.16–9.42, p=0.022), need for a blood transfusion (OR: 6.46, 95% CI: 2.40–17.40, p<0.001) and repeat laparotomy (p<0.001) had a significant influence on the development of general complications. Conclusions Although mortality was low after a pancreatic stab wound, morbidity was high. Increasing AAST grade of injury, high RTS, shock on admission to hospital, need for blood transfusion and repeat laparotomy were significant factors related to morbidity. PMID:25198973

Diabetes during Pregnancy: Influence of Body Mass Index on Composite Morbidity.

PubMed

O'Neil Dudley, Amy E; Jenner, Zachary B; Mendez-Figueroa, Hector; Ellis, Viviana S; Chauhan, Suneet P

2017-04-01

Objective  This study aims to compare composite maternal and neonatal morbidities (MM, NM) among pregnant women with diabetes mellitus whose body mass index (BMI) at delivery was < 30 (group 1), 30.0 to 39.9 (group 2), and ≥ 40 kg/m 2 (group 3). We hypothesized that increased BMI class at delivery would be associated with worsening maternal and neonatal outcomes. Methods  This is a retrospective cohort study. MM was defined as: chorioamnionitis, wound infection, eclampsia, diabetic ketoacidosis, hypoglycemia admission, third/fourth degree laceration, and/or death. NM was defined as umbilical arterial pH < 7.0, 5 minute Apgar < 4, respiratory distress syndrome, mechanical ventilation, neonatal sepsis, stillbirth, and/or death. Odds ratios were adjusted for possible confounders. Results  MM was noted in 8, 13, and 24% of groups 1, 2, and 3, respectively, and significantly more common in group 2 versus 1 (adjusted odds ratio [aOR]: 1.66) and group 3 versus 1 (aOR: 3.06). NM was noted in 7, 8, and 15% of each BMI group, respectively, and differed significantly between group 3 vs. 2 (aOR: 1.77). Conclusions  The increased rate of morbidities between the BMI groups is useful to inform diabetic women and highlights the need for further investigation of diabetes and obesity as comorbidities in pregnancy.

Factors influencing perceived angular velocity.

PubMed

Kaiser, M K; Calderone, J B

1991-11-01

The assumption that humans are able to perceive and process angular kinematics is critical to many structure-from-motion and optical flow models. The current studies investigate this sensitivity, and examine several factors likely to influence angular velocity perception. In particular, three factors are considered: (1) the extent to which perceived angular velocity is determined by edge transitions of surface elements, (2) the extent to which angular velocity estimates are influenced by instantaneous linear velocities of surface elements, and (3) whether element-velocity effects are related to three-dimensional (3-D) tangential velocities or to two-dimensional (2-D) image velocities. Edge-transition rate biased angular velocity estimates only when edges were highly salient. Element velocities influenced perceived angular velocity; this bias was related to 2-D image velocity rather than 3-D tangential velocity. Despite these biases, however, judgments were most strongly determined by the true angular velocity. Sensitivity to this higher order motion parameter was surprisingly good, for rotations both in depth (y-axis) and parallel to the line of sight (z-axis).

Diet and hygiene practices influence morbidity in schoolchildren living in Schistosomiasis endemic areas along Lake Victoria in Kenya and Tanzania-A cross-sectional study.

PubMed

Mohamed, Iman; Kinung'hi, Safari; Mwinzi, Pauline N M; Onkanga, Isaac O; Andiego, Kennedy; Muchiri, Geoffrey; Odiere, Maurice R; Vennervald, Birgitte Jyding; Olsen, Annette

2018-03-01

Since 2011, cohorts of schoolchildren in regions bordering Lake Victoria in Kenya and Tanzania have been investigated for morbidity caused by Schistosoma mansoni infection. Despite being neighbouring countries with similar lifestyles and ecological environments, Tanzanian schoolchildren had lower S. mansoni prevalence and intensity and they were taller and heavier, fewer were wasted and anaemic, and more were physical fit compared to their Kenyan peers. The aim of the present study was to evaluate whether diet and school-related markers of socioeconomic status (SES) could explain differences in morbidity beyond the effect of infection levels. Parasitological and morbidity data from surveys in 2013-2014 were compared with information on diet and school-related markers of SES collected in 2015 using questionnaires. A total of 490 schoolchildren (163 Kenyans and 327 Tanzanians) aged 9-11 years provided data. A higher proportion of Tanzanian pupils (69.4%, 95% CI: 64.3-74.5) knew where to wash hands after toilet visits compared to Kenyan pupils (48.5%, 95% CI: 40.9-56.1; P<0.0005). Similar proportions of children in the two countries ate breakfast, lunch and dinner, but the content of the meals differed. At all three meals, a higher proportion (95% CI) of Tanzanian pupils consumed animal proteins (mostly fish proteins) compared to their Kenyan peers (35.0% (28.3-41.7) vs. 0%; P<0.0005 at breakfast; 69.0% (63.9-74.1) vs. 43.6% (35.8-51.4); P<0.0005 at lunch; and 67.2% (62.1-72.3) vs. 53.4% (45.8-61.0); P = 0.003 at dinner). Multivariable analyses investigating risk factors for important morbidity markers among individuals revealed that after controlling for schistosome and malaria infections, eating animal proteins (fish) and knowing where to wash hands after toilet visits were significant predictors for both haemoglobin levels and physical fitness (measured as VO2 max). These results suggest that the differences in morbidity may be affected by factors other than S

Vocal cord paralysis post patent ductus arteriosus ligation surgery: risks and co-morbidities.

PubMed

Rukholm, Gavin; Farrokhyar, Forough; Reid, Diane

2012-11-01

1. To determine the prevalence of left vocal cord paralysis (LVCP) post patent ductus arteriosus (PDA) ligation at a Tertiary Care Centre. 2. To identify risk factors associated with LVCP. 3. To identify co-morbidities associated with LVCP. 4. To determine the frequency of pre- and post-operative nasopharyngolaryngoscopic (NPL) examination in this patient population. Retrospective chart review of all infants who underwent PDA ligation surgery at a tertiary care academic hospital between July 2003 and July 2010. Data on patient age, gender, weight, method of PDA ligation, and results of NPL scoping were collected, as well as patient co-morbidities post PDA ligation. One hundred and fifteen patients underwent PDA ligation surgery. Four patients were excluded due to bilateral vocal cord paralysis. Of the remaining 111 patients, nineteen patients (17.1%) were found to have LVCP. Low birth weight was identified as a significant risk factor for LVCP (p=0.002). Gastroesophageal reflux was identified as a significant co-morbidity associated with LVCP post PDA ligation (p=0.002). Only 0.9% of patients were scoped pre-operatively, and 27.9% were scoped postoperatively. LVCP is associated with multiple morbidities. The authors strongly recommend routine post-operative scoping of all patients post PDA ligation surgery, and preoperative scoping when possible. A prospective study is warranted, in order to confirm the prevalence of LVCP as well as risk factors and associated co-morbidities. Crown Copyright © 2012. Published by Elsevier Ireland Ltd. All rights reserved.

Social Factors Influencing Child Health in Ghana

PubMed Central

Quansah, Emmanuel; Ohene, Lilian Akorfa; Norman, Linda; Mireku, Michael Osei; Karikari, Thomas K.

2016-01-01

Objectives Social factors have profound effects on health. Children are especially vulnerable to social influences, particularly in their early years. Adverse social exposures in childhood can lead to chronic disorders later in life. Here, we sought to identify and evaluate the impact of social factors on child health in Ghana. As Ghana is unlikely to achieve the Millennium Development Goals’ target of reducing child mortality by two-thirds between 1990 and 2015, we deemed it necessary to identify social determinants that might have contributed to the non-realisation of this goal. Methods ScienceDirect, PubMed, MEDLINE via EBSCO and Google Scholar were searched for published articles reporting on the influence of social factors on child health in Ghana. After screening the 98 articles identified, 34 of them that met our inclusion criteria were selected for qualitative review. Results Major social factors influencing child health in the country include maternal education, rural-urban disparities (place of residence), family income (wealth/poverty) and high dependency (multiparousity). These factors are associated with child mortality, nutritional status of children, completion of immunisation programmes, health-seeking behaviour and hygiene practices. Conclusions Several social factors influence child health outcomes in Ghana. Developing more effective responses to these social determinants would require sustainable efforts from all stakeholders including the Government, healthcare providers and families. We recommend the development of interventions that would support families through direct social support initiatives aimed at alleviating poverty and inequality, and indirect approaches targeted at eliminating the dependence of poor health outcomes on social factors. Importantly, the expansion of quality free education interventions to improve would-be-mother’s health knowledge is emphasised. PMID:26745277

Social Factors Influencing Child Health in Ghana.

PubMed

Quansah, Emmanuel; Ohene, Lilian Akorfa; Norman, Linda; Mireku, Michael Osei; Karikari, Thomas K

2016-01-01

Social factors have profound effects on health. Children are especially vulnerable to social influences, particularly in their early years. Adverse social exposures in childhood can lead to chronic disorders later in life. Here, we sought to identify and evaluate the impact of social factors on child health in Ghana. As Ghana is unlikely to achieve the Millennium Development Goals' target of reducing child mortality by two-thirds between 1990 and 2015, we deemed it necessary to identify social determinants that might have contributed to the non-realisation of this goal. ScienceDirect, PubMed, MEDLINE via EBSCO and Google Scholar were searched for published articles reporting on the influence of social factors on child health in Ghana. After screening the 98 articles identified, 34 of them that met our inclusion criteria were selected for qualitative review. Major social factors influencing child health in the country include maternal education, rural-urban disparities (place of residence), family income (wealth/poverty) and high dependency (multiparousity). These factors are associated with child mortality, nutritional status of children, completion of immunisation programmes, health-seeking behaviour and hygiene practices. Several social factors influence child health outcomes in Ghana. Developing more effective responses to these social determinants would require sustainable efforts from all stakeholders including the Government, healthcare providers and families. We recommend the development of interventions that would support families through direct social support initiatives aimed at alleviating poverty and inequality, and indirect approaches targeted at eliminating the dependence of poor health outcomes on social factors. Importantly, the expansion of quality free education interventions to improve would-be-mother's health knowledge is emphasised.

Factors potentially influencing aminoglycoside use and expenditure

DOE Office of Scientific and Technical Information (OSTI.GOV)

DiPiro, J.T.; Kilsdonk, G.F.; Amerson, A.B.

1982-07-01

Factors that may have influenced aminoglycoside use and expenditure in one hospital were examined. Factors that were evaluated as to their influence on aminoglycoside-use patterns were: (1) formulary status; (2) bacterial susceptibility patterns; (3) identified or perceived differences in toxicity; (4) changes in patient population; (5) price paid by the hospital for aminoglycosides; (6) distribution of newsletters or memoranda; (7) advertising and detailing; and (8) pharmacy policies. For FY 1976-77 to 1979-80, the largest proportion of aminoglycoside expense was for gentamicin. During FY 1980-81, the expenditure for gentamicin decreased and tobramycin accounted for the largest proportion of total expenditure. Monthlymore » gentamicin use decreased 20% during FY 1980-81 from the previous year. Tobramycin use increased from January 1979 to November 1980 and decreased from December 1980 to June 1981. Kanamycin use and amikacin use were fairly constant during the study period. Based on temporal relationships, the following factors appeared to influence aminoglycoside use and expenditure: (1) a study conducted at the institution from June 1977 to June 1979 comparing gentamicin and tobramycin nephrotoxicity; (2) a comparative nephrotoxicity study published in a widely circulated medical journal in May 1980; and (3) an intramural newsletter and memorandum distributed in March 1981 encouraging selective aminoglycoside use. The identification of factors that potentially influenced aminoglycoside use can be used to anticipate the future impact of similar events and to devise strategies to influence antimicrobial use.« less

Influence of organizational factors on safety

DOE Office of Scientific and Technical Information (OSTI.GOV)

Haber, S.B.; Metlay, D.S.; Crouch, D.A.

There is a need for a better understanding of exactly how organizational management factors at a nuclear power plant (NPP) affect plant safety performance, either directly or indirectly, and how these factors might be observed, measured, and evaluated. The purpose of this research project is to respond to that need by developing a general methodology for characterizing these organizational and management factors, systematically collecting information on their status and integrating that information into various types of evaluative activities. Research to date has included the development of the Nuclear Organization and Management Analysis Concept (NOMAC) of a NPP, the identification ofmore » key organizational and management factors, and the identification of the methods for systematically measuring and analyzing the influence of these factors on performance. Most recently, two field studies, one at a fossil fuel plant and the other at a NPP, were conducted using the developed methodology. Results are presented from both studies highlighting the acceptability, practicality, and usefulness of the methods used to assess the influence of various organizational and management factors including culture, communication, decision-making, standardization, and oversight. 6 refs., 3 figs., 1 tab.« less

Factors Influencing Resident Choice of Prosthodontic Residency Program.

PubMed

Wojnarwsky, Pandora Keala Lee; Wang, Yan; Shah, Kumar; Koka, Sreenivas

2017-06-01

The decision by prosthodontic residency program directors to employ the Match process highlights the need to understand applicant priorities that influence their choice of which programs to rank highly. The purpose of this study is to determine the factors that were most important to residents when choosing from among nonmilitary based prosthodontics dental residency programs in the United States. Following completion of a pilot study, all currently enrolled prosthodontic residents at nonmilitary residency programs were invited to participate via the internet. The study consisted of a survey instrument asking residents to rank 26 possible factors that might impact an applicant's choice of residency program. In addition, the instrument collected other possible influencing variables including gender and debt load. Mean rank scores were compared to determine the most and least important factors. Kruskal-Wallis test was used to compare specific factors between the possible influencing variables. Two hundred and thirty residents completed the survey instrument, representing a 54.1% response rate of possible participants. With regard to factors influencing program choice, reputation of the residency program was the factor ranked the highest by participants, followed in descending order by the program director's personality, curriculum content, access to use of the latest digital technology, and opportunities for dental implant placement. Quality of schools for children, community outreach opportunities, and the ability to moonlight were ranked as the least important factors. Male and female residents ranked factors such as tuition/stipend, curriculum content, and community outreach opportunities significantly differently. Depending on debt load, residents ranked the factors tuition/stipend, ability to moonlight, curriculum content, and safety of the area where the program is differently. Current prosthodontic residents valued the reputation of the program as the most

Factors influencing self-care behaviors of African Americans with heart failure: a photovoice project.

PubMed

Woda, Aimee; Belknap, Ruth Ann; Haglund, Kristin; Sebern, Margaret; Lawrence, Ashley

2015-01-01

The purpose of this study was to understand the influences of heart failure (HF) self-care among low income, African Americans. Compared to all other racial groups, African Americans have the highest risk of developing HF, coupled with high mortality and morbidity rates. Using the photovoice method, participants related important lifestyle factors through photography. The participants and researcher met for reflection and discussion 2 h per week for six weeks. Four themes emerged: family support gives me the push I need, social interaction lifts me up, improving my mind to lift depression can improve my heart, and it is important but challenging to follow the HF diet. The findings from this study may assist policy makers, health care professionals, patients, and support systems in understanding the complexity of engaging in HF self-care. This understanding may lead to the development of appropriate patient-centered assessments and interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

Morbidity of curative cancer surgery and suicide risk.

PubMed

Jayakrishnan, Thejus T; Sekigami, Yurie; Rajeev, Rahul; Gamblin, T Clark; Turaga, Kiran K

2017-11-01

Curative cancer operations lead to debility and loss of autonomy in a population vulnerable to suicide death. The extent to which operative intervention impacts suicide risk is not well studied. To examine the effects of morbidity of curative cancer surgeries and prognosis of disease on the risk of suicide in patients with solid tumors. Retrospective cohort study using Surveillance, Epidemiology, and End Results data from 2004 to 2011; multilevel systematic review. General US population. Participants were 482 781 patients diagnosed with malignant neoplasm between 2004 and 2011 who underwent curative cancer surgeries. Death by suicide or self-inflicted injury. Among 482 781 patients that underwent curative cancer surgery, 231 committed suicide (16.58/100 000 person-years [95% confidence interval, CI, 14.54-18.82]). Factors significantly associated with suicide risk included male sex (incidence rate [IR], 27.62; 95% CI, 23.82-31.86) and age >65 years (IR, 22.54; 95% CI, 18.84-26.76). When stratified by 30-day overall postoperative morbidity, a significantly higher incidence of suicide was found for high-morbidity surgeries (IR, 33.30; 95% CI, 26.50-41.33) vs moderate morbidity (IR, 24.27; 95% CI, 18.92-30.69) and low morbidity (IR, 9.81; 95% CI, 7.90-12.04). Unit increase in morbidity was significantly associated with death by suicide (odds ratio, 1.01; 95% CI, 1.00-1.03; P = .02) and decreased suicide-specific survival (hazards ratio, 1.02; 95% CI, 1.00-1.03, P = .01) in prognosis-adjusted models. In this sample of cancer patients in the Surveillance, Epidemiology, and End Results database, patients that undergo high-morbidity surgeries appear most vulnerable to death by suicide. The identification of this high-risk cohort should motivate health care providers and particularly surgeons to adopt screening measures during the postoperative follow-up period for these patients. Copyright © 2016 John Wiley & Sons, Ltd.

Factors influencing pacing in triathlon

PubMed Central

Wu, Sam SX; Peiffer, Jeremiah J; Brisswalter, Jeanick; Nosaka, Kazunori; Abbiss, Chris R

2014-01-01

Triathlon is a multisport event consisting of sequential swim, cycle, and run disciplines performed over a variety of distances. This complex and unique sport requires athletes to appropriately distribute their speed or energy expenditure (ie, pacing) within each discipline as well as over the entire event. As with most physical activity, the regulation of pacing in triathlon may be influenced by a multitude of intrinsic and extrinsic factors. The majority of current research focuses mainly on the Olympic distance, whilst much less literature is available on other triathlon distances such as the sprint, half-Ironman, and Ironman distances. Furthermore, little is understood regarding the specific physiological, environmental, and interdisciplinary effects on pacing. Therefore, this article discusses the pacing strategies observed in triathlon across different distances, and elucidates the possible factors influencing pacing within the three specific disciplines of a triathlon. PMID:25258562

The influence of the risk factor on the abdominal complications in colon injury management

PubMed Central

TORBA, M.; GJATA, A.; BUCI, S.; BUSHI, G.; ZENELAJ, A.; KAJO, I.; KOCEKU, S.; KAGJINI, K.; SUBASHI, K.

2015-01-01

Introduction The management of colon injuries has distinctly evolved over the last three decades. However, trauma surgeons often find themselves in a dilemma, whether to perform a diversion or to perform a primary repair. The purpose of this study is to evaluate risk factors in colon injury management and their influence on abdominal complications. Patients and methods This is a prospective study conducted at a national level I trauma center in Tirana, Albania from January 2009 to December 2012. The data with respect to demographics, physiological risk factors, intraoperative findings, and surgical procedures were collected. Colonic injury-related morbidity and mortality were analyzed. Multivariate logistic regression analysis was performed by assessing the influence of risk factors on abdominal complications. Results Of the 157 patients treated with colon injury, was performed a primary repair in 107 (68.15%) of the patients and a diversion in the remaining 50 (31.85%). The mean PATI was 18.6, while 37 (23.6%) of patients had PATI greater than 25. The complications and their frequencies according to the surgical technique used (primay repair vs diversion respectively) includes: wound infections (9.3% vs 50%), anastomotic leak (1.8% vs 8.7%), and intra-abdominal abscess (1.8% vs 6.5%). The multivariate analysis identified two independent risk factors for abdominal complications: transfusions of 4 units of blood within the first 24 hours (OR = 1.2 95% CI (1.03 –1.57) p =0.02), and diversion (OR = 9.6, 95% CI 4.4 – 21.3, p<0.001). Conclusion Blood transfusions of more than 4 units within the first 24 hours and diversion during the management of destructive colon injuries are both independent risk factors for abdominal complications. The socioeconomic impact and the need for a subsequent operation in colostomy patients are strong reasons to consider primary repair in the management of colon injuries. PMID:26017103

Morbidly adherent placenta treatments and outcomes.

PubMed

Bailit, Jennifer L; Grobman, William A; Rice, Madeline Murguia; Reddy, Uma M; Wapner, Ronald J; Varner, Michael W; Leveno, Kenneth J; Iams, Jay D; Tita, Alan T N; Saade, George; Rouse, Dwight J; Blackwell, Sean C

2015-03-01

To describe recent maternal and neonatal delivery outcomes among women with a morbidly adherent placenta in major centers across the United States. This study reviewed a cohort of 115,502 women and their neonates born in 25 hospitals in the United States between March 2008 and February 2011 from the Assessment of Perinatal EXcellence data set. All cases of morbidly adherent placenta were identified. Maternal demographics, procedures undertaken, and maternal and neonatal outcomes were analyzed. There were 158 women with a morbidly adherent placenta (1/731 births, 95% confidence interval 1/632-866). Eighteen percent of women with a morbidly adherent placenta were nulliparous and 37% had no prior cesarean delivery. Only 53% (84/158) were suspected to have a morbidly adherent placenta before delivery. Women with a prenatally suspected morbidly adherent placenta experienced large blood loss (33%), hysterectomy (92%), and intensive care unit admission (39%) compared with 19%, 45%, and 22%, respectively, in those not suspected prenatally to have a morbidly adherent placenta (P<.05 for all). Eighteen percent of women with a morbidly adherent placenta were nulliparous. Half of the morbidly adherent placenta cases were suspected before delivery and outcomes were poorer in this group, probably because the more clinically significant morbidly adherent placentas are more likely to be suspected before delivery. : II.

The structure of genetic and environmental risk factors for phobias in women.

PubMed

Czajkowski, N; Kendler, K S; Tambs, K; Røysamb, E; Reichborn-Kjennerud, T

2011-09-01

To explore the genetic and environmental factors underlying the co-occurrence of lifetime diagnoses of DSM-IV phobia. Female twins (n=1430) from the population-based Norwegian Institute of Public Health Twin Panel were assessed at personal interview for DSM-IV lifetime specific phobia, social phobia and agoraphobia. Comorbidity between the phobias were assessed by odds ratios (ORs) and polychoric correlations and multivariate twin models were fitted in Mx. Phenotypic correlations of lifetime phobia diagnoses ranged from 0.55 (agoraphobia and social phobia, OR 10.95) to 0.06 (animal phobia and social phobia, OR 1.21). In the best fitting twin model, which did not include shared environmental factors, heritability estimates for the phobias ranged from 0.43 to 0.63. Comorbidity between the phobias was accounted for by two common liability factors. The first loaded principally on animal phobia and did not influence the complex phobias (agoraphobia and social phobia). The second liability factor strongly influenced the complex phobias, but also loaded weak to moderate on all the other phobias. Blood phobia was mainly influenced by a specific genetic factor, which accounted for 51% of the total and 81% of the genetic variance. Phobias are highly co-morbid and heritable. Our results suggest that the co-morbidity between phobias is best explained by two distinct liability factors rather than a single factor, as has been assumed in most previous multivariate twin analyses. One of these factors was specific to the simple phobias, while the other was more general. Blood phobia was mainly influenced by disorder specific genetic factors.

Parental psychosocial stress and asthma morbidity in Puerto Rican twins.

PubMed

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

2011-03-01

Little is known about paternal psychosocial factors and childhood asthma. We sought to examine the link between maternal and paternal psychosocial stress and asthma outcomes in young children. 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 year and again about their child's asthma at age 3 years. Fathers were asked about symptoms of posttraumatic stress disorder (PTSD), depression, and antisocial 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. After multivariable adjustment, paternal PTSD symptoms, depression, and antisocial behavior were each associated with increased asthma symptoms at age 1 year (eg, odds ratio, 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 (odds ratio 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. Both paternal and maternal psychosocial factors can influence asthma morbidity in young Puerto Rican children. Copyright © 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

Recipient characteristics and morbidity and mortality after liver transplantation.

PubMed

Asrani, Sumeet K; Saracino, Giovanna; O'Leary, Jacqueline G; Gonzales, Stevan; Kim, Peter T; McKenna, Greg J; Klintmalm, Goran; Trotter, James

2018-07-01

Over the last decade, liver transplantation of sicker, older non-hepatitis C cirrhotics with multiple co-morbidities has increased in the United States. We sought to identify an easily applicable set of recipient factors among HCV negative adult transplant recipients associated with significant morbidity and mortality within five years after liver transplantation. We collected national (n = 31,829, 2002-2015) and center-specific data. Coefficients of relevant recipient factors were converted to weighted points and scaled from 0-5. Recipient factors associated with graft failure included: ventilator support (five patients; hazard ratio [HR] 1.59; 95% CI 1.48-1.72); recipient age >60 years (three patients; HR 1.29; 95% CI 1.23-1.36); hemodialysis (three patients; HR 1.26; 95% CI 1.16-1.37); diabetes (two patients; HR 1.20; 95% CI 1.14-1.27); or serum creatinine ≥1.5 mg/dl without hemodialysis (two patients; HR 1.15; 95% CI 1.09-1.22). Graft survival within five years based on points (any combination) was 77.2% (0-4), 69.1% (5-8) and 57.9% (>8). In recipients with >8 points, graft survival was 42% (model for end-stage liver disease [MELD] score <25) and 50% (MELD score 25-35) in recipients receiving grafts from donors with a donor risk index >1.7. In center-specific data within the first year, subjects with ≥5 points (vs. 0-4) had longer hospitalization (11 vs. 8 days, p <0.01), higher admissions for rehabilitation (12.3% vs. 2.7%, p <0.01), and higher incidence of cardiac disease (14.2% vs. 5.3%, p <0.01) and stage 3 chronic kidney disease (78.6% vs. 39.5%, p = 0.03) within five years. The impact of co-morbidities in an MELD-based organ allocation system need to be reassessed. The proposed clinical tool may be helpful for center-specific assessment of risk of graft failure in non-HCV patients and for discussion regarding relevant morbidity in selected subsets. Over the last decade, liver transplantation of sicker, older patient with

100 obese patients after laparoscopic adjustable gastric banding - the influence on BMI, gherlin and insulin concentration, parameters of lipid balance and co-morbidities.

PubMed

Hady, H R; Dadan, J; Gołaszewski, P

2012-06-01

Obesity is a widespread health issue caused by chronic impaired balance between energy supply and its expenditure. It leads to gathering of excessive fat tissue and numerous co-morbidities.The aim of this study is to present the influence of laparoscopic adjustable gastric banding (LAGB) on plasma ghrelin, insulin, glucose, triglycerides, total, HDL- and LDL-cholesterol concentration as well as on alanine and aspartate aminotransferase in obese patients and influence on co-morbidities such as type 2 diabetes mellitus, dislipidemy, hypertension and sleep apnea. 100 obese patients underwent LAGB: 34 men - average age 39.18 ± 12.17 years old and 66 women - average age 37.0 ± 12.6 years old. During 6 months follow-up, particular measurements have been conducted in different time points. Evaluation of body mass loss (%EWL, %EBL) and the homeostatic model assessment insulin resistance (HOMA IR) was conducted. In the same time ghrelin, insulin, glucose, triglycerides, total cholesterol, HDL- and LDL-cholesterol concentration was determined after 7 days, 1, 3 and 6 months after the surgery. Significant decrease in BMI and HOMA IR was observed as well as in insulin and glucose concentration. Increase in ghrelin concentration in comparison to preoperative values was also stated. LAGB leads to significant body mass loss, improvement in patients' general health state and to normalization of metabolic parameters. Improvement or total resolution of type 2 diabetes (T2DM), hypertension and sleep apnea was also noticed.

Do Elderly Patients Experience Increased Perioperative or Postoperative Morbidity or Mortality When Given Neoadjuvant Chemoradiation Before Esophagectomy?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fogh, Shannon E., E-mail: foghse@radonc.ucsf.edu; Yu, Anthony; Kubicek, Gregory J.

2011-08-01

Background: The use of induction chemoradiotherapy followed by surgery has been widely used for the treatment of esophageal cancer. The presumed risk of increased postoperative morbidity and mortality with this regimen has led to reluctance to offer this therapy to elderly patients. We compared the perioperative morbidity and mortality of patients 70 years old and older with those of patients younger than 70 who received CRT followed by esophagectomy and sought to identify preoperative risk factors that may predict higher risk of postoperative death or complications. Methods and Materials: We identified 260 patients who underwent preoperative chemoradiotherapy followed by esophagectomy.more » The association of age with postoperative death and complications was evaluated. The Charlson index, prior cardiac history, and diabetes were identified as preoperative risk factors and were evaluated as potential confounders or effect modifiers. Results: Cardiac disease and the Charlson index were potential modifiers of the effect of age on length of hospital stay (p = 0.08 and p = 0.07, respectively) and postoperative complications (p = 0.1 and p = 0.2) but were not statistically significant. There was a slight nonsignificant decrease in the risk of death in elderly patients after adjustment for the Charlson index (p = 0.2). Conclusion: No significant differences were detected with respect to morbidity and mortality in elderly patients. The presence of cardiac disease, higher scores on the Charlson index, or diabetes did not significantly influence length of stay, postoperative complications, or postoperative death. Given the potential to improve outcomes, this regimen should not be discounted in elderly patients.« less

Tobacco use and self-reported morbidity among rural Indian adults.

PubMed

Barik, Anamitra; Rai, Rajesh Kumar; Chowdhury, Abhijit

2016-09-01

Aim To measure the prevalence of self-reported morbidity and its associated factors among adults (aged ⩾15 years) in a select rural Indian population. Self-reporting of smoking has been validated as population-based surveys using self-reported data provide reasonably consistent estimates of smoking prevalence, and are generally considered to be sufficiently accurate for tracking the general pattern of morbidity associated with tobacco use in populations. However, to gauge the true disease burden using self-reported morbidity data requires cautious interpretation. During 2010-2011, a cross-sectional survey was conducted under the banner of the Health and Demographic Surveillance System, Birbhum, an initiative of the Department of Health and Family Welfare, Government of West Bengal, India. With over 93.6% response rate from the population living in 12 300 households, this study uses the responses from 16 354 individuals: 8012 smokers, and 8333 smokeless tobacco users. Smokers and smokeless tobacco users were asked whether they have developed any morbidity symptoms due to smoking, or smokeless tobacco use. Bivariate, as well as multivariate logistic regression analyses were deployed to attain the study objective. Findings Over 20% of smokers and over 9% of smokeless tobacco users reported any morbidity. Odds ratio (OR) with 95% confidence interval (CI) estimated using logistic regression shows that women are less likely to report any morbidity attributable to smoking (OR: 0.69; CI: 0.54-0.87), and more likely to report any morbidity due to smokeless tobacco use (OR: 1.68; CI: 1.36-2.09). Non-Hindus have higher odds, whereas the wealthiest respondents have lower odds of reporting any morbidity. With a culturally appropriate intervention to change behaviour, youth (both men and women) could be targeted with comprehensive tobacco cessation assistance programmes. A focussed intervention could be designed for unprocessed tobacco users to curb hazardous effects of

Fibroblast growth factor-21 and omentin-1 hepatic mRNA expression and serum levels in morbidly obese women with non-alcoholic fatty liver disease.

PubMed

Waluga, M; Kukla, M; Zorniak, M; Kajor, M; Liszka, L; Dyaczynski, M; Kowalski, G; Zadlo, D; Waluga, E; Olczyk, P; Buldak, R J; Berdowska, A; Hartleb, M

2017-06-01

Fibroblast growth factor-21 (FGF21) and omentin-1 have been recognized as potent antidiabetic agents with potential hepatoprotective activity. The aim of this study was to evaluate hepatic FGF21 and omentin-1 mRNA expression as well as their serum levels as predictive markers of liver injury and insulin resistance in morbidly obese women with non-alcoholic fatty liver disease (NAFLD). This study included 56 severely obese women who underwent intraoperative wedge liver biopsy during the bariatric surgery. Hepatic FGF21 and omentin-1 mRNA were assessed by quantitative real-time PCR, while their serum concentrations were measured with commercially available enzyme-linked immunosorbent assays. The FGF21 serum level was significantly higher in patients with a greater extent of steatosis (grade 2 and 3) compared to those without or with mild steatosis (grade 0 and 1) (P = 0.049). Receiver Operating Characteristic analysis, however, showed poor discriminant power for the FGF21 serum levels in differentiating between more and less extensive steatosis with an AUC = 0.666. There was a tendency towards higher levels of hepatic FGF21 mRNA in patients with lobular inflammation and fibrosis and towards lower levels in the case of hepatocyte ballooning and steatosis. There was a positive mutual correlation between hepatic FGF21 and omentin-1 mRNA levels (r = 0.78; P < 0.001). Fibrosis stage was associated with serum glucose and homeostatic model assessment for insulin resistance (HOMA-IR) (P = 0.03 and P = 0.02, respectively). Serum omentin-1 was not associated with histopathological features. The hepatic omentin-1 mRNA levels showed a tendency to be lower in patients with advanced steatosis and hepatocyte ballooning. In conclusion, our study, which focused on hepatic FGF21 and omentin-1 mRNA expression, confirmed marked expression of both molecules in the liver of morbidly obese patients with NAFLD. More extensive steatosis was associated with evident changes in the serum FGF21

Estimating the Hospital Delivery Costs Associated With Severe Maternal Morbidity in New York City, 2008-2012.

PubMed

Howland, Renata E; Angley, Meghan; Won, Sang Hee; Wilcox, Wendy; Searing, Hannah; Tsao, Tsu-Yu

2018-02-01

To quantify the average and total hospital delivery costs associated with severe maternal morbidity in excess of nonsevere maternal morbidity deliveries over a 5-year period in New York City adjusting for other sociodemographic and clinical factors. We conducted a population-based cross-sectional study using linked birth certificates and hospital discharge data for New York City deliveries from 2008 to 2012. Severe maternal morbidity was defined using a published algorithm of International Classification of Diseases, 9 Revision, Clinical Modification disease and procedure codes. Hospital costs were estimated by converting hospital charges using factors specific to each year and hospital and to each diagnosis. These estimates approximate what it costs the hospital to provide services (excluding professional fees) and were used in all subsequent analyses. To estimate adjusted mean costs associated with severe maternal morbidity, we used multivariable regression models with a log link, gamma distribution, robust standard errors, and hospital fixed effects, controlling for age, race and ethnicity, neighborhood poverty, primary payer, number of deliveries, method of delivery, comorbidities, and year. We used the adjusted mean cost to determine the average and total hospital delivery costs associated with severe maternal morbidity in excess of nonsevere maternal morbidity deliveries from 2008 to 2012. Approximately 2.3% (n=13,502) of all New York City delivery hospitalizations were complicated by severe maternal morbidity. Compared with nonsevere maternal morbidity deliveries, these hospitalizations were clinically complicated, required more and intensive clinical services, and had a longer stay in the hospital. The average cost of delivery with severe maternal morbidity was $14,442 (95% CI $14,128-14,756), compared with $7,289 (95% CI $7,276-7,302) among deliveries without severe maternal morbidity. After adjusting for other factors, the difference between deliveries

A model for morbidity after lung resection in octogenarians.

PubMed

Berry, Mark F; Onaitis, Mark W; Tong, Betty C; Harpole, David H; D'Amico, Thomas A

2011-06-01

Age is an important risk factor for morbidity after lung resection. This study was performed to identify specific risk factors for complications after lung resection in octogenarians. A prospective database containing patients aged 80 years or older, who underwent lung resection at a single institution between January 2000 and June 2009, was reviewed. Preoperative, histopathologic, perioperative, and outcome variables were assessed. Morbidity was measured as a patient having any perioperative event as defined by the Society of Thoracic Surgeons General Thoracic Surgery Database. A multivariable risk model for morbidity was developed using a panel of established preoperative and operative variables. Survival was calculated using the Kaplan-Meier method. During the study period, 193 patients aged 80 years or older (median age 82 years) underwent lung resection: wedge resection in 77, segmentectomy in 13, lobectomy in 96, bilobectomy in four, and pneumonectomy in three. Resection was accomplished via thoracoscopy in 149 patients (77%). Operative mortality was 3.6% (seven patients) and morbidity was 46% (89 patients). A total of 181 (94%) patients were discharged directly home. Postoperative events included atrial arrhythmia in 38 patients (20%), prolonged air leak in 24 patients (12%), postoperative transfusion in 22 patients (11%), delirium in 16 patients (8%), need for bronchoscopy in 14 patients (7%), and pneumonia in 10 patients (5%). Significant predictors of morbidity by multivariable analysis included resection greater than wedge (odds ratio 2.98, p=0.006), thoracotomy as operative approach (odds ratio 2.6, p=0.03), and % predicted forced expiratory volume in 1s (odds ratio 1.28 for each 10% decrement, p=0.01). Octogenarians can undergo lung resection with low mortality. Extent of resection, use of a thoracotomy, and impaired lung function increase the risk of complications. Careful evaluation is necessary to select the most appropriate approach in

Assessing the impact of a fistula after a pancreaticoduodenectomy using the Post-operative Morbidity Index.

PubMed

Miller, Benjamin C; Christein, John D; Behrman, Stephen W; Callery, Mark P; Drebin, Jeffrey A; Kent, Tara S; Pratt, Wande B; Lewis, Russell S; Vollmer, Charles M

2013-10-01

The Post-operative Morbidity Index (PMI) is a quantitative utility measure of a complication burden created by severity weighting. The Fistula Risk Score (FRS) is a validated model that predicts whether a patient will develop a post-operative pancreatic fistula (POPF). These novel tools might provide further discrimination of the ISGPF grading system. From 2001 to 2012, 1021 pancreaticoduodenectomies were performed at four institutions. POPFs were categorized by ISGPF standards. PMI scores were calculated based on the Modified Accordion Severity Grading System. FRS scores were assigned according to the relative influence of four recognized factors for developing a clinically relevant POPF (CR-POPF). In total, 231 patients (22.6%) developed a POPF, of which 54.1% were CR-POPFs. The PMI differed significantly between the ISGPF grades and patients with no or non-fistulous complications (P < 0.001). 64.9% of POPFs and 84.0% of CR-POPFs contributed the highest Accordion grade to the PMI. Overall, the FRS correlated well with PMI (R(2) = 0.81, P < 0.001). These data quantitatively reinforce the ISGPF grades that were developed qualitatively around the concept of clinical severity. CR-POPFs usually reflect the patient's highest Accordion score whereas biochemical POPFs are often superseded. The correlation between FRS and PMI indicates that risk factors for a fistula contribute to overall pancreaticoduodenectomy morbidity. © 2013 International Hepato-Pancreato-Biliary Association.

Factors influencing workplace health promotion intervention: a qualitative systematic review.

PubMed

Rojatz, Daniela; Merchant, Almas; Nitsch, Martina

2017-10-01

Although workplace health promotion (WHP) has evolved over the last 40 years, systematically collected knowledge on factors influencing the functioning of WHP is scarce. Therefore, a qualitative systematic literature review was carried out to systematically identify and synthesize factors influencing the phases of WHP interventions: needs assessment, planning, implementation and evaluation. Research evidence was identified by searching electronic databases (Scopus, PubMed, Social Sciences Citation Index, ASSIA, ERIC, IBBS and PsycINFO) from 1998 to 2013, as well as by cross-checking reference lists of included peer-reviewed articles. The inclusion criteria were: original empirical research, description of WHP, description of barriers to and/or facilitators of the planning, implementation and/or evaluation of WHP. Finally, 54 full texts were included. From these, influencing factors were extracted and summarized using thematic analysis. The majority of influencing factors referred to the implementation phase, few dealt with planning and/or evaluation and none with needs assessment. The influencing factors were condensed into topics with respect to factors at contextual level (e.g. economic crisis); factors at organizational level (e.g. management support); factors at intervention level (e.g. quality of intervention concept); factors at implementer level (e.g. resources); factors at participant level (e.g. commitment to intervention) and factors referring to methodological and data aspects (e.g. data-collection issues). Factors regarding contextual issues and organizational aspects were identified across three phases. Therefore, future research and practice should consider not only the influencing factors at different levels, but also at different phases of WHP interventions. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Factors that influence nurses' customer orientation.

PubMed

Darby, D N; Daniel, K

1999-09-01

Hospital care mostly involves complex processes that are continuously adjusted to match individual client needs. As most patients cannot evaluate the technology used, they focus on personal interactions with care providers when making judgements about the care received. Nurses are the care team members that primarily provide ongoing care. This study aims to further understand factors that influence the way nursing staff relate to their patients. A model is presented of the contextual and self-perceptual factors that influence the level of customer/client orientation of nursing services in an Australian hospital setting along with details of a quantitative study. Nurses completed an anonymous questionnaire, which was then mailed directly to the researchers. Analysis of the data included factor analysis, regression and path analysis. The results show that contextual elements such as management commitment to service quality and self-perceptual factors such as role stress impact on the nurses' client service orientation. However, the variables being studied commonly have both direct and indirect effects with feelings about commitment to the organization having a notable mediating influence. The scales adapted from use in other industries are able to measure the perceptual and outcome variables in a health institutional setting. The managerial implications are that both a comprehensive programme of organizational culture and individual staff member development is needed if an enhanced customer orientation and the consequent improvement in client satisfaction with nursing care is to occur.

Organisational merger and psychiatric morbidity: a prospective study in a changing work organisation.

PubMed

Väänänen, Ari; Ahola, Kirsi; Koskinen, Aki; Pahkin, Krista; Kouvonen, Anne

2011-08-01

Prospective studies on the relationship between organisational merger and mental health have been conducted using subjective health indicators. The objective of this prospective occupational cohort study was to examine whether a negative change during an organisational merger is an independent predictive factor of psychiatric morbidity. Survey data on organisational characteristics, health and other factors were collected prior to (1996) and after the merger (2000); register data on psychiatric morbidity were collected at baseline (1/1/1994-30/9/2000) and during the follow-up (1/10/2000-31/12/2005). Participants were 6511 (77% men) industrial employees aged 21-65 years with no register-based diagnosed psychiatric events prior to the follow-up (the Still Working Study). During the follow-up, 252 participants were admitted to the hospital due to psychiatric disorders, were prescribed a psychotropic drug or attempted or committed suicide. A negative self-reported change in the work organisation during the merger was associated with increased risk of postmerger psychiatric event (HR 1.60, 95% CI 1.19 to 2.14). This association was independent of mental health-related factors measured before the merger announcement, such as demographic characteristics, occupational status, personal orientation to life, self-rated health, self-reported psychiatric morbidity or chronic disease. A negative change in work organisation during an organisational merger may elevate the risk for postmerger psychiatric morbidity.

Consideration of Real World Factors Influencing Greenhouse ...

EPA Pesticide Factsheets

Discuss a variety of factors that influence the simulated fuel economy and GHG emissions that are often overlooked and updates made to ALPHA based on actual benchmarking data observed across a range of vehicles and transmissions. ALPHA model calibration is also examined, focusing on developing generic calibrations for driver behavior, transmission gear selection and torque converter lockup. In addition, show the derivation of correction factors needed to estimate cold start emission results. To provide an overview of the ALPHA tool with additional focus on recent updates by presenting the approach for validating and calibrating ALPHA to match particular vehicles in a general sense, then by looking at the individual losses, and calibration factors likely to influence fuel economy.

Co-morbid anxiety disorders in bipolar disorder and major depression: familial aggregation and clinical characteristics of co-morbid panic disorder, social phobia, specific phobia and obsessive-compulsive disorder.

PubMed

Goes, F S; McCusker, M G; Bienvenu, O J; Mackinnon, D F; Mondimore, F M; Schweizer, B; Depaulo, J R; Potash, J B

2012-07-01

Co-morbidity of mood and anxiety disorders is common and often associated with greater illness severity. This study investigates clinical correlates and familiality of four anxiety disorders in a large sample of bipolar disorder (BP) and major depressive disorder (MDD) pedigrees. The sample comprised 566 BP families with 1416 affected subjects and 675 MDD families with 1726 affected subjects. Clinical characteristics and familiality of panic disorder, social phobia, specific phobia and obsessive-compulsive disorder (OCD) were examined in BP and MDD pedigrees with multivariate modeling using generalized estimating equations. Co-morbidity between mood and anxiety disorders was associated with several markers of clinical severity, including earlier age of onset, greater number of depressive episodes and higher prevalence of attempted suicide, when compared with mood disorder without co-morbid anxiety. Familial aggregation was found with co-morbid panic and OCD in both BP and MDD pedigrees. Specific phobia showed familial aggregation in both MDD and BP families, although the findings in BP were just short of statistical significance after adjusting for other anxiety co-morbidities. We found no evidence for familiality of social phobia. Our findings suggest that co-morbidity of MDD and BP with specific anxiety disorders (OCD, panic disorder and specific phobia) is at least partly due to familial factors, which may be of relevance to both phenotypic and genetic studies of co-morbidity.

Co-morbid anxiety disorders in bipolar disorder and major depression : familial aggregation and clinical characteristics of co-morbid panic disorder, social phobia, specific phobia and obsessive-compulsive disorder

PubMed Central

Goes, F. S.; McCusker, M. G.; Bienvenu, O. J.; MacKinnon, D. F.; Mondimore, F. M.; Schweizer, B.; DePaulo, J. R.; Potash, J. B.

2013-01-01

Background Co-morbidity of mood and anxiety disorders is common and often associated with greater illness severity. This study investigates clinical correlates and familiality of four anxiety disorders in a large sample of bipolar disorder (BP) and major depressive disorder (MDD) pedigrees. Method The sample comprised 566 BP families with 1416 affected subjects and 675 MDD families with 1726 affected subjects. Clinical characteristics and familiality of panic disorder, social phobia, specific phobia and obsessivecompulsive disorder (OCD] were examined in BP and MDD pedigrees with multivariate modeling using generalized estimating equations. Results Co-morbidity between mood and anxiety disorders was associated with several markers of clinical severity, including earlier age of onset, greater number of depressive episodes and higher prevalence of attempted suicide, when compared with mood disorder without co-morbid anxiety. Familial aggregation was found with co-morbid panic and OCD in both BP and MDD pedigrees. Specific phobia showed familial aggregation in both MDD and BP families, although the findings in BP were just short of statistical significance after adjusting for other anxiety co-morbidities. We found no evidence for familiality of social phobia. Conclusions Our findings suggest that co-morbidity of MDD and BP with specific anxiety disorders [OCD, panic disorder and specific phobia] is at least partly due to familial factors, which may be of relevance to both phenotypic and genetic studies of co-morbidity. PMID:22099954

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

What factors influence British medical students' career intentions?

PubMed

Ibrahim, Michael; Fanshawe, Angela; Patel, Vanash; Goswami, Karan; Chilvers, Geoffrey; Ting, Michelle; Pilavakis, Yiannis; Rao, Christopher; Athanasiou, Thanos

2014-12-01

The aim of this study was to identify factors that influence career choice in UK medical students. Students at seven institutions were invited to rate how important various factors were on influencing their career choices and how interested they were in pursuing different specialties. The influence of interpersonal relationship networks on career choice was also evaluated. 641 responses were collected. 44% (283) were male, 16% (105) were graduates and 41% (263) were final-year students. For Dermatology (p = 0.009), Paediatrics (p = 0.000), Radiology (p = 0.000), Emergency Medicine (p = 0.018) and Cardiothoracic Surgery (p = 0.000), there was a clear correlation between completing a clinical attachment and an interest in pursuing the specialty. Perceived characteristics of the speciality, individually and in clusters were considered important by specific subgroups of students, such as those interested in surgery. These students considered prestige (p = 0.0003), role models (p = 0.014), financial rewards after training (p = 0.0196) and technical challenge (p = 0.0011) as important factors. Demographics such as sex and age played a significant role in career choice. Interpersonal relationship networks do not have a significant influence on career intentions. This study shows that the career intentions of British medical students are influenced by their undergraduate experience and by the weight they place on different specialty-related factors.

Environmental influences: factors influencing a woman's decision to use dietary supplements.

PubMed

Conner, Mark; Kirk, Sara F L; Cade, Janet E; Barrett, Jennifer H

2003-06-01

Use of dietary supplements by women, particularly those over 40 years of age may be widespread in the United Kingdom. However, from surveillance data, there appears to be a disparity between nutrition and health needs and the rationale for and actual use of dietary supplements by women. This apparent paradox forms the basis for an inverse supplement hypothesis (i.e., supplement use in women appears to be most prevalent among those with least need). Little research has been done to examine the factors underlying the decision to use dietary supplements. Reasons for consuming dietary supplements are often complex, combining social, psychological, knowledge and economic factors. The theory of planned behavior is a widely used model for assessing factors influencing behavioral motivation and action that may be useful for assessing specific diet- and nutrition-related practices. It provided the basis for the development of a questionnaire to explore overall dietary supplement use in a cohort of women in the United Kingdom. The analysis of factors related to beliefs underlying dietary supplement use revealed differences between supplement users and nonusers. Differences included a stronger belief by users than nonusers that taking dietary supplements ensures against possible ill health. Both users and nonusers of supplements also perceived the media (books and magazines) to be a powerful influence on a person's decision to use supplements. These findings highlight the potential of the theory of planned behavior in exploring supplement-taking behavior while throwing light on the factors influencing an individual's motivations to use dietary supplements.

Uncovering Factors Influencing Interpersonal Health Communication

PubMed Central

Donné, Lennie; Jansen, Carel; Hoeks, John

2017-01-01

Talking to friends, family, or peers about health issues might, among other things, increase knowledge of social norms and feelings of self-efficacy in adopting a healthier lifestyle. We often see interpersonal health communication as an important mediating factor in the effects of health campaigns on health behavior. No research has been done so far, however, on factors that influence whether and how people talk about health issues without being exposed to a health campaign first. In this exploratory study, we interviewed 12 participants about their communication behavior concerning six different health themes, like smoking and exercising. The results suggest that at least four types of interpersonal health communication can be distinguished, each influenced by different factors, like conversational partner and objective of the conversation. Future research should take this diversity of interpersonal health communication into account, and focus on designing health campaigns that aim to trigger dialogue within target populations. PMID:28660238

Hierarchical and coupling model of factors influencing vessel traffic flow.

PubMed

Liu, Zhao; Liu, Jingxian; Li, Huanhuan; Li, Zongzhi; Tan, Zhirong; Liu, Ryan Wen; Liu, Yi

2017-01-01

Understanding the characteristics of vessel traffic flow is crucial in maintaining navigation safety, efficiency, and overall waterway transportation management. Factors influencing vessel traffic flow possess diverse features such as hierarchy, uncertainty, nonlinearity, complexity, and interdependency. To reveal the impact mechanism of the factors influencing vessel traffic flow, a hierarchical model and a coupling model are proposed in this study based on the interpretative structural modeling method. The hierarchical model explains the hierarchies and relationships of the factors using a graph. The coupling model provides a quantitative method that explores interaction effects of factors using a coupling coefficient. The coupling coefficient is obtained by determining the quantitative indicators of the factors and their weights. Thereafter, the data obtained from Port of Tianjin is used to verify the proposed coupling model. The results show that the hierarchical model of the factors influencing vessel traffic flow can explain the level, structure, and interaction effect of the factors; the coupling model is efficient in analyzing factors influencing traffic volumes. The proposed method can be used for analyzing increases in vessel traffic flow in waterway transportation system.

Factors Influencing College Science Success

ERIC Educational Resources Information Center

Tai, Robert H.; Sadler, Philip M.; Mintzes, Joel J.

2006-01-01

In this paper, the authors report some of the salient findings of a large-scale, four-year national study, conducted at the Harvard-Smithsonian Center for Astrophysics, entitled "Factors Influencing College Science Success" (FICSS), which surveyed college students who enrolled in first-year biology, chemistry, and physics courses…

Assessment of Factors Influencing Communication in Clinical Pharmacy.

PubMed

Yao, Dongning; Jiang, Liang; Huang, Yuankai; Chen, Lei; Wang, Yitao; Xi, Xiaoyu

2018-01-01

This study aimed to identify and assess the factors that influence communication quality between clinical pharmacists and patients using a structural equation model based on the predisposing, reinforcing, and enabling constructs in educational/environmental diagnosis and evaluation-policy, regulatory, and organizational constructs in educational and ecological development model to identify the most effective path to increase their communication quality. A survey was conducted at 253 Class-A tertiary hospitals in China from March to December 2016. During on-site observations, verbal communications between clinical pharmacists ( n = 752) and patients were audio recorded, and communication quality was rated by an expert panel on an 8-item Quality of Communication Rating Scale. Clinical pharmacists completed questionnaires that examined the predisposing, enabling, and reinforcing factors that influenced communication quality. Finally, AMOS was employed to examine the relationships between the three factors and communication quality. The results indicated that all three factors positively affected communication quality, with correlation coefficients of .26, .13, and .17, respectively. The most influential predisposing factor was attitude (.77), the most influential enabling factors were self-efficacy (.71) and confidence (.72), and the most influential reinforcing factor was rewards (.74). The findings suggest that pharmacists' attitudes toward, perceived knowledge of, and skill and confidence in communication, and the rewards offered by pharmacy management are the most influential factors that influence communication quality.

The structure of genetic and environmental risk factors for phobias in women

PubMed Central

Czajkowski, N.; Kendler, K. S.; Tambs, K.; Røysamb, E.; Reichborn-Kjennerud, T.

2011-01-01

Background To explore the genetic and environmental factors underlying the co-occurrence of lifetime diagnoses of DSM-IV phobia. Method Female twins (n = 1430) from the population-based Norwegian Institute of Public Health Twin Panel were assessed at personal interview for DSM-IV lifetime specific phobia, social phobia and agoraphobia. Comorbidity between the phobias were assessed by odds ratios (ORs) and polychoric correlations and multivariate twin models were fitted in Mx. Results Phenotypic correlations of lifetime phobia diagnoses ranged from 0.55 (agoraphobia and social phobia, OR 10.95) to 0.06 (animal phobia and social phobia, OR 1.21). In the best fitting twin model, which did not include shared environmental factors, heritability estimates for the phobias ranged from 0.43 to 0.63. Comorbidity between the phobias was accounted for by two common liability factors. The first loaded principally on animal phobia and did not influence the complex phobias (agoraphobia and social phobia). The second liability factor strongly influenced the complex phobias, but also loaded weak to moderate on all the other phobias. Blood phobia was mainly influenced by a specific genetic factor, which accounted for 51% of the total and 81% of the genetic variance. Conclusions Phobias are highly co-morbid and heritable. Our results suggest that the co-morbidity between phobias is best explained by two distinct liability factors rather than a single factor, as has been assumed in most previous multivariate twin analyses. One of these factors was specific to the simple phobias, while the other was more general. Blood phobia was mainly influenced by disorder specific genetic factors. PMID:21211096

[Medical and ecological assessment of climate effects on urolithiasis morbidity in population of Primorsky territory].

PubMed

Koval'chuk, V K

2004-01-01

The article presents medicoecological estimation of quantitative relations between monsoon climate and urolithiasis primary morbidity in the Primorsky Territory. Quantitative estimation of the climate was performed by V. I. Rusanov (1973) who calculated daily meteorological data for 1 p.m. throughout 1991-1999. Primary urolithiasis morbidity for this period of time was provided by regional health department. The data were processed by methods of medical mapping and paired correlation analysis. In the Territory, mapping revealed the same location of the zones with high frequency of discomfortable weather of class V and VI causing chilblain in positive air temperatures and zones with elevated primary urolithiasis morbidity in children and adults. Correlation analysis confirmed mapping results and determined significant negative correlations between frequency of relatively comfortable moment weather classes II-IV and morbidity of children and adults, positive correlation between frequency of discomfortable class VI and adult morbidity. Thus, high frequency of days per year with discomfortable classes of moment weather in low positive air temperatures may be one of the factors of urolithiasis risk in population of the Primorsky Territory. Climatic factors should be taken into consideration in planning primary prophylaxis of this disease in the Primorsky Territory.

Excess morbidity and mortality in patients with craniopharyngioma: a hospital-based retrospective cohort study.

PubMed

Wijnen, Mark; Olsson, Daniel S; van den Heuvel-Eibrink, Marry M; Hammarstrand, Casper; Janssen, Joseph A M J L; van der Lely, Aart J; Johannsson, Gudmundur; Neggers, Sebastian J C M M

2018-01-01

Most studies in patients with craniopharyngioma did not investigate morbidity and mortality relative to the general population nor evaluated risk factors for excess morbidity and mortality. Therefore, the objective of this study was to examine excess morbidity and mortality, as well as their determinants in patients with craniopharyngioma. Hospital-based retrospective cohort study conducted between 1987 and 2014. We included 144 Dutch and 80 Swedish patients with craniopharyngioma identified by a computer-based search in the medical records (105 females (47%), 112 patients with childhood-onset craniopharyngioma (50%), 3153 person-years of follow-up). Excess morbidity and mortality were analysed using standardized incidence and mortality ratios (SIRs and SMRs). Risk factors were evaluated univariably by comparing SIRs and SMRs between non-overlapping subgroups. Patients with craniopharyngioma experienced excess morbidity due to type 2 diabetes mellitus (T2DM) (SIR: 4.4, 95% confidence interval (CI): 2.8-6.8) and cerebral infarction (SIR: 4.9, 95% CI: 3.1-8.0) compared to the general population. Risks for malignant neoplasms, myocardial infarctions and fractures were not increased. Patients with craniopharyngioma also had excessive total mortality (SMR: 2.7, 95% CI: 2.0-3.8), and mortality due to circulatory (SMR: 2.3, 95% CI: 1.1-4.5) and respiratory (SMR: 6.0, 95% CI: 2.5-14.5) diseases. Female sex, childhood-onset craniopharyngioma, hydrocephalus and tumour recurrence were identified as risk factors for excess T2DM, cerebral infarction and total mortality. Patients with craniopharyngioma are at an increased risk for T2DM, cerebral infarction, total mortality and mortality due to circulatory and respiratory diseases. Female sex, childhood-onset craniopharyngioma, hydrocephalus and tumour recurrence are important risk factors. © 2018 European Society of Endocrinology.

Exploring factors influencing smoking behaviour in Malaysia.

PubMed

Cheah, Yong Kang; Naidu, Balkish Mahadir

2012-01-01

The objective of present study is to investigate the determinants of smoking behaviour among adults in Malaysia. Findings of the Third National Health and Morbidity Survey (NHMS-3) by the Ministry of Health, Malaysia, were used. The sample consisted of 34,539 observations. A logistic regression model was thus applied to estimate the probability to participate in smoking. Age, income, gender, marital status, ethnicity, employment status, residential area, education, lifestyle and health status were statistically significant in affecting the likelihood of smoking. Specifically, youngsters, low income earners, males, unmarried individuals, Malays, employed individuals, rural residents and primary educated individuals were more likely to smoke. In conclusion, socio-demographic, lifestyle and health factors have significant impacts on smoking participation in Malaysia. Based on these empirical findings, several policy implications are suggested.

[Association between neontal morbidity, gestational age and developmental delays in moderate to late preterm children].

PubMed

Schonhaut, Luisa; Pérez, Marcela; Muñoz, Sergio

2015-01-01

There is evidence that children born moderate-to-late preterm (MLP) have a higher risk of hospitalisation, neonatal morbidity, and developmental delay (DD). To determine the association between DD, gestational age, and neonatal morbidity in MLP children. A case control study design nested in a cohort of MLP children born between 2006 and 2009 at a private hospital located in the Metropolitan area of Santiago. The children were assessed with the Bayley-III Scales of Infant Development at 8 or 18 months corrected age, or at 30 months of chronological age. Neonatal records were retrospectively reviewed. A multivariate analysis was performed to determine the effect of neonatal morbidity on development. A total of 130 MLP children, 25 cases and 105 controls, were studied. Most of them (83.8%) were hospitalised during the neonatal period. Significant differences between cases and controls regarding maternal age and symptomatic hypoglycaemia were observed (crude OR 3.5, adjusted OR 8.18). It was concluded that the variables that negatively affect the rate of development are male gender, being a twin, and gestational age. Symptomatic hypoglycaemia is the main risk factor for DD, while being a twin, male gender, and gestational age influenced the total development rate obtained. It is essential to develop strategies for prevention, screening, and early management of this metabolic disorder to prevent future DD. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Factors influencing the implementation of evidence in Chinese nursing practice.

PubMed

Cheng, Lei; Broome, Marion E; Feng, Sheng; Hu, Yan

2017-12-01

To explore the influencing factors from staff nurses, nurse managers, nursing directors and a physician involved in nursing evidence implementation in Mainland China. Although the need for evidence-based nursing is well recognised, continuous efforts are needed to strive for closing the gap from evidence to action. Previous studies have explored influencing factors from individual and organisational perspectives in Western countries. However, it remains unclear what the influences (i.e., context and culture) in the developing countries as China. A grounded theory design using in-depth individual interviews was conducted. Interviews with 56 participants from 24 evidence-based nursing implementation projects were conducted in Mainland China. Constant comparative analysis was used to discover the concepts describing the influencing factors during the implementation process. Factors that influenced implementation of evidence-based practice in the Chinese context were identified. These included the leaders of the projects, the nature of the evidence, practising nurses, patients involved in the projects, the system where the projects were implemented, as well as the influence from outside of the system. A variety of factors influencing evidence implementation in Chinese nursing context were identified and further explored from the perspective of different project leaders and culture influence. There is apparently a strong demand for a supportive system, targeted strategies to facilitate various evidence implementations and integrated core elements of evidence-based practice at the point care. The blurred boundaries and complexity of influencing factors call for a systematic and dynamic perspective during implementation. The competitive priorities emphasise the importance of integration between clinical nursing care and evidence-based practice. © 2017 John Wiley & Sons Ltd.

A Study of Morbidity Pattern in Street Sweepers: A Cross-sectional Study.

PubMed

Sabde, Yogesh D; Zodpey, Sanjay P

2008-10-01

Street sweepers play an important role in maintaining the health and hygiene within the cities. This job exposes the street sweepers to a variety of risk factors such as dust, toxins and diesel exhaust pollution, which make them vulnerable to develop certain occupational diseases. Therefore, it was thought necessary to study the morbidity profile in this occupational group. To study the prevalence of morbidities among street sweepers and comparison group. A cross-sectional study with a comparison group. Nagpur Municipal Corporation, Nagpur. THE STUDY INCLUDED TWO GROUPS: (1) A study group comprising 273 street sweepers. (2) A comparison group comprising 142 class IV workers working in the office buildings of Nagpur Municipal Corporation, Nagpur. A pretested proforma was used to record the necessary information such as clinical history, sociodemographic factors, findings of clinical examination and investigations performed. THE IMPORTANT MORBIDITIES DETECTED AMONG STREET SWEEPERS WERE THE FOLLOWING: anemia (20.5%), hypertension (9.5%), upper respiratory tract infections (URTI) (7.3%) and chronic bronchitis (5.9%). In the comparison group, important morbidities detected were the following: anemia (20.4%), hypertension (11.3%), hyperacidity (9.9%), URTI (7.0%) and refractive error (7.0%). Chronic bronchitis was detected in two subjects (1.4%) of the comparison group. The prevalence of chronic bronchitis was significantly high among street sweepers than that of subjects of the comparison group. Therefore, it is recommended that further studies with a larger sample size be undertaken to identify the factors responsible for higher prevalence of chronic bronchitis among the street sweepers.

The cystatin C/creatinine ratio, a marker of glomerular filtration quality: associated factors, reference intervals, and prediction of morbidity and mortality in healthy seniors.

PubMed

Purde, Mette-Triin; Nock, Stefan; Risch, Lorenz; Medina Escobar, Pedro; Grebhardt, Chris; Nydegger, Urs E; Stanga, Zeno; Risch, Martin

2016-03-01

The ratio of cystatin C (cysC) to creatinine (crea) is regarded as a marker of glomerular filtration quality associated with cardiovascular morbidities. We sought to determine reference intervals for serum cysC-crea ratio in seniors. Furthermore, we sought to determine whether other low-molecular weight molecules exhibit a similar behavior in individuals with altered glomerular filtration quality. Finally, we investigated associations with adverse outcomes. A total of 1382 subjectively healthy Swiss volunteers aged 60 years or older were enrolled in the study. Reference intervals were calculated according to Clinical & Laboratory Standards Institute (CLSI) guideline EP28-A3c. After a baseline exam, a 4-year follow-up survey recorded information about overall morbidity and mortality. The cysC-crea ratio (mean 0.0124 ± 0.0026 mg/μmol) was significantly higher in women and increased progressively with age. Other associated factors were hemoglobin A1c, mean arterial pressure, and C-reactive protein (P < 0.05 for all). Participants exhibiting shrunken pore syndrome had significantly higher ratios of 3.5-66.5 kDa molecules (brain natriuretic peptide, parathyroid hormone, β2-microglobulin, cystatin C, retinol-binding protein, thyroid-stimulating hormone, α1-acid glycoprotein, lipase, amylase, prealbumin, and albumin) and creatinine. There was no such difference in the ratios of very low-molecular weight molecules (urea, uric acid) to creatinine or in the ratios of molecules larger than 66.5 kDa (transferrin, haptoglobin) to creatinine. The cysC-crea ratio was significantly predictive of mortality and subjective overall morbidity at follow-up in logistic regression models adjusting for several factors. The cysC-crea ratio exhibits age- and sex-specific reference intervals in seniors. In conclusion, the cysC-crea ratio may indicate the relative retention of biologically active low-molecular weight compounds and can independently predict the risk for overall mortality

[Factors influencing nurses' organizational citizenship behavior].

PubMed

Park, Junhee; Yun, Eunkyung; Han, Sangsook

2009-08-01

This study was conducted to identify the factors that influence nurses' organizational citizenship behavior. A cross-sectional design was used, with a convenience sample of 547 nurses from four university hospitals in Seoul and Gyeonggi province. The data were collected through a questionnaire survey done from September 22 to October 10, 2008. The tools used for this study were scales on organizational citizenship behavior (14 items), self-leadership (14 items), empowerment (10 items), organizational commitment (7 items), job satisfaction (8 items) and transformational.transactional leadership (14 items). Cronbach's alpha and factor analysis were examined to test reliability and construct validity of the scale. The data collected were processed using SPSS Window 15.0 Program for actual numbers and percentages, differences in the dependent variable according to general characteristics, and means, standard deviations, correlation coefficients and multiple regression analysis. The factors influencing nurses' organizational citizenship behavior were identified as self-leadership(beta=.247), empowerment (beta=.233), job satisfaction (beta=.209), organizational commitment (beta=.158), and transactional leadership (beta=.142). Five factors explained 42.0% of nurses' organizational citizenship behavior. The results of this study can be used to develop further management strategies for enhancement of nurses' organizational citizenship behavior.

Factors Influencing Title VII Bilingual Program Institutionalization.

ERIC Educational Resources Information Center

Lewis, Gerald R.; And Others

1985-01-01

This study of the primary restraining and driving forces that influence Title VII bilingual education programs found the external environment, the local community, to be the main factor influencing institutionalization and self-renewal. The internal environment--the local school, and the local school's organization or central office, school board,…

Discriminability of Personality Profiles in Isolated and Co-Morbid Marijuana and Nicotine Users

PubMed Central

Ketcherside, Ariel; Jeon-Slaughter, Haekyung; Baine, Jessica L.; Filbey, Francesca M

2016-01-01

Specific personality traits have been linked with substance use disorders (SUDs), genetic mechanisms, and brain systems. Thus, determining the specificity of personality traits to types of SUD can advance the field towards defining SUD endophenotypes as well as understanding the brain systems involved for the development of novel treatments. Disentangling these factors is particularly important in highly co-morbid SUDs, such as marijuana and nicotine use, so treatment can occur effectively for both. This study evaluated personality traits that distinguish isolated and co-morbid use of marijuana and nicotine. To that end, we collected the NEO Five Factor Inventory in participants who used marijuana-only (n=59), nicotine-only (n=27), both marijuana and nicotine (n=28), and in non-using controls (n=28). We used factor analyses to identify personality profiles, which are linear combinations of the five NEO Factors. We then conducted Receiver Operating Characteristics (ROC) curve analysis to test accuracy of the personality factors in discriminating isolated and co-morbid marijuana and nicotine users from each other. ROC curve analysis distinguished the four groups based on their NEO personality patterns. Results showed that NEO Factor 2 (openness, extraversion, agreeableness) discriminated marijuana and marijuana + nicotine users from controls and nicotine-only users with high predictability. Additional ANOVA results showed that the openness dimension discriminated marijuana users from nicotine users. These findings suggest that personality dimensions distinguish marijuana users from nicotine users and should be considered in prevention strategies. PMID:27086256

Impact of resident participation on morbidity and mortality in neurosurgical procedures: an analysis of 16,098 patients.

PubMed

Bydon, Mohamad; Abt, Nicholas B; De la Garza-Ramos, Rafael; Macki, Mohamed; Witham, Timothy F; Gokaslan, Ziya L; Bydon, Ali; Huang, Judy

2015-04-01

The authors sought to determine the impact of resident participation on overall 30-day morbidity and mortality following neurosurgical procedures. The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who had undergone neurosurgical procedures between 2006 and 2012. The operating surgeon(s), whether an attending only or attending plus resident, was assessed for his or her influence on morbidity and mortality. Multivariate logistic regression, was used to estimate odds ratios for 30-day postoperative morbidity and mortality outcomes for the attending-only compared with the attending plus resident cohorts (attending group and attending+resident group, respectively). The study population consisted of 16,098 patients who had undergone elective or emergent neurosurgical procedures. The mean patient age was 56.8 ± 15.0 years, and 49.8% of patients were women. Overall, 15.8% of all patients had at least one postoperative complication. The attending+resident group demonstrated a complication rate of 20.12%, while patients with an attending-only surgeon had a statistically significantly lower complication rate at 11.70% (p < 0.001). In the total population, 263 patients (1.63%) died within 30 days of surgery. Stratified by operating surgeon status, 162 patients (2.07%) in the attending+resident group died versus 101 (1.22%) in the attending group, which was statistically significant (p < 0.001). Regression analyses compared patients who had resident participation to those with only attending surgeons, the referent group. Following adjustment for preoperative patient characteristics and comorbidities, multivariate regression analysis demonstrated that patients with resident participation in their surgery had the same odds of 30-day morbidity (OR = 1.05, 95% CI 0.94-1.17) and mortality (OR = 0.92, 95% CI 0.66-1.28) as their attending only counterparts. Cases with resident participation had higher rates of

Morbidity and Mortality in Sarcoidosis

PubMed Central

Gerke, Alicia K.

2015-01-01

Purpose of Review Chronic sarcoidosis is a complex disease with numerous comorbid conditions and can be fatal in some cases. Recognizing causes of morbidity and mortality is important to effectively select treatments, manage symptoms, and improve outcomes. The purpose of this review is to examine emerging knowledge on morbidity and mortality in sarcoidosis. Recent Findings Approximately one to five percent of patients with sarcoidosis die from complications of sarcoidosis. Recent population studies indicate that mortality may be increasing over the past decade. The reasons behind these trends are unclear, but could include increasing incidence, detection rates, severity of disease, or age of the population. Morbidity of sarcoidosis is reflected by a trend of increased hospitalizations over recent years and increased use of healthcare resources. Morbidity can be caused by organ damage from granulomatous inflammation, treatment complications, and psychosocial effects of the disease. Recent studies are focused on morbidity related to cardiopulmonary complications, bone health, and aging within the sarcoidosis population. Last, sarcoidosis is associated with autoimmune diseases, pulmonary embolism, and malignancy; however, the underlying mechanisms linking diseases continue to be debated. Summary Morbidity in sarcoidosis is significant and multifactorial. Mortality is infrequent, but may be increasing over the years. PMID:25029298

Risk Factors Associated with Self-Injurious Behaviors in Children and Adolescents with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Duerden, Emma G.; Oatley, Hannah K.; Mak-Fan, Kathleen M.; McGrath, Patricia A.; Taylor, Margot J.; Szatmari, Peter; Roberts, S. Wendy

2012-01-01

While self-injurious behaviors (SIB) can cause significant morbidity for children with autism spectrum disorders (ASD), little is known about its associated risk factors. We assessed 7 factors that may influence self-injury in a large cohort of children with ASD: (a) atypical sensory processing; (b) impaired cognitive ability; (c) abnormal…

Time to foster a rational approach to preventing cardiovascular morbid events.

PubMed

Cohn, Jay N; Duprez, Daniel A

2008-07-29

Efforts to prevent atherosclerotic morbid events have focused primarily on risk factor prevention and intervention. These approaches, based on the statistical association of risk factors with events, have dominated clinical practice in the last generation. Because the cardiovascular abnormalities eventuating in morbid events are detectable in the arteries and heart before the development of symptomatic disease, recent efforts have focused on identifying the presence of these abnormalities as a more sensitive and specific guide to the need for therapy. Advances in noninvasive techniques for studying the vasculature and the left ventricle now provide the opportunity to use early disease rather than risk factors as the tool for clinical decision making. A disease scoring system has been developed using 10 tests of vascular and cardiac function and structure. More extensive data to confirm the sensitivity and specificity of this scoring system and to demonstrate its utility in tracking the response to therapy are needed to justify widespread application in clinical practice.

Functional polymorphisms of macrophage migration inhibitory factor as predictors of morbidity and mortality of pneumococcal meningitis

PubMed Central

Savva, Athina; Brouwer, Matthijs C.; Valls Serón, Mercedes; Le Roy, Didier; Ferwerda, Bart; van der Ende, Arie; Bochud, Pierre-Yves; van de Beek, Diederik; Calandra, Thierry

2016-01-01

Pneumococcal meningitis is the most frequent and critical type of bacterial meningitis. Because cytokines play an important role in the pathogenesis of bacterial meningitis, we examined whether functional polymorphisms of the proinflammatory cytokine macrophage migration inhibitory factor (MIF) were associated with morbidity and mortality of pneumococcal meningitis. Two functional MIF promoter polymorphisms, a microsatellite (−794 CATT5–8; rs5844572) and a single-nucleotide polymorphism (−173 G/C; rs755622) were genotyped in a prospective, nationwide cohort of 405 patients with pneumococcal meningitis and in 329 controls matched for age, gender, and ethnicity. Carriages of the CATT7 and −173 C high-expression MIF alleles were associated with unfavorable outcome (P = 0.005 and 0.003) and death (P = 0.03 and 0.01). In a multivariate logistic regression model, shock [odds ratio (OR) 26.0, P = 0.02] and carriage of the CATT7 allele (OR 5.12, P = 0.04) were the main predictors of mortality. MIF levels in the cerebrospinal fluid were associated with systemic complications and death (P = 0.0002). Streptococcus pneumoniae strongly up-regulated MIF production in whole blood and transcription activity of high-expression MIF promoter Luciferase reporter constructs in THP-1 monocytes. Consistent with these findings, treatment with anti-MIF immunoglogulin G (IgG) antibodies reduced bacterial loads and improved survival in a mouse model of pneumococcal pneumonia and sepsis. The present study provides strong evidence that carriage of high-expression MIF alleles is a genetic marker of morbidity and mortality of pneumococcal meningitis and also suggests a potential role for MIF as a target of immune-modulating adjunctive therapy. PMID:26976591

Hierarchical and coupling model of factors influencing vessel traffic flow

PubMed Central

Liu, Jingxian; Li, Huanhuan; Li, Zongzhi; Tan, Zhirong; Liu, Ryan Wen; Liu, Yi

2017-01-01

Understanding the characteristics of vessel traffic flow is crucial in maintaining navigation safety, efficiency, and overall waterway transportation management. Factors influencing vessel traffic flow possess diverse features such as hierarchy, uncertainty, nonlinearity, complexity, and interdependency. To reveal the impact mechanism of the factors influencing vessel traffic flow, a hierarchical model and a coupling model are proposed in this study based on the interpretative structural modeling method. The hierarchical model explains the hierarchies and relationships of the factors using a graph. The coupling model provides a quantitative method that explores interaction effects of factors using a coupling coefficient. The coupling coefficient is obtained by determining the quantitative indicators of the factors and their weights. Thereafter, the data obtained from Port of Tianjin is used to verify the proposed coupling model. The results show that the hierarchical model of the factors influencing vessel traffic flow can explain the level, structure, and interaction effect of the factors; the coupling model is efficient in analyzing factors influencing traffic volumes. The proposed method can be used for analyzing increases in vessel traffic flow in waterway transportation system. PMID:28414747

Morbidity figures from general practice: sex differences in traumatology.

PubMed

Lagro-Janssen, Toine; Grosicar, Janja

2010-08-01

Trauma prevention starts with to find out the extent of the problem and who it affects. Insight into morbidity figures is therefore necessary. To explore sex differences in traumatology and secondary medical care utilization in primary care related to age and socio-economic status (SES). Data were obtained from an academic continuous morbidity registration project in the Netherlands in the period from 1996 to 2006, in which 13,000 patients were followed in 10 successive years. Sex differences showed a male excess from childhood to 45 years and women showing almost double trauma rates in the elderly. Low SES was associated with the greatest incidence of traumas. The largest sex difference in incidence above 65 years appeared in the high SES with more traumas in women compared with men. From this age on, female morbidity in traumatology outnumbered male morbidity regardless of SES. Considering use of referrals, we found that in the age group 15-45 years men made a greater use of secondary medical care. However, the vastest gender influence in medical care utilization was noticed in the age group over 65 years, outnumbered with women. Young men and old women are the most at risk for traumatic health problems: men presenting with traumata of the skull, the tibia and ocular trauma's and women with fractures of the femur, humerus and wrist. For both men and women the greatest incidence is in the low SES. Family physicians can play a pivotal role in prevention to focus on their patients with high risks.

Quantitative influence of risk factors on blood glucose level.

PubMed

Chen, Songjing; Luo, Senlin; Pan, Limin; Zhang, Tiemei; Han, Longfei; Zhao, Haixiu

2014-01-01

The aim of this study is to quantitatively analyze the influence of risk factors on the blood glucose level, and to provide theory basis for understanding the characteristics of blood glucose change and confirming the intervention index for type 2 diabetes. The quantitative method is proposed to analyze the influence of risk factors on blood glucose using back propagation (BP) neural network. Ten risk factors are screened first. Then the cohort is divided into nine groups by gender and age. According to the minimum error principle, nine BP models are trained respectively. The quantitative values of the influence of different risk factors on the blood glucose change can be obtained by sensitivity calculation. The experiment results indicate that weight is the leading cause of blood glucose change (0.2449). The second factors are cholesterol, age and triglyceride. The total ratio of these four factors reaches to 77% of the nine screened risk factors. And the sensitivity sequences can provide judgment method for individual intervention. This method can be applied to risk factors quantitative analysis of other diseases and potentially used for clinical practitioners to identify high risk populations for type 2 diabetes as well as other disease.

[Morbidity rate of obesity in children in ukraine. Overweight as noncontagious disease risk factor].

PubMed

Заболотна, Ірина Е

The upsurge of prevalence rate of obesity and overweight that in the majority of cases traces back to childhood is a risk factor of the most common noncontagious diseases in adults. The aim was to analyze prevalence of obesity in children in Ukraine and to conduct the pilot study of medical condition of overweight children. Official state statistics of prevalence rate of obesity in kids and screening data of anthropometric characteristics, arterial tension levels, physical performance decrement and medical condition of children (boys - 50, girls - 90, average age - 15,1±0,1 years) was used in research. Data calculation performed by Statistica v. 6.0 software. Over the past few decades, the morbidity rate of obesity in children in Ukraine has greatly increased, especially in year class 15-17. Insufficient diagnosis of obesity in children is the consequence of the inadequacy of the existing system of preventive care and monitoring survey of decease risk factors. Children with body mass index (BMI) above normal have a risk of work decrement in 5,2 times (odds ratio, OR=5,2, CI95%: 1,7-10,6). Such children have higher risk of development of the diseases of the respiratory system (OR=8,1; CI95%: 3,9-13,6) and allergic dermatitis (OR=7,7; CI95%: 3,7-12,9). The odds ratio of arterial hypertension in such children is equal to 3,46±0,3 (95%CI: 2,0-5,9). According to prediction calculations, the situation with the increase of prevalence rate of obesity in children in Ukraine is unfavorable. The introduction of measures aimed at finding children with obesity, their registration and monitoring of patients' health with due regard to decease risk factors at the primary care level would conduce to improving prevention of obesity and prevention of alimentary diseases progression.

Factors influencing healthcare service quality

PubMed Central

Mosadeghrad, Ali Mohammad

2014-01-01

Background: The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods: Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results: Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion: This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality. PMID:25114946

Soft Factors Influence College Enrollment

ERIC Educational Resources Information Center

Fogg, Neeta P.; Harrington, Paul E.

2010-01-01

Evidence about the role that "soft factors" like student engagement and school environment play in influencing whether high school students go on to enroll in college is hard to come by. Over the past two years, the Center for Labor Market Studies (CLMS) of Northeastern University, with support from the Nellie Mae Education Foundation…

Factors influencing US medical students' decision to pursue surgery.

PubMed

Schmidt, Lauren E; Cooper, Clairice A; Guo, Weidun Alan

2016-06-01

Interest and applications to surgery have steadily decreased over recent years in the United States. The goal of this review is to collect the current literature regarding US medical students' experience in surgery and factors influencing their intention to pursue surgery as a career. We hypothesize that multiple factors influence US medical students' career choice in surgery. Six electronic databases (PubMed, SCOPUS, Web of Science, Education Resources Information Center, Embase, and PsycINFO) were searched. The inclusion criteria were studies published after the new century related to factors influencing surgical career choice among US medical students. Factors influencing US medical student surgical career decision-making were recorded. A quality index score was given to each article selected to minimize risk of bias. We identified 38 relevant articles of more than 1000 nonduplicated titles. The factors influencing medical student decision for a surgical career were categorized into five domains: mentorship and role model (n = 12), experience (clerkship n = 9, stereotype n = 4), timing of exposure (n = 9), personal (lifestyle n = 8, gender n = 6, finance n = 3), and others (n = 2). This comprehensive systemic review identifies mentorship, experience in surgery, stereotypes, timing of exposure, and personal factors to be major determinants in medical students' decisions to pursue surgery. These represent areas that can be improved to attract applicants to general surgery residencies. Surgical faculty and residents can have a positive influence on medical students' decisions to pursue surgery as a career. Early introduction to the field of surgery, as well as recruitment strategies during the preclinical and clinical years of medical school can increase students' interest in a surgical career. Copyright © 2016 Elsevier Inc. All rights reserved.

Influence of Body Mass Index and Albumin on Perioperative Morbidity and Clinical Outcomes in Resected Pancreatic Adenocarcinoma

PubMed Central

Hendifar, Andrew; Osipov, Arsen; Khanuja, Jasleen; Nissen, Nicholas; Naziri, Jason; Yang, Wensha; Li, Quanlin; Tuli, Richard

2016-01-01

Obesity is a known risk factor for PDA and recent reports suggest obesity has a negative impact on clinical outcomes in patients with PDA. Pretreatment body mass index (BMI) and serum albumin (SA) have been shown to be associated with worse overall survival in patients with advanced and metastatic PDA. However, minimal data exists on the impact of BMI and SA on perioperative and long-term clinical outcomes in patients with early-stage resected PDA. Herein, we report on the impact of these variables on perioperative clinical outcomes, overall survival (OS) and disease free survival (DFS) in patients with resected PDA. With IRB approval, we evaluated 1,545 patients with PDA treated at a single institution from 2007–2013 and identified 106 patients who underwent upfront resection with curative intent. BMI and SA were calculated preoperatively and at the time of last clinical evaluation. Influence of preoperative BMI, SA, change in either variable, and influence of other clinical and pathologic variables on perioperative morbidity and mortality was assessed. The impact of these variables on DFS and OS was assessed with cox regression modeling and ANOVA. Actuarial estimates for DFS and OS were calculated using Kaplan-Meier methods. Median follow up time was 16 months (3–89). Mean age was 68 years. Median survival was 14 months (3–65) and median time to recurrence was 11 months (1–79). Length of hospital stay was associated with BMI (p = .023), change in BMI (p = .003) and SA (p = .004). Post-operative transfusion rate was associated with SA (p = .021). There was a strong correlation between BMI change and positive margin (p = .04) and lymph node status (p = .01). On multivariate analysis, change in SA (p = .03) and node positivity (p = .008) were associated with decreased DFS. Additionally, preoperative SA (p = .023), node positivity (p = .026) and poor differentiation (p = .045) were associated with worse OS on multivariate analysis. Low preoperative SA was

Influence of Body Mass Index and Albumin on Perioperative Morbidity and Clinical Outcomes in Resected Pancreatic Adenocarcinoma.

PubMed

Hendifar, Andrew; Osipov, Arsen; Khanuja, Jasleen; Nissen, Nicholas; Naziri, Jason; Yang, Wensha; Li, Quanlin; Tuli, Richard

2016-01-01

Obesity is a known risk factor for PDA and recent reports suggest obesity has a negative impact on clinical outcomes in patients with PDA. Pretreatment body mass index (BMI) and serum albumin (SA) have been shown to be associated with worse overall survival in patients with advanced and metastatic PDA. However, minimal data exists on the impact of BMI and SA on perioperative and long-term clinical outcomes in patients with early-stage resected PDA. Herein, we report on the impact of these variables on perioperative clinical outcomes, overall survival (OS) and disease free survival (DFS) in patients with resected PDA. With IRB approval, we evaluated 1,545 patients with PDA treated at a single institution from 2007-2013 and identified 106 patients who underwent upfront resection with curative intent. BMI and SA were calculated preoperatively and at the time of last clinical evaluation. Influence of preoperative BMI, SA, change in either variable, and influence of other clinical and pathologic variables on perioperative morbidity and mortality was assessed. The impact of these variables on DFS and OS was assessed with cox regression modeling and ANOVA. Actuarial estimates for DFS and OS were calculated using Kaplan-Meier methods. Median follow up time was 16 months (3-89). Mean age was 68 years. Median survival was 14 months (3-65) and median time to recurrence was 11 months (1-79). Length of hospital stay was associated with BMI (p = .023), change in BMI (p = .003) and SA (p = .004). Post-operative transfusion rate was associated with SA (p = .021). There was a strong correlation between BMI change and positive margin (p = .04) and lymph node status (p = .01). On multivariate analysis, change in SA (p = .03) and node positivity (p = .008) were associated with decreased DFS. Additionally, preoperative SA (p = .023), node positivity (p = .026) and poor differentiation (p = .045) were associated with worse OS on multivariate analysis. Low preoperative SA was associated

Trends in respiratory morbidity of children in relation to their passive smoking exposure.

PubMed

Kukla, Lubomír; Hrubá, Drahoslava; Tyrlík, Mojmír

2006-12-01

Exposure of children to passive smoking is significantly associated with respiratory morbidity. Youngest children between 0-2 years are harmed in the most significant way, while, together with the growing age a decrease is observed of prevalence of respiratory diseases and influence of passive smoking. During repeated investigations of children from European Longitudinal Study of Pregnancy and Childhood (ELSPAC) it was assessed, whether and how in the period from the birth to five years of age varied the rate of children exposed to environment filled with smoke and what were the differences in the frequency of diseases among the groups of children with different exposure level. Some selected characteristics of health were chosen from documentation provided in the 6th, 18th month and 5 years of children's age and processed in four children groups that differ in smoking behaviour of their mothers. The differences were statistically assessed in SPSS programme. In all compared age categories were children of smoking mothers more often exposed to stay in environment filled with smoke: children of middle and heavy smokers more, children of light smokers less. In all groups of smoking mothers, children were more often protected from exposure to passive smoking in the age of six months than after they reached 18 months and 5 years of age: differences were mostly statistically significant on the level of 1% of significance. Attending the kindergarten presents significant protecting factor for five years old children: they are more exposed during weekends than on week days (p < 0.001, resp. p < 0.01). Both respiratory symptomatology and morbidity were highly significantly increased in previous life periods of those children, whose mothers smoked. At the age of five, life in smoking household causes more frequent incidence of asthmatic symptomatology: wheezing and apnoe, and higher prevalence of allergies against home and pollen dust with breathlessness and wheezing as well

Relationship between obstructive sleep apnea and liver abnormalities in morbidly obese patients: a prospective study.

PubMed

Jouët, Pauline; Sabaté, Jean-Marc; Maillard, Dominique; Msika, Simon; Mechler, Charlotte; Ledoux, Séverine; Harnois, Florence; Coffin, Benoit

2007-04-01

Morbid obesity is a risk factor of nonalcoholic steatohepatitis (NASH). Obstructive sleep apnea (OSA) could also be an independent risk factor for elevated liver enzymes and NASH. The relationships between liver injuries and OSA in morbidly obese patients requiring bariatric surgery were studied prospectively. Every consecutive morbidly obese patient (BMI > or =40 kg/m2 or > or =35 kg/m2 with severe comorbidities) requiring bariatric surgery was included between January 2003 and October 2004. Polygraphic recording, serum aminotransferases (ALT, AST), gamma-glutamyltransferase (GGT) and liver biopsy were systematically performed. OSA was present when the apnea-hypopnea index (AHI) was >10/h. 62 patients (54 F; age 38.5 +/- 11.0 (SD) yrs; BMI 47.8 +/- 8.4 kg/m2) were included. Liver enzymes (AST, ALT or GGT) were increased in 46.6%. NASH was present in 34.4% and OSA in 84.7%. Patients with OSA were significantly older (P = 0.015) and had a higher BMI (P = 0.003). In multivariate analysis, risk factors for elevated liver enzymes were the presence of OSA and male sex. The presence of NASH was similar in patients with or without OSA (32.7% vs 44.4% of patients, P = 0.76). In this cohort of morbidly obese patients requiring bariatric surgery, one-third of patients had NASH, a prevalence similar to previous studies. OSA was found to be a risk factor for elevated liver enzymes but not for NASH.

Women's experience of maternal morbidity: a qualitative analysis.

PubMed

Meaney, S; Lutomski, J E; O' Connor, L; O' Donoghue, K; Greene, R A

2016-07-25

Maternal morbidity refers to pregnancy-related complications, ranging in severity from acute to chronic. In Ireland one in 210 maternities will experience a severe morbidity. Yet, how women internalize their experience of morbidity has gone largely unexplored. This study aimed to explore women's experiences of maternal morbidity. A qualitative semi-structured interview format was utilized. Purposive sampling was used to recruit 14 women with a maternal morbidity before, during or after birth; nine women were diagnosed with one morbidity including hypertensive disorders, haemorrhage, placenta praevia and gestational diabetes whereas five women were diagnosed with two or more morbidities. Thematic analysis was employed as the analytic strategy. Four superordinate themes were identified: powerlessness, morbidity management, morbidity treatment and socio-behavioural responses to morbidities. Women were accepting of the uncontrollable nature of the adverse outcome experienced. While being treated for trauma, women were satisfied to relinquish their autonomy to ensure the safety of themselves and their babies. However, these events were debilitating. Women's inability to control their own bodies, as a result of the morbidity, contributed to high levels of frustration and anxiety. Morbidities impacted greatly on women's quality of life and sometimes these effects persisted for a prolonged period after delivery. Women felt that they were provided very little information on the practicalities of living with their condition; many were uncertain how to manage their morbidities in the home setting. Healthcare providers should ensure that women who experience a maternal morbidity are fully debriefed and have sufficient information on the morbidity including ongoing care and expectations prior to discharge.

Factors that influence the childbearing intentions of Canadian men.

PubMed

Roberts, E; Metcalfe, A; Jack, M; Tough, S C

2011-05-01

The role of men in the childbearing decision process and the factors that influence men's childbearing intentions have been relatively unexplored in the literature. This study aimed to describe the factors that strongly influence the childbearing intentions of men and to describe differences in these factors according to men's age group. A telephone survey (response rate 84%) was conducted with 495 men between the ages of 20 and 45 living in an urban setting who, at the time of contact, did not have biological children. Men were asked about what factors strongly influence their intention to have children. Univariable and multivariable logistic regressions were conducted to determine if these factors were significantly associated with age. Of those sampled, 86% of men reported that at some point in the future they planned to become a parent. The factors that men considered to be most influential in their childbearing intentions were: the need to be financially secure, their partner's interest/desire to have children, their partner's suitability to be a parent and their personal interest/desire to have children. Men who were 35-45 years old had lower odds of stating that financial security (crude OR: 0.32, 95% CI: 0.18-0.54) and partner's interest in having children (crude OR: 0.57, 95% CI: 0.33-0.99) were very influential, but had higher odds of stating that their biological clock (crude OR: 4.37, 95% CI: 1.78-10.76) was very influential in their childbearing intentions than men in the 20-24 year age group. The factors that influence men's intentions about when to become a parent may change with age. Understanding what influences men to have children, and what they understand about reproductive health is important for education, program and policy development.

A prospective study of morbidity patterns in a petroleum refinery and chemical plant.

PubMed Central

Tsai, S P; Dowd, C M; Cowles, S R; Ross, C E

1992-01-01

This study examined the morbidity experience from 1981 to 1988 of a prospective cohort of 3422 refinery and petrochemical plant employees from the Shell Deer Park manufacturing complex. The morbidity data for this study, which include all illness and absence records in excess of five days, were extracted from the morbidity section of the Shell health surveillance system. Standardised morbidity ratios (SMRs) of disease prevalence in this cohort were calculated using an internal comparison group of all manufacturing employees of the Shell Oil Company. Among production employees, the overall morbidity was statistically significantly higher (SMR = 109) than that of the comparison group. Illness due to hypertension (SMR = 144), haemorrhoids (SMR = 149), diseases of the nervous system (SMR = 120), respiratory system (SMR = 108), and digestive system (SMR = 117) were also raised for this group. The increased risk due to these medical conditions does not appear to be associated with occupational factors. Lymphatic and haematopoietic tissue neoplasms were raised (SMR = 124), but were based on only four cases. PMID:1637713

Discriminability of personality profiles in isolated and Co-morbid marijuana and nicotine users.

PubMed

Ketcherside, Ariel; Jeon-Slaughter, Haekyung; Baine, Jessica L; Filbey, Francesca M

2016-04-30

Specific personality traits have been linked with substance use disorders (SUDs), genetic mechanisms, and brain systems. Thus, determining the specificity of personality traits to types of SUD can advance the field towards defining SUD endophenotypes as well as understanding the brain systems involved for the development of novel treatments. Disentangling these factors is particularly important in highly co morbid SUDs, such as marijuana and nicotine use, so treatment can occur effectively for both. This study evaluated personality traits that distinguish isolated and co-morbid use of marijuana and nicotine. To that end, we collected the NEO Five Factor Inventory in participants who used marijuana-only (n=59), nicotine-only (n=27), both marijuana and nicotine (n=28), and in non-using controls (n=28). We used factor analyses to identify personality profiles, which are linear combinations of the five NEO Factors. We then conducted Receiver Operating Characteristics (ROC) curve analysis to test accuracy of the personality factors in discriminating isolated and co-morbid marijuana and nicotine users from each other. ROC curve analysis distinguished the four groups based on their NEO personality patterns. Results showed that NEO Factor 2 (openness, extraversion, agreeableness) discriminated marijuana and marijuana+nicotine users from controls and nicotine-only users with high predictability. Additional ANOVA results showed that the openness dimension discriminated marijuana users from nicotine users. These findings suggest that personality dimensions distinguish marijuana users from nicotine users and should be considered in prevention strategies. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Factors influencing alcohol safety action project police officers' DWI arrests

DOT National Transportation Integrated Search

1974-04-29

This report summarizes the results of a study to determine the factors influencing ASAP police officers' DWI arrests and the formulation of approaches to minimize the influence of those factors which might tend to constrain the arrest of persons who ...

Marketing Factors Influencing the Overall Satisfaction of Marriage Education Participants.

ERIC Educational Resources Information Center

Morris, Michael Lane; Cooper, Catherine; Gross, Kevin H.

1999-01-01

Seventy-one married couples attending marriage education workshops were surveyed regarding price, product, place, people, and promotional marketing factors influencing their overall satisfaction as workshop participants. Findings suggest both similar and unique marketing factors influenced husbands' and wives' satisfaction. Recommendations for…

Psychiatric morbidity and its correlates among informal caregivers of older adults.

PubMed

Vaingankar, Janhavi Ajit; Chong, Siow Ann; Abdin, Edimansyah; Picco, Louisa; Shafie, Saleha; Seow, Esmond; Pang, Shirlene; Sagayadevan, Vathsala; Chua, Boon Yiang; Chua, Hong Choon; Subramaniam, Mythily

2016-07-01

This present study estimated the psychiatric morbidity among informal caregivers of older adults and investigated its association with their socio-demographic factors and older adult's health status, including dementia, depression and physical health conditions. Data from a national cross-sectional survey were used. For each participating older adult, an informal caregiver who 'knew the older adult best' and was aware of their health condition, was also interviewed to collect information on the older adults' care needs, and behavioral and psychological symptoms of dementia (BPSD). Data from 693 pairs was used. Informal caregivers were administered the Self Reporting Questionnaire (SRQ)-20 and psychiatric morbidity was defined as those with a total SRQ score of ≥8. Measures included informal caregivers' socio-demographic characteristics, assessment of dementia and depression in the older adults and self-report on their lifetime and current physical conditions. The association of socio-demographic characteristics, health conditions, care assistance and BPSD was investigated using backward stepwise logistic regression analysis where psychiatric morbidity (total SRQ scoremorbidity. Higher proportions of spousal caregivers and caregivers of older adults having more care needs and BPSD exhibited psychiatric morbidity. After adjusting for all covariates, caregivers' marital status, and the presence of BPSD and dementia in the older adults were identified as the strongest correlates of caregivers' psychiatric morbidity. The prevalence of psychiatric morbidity was 10%, 13.9% and 12.7% respectively in these groups. Married caregivers had higher odds of psychiatric morbidity (OR 2.50, 95% CI: 1.13-5.52). In addition, caregivers of older adults' with any BPSD (OR 5.87, 95% CI: 2.60-13.24) and dementia (OR 2.28, 95% CI: 1

Antidepressant Prescription Pattern in the Presence of Medical Co-morbidity: REAP-AD 2013 Study.

PubMed

Grover, S; Avasthi, A; Tripathi, A; Tanra, A J; Chee, K Y; He, Y L; Chiu, H Fk; Kuga, H; Lee, M S; Chong, M Y; Udormatn, P; Kanba, S; Yang, S Y; Si, T M; Sim, K; Tan, C H; Shen, W W; Xiang, Y T; Sartorius, N; Shinfuku, N

2015-09-01

To evaluate the prescription pattern of antidepressants in patients with medical co-morbidity from major psychiatric centres in Asia. The Research on Asian Psychotropic Prescription Pattern for Antidepressants (REAP-AD 2013) collected data from 42 psychiatric centres in 10 Asian countries and regions. Antidepressant prescriptions of 2320 patients with various psychiatric disorders were evaluated. Of these, 370 patients who had specified medical co-morbidities formed the study cohort. Escitalopram (20%) and mirtazapine (20%) were the most commonly prescribed antidepressants in patients with medical co-morbidity followed by sertraline (16%), trazodone (15%), and paroxetine (12%). Overall, more than half (52%; 247/476) of prescriptions comprised selective serotonin reuptake inhibitors. Slightly less than two-thirds (63%; n = 233) of patients received at least 1 selective serotonin reuptake inhibitor. In addition, 79% of patients were prescribed only 1 antidepressant. The mean number of antidepressants used per patient was 1.25 (standard deviation, 0.56). There were subtle differences in the most preferred antidepressant across medical illnesses such as diabetes mellitus, liver dysfunction, acid peptic disease, and cerebrovascular disease. Differences were also seen in prescription patterns across different countries. Although selective serotonin reuptake inhibitors formed the bulk of antidepressant prescriptions in the presence of medical co-morbidity, mirtazapine was also commonly used in the presence of medical co-morbidities. Specified medical morbidities do influence the selection of antidepressants.

Co-morbid substance use behaviors among youth: any impact of school environment?

PubMed

Costello, Mary Jean E; Leatherdale, Scott T; Ahmed, Rashid; Church, Dana L; Cunningham, John A

2012-03-01

Substance use is common among youth; however, our understanding of co-morbid tobacco, alcohol and marijuana use remains limited. The school-environment may play an important role in the likelihood a student engages in high risk substance use behaviors, including co-morbid use. This study aims to: (i) describe the prevalence of co-morbid substance use behaviors among youth; (ii) identify and compare the characteristics of youth who currently use a single substance, any two substances, and all three substances; (iii) examine if the likelihood of co-morbid use varies by school and; (iv) examine what factors are associated with co-morbid use. This study used nationally representative data collected from students in grades 9 to 12 (n = 41,886) as part of the 2006-2007 Canadian Youth Smoking Survey (YSS). Demographic and behavioral data were collected including, current cigarette, alcohol and marijuana use. Results. 6.5% (n = 107,000) reported current use of all three substances and 20.3% (n = 333,000) of any two substances. Multi-level analysis revealed significant between school variability in the odds a student used all three substances and any two substances; accounting for 16.9% and 13.5% of the variability, respectively. Co-morbid use was associated with sex, grade, amount of available spending money and perceived academic performance. Co-morbid substance use is high among youth; however, not all schools share the same prevalence. Knowing the school characteristics that place particular schools at risk for student substance use is important for tailoring drug and alcohol education programs. Interventions that target the prevention of co-morbid substance use are required.

Ethnic variations in severe maternal morbidity in the UK- a case control study.

PubMed

Nair, Manisha; Kurinczuk, Jennifer J; Knight, Marian

2014-01-01

Previous studies showed a higher risk of maternal morbidity amongst black and other minority ethnic (BME) groups, but were unable to investigate whether this excess risk was concentrated within specific BME groups in the UK. Our aim was to analyse the specific risks and to investigate reasons for any disparity. Unmatched case-control analysis using data from the United Kingdom Obstetric Surveillance System (UKOSS), February 2005-January 2013. Cases were 1,753 women who experienced severe morbidity during the peripartum period. Controls were 3,310 women who delivered immediately before the cases in the same hospital. Multivariable logistic regression modelling was used to adjust for known confounders and to understand their effects. Compared with white European women, the odds of severe maternal morbidity were 83% higher among black African women (adjusted odds ratio (aOR) = 1.83; 95% Confidence Interval (CI) = 1.39-2.40), 80% higher among black Caribbean (aOR = 1.80; 95% CI = 1.14-2.82), 74% higher in Bangladeshi (aOR = 1.74; 95% CI = 1.05-2.88), 56% higher in other non-whites (non-Asian) (aOR = 1.56; 95% CI = 1.05-2.33) and 43% higher among Pakistani women (aOR = 1.43; 95% CI = 1.07-1.92). There was no evidence of substantial confounding. Anaemia in current pregnancy, previous pregnancy problems, inadequate utilisation of antenatal care, pre-existing medical conditions, parity>3, and being younger and older were independent risk factors but, the odds of severe maternal morbidity did not differ by socioeconomic status, between smokers and non-smokers or by BMI. This national study demonstrates an increased risk of severe maternal morbidity among women of ethnic minority backgrounds which could not be explained by known risk factors for severe maternal morbidity.

Prevalence and Impact of Co-morbidity Burden as Defined by the Charlson Co-morbidity Index on 30-Day and 1- and 5-Year Outcomes After Coronary Stent Implantation (from the Nobori-2 Study).

PubMed

Mamas, Mamas A; Fath-Ordoubadi, Farzin; Danzi, Gian B; Spaepen, Erik; Kwok, Chun Shing; Buchan, Iain; Peek, Niels; de Belder, Mark A; Ludman, Peter F; Paunovic, Dragica; Urban, Philip

2015-08-01

Co-morbidities have typically been considered as prevalent cardiovascular risk factors and cardiovascular diseases rather than systematic measures of general co-morbidity burden in patients who underwent percutaneous coronary intervention (PCI). Charlson co-morbidity index (CCI) is a measure of co-morbidity burden providing a means of quantifying the prognostic impact of 22 co-morbid conditions on the basis of their number and prognostic impact. The study evaluated the impact of the CCI on cardiac mortality and major adverse cardiovascular events (MACE) after PCI through analysis of the Nobori-2 study. The prognostic impact of CCI was studied in 3,067 patients who underwent PCI in 4,479 lesions across 125 centers worldwide on 30-day and 1- and 5-year cardiac mortality and MACE. Data were adjusted for potential confounders using stepwise logistic regression; 2,280 of 3,067 patients (74.4%) had ≥1 co-morbid conditions. CCI (per unit increase) was independently associated with an increase in both cardiac death (odds ratio [OR] 1.47 95% confidence interval [CI] 1.20 to 1.80, p = 0.0002) and MACE (OR 1.29 95% CI 1.14 to 1.47, p ≤0.0011) at 30 days, with similar observations recorded at 1 and 5 years. CCI score ≥2 was independently associated with increased 30-day cardiac death (OR 4.25, 95% CI 1.24 to 14.56, p = 0.02) at 1 month, and this increased risk was also observed at 1 and 5 years. In conclusion, co-morbid burden, as measured using CCI, is an independent predictor of adverse outcomes in the short, medium, and long term. Co-morbidity should be considered in the decision-making process when counseling patients regarding the periprocedural risks associated with PCI, in conjunction with traditional risk factors. Copyright © 2015 Elsevier Inc. All rights reserved.

The role of infection and sepsis in the Brazilian Network for Surveillance of Severe Maternal Morbidity.

PubMed

Pfitscher, L C; Cecatti, J G; Haddad, S M; Parpinelli, M A; Souza, J P; Quintana, S M; Surita, F G; Costa, M L

2016-02-01

To identify the burden of severe infection within the Brazilian Network for Surveillance of Severe Maternal Morbidity and factors associated with worse maternal outcomes. This was a multicentre cross-sectional study involving 27 referral maternity hospitals in Brazil. WHO's standardised criteria for potentially life-threatening conditions and maternal near miss were used to identify cases through prospective surveillance and the main cause of morbidity was identified as infection or other causes (hypertension, haemorrhage or clinical/surgical). Complications due to infection were compared to complications due to the remaining causes of morbidity. Factors associated with a severe maternal outcome were assessed for the cases of infection. A total of 502 (5.3%) cases of maternal morbidity were associated with severe infection vs. 9053 cases (94.7%) with other causes. Considering increased severity of cases, infection was responsible for one-fourth of all maternal near miss (23.6%) and nearly half (46.4%) of maternal deaths, with a maternal near miss to maternal death ratio three times (2.8:1) that of cases without infection (7.8:1) and a high mortality index (26.3%). Within cases of infection, substandard care was present in over one half of the severe maternal outcome cases. Factors independently associated with worse maternal outcomes were HIV/AIDS, hysterectomy, prolonged hospitalisation, intensive care admission and delays in medical care. Infection is an alarming cause of maternal morbidity and mortality and timely diagnosis and adequate management are key to improving outcomes during pregnancy. Delays should be addressed, risk factors identified, and specific protocols of surveillance and care developed for use during pregnancy. © 2015 John Wiley & Sons Ltd.

Preventing cold-related morbidity and mortality in a changing climate

PubMed Central

Conlon, Kathryn C; Rajkovich, Nicholas B; White-Newsome, Jalonne L; Larsen, Larissa; Neill, Marie S O

2011-01-01

Winter weather patterns are anticipated to become more variable with increasing average global temperatures. Research shows that excess morbidity and mortality occurs during cold weather periods. We critically reviewed evidence relating temperature variability, health outcomes, and adaptation strategies to cold weather. Health outcomes included cardiovascular-, respiratory-, cerebrovascular-, and all-cause morbidity and mortality. Individual and contextual risk factors were assessed to highlight associations between individual- and neighborhood- level characteristics that contribute to a person’s vulnerability to variability in cold weather events. Epidemiologic studies indicate that the populations most vulnerable to variations in cold winter weather are the elderly, rural and, generally, populations living in moderate winter climates. Fortunately, cold-related morbidity and mortality are preventable and strategies exist for protecting populations from these adverse health outcomes. We present a range of adaptation strategies that can be implemented at the individual, building, and neighborhood level to protect vulnerable populations from cold-related morbidity and mortality. The existing research justifies the need for increased outreach to individuals and communities for education on protective adaptations in cold weather. We propose that future climate change adaptation research couple building energy and thermal comfort models with epidemiological data to evaluate and quantify the impacts of adaptation strategies. PMID:21592693

Impact of climate change on ozone-related mortality and morbidity in Europe.

PubMed

Orru, Hans; Andersson, Camilla; Ebi, Kristie L; Langner, Joakim; Aström, Christofer; Forsberg, Bertil

2013-02-01

Ozone is a highly oxidative pollutant formed from precursors in the presence of sunlight, associated with respiratory morbidity and mortality. All else being equal, concentrations of ground-level ozone are expected to increase due to climate change. Ozone-related health impacts under a changing climate are projected using emission scenarios, models and epidemiological data. European ozone concentrations are modelled with the model of atmospheric transport and chemistry (MATCH)-RCA3 (50×50 km). Projections from two climate models, ECHAM4 and HadCM3, are applied under greenhouse gas emission scenarios A2 and A1B, respectively. We applied a European-wide exposure-response function to gridded population data and country-specific baseline mortality and morbidity. Comparing the current situation (1990-2009) with the baseline period (1961-1990), the largest increase in ozone-associated mortality and morbidity due to climate change (4-5%) have occurred in Belgium, Ireland, the Netherlands and the UK. Comparing the baseline period and the future periods (2021-2050 and 2041-2060), much larger increases in ozone-related mortality and morbidity are projected for Belgium, France, Spain and Portugal, with the impact being stronger using the climate projection from ECHAM4 (A2). However, in Nordic and Baltic countries the same magnitude of decrease is projected. The current study suggests that projected effects of climate change on ozone concentrations could differentially influence mortality and morbidity across Europe.

Shoulder joint impairment among Finns aged 30 years or over: prevalence, risk factors and co-morbidity.

PubMed

Mäkelä, M; Heliövaara, M; Sainio, P; Knekt, P; Impivaara, O; Aromaa, A

1999-07-01

To describe the prevalence, risk factors and consequences of shoulder joint impairment in the population. A representative sample (n = 7217) of the Finnish population aged > or = 30 yr participated in a health examination survey (the Mini-Finland Health Survey). The design of the survey allowed an independent assessment of disability, reported shoulder pain, shoulder joint impairment and major chronic co-morbidity. Shoulder impairment was observed in 8.8%, while pain was reported by 30%. The prevalence of shoulder pain decreased among the elderly, whereas impairments increased up to 20% of those aged 75-80 yr. In addition to age, sex, previous injury to the shoulder joint and a history of physically heavy work, diabetes was associated with shoulder impairment (OR 1.6, 95% CI 1.2-2.1). Shoulder impairment was associated with disability (adjusted OR 2.0, CI 1.6-2.5). Shoulder impairment is an important component of ill health among the elderly, and cannot be reduced to reported pain alone.

Factors influencing arrests for alcohol-related traffic violations

DOT National Transportation Integrated Search

1974-09-01

This report describes factors that were found to influence police officers' arrests of persons suspected of alcohol-related (A/R) traffic violations, and presents recommendations for treating these factors so that a higher level of enforcement might ...

Synergistic effect of age and body mass index on mortality and morbidity in general surgery.

PubMed

Yanquez, Federico J; Clements, John M; Grauf, Dawn; Merchant, Aziz M

2013-09-01

The elderly population (aged 65 y and older) is expected to be the dominant age group in the United States by 2030. In addition, the prevalence of obesity in the United States is growing exponentially. Obese elderly patients are increasingly undergoing elective or emergent general surgery. There are few, if any, studies highlighting the combined effect of age and body mass index (BMI) on surgical outcomes. We hypothesize that increasing age and BMI synergistically impact morbidity and mortality in general surgery. We collected individual-level, de-identified patient data from the Michigan Surgical Quality Collaborative. Subjects underwent general surgery with general anesthetic, were >18 y, and had a BMI between 19 and 60. Primary and secondary outcomes were 30-d "Any morbidity" and mortality (from wound, respiratory, genitourinary, central nervous system, and cardiac systems), respectively. Preoperative risk variables included diabetes, dialysis, steroid use, cardiac risk, wound classification, American Society of Anesthesiology class, emergent cases, and 13 other variables. We conducted binary logistic regression models for 30-d morbidity and mortality to determine independent effects of age, BMI, interaction between both age and BMI, and a saturated model for all independent variables. We identified 149,853 patients. The average age was 54.6 y, and the average BMI was 30.9. Overall 30-d mortality was 2%, and morbidity was 6.7%. Age was a positive predictor for mortality and morbidity, and BMI was negatively associated with mortality and not significantly associated with morbidity. Age combined with higher BMI was positively associated with morbidity and mortality when the higher age groups were analyzed. Saturated models revealed age and American Society of Anesthesiology class as highest predictors of poor outcomes. Although BMI itself was not a major independent factor predicting 30-d major morbidity or mortality, the morbidly obese, elderly (>50 and 70 y

Postoperative dental morbidity in children following dental treatment under general anesthesia.

PubMed

Hu, Yu-Hsuan; Tsai, Aileen; Ou-Yang, Li-Wei; Chuang, Li-Chuan; Chang, Pei-Ching

2018-05-10

General anesthesia has been widely used in pediatric dentistry in recent years. However, there remain concerns about potential postoperative dental morbidity. The goal of this study was to identify the frequency of postoperative dental morbidity and factors associated with such morbidity in children. From March 2012 to February 2013, physically and mentally healthy children receiving dental treatment under general anesthesia at the Department of Pediatric Dentistry of the Chang Gung Memorial Hospital in Taiwan were recruited. This was a prospective and observational study with different time evaluations based on structured questionnaires and interviews. Information on the patient demographics, anesthesia and dental treatment performed, and postoperative dental morbidity was collected and analyzed. Correlations between the study variables and postoperative morbidity were analyzed based on the Pearson's chi-square test. Correlations between the study variables and the scale of postoperative dental pain were analyzed using the Mann-Whitney U test. Fifty-six pediatric patients participated in this study, with an average age of 3.34 ± 1.66 years (ranging from 1 to 8 years). Eighty-two percent of study participants reported postoperative dental pain, and 23% experienced postoperative dental bleeding. Both dental pain and bleeding subsided 3 days after the surgery. Dental pain was significantly associated with the total number of teeth treated, while dental bleeding, with the presence of teeth extracted. Patients' gender, age, preoperative dental pain, ASA classification, anesthesia time, and duration of the operation were not associated with postoperative dental morbidity. Dental pain was a more common postoperative dental morbidity than bleeding. The periods when parents reported more pain in their children were the day of the operation (immediately after the procedure) followed by 1 day and 3 days after the treatment.

The prevalence of early postpartum psychiatric morbidity in Dubai: a transcultural perspective.

PubMed

Abou-Saleh, M T; Ghubash, R

1997-05-01

There have been numerous studies of the prevalence of postpartum psychiatric illness and its putative risk factors in Western Europe and North America, but very few studies have been undertaken in developing countries, including the Arab world. A total of 95 women admitted to the New Dubai Hospital in Dubai, United Arab Emirates, for childbirth were studied. All subjects were assessed in the postpartum period using clinical and socio-cultural instruments, namely the Self-Reporting Questionnaire (SRQ) on day 2 and the Edinburgh Postnatal Depression Scale (EPDS) on day 7 after delivery. The prevalence of psychiatric morbidity was 24% according to the SRQ and 18% according to the EPDS. A number of psychosocial factors emerged as putative risk factors for postpartum psychiatric disturbance, including depressive illness. It is concluded that the prevalence of postpartum psychiatric morbidity and its risk factors in this Arab culture are similar to the results obtained in numerous previous studies conducted in industrialized countries. These findings have implications for the early detection and care of women at risk for postpartum psychiatric illness.

Social and Demographic Factors Associated with Morbidities in Young Children in Egypt: A Bayesian Geo-Additive Semi-Parametric Multinomial Model.

PubMed

Khatab, Khaled; Adegboye, Oyelola; Mohammed, Taofeeq Ibn

2016-01-01

Globally, the burden of mortality in children, especially in poor developing countries, is alarming and has precipitated concern and calls for concerted efforts in combating such health problems. Examples of diseases that contribute to this burden of mortality include diarrhoea, cough, fever, and the overlap between these illnesses, causing childhood morbidity and mortality. To gain insight into these health issues, we employed the 2008 Demographic and Health Survey Data of Egypt, which recorded details from 10,872 children under five. This data focused on the demographic and socio-economic characteristics of household members. We applied a Bayesian multinomial model to assess the area-specific spatial effects and risk factors of co-morbidity of fever, diarrhoea and cough for children under the age of five. The results showed that children under 20 months of age were more likely to have the three diseases (OR: 6.8; 95% CI: 4.6-10.2) than children between 20 and 40 months (OR: 2.14; 95% CI: 1.38-3.3). In multivariate Bayesian geo-additive models, the children of mothers who were over 20 years of age were more likely to have only cough (OR: 1.2; 95% CI: 0.9-1.5) and only fever (OR: 1.2; 95% CI: 0.91-1.51) compared with their counterparts. Spatial results showed that the North-eastern region of Egypt has a higher incidence than most of other regions. This study showed geographic patterns of Egyptian governorates in the combined prevalence of morbidity among Egyptian children. It is obvious that the Nile Delta, Upper Egypt, and south-eastern Egypt have high rates of diseases and are more affected. Therefore, more attention is needed in these areas.

Sources of stress and psychological morbidity among undergraduate physiotherapy students.

PubMed

Walsh, J M; Feeney, C; Hussey, J; Donnellan, C

2010-09-01

Professional education can be a stressful experience for some individuals, and may impact negatively on emotional well-being and academic performance. Psychological morbidity and associated sources of stress have not been investigated extensively in physiotherapy students. This study explored sources of stress, psychological morbidity and possible associations between these variables in undergraduate physiotherapy students. A questionnaire-based survey. The Undergraduate Sources of Stress Questionnaire was used to identify sources of stress, and the General Health Questionnaire-12 (GHQ-12) was used to rate the prevalence of psychological morbidity, using a conservative GHQ threshold of 3 to 4 to determine probable 'cases'. Uni- and multivariate tests of correlation were used to analyse the data. An Irish educational institution. One hundred and twenty-five physiotherapy undergraduate students. More than one-quarter of all students (27%) scored above the GHQ threshold, indicating probable psychological morbidity. This is higher than the level of psychological morbidity reported by the general population. Regression analysis showed that academic (beta=0.31, P<0.001) and personal (beta=0.50, P<0.001) sources of stress subscales were significant coefficients, explaining 48% of the variance in psychological morbidity after controlling for part-time employment and hours spent studying. Individual significant items from these subscales were stressful events (beta=0.24, P=0.004), mood (beta=0.43, P< or =0.001) and overall level of stress (beta=0.35, P< or =0.001). The results highlighted the emotional vulnerability of a significant proportion of physiotherapy students, with academic and personal issues being the greatest concern. While personal causes of stress such as stressful events and mood are more difficult to control, manipulation of curricular factors may have positive effects on academic sources of stress. Copyright 2010 Chartered Society of Physiotherapy

Morbidity, Disability and Death Rates of The Population Due to Malignant Neoplasms in Uralsk City in The Republic of Kazakhstan

PubMed

Umarova, Gulmira; Mamyrbayev, Аrstan; Bermagambetova, Saule; Baspakova, Akmaral; Satybaldieva, Umyt; Sabyrakhmetova, Valentina; Abilov, Talgar; Sultanova, Gulnar; Uraz, Raisa

2016-12-01

Objective: The dynamics of morbidity, disability and death rates due to malignant neoplasms in the population in Uralsk city of the Republic of Kazakhstan were studied for 2011-2015, with a focus on age and sex, as well as tumor location. Methods: Statistics for total morbidity, primary disability and mortality from cancer in the adult population of the city of Uralsk for 2011-2015 were calculated per 100 thousand. Estimation of morbidity was based on data from form - №12 «Report on the number of diseases registered in patients living in the area of health care organizations and patient population under medical observation”. Evaluation of primary disability was based on form №7 «The distribution of newly recognized disabled by disease class, age, sex and disability groups” for 2011-2015 in Ural city and analysis of cancer was carried out using annual form 7 “Report on the sick, and diseases of malignant neoplasms”. Result: The most common localizations of cancer were the trachea, bronchi, lungs, stomach and mammary glands. High death rates were noted for patients with cancer of the trachea, bronchi, lung, as compared to stomach and esophagus. Conclusion: The results of our investigation and data in the literature indicate that regional characteristics influence the impact of risk factors associated with cancer. An unfavorable environmental background contributes to ill health of urban populations, contributing to development of cancer. Moreover behavioral risk factors are very important, such as smoking, alcohol drinking, and an unhealthy diet. All these factors require urgent adoption of a package of measures for prevention, early detection and timely treatment. Detailed study of cancer is necessary to develop national programs and activities for prevention and control. Creative Commons Attribution License

Factors influencing health information system adoption in American hospitals.

PubMed

Wang, Bill B; Wan, Thomas T H; Burke, Darrell E; Bazzoli, Gloria J; Lin, Blossom Y J

2005-01-01

To study the number of health information systems (HISs), applicable to administrative, clinical, and executive decision support functionalities, adopted by acute care hospitals and to examine how hospital market, organizational, and financial factors influence HIS adoption. A cross-sectional analysis was performed with 1441 hospitals selected from metropolitan statistical areas in the United States. Multiple data sources were merged. Six hypotheses were empirically tested by multiple regression analysis. HIS adoption was influenced by the hospital market, organizational, and financial factors. Larger, system-affiliated, and for-profit hospitals with more preferred provider organization contracts are more likely to adopt managerial information systems than their counterparts. Operating revenue is positively associated with HIS adoption. The study concludes that hospital organizational and financial factors influence on hospitals' strategic adoption of clinical, administrative, and managerial information systems.

Maturity of hospital information systems: Most important influencing factors.

PubMed

Vidal Carvalho, João; Rocha, Álvaro; Abreu, António

2017-07-01

Maturity models facilitate organizational management, including information systems management, with hospital organizations no exception. This article puts forth a study carried out with a group of experts in the field of hospital information systems management with a view to identifying the main influencing factors to be included in an encompassing maturity model for hospital information systems management. This study is based on the results of a literature review, which identified maturity models in the health field and relevant influencing factors. The development of this model is justified to the extent that the available maturity models for the hospital information systems management field reveal multiple limitations, including lack of detail, absence of tools to determine their maturity and lack of characterization for stages of maturity structured by different influencing factors.

A Review of Factors Influencing Athletes' Food Choices.

PubMed

Birkenhead, Karen L; Slater, Gary

2015-11-01

Athletes make food choices on a daily basis that can affect both health and performance. A well planned nutrition strategy that includes the careful timing and selection of appropriate foods and fluids helps to maximize training adaptations and, thus, should be an integral part of the athlete's training programme. Factors that motivate food selection include taste, convenience, nutrition knowledge and beliefs. Food choice is also influenced by physiological, social, psychological and economic factors and varies both within and between individuals and populations. This review highlights the multidimensional nature of food choice and the depth of previous research investigating eating behaviours. Despite numerous studies with general populations, little exploration has been carried out with athletes, yet the energy demands of sport typically require individuals to make more frequent and/or appropriate food choices. While factors that are important to general populations also apply to athletes, it seems likely, given the competitive demands of sport, that performance would be an important factor influencing food choice. It is unclear if athletes place the same degree of importance on these factors or how food choice is influenced by involvement in sport. There is a clear need for further research exploring the food choice motives of athletes, preferably in conjunction with research investigating dietary intake to establish if intent translates into practice.

Favorable Cardiovascular Health, Compression of Morbidity, and Healthcare Costs: Forty-Year Follow-Up of the CHA Study (Chicago Heart Association Detection Project in Industry).

PubMed

Allen, Norrina B; Zhao, Lihui; Liu, Lei; Daviglus, Martha; Liu, Kiang; Fries, James; Shih, Ya-Chen Tina; Garside, Daniel; Vu, Thanh-Huyen; Stamler, Jeremiah; Lloyd-Jones, Donald M

2017-05-02

We examined the association of cardiovascular health at younger ages with the proportion of life lived free of morbidity, the cumulative burden of morbidity, and average healthcare costs at older ages. The CHA study (Chicago Heart Association Detection Project in Industry) is a longitudinal cohort of employed men and women 18 to 74 years of age at baseline examination in 1967 to 1973. Baseline measurements included blood pressure, cholesterol, diabetes mellitus, body mass index, and smoking. Individuals were classified into 1 of 4 strata of cardiovascular health: favorable levels of all factors, 0 factors high but ≥1 elevated risk factors, 1 high risk factor, and ≥2 high risk factors. Linked Medicare and National Death Index data from 1984 to 2010 were used to determine morbidity in older age. An individual's all-cause morbidity score and cardiovascular morbidity score were calculated from International Classification of Disease, Ninth Revision codes for each year of follow-up. We included 25 804 participants who became ≥65 years of age by 2010, representing 65% of all original CHA participants (43% female; 90% white; mean age, 44 years at baseline); 6% had favorable levels of all factors, 19% had ≥1 risk factors at elevated levels, 40% had 1 high risk factor, and 35% had ≥2 high risk factors. Favorable cardiovascular health at younger ages extended survival by almost 4 years and postponed the onset of all-cause and cardiovascular morbidity by 4.5 and 7 years, respectively, resulting in compression of morbidity in both absolute and relative terms. This translated to lower cumulative and annual healthcare costs for those in favorable cardiovascular health ( P <0.001) during Medicare eligibility. Individuals in favorable cardiovascular health in early middle age live a longer, healthier life free of all types of morbidity. These findings provide strong support for prevention efforts earlier in life aimed at preserving cardiovascular health and reducing

Perinatal risk factors for pneumothorax and morbidity and mortality in very low birth weight infants.

PubMed

García-Muñoz Rodrigo, Fermín; Urquía Martí, Lourdes; Galán Henríquez, Gloria; Rivero Rodríguez, Sonia; Tejera Carreño, Patricia; Molo Amorós, Silvia; Cabrera Vega, Pedro; Rodríguez Ramón, Fernando

2017-11-01

To determine the perinatal risk factors for pneumothorax in Very-Low-Birth-Weight (VLBW) infants and the associated morbidity and mortality in this population. Retrospective analysis of data collected prospectively from a cohort of VLBW neonates assisted in our Unit (2006-2013). We included all consecutive in-born patients with ≤ 1500 g, without severe congenital anomalies. Perinatal history, demographics, interventions and clinical outcomes were collected. Associations were evaluated by logistic regression analysis. During the study period, 803 VLBW infants were assisted in our Unit, of whom 763 were inborn. Ten patients (1.2%) died in delivery room, and 18 (2.2%) with major congenital anomalies were excluded. Finally, 735 (91.5%) neonates were included in the study. Seventeen (2.3%) developed pneumothorax during the first week of life [median (IQR): 2 (1-2) days]. After correcting for GA and other confounders, prolonged rupture of membranes [aOR =1.002 (95% CI 1.000-1.003); p = 0.040] and surfactant administration [aOR = 6.281 (95% CI 1.688-23.373); p = 0.006] were the independent risk factors associated with pneumothorax. Patients with pneumothorax had lower probabilities of survival without major brain damage (MBD): aOR = 0.283 (95% CI = 0.095-0.879); p = 0.029. Pneumothorax in VLBW seems to be related to perinatal inflammation and surfactant administration, and it is significantly associated with a reduction in the probabilities of survival without MBD.

Ten years and 100,000 participants later: occupational and other factors influencing participation in US Gulf War health registries.

PubMed

Smith, Tyler C; Smith, Besa; Ryan, Margaret A K; Gray, Gregory C; Hooper, Tomoko I; Heller, Jack M; Dalager, Nancy A; Kang, Han K; Gackstetter, Gary D

2002-08-01

For more than a decade after the Gulf War, there has been concern that wartime exposures have resulted in significant morbidity among Gulf War veterans. After the end of the war, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) initiated health registries to provide systematic clinical evaluations of Gulf War veterans who chose to participate. By September 1999, there were 32,876 participants in the DoD Comprehensive Clinical Evaluation Program and 70,385 participants in the VA Gulf War Registry Health Examination Program. We identified demographic and military service factors, as well as potential war-related exposures associated with subsequent registry participation after 10 years of observation. Veterans potentially exposed to oil well fire smoke, those near Khamisiyah, Reserve and National Guard, Army veterans, and veterans in the theater of operations during intense combat periods were most likely to elect to participate in a registry. These findings support the hypothesis that certain occupational factors and wartime exposures may influence subsequent health care-seeking behavior.

Factors Influencing Teaching Choice in Turkey

ERIC Educational Resources Information Center

Kilinc, Ahmet; Watt, Helen M. G.; Richardson, Paul W.

2012-01-01

Why choose to become a teacher in Turkey? The authors examined motivations and perceptions among preservice teachers (N = 1577) encompassing early childhood, primary and secondary education. The Factors Influencing Teaching Choice (FIT-Choice) instrument was translated into Turkish and its construct validity and reliability assessed. Altruistic…

Factors Influencing Part-time Faculty Engagement With Online Nursing Programs.

PubMed

Reneau, Margaret; Wallace, Cara; Claywell, Lora; Price, Jill; Burdi, Melissa; Trybulski, Joanne

2018-03-28

This research investigated factors that influenced the engagement of part-time faculty teaching in online nursing programs with their institutions. Of the 257 part-time faculty surveyed, the most significant factor was being supported in decisions regarding student issues, followed by institutional commitment to quality online education. Compensation was moderately influential; a negative factor was requiring too frequent meetings. Understanding factors that influence the engagement of part-time faculty teaching in online nursing programs can help leaders of online programs attract and retain experienced, highly skilled faculty.

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

Factors That Influence the Practice of Elective Induction of Labor

PubMed Central

Moore, Jennifer; Low, Lisa Kane

2012-01-01

Elective induction of labor has been linked to increased rates of prematurity and rising rates of cesarean birth. The purpose of this investigation was to evaluate current trends in induction of labor scholarship focusing on evidence-based factors that influence the practice of elective induction. A key word search was conducted to identify studies on the practice of elective induction of labor. Analysis of the findings included clustering and identification of recurrent themes among the articles with 3 categories being identified. Under each category, the words/phrases were further clustered until a construct could be named. A total of 49 articles met inclusion criteria: 7 patient, 6 maternity care provider, and 4 organization factors emerged. Only 4 of the articles identified were evidence based. Patient factors were divided into preferences/convenience, communication, fear, pressure/influence, trust, external influences, and technology. Provider factors were then divided into practice preferences/convenience, lack of information, financial incentives, fear, patient desire/demand, and technology. Organization factors were divided into lack of enforcement/accountability, hospital culture, scheduling of staff, and market share issues. Currently, there is limited data-based information focused on factors that influence elective induction of labor. Despite patient and provider convenience/preferences being cited in the literature, the evidence does not support this practice. PMID:22843006

[Hypothermia risk factors in the very low weight newborn and associated morbidity and mortality in a neonatal care unit].

PubMed

García-Muñoz Rodrigo, F; Rivero Rodríguez, S; Siles Quesada, C

2014-03-01

Heat loss in the newborn after delivery could interfere with post-natal adaptation due to metabolic and hemodynamic instability. Associated perinatal factors and their relationship with morbidity and mortality during the neonatal period have not been systematically studied in our unit. To determine the temperature of very low birth weight (VLBW) infants on admission to our NICU, and to determine the associated perinatal variables, and the association of temperature with morbidity and mortality. Infants born in our maternity from January 2006 to November 2012, with birth weights (BW) 401 g to 1,499 g and/or less than 30 weeks gestational age, were included. A multivariate analysis was performed using the perinatal variables and the temperature on admission, as well as a logistic regression between these and the morbidity-mortality variables, in order to detect any independent associations. A total of 635 infants were included, with a mean (± SD) birth weight and gestational age of 1,137.6 ± 257.6g, and 29.5 ± 2.0 weeks, respectively. The mean admission temperature was 35.8 ± 0.6°C (range: 33.0-37.8°C). The proportion of infants with a temperature < 36°C was 44.4%. Independently associated perinatal variables were chorioamnionitis, birth weight, vaginal delivery, and advanced cardiopulmonary resuscitation (CPR). Admission hypothermia was associated with severe intraventricular haemorrhage (IVH) (grades 3 and 4) (OR: 0.377; 95% CI: 0.221-0.643; P<.001), and mortality (OR: 0.329; 95% CI: 0.208-0.519; P=.012). Hypothermia on admission is frequent among our VLBW infants. Birth weight, vaginal delivery, and advanced CPR were the principal variables associated with hypothermia. A low temperature on admission was related to an increased risk of IVH and mortality. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Depression and Anxiety as Risk Factors for Morbidity and Mortality After Organ Transplantation: A Systematic Review and Meta-Analysis.

PubMed

Dew, Mary Amanda; Rosenberger, Emily M; Myaskovsky, Larissa; DiMartini, Andrea F; DeVito Dabbs, Annette J; Posluszny, Donna M; Steel, Jennifer; Switzer, Galen E; Shellmer, Diana A; Greenhouse, Joel B

2015-05-01

Depression and anxiety are common mental health problems in transplant populations. There is mixed evidence concerning whether they increase morbidity and mortality risks after transplantation. If such associations exist, additional risk reduction strategies may be needed. Four bibliographic databases were searched from 1981 through September 2014 for studies prospectively examining whether depression or anxiety (determined with diagnostic evaluations or standardized symptom scales) affected risk for posttransplant mortality, graft loss, acute graft rejection, chronic rejection, cancer, infection, and rehospitalization. Twenty-seven studies (10 heart, total n = 1738; 6 liver, n = 1063; 5 kidney, n = 49515; 4 lung, n = 584; 1 pancreas, n = 80; 1 mixed recipient sample, n = 205) were identified. In each, depression and/or anxiety were typically measured before or early after transplantation. Follow-up for outcomes was a median of 5.8 years (range, 0.50-18.0). Depression increased the relative risk (RR) of mortality by 65% (RR, 1.65; 95% confidence interval [95% CI], 1.34-2.05; 20 studies). Meta-regression indicated that risk was stronger in studies that did (vs did not) control for potential confounders (P = .032). Risk was unaffected by type of transplant or other study characteristics. Depression increased death-censored graft loss risk (RR, 1.65; 95% CI, 1.21-2.26, 3 studies). Depression was not associated with other morbidities (each morbidity was assessed in 1-4 studies). Anxiety did not significantly increase mortality risk (RR, 1.39; 95% CI, 0.85-2.27, 6 studies) or morbidity risks (assessed in single studies). Depression increases risk for posttransplant mortality. Few studies considered morbidities; the depression-graft loss association suggests that linkages with morbidities deserve greater attention. Depression screening and treatment may be warranted, although whether these activities would reduce posttransplant mortality requires study.

Factors influencing bladder stone formation in patients with spinal cord injury.

PubMed

Favazza, Terry; Midha, Meena; Martin, Jessicca; Grob, B Mayer

2004-01-01

Bladder stones that form in patients with spinal cord injury (SCI) can cause significant morbidity. This study sought to analyze factors associated with bladder stone formation to determine which patients might be at increased risk to develop bladder stones. A review of 56 SCI patients treated for bladder calculi over a 10-year period at a single institution was performed. These patients were compared with a control population of general SCI patients known to be stone free. The factors compared were patient age, duration of injury, level of injury, completeness of injury, method of bladder management, and the presence of documented urinary tract infections with urease-producing organisms. All patients with stones were male and had a median age of 58.5 years. The median level of injury was C6, the median time since injury was 21 years, 66% had complete injuries, 68% managed their bladders with indwelling catheters or suprapubic tubes, and 83% had a history of infections with urease-producing organisms. When compared with the control group, patients forming bladder stones were older (P = 0.03), were more likely to have indwelling catheters (P < 0.0001), had a history of infections with urease-producing organisms (P = 0.04), and had complete injuries (P = 0.018). This information can be used to identify patients who have an increased risk of bladder stones and measures can be taken to reduce their incidence and morbidity.

Factors which influence necropsy requests: a psychological approach.

PubMed Central

Start, R. D.; Hector-Taylor, M. J.; Cotton, D. W.; Startup, M.; Parsons, M. A.; Kennedy, A.

1992-01-01

AIMS: To determine which factors influence a clinician's decision to request a necropsy. METHODS: Patient age, confidence in premortem diagnosis, relatives' attitudes, and conditions of necropsy practice were combined factorially (two levels each) in separate medical and surgical questionnaires based on clinical case histories. The interactions between the factors were measured by a repeated measures factorial analysis of variance for each of the two clinical groups. The influence of the clinician's interest in necropsies on these interactions was also examined by a similar method. RESULTS: Necropsies were more likely to be requested on young patients, when diagnostic confidence was low, and when relatives' attitudes were favourable. Conditions of necropsy practice did not affect the likelihood of a request and there was no apparent overall difference in necropsy requests between the two groups of clinicians. The "patient age" and "relatives" factors had less influence on the decision of the surgical group to request necropsy. This was attributed to the opportunity to "see for themselves" at operation and was supported by the finding that surgeons were very likely to request necropsies in the absence of surgical intervention. Clinicians from both groups with a high pre-existing interest in the necropsy were consistently more likely to request necropsies. CONCLUSIONS: The "case history" based questionnaires successfully measured the relative influence of multiple factors in relation to the decision of clinicians to request a necropsy. These findings suggest that any attempt to reverse the decline in necropsy rates should focus on changing the clinician's perception of the value of the modern necropsy. PMID:1556237

Factors influencing women's decisions about timing of motherhood.

PubMed

Benzies, Karen; Tough, Suzanne; Tofflemire, Karen; Frick, Corine; Faber, Alexandra; Newburn-Cook, Christine

2006-01-01

To examine the factors that influence women's decisions about the timing of motherhood from a life span perspective. Qualitative. Large Western Canadian city with a high rate of infants born to women aged 35 years and older. 45 Canadian women aged 20 to 48 years. Independence, a stable relationship, and declining fertility influenced women's decisions about the timing of motherhood. Women integrated child developmental transitions into a projected life plan as they considered the timing of motherhood. Partner readiness and family of origin influences played a lesser role. Delayed childbearing has become more socially acceptable, with subsequent negative connotations associated with younger motherhood. Parental benefits have limited influence on the timing of motherhood. Recognition by nurses of the various and complex factors that influence women's decisions about the timing of motherhood may flag the importance of pregnancy-related counseling for woman across the fertility life span. Policy decision makers must be cognizant of the need for additional high-risk obstetric and neonatal health services when societal norms encourage women to delay childbearing in favor of completing education and establishing a career. (c) 2006, AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses

Prenatal docosahexaenoic acid supplementation and infant morbidity: randomized controlled trial.

PubMed

Imhoff-Kunsch, Beth; Stein, Aryeh D; Martorell, Reynaldo; Parra-Cabrera, Socorro; Romieu, Isabelle; Ramakrishnan, Usha

2011-09-01

Long-chain polyunsaturated fatty acids such as docosahexaenoic acid (DHA) influence immune function and inflammation; however, the influence of maternal DHA supplementation on infant morbidity is unknown. We investigated the effects of prenatal DHA supplementation on infant morbidity. In a double-blind randomized controlled trial conducted in Mexico, pregnant women received daily supplementation with 400 mg of DHA or placebo from 18 to 22 weeks' gestation through parturition. In infants aged 1, 3, and 6 months, caregivers reported the occurrence of common illness symptoms in the preceding 15 days. Data were available at 1, 3, and 6 months for 849, 834, and 834 infants, respectively. The occurrence of specific illness symptoms did not differ between groups; however, the occurrence of a combined measure of cold symptoms was lower in the DHA group at 1 month (OR: 0.76; 95% CI: 0.58-1.00). At 1 month, the DHA group experienced 26%, 15%, and 30% shorter duration of cough, phlegm, and wheezing, respectively, but 22% longer duration of rash (all P ≤ .01). At 3 months, infants in the DHA group spent 14% less time ill (P < .0001). At 6 months, infants in the DHA group experienced 20%, 13%, 54%, 23%, and 25% shorter duration of fever, nasal secretion, difficulty breathing, rash, and "other illness," respectively, but 74% longer duration of vomiting (all P < .05). DHA supplementation during pregnancy decreased the occurrence of colds in children at 1 month and influenced illness symptom duration at 1, 3, and 6 months.

Prenatal Docosahexaenoic Acid Supplementation and Infant Morbidity: Randomized Controlled Trial

PubMed Central

Imhoff-Kunsch, Beth; Stein, Aryeh D.; Martorell, Reynaldo; Parra-Cabrera, Socorro; Romieu, Isabelle

2011-01-01

OBJECTIVE: Long-chain polyunsaturated fatty acids such as docosahexaenoic acid (DHA) influence immune function and inflammation; however, the influence of maternal DHA supplementation on infant morbidity is unknown. We investigated the effects of prenatal DHA supplementation on infant morbidity. METHODS: In a double-blind randomized controlled trial conducted in Mexico, pregnant women received daily supplementation with 400 mg of DHA or placebo from 18 to 22 weeks' gestation through parturition. In infants aged 1, 3, and 6 months, caregivers reported the occurrence of common illness symptoms in the preceding 15 days. RESULTS: Data were available at 1, 3, and 6 months for 849, 834, and 834 infants, respectively. The occurrence of specific illness symptoms did not differ between groups; however, the occurrence of a combined measure of cold symptoms was lower in the DHA group at 1 month (OR: 0.76; 95% CI: 0.58–1.00). At 1 month, the DHA group experienced 26%, 15%, and 30% shorter duration of cough, phlegm, and wheezing, respectively, but 22% longer duration of rash (all P ≤ .01). At 3 months, infants in the DHA group spent 14% less time ill (P < .0001). At 6 months, infants in the DHA group experienced 20%, 13%, 54%, 23%, and 25% shorter duration of fever, nasal secretion, difficulty breathing, rash, and “other illness,” respectively, but 74% longer duration of vomiting (all P < .05). CONCLUSIONS: DHA supplementation during pregnancy decreased the occurrence of colds in children at 1 month and influenced illness symptom duration at 1, 3, and 6 months. PMID:21807696

Factors influencing internal color of cooked meats.

PubMed

Suman, Surendranath P; Nair, Mahesh N; Joseph, Poulson; Hunt, Melvin C

2016-10-01

This manuscript overviews the pertinent research on internal color of uncured cooked meats, biochemical processes involved in meat cookery, and fundamental mechanisms governing myoglobin thermal stability. Heat-induced denaturation of myoglobin, responsible for the characteristic dull-brown color of cooked meats, is influenced by a multitude of endogenous (i.e., pH, muscle source, species, redox state) and exogenous (i.e., packaging, ingredients, storage) factors. The interactions between these factors critically influence the internal cooked color and can confuse the consumers, who often perceive cooked color to be a reliable indicator for doneness and safety. While certain phenomena in cooked meat color are cosmetic in nature, others can mislead consumers and result in foodborne illnesses. Research in meat color suggests that processing technologies and cooking practices in industry as well as households influence the internal cooked color. Additionally, the guidelines of many international public health and regulatory authorities recommend using meat thermometers to determine safe cooking endpoint temperature and to ensure product safety. Copyright © 2016 Elsevier Ltd. All rights reserved.

Factors Influencing the Decline in Stroke Mortality

PubMed Central

Lackland, Daniel T.; Roccella, Edward J.; Deutsch, Anne; Fornage, Myriam; George, Mary G.; Howard, George; Kissela, Brett; Kittner, Steven J.; Lichtman, Judith H.; Lisabeth, Lynda; Schwamm, Lee H.; Smith, Eric E.; Towfighi, Amytis

2017-01-01

Background and Purpose Stroke mortality has been declining since the early twentieth century. The reasons for this are not completely understood, although the decline is welcome. As a result of recent striking and more accelerated decreases in stroke mortality, stroke has fallen from the third to the fourth leading cause of death in the United States. This has prompted a detailed assessment of the factors associated with this decline. This review considers the evidence of various contributors to the decline in stroke risk and mortality and can be used in the design of future interventions regarding this major public health burden. Methods Writing group members were nominated by the committee chair and co-chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council’s Scientific Statement Oversight Committee and the AHA’s Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize evidence and indicate gaps in current knowledge. All members of the writing group had the opportunity to comment and approved the final version of this document. The document underwent extensive AHA internal peer review, Stroke Council Leadership review and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results The decline in stroke mortality over the past decades represents a major improvement in population health and is observed for both genders, and all race and age groups. In addition to the overall impact on fewer lives lost to stroke, the major decline in stroke mortality seen among individuals less than 65 years of age represents a reduction on years of potential life lost. The decline in

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…

Laparoscopic Sleeve Gastrectomy Improves Olfaction Sensitivity in Morbidly Obese Patients.

PubMed

Hancı, Deniz; Altun, Huseyin; Altun, Hasan; Batman, Burcin; Karip, Aziz Bora; Serin, Kursat Rahmi

2016-03-01

Olfactory abilities of the patients are known to be altered by eating and metabolic disorders, including obesity. There are only a number of studies investigating the effect of obesity on olfaction, and there is limited data on the changes in olfactory abilities of morbidly obese patients after surgical treatment. Here we investigated the changes in olfactory abilities of 54 morbidly obese patients (M/F, 22/32; age range 19-57 years; body mass index (BMI) range 30.5-63.0 kg/m(2)) after laparoscopic sleeve gastrectomy. A laparoscopic sleeve gastrectomy was performed by the same surgeon using five-port technique. Olfactory abilities were tested preoperatively and 1, 3, and 6 months after the surgery using a standardized Sniffin' Sticks Extended Test kit. Analyses of variance indicated statistically significant improvement in T, D, and I scores of morbidly obese patients within time factors (preoperative vs. 1, 3, and 6 months; 1 vs. 3 and 6 months; and 3 vs. 6 months; p < 0.001 for all). There was a statistically significant improvement in overall TDI scores with an increase from 25 to 41 during the 6 months follow-up period (p < 0.001 for all). Here, for the first time in literature, we were able to show the significant improvement in olfactory abilities of morbidly obese patients after laparoscopic sleeve gastrectomy.

Surgery for prosthetic valve endocarditis: associations between morbidity, mortality and costs†

PubMed Central

Grubitzsch, Herko; Christ, Torsten; Melzer, Christoph; Kastrup, Marc; Treskatsch, Sascha; Konertz, Wolfgang

2016-01-01

OBJECTIVES Surgery for prosthetic valve endocarditis (PVE) is associated with significant morbidity and mortality as well as with increased resource utilization and costs. For risk and cost reduction, an understanding of contributing factors and interrelations is essential. METHODS Out of 1080 heart valve procedures performed between January 2010 and December 2012, 41 patients underwent surgery for PVE. Complete economic data were available for 30 of them (study cohort). The patients' mean age was 64 ± 12 years (range 37–79 years), and 73% were men. The clinical course was reviewed and morbidity, mortality and costs as well as associations between them were analysed. The cost matrix for each individual patient was obtained from the Institute for the Hospital Remuneration System (InEK GmbH, Germany). The median follow-up was 2.6 years [interquartile range (IQR) 3.7 years; 100% complete]. RESULTS Preoperative status was critical (EuroSCORE II >20%) in 43% of patients. Staphylococci were the most common infecting micro-organisms (27%). The operative mortality rate (≤30 days) was 17%. At 1 year, the overall survival rate was 71 ± 9%. At least one disease- or surgery-related complication affected 21 patients (early morbidity 70%), >1 complication affected 12 patients (40%). There was neither a recurrence of endocarditis, nor was a reoperation required. The mean total hospital costs were 42.6 ± 37.4 Thousand Euro (T€), median 25.7 T€, IQR 28.4 T€ and >100 T€ in 10% of cases. Intensive care unit/intermediate care (ICU/IMC) and operation accounted for 40.4 ± 18.6 and 25.7 ± 12.1% of costs, respectively. There was a significant correlation (Pearson's sample correlation coefficient) between total costs and duration of hospital stay (r = 0.83, P < 0.001) and between ICU/IMC costs and duration of ICU/IMC stay (r = 0.97, P < 0.001). The median daily hospital costs were 1.8 T€/day, but >2.4 T€/day in 25% of patients (upper quartile). The following pattern of

Factors Influencing Career Aspirations of Primary and Secondary Grade Students.

ERIC Educational Resources Information Center

Canale, Joseph R.; Dunlap, Linda L.

Many studies have examined factors influencing the career aspirations of high school students, but little has been done to explore this issue with primary school students. This study investigated factors that might influence the career aspirations of children across a broad age spectrum. Students (N=150) from grades 2, 5, 8, and 12 completed…

Factors influencing selection of office furniture by corporations and universities

Treesearch

R. Bruce Anderson

1976-01-01

Evaluation of the factors that influence the selection of office furniture by large corporations and universities shows that quality, appearance, and purchase price have the most important influence on the purchase decision. The intended use of the furniture and the appearance of the furniture were the key factors in the purchase of wooden furniture.

Child Health in the Peruvian Amazon: Prevalence and Factors Associated with Referred Morbidity and Health Care Access in the City of Iñapari

PubMed Central

Guimarães, Maria Gabriela Silva; Braña, Athos Muniz; Oliart-Guzmán, Humberto; Branco, Fernando Luiz Cunha Castelo; Delfino, Breno Matos; Pereira, Thasciany Moraes; Mantovani, Saulo Augusto Silva; Martins, Antonio Camargo; Santos, Ana Paula; Filgueira-Júnior, José Alcântara; Ramalho, Alanderson Alves; Guimarães, Andreia da Silva; Oliveira, Cristieli Sérgio de Menezes; de Araújo, Thiago Santos; Estrada, Carlos Hermógenes Manrique de Lara; Arróspide, Nancy; da Silva-Nunes, Mônica

2015-01-01

Introduction. Children under 5 years of age are more susceptible to developing morbidities such as diarrhea, respiratory infections, anemia, and malnutrition. The objective of the study is to evaluate the prevalence of reported morbidities in this age group in the city of Iñapari (Peru) and the access to health services in this municipality. Methods. Data collection using interviews that assessed socioeconomic and demographic conditions, child morbidity, and access to health services was performed in 2011. Statistical analysis was performed using SPSS 13.0. Results. Regarding morbidities that occurred during lifetime, 39.8% reported previous anemia and intestinal parasite infection. About 53.7% of the children reported any type of morbidities in the last 15 days before interview, being most frequent respiratory symptoms (38.9%), diarrhea (23,4%), and fever (23,1%). Only 63.1% of those reporting recent morbidities sought health care. These morbidities were associated with precarious sanitation and lack of infrastructure, the presence of other comorbidities, and poor access to health services. Conclusion. The main referred morbidities in Amazonian Peruvian children were diarrhea, respiratory symptoms, anemia, and vomiting. Incentives and improvements in the health and sanitation conditions would be important measures to improve the quality of life of the Amazonian child population. PMID:26640493

Aging with a traumatic brain injury: Could behavioral morbidities and endocrine symptoms be influenced by microglial priming?

PubMed

Ziebell, Jenna M; Rowe, Rachel K; Muccigrosso, Megan M; Reddaway, Jack T; Adelson, P David; Godbout, Jonathan P; Lifshitz, Jonathan

2017-01-01

A myriad of factors influence the developmental and aging process and impact health and life span. Mounting evidence indicates that brain injury, even moderate injury, can lead to lifetime of physical and mental health symptoms. Therefore, the purpose of this mini-review is to discuss how recovery from traumatic brain injury (TBI) depends on age-at-injury and how aging with a TBI affects long-term recovery. TBI initiates pathophysiological processes that dismantle circuits in the brain. In response, reparative and restorative processes reorganize circuits to overcome the injury-induced damage. The extent of circuit dismantling and subsequent reorganization depends as much on the initial injury parameters as other contributing factors, such as genetics and age. Age-at-injury influences the way the brain is able to repair itself, as a result of developmental status, extent of cellular senescence, and injury-induced inflammation. Moreover, endocrine dysfunction can occur with TBI. Depending on the age of the individual at the time of injury, endocrine dysfunction may disrupt growth, puberty, influence social behaviors, and possibly alter the inflammatory response. In turn, activation of microglia, the brain's immune cells, after injury may continue to fuel endocrine dysfunction. With age, the immune system develops and microglia become primed to subsequent challenges. Sustained inflammation and microglial activation can continue for weeks to months post-injury. This prolonged inflammation can influence developmental processes, behavioral performance and age-related decline. Overall, brain injury may influence the aging process and expedite glial and neuronal alterations that impact mental health. Copyright © 2016 Elsevier Inc. All rights reserved.

Cerebrospinal Fluid Pressure: Revisiting Factors Influencing Optic Nerve Head Biomechanics

PubMed Central

Hua, Yi; Voorhees, Andrew P.; Sigal, Ian A.

2018-01-01

Purpose To model the sensitivity of the optic nerve head (ONH) biomechanical environment to acute variations in IOP, cerebrospinal fluid pressure (CSFP), and central retinal artery blood pressure (BP). Methods We extended a previously published numerical model of the ONH to include 24 factors representing tissue anatomy and mechanical properties, all three pressures, and constraints on the optic nerve (CON). A total of 8340 models were studied to predict factor influences on 98 responses in a two-step process: a fractional factorial screening analysis to identify the 16 most influential factors, followed by a response surface methodology to predict factor effects in detail. Results The six most influential factors were, in order: IOP, CON, moduli of the sclera, lamina cribrosa (LC) and dura, and CSFP. IOP and CSFP affected different aspects of ONH biomechanics. The strongest influence of CSFP, more than twice that of IOP, was on the rotation of the peripapillary sclera. CSFP had similar influence on LC stretch and compression to moduli of sclera and LC. On some ONHs, CSFP caused large retrolamina deformations and subarachnoid expansion. CON had a strong influence on LC displacement. BP overall influence was 633 times smaller than that of IOP. Conclusions Models predict that IOP and CSFP are the top and sixth most influential factors on ONH biomechanics. Different IOP and CSFP effects suggest that translaminar pressure difference may not be a good parameter to predict biomechanics-related glaucomatous neuropathy. CON may drastically affect the responses relating to gross ONH geometry and should be determined experimentally. PMID:29332130

Differences in resuscitation in morbidly obese burn patients may contribute to high mortality.

PubMed

Rae, Lisa; Pham, Tam N; Carrougher, Gretchen; Honari, Shari; Gibran, Nicole S; Arnoldo, Brett D; Gamelli, Richard L; Tompkins, Ronald G; Herndon, David N

2013-01-01

extent of their lower BMI counterparts (P values .04 and .03). Complications and morbidities across BMI groups were similar, although examination of organ failure scores indicated more severe organ dysfunction in the morbidly obese group. Compared with being normal weight, being morbidly obese was an independent risk factor for death (odds ratio = 10.1; confidence interval, 1.94-52.5; P = .006). Morbidly obese patients with severe burns tend to receive closer to predicted fluid resuscitation volumes for their actual weight. However, this patient group has persistent metabolic acidosis during the resuscitation phase and is at risk of developing more severe multiple organ failure. These factors may contribute to higher mortality risk in the morbidly obese burn patient.

Factors That Influence Technology Integration in the Classroom

ERIC Educational Resources Information Center

Montgomery, Maureen C.

2017-01-01

Education is one area where the use of technology has had great impact on student learning. The integration of technology in teaching and learning can significantly influence the outcome of education in the classroom. However, there are a myriad of factors that influence technology integration in the classroom. The purpose of this study was to…

Factors influencing the, selection of state office furniture

Treesearch

R. Bruce Anderson; R. Bruce Anderson

1973-01-01

Evaluation of the factors influencing the selection of office furniture by nine state governments shows that quality and purchase price have the most important influence on the purchase decision. The intended use of the furniture and the purchasing regulations of the states were key f8CbrS in the use of wood furniture.

Relative importance of natural and anthropogenic factors influencing karst rocky desertification

NASA Astrophysics Data System (ADS)

Xu, Erqi; Zhang, Hongqi

2017-04-01

As the most severe ecological issue in southwest China, karst rocky desertification (KRD) has both threatened and constrained regional sustainable development. Comprehensively understanding the relationship between the evolution of KRD and relevant driving data would provide more information to combat KRD in such complex karst environments. Past studies have been limited in quantifying the relative importance of driving factors influencing fine-scale KRD evolution, and have also lacked insight into their interactive impacts. To address these issues, we have used geographical information system techniques and a geographical detector model to explore the spatial consistency of driving factors and their interactions in relation to the evolution of KRD. Changshun County in China was selected as a representative area for the study. Nine relevant driving factors, including both natural and anthropogenic factors, were studied in regard to their relationships with KRD transformation between 2000 and 2010. Our results demonstrate the relative importance of driving data in influencing the improvement and deterioration of KRD. Lithology, soil type and road influence are identified as the leading factors. Interestingly, to our study at least, there is no significant difference between the impacts of natural and anthropogenic factors influencing KRD improvement, and even natural factors have a higher impact on KRD deterioration. Factors were found to enhance the influence of each other for KRD transformation. In particular, the results show a non-linearly enhanced effect between driving factors, which significantly aggravates KRD. New information found in our study helps to effectively control and restore areas afflicted by KRD.

Thromboxane production in morbidly obese subjects.

PubMed

Graziani, Francesca; Biasucci, Luigi M; Cialdella, Pio; Liuzzo, Giovanna; Giubilato, Simona; Della Bona, Roberta; Pulcinelli, Fabio M; Iaconelli, Amerigo; Mingrone, Geltrude; Crea, Filippo

2011-06-01

Postmortem studies have demonstrated that morbidly obese subjects, surprisingly, have less coronary atherosclerosis than obese subjects. However, the reasons for this apparent protection from atherosclerosis are not yet clear. Thromboxane A2, a marker of platelet activation, is greater in obese subjects than in lean subjects, and this might be a clue to their increased cardiovascular risk. However, data on thromboxane A2 in morbidly obese subjects are lacking; therefore, we hypothesized that lower levels of thromboxane A2 in morbidly obese subjects might play a role in their lower atherothrombotic burden. We measured the serum levels of thromboxane B2 (TxB2), a stable metabolite of thromboxane A2, high-sensitivity C-reactive protein (hs-CRP) and leptin in 17 lean subjects (body mass index [BMI] 22.9 ± 1.6 kg/m(2)), 25 obese subjects (BMI 32.6 ± 2.4 kg/m(2)), and 23 morbidly obese subjects (BMI 48.6 ± 7.1 kg/m(2)), without insulin resistance, diabetes, or overt cardiovascular disease. The serum TxB2 levels were lower in the lean subjects than in the obese subjects (p = 0.046) and in the morbidly obese subjects than in the lean and obese subjects (p = 0.015 and p <0.001, respectively). In contrast, the hs-CRP and leptin levels were greater in the obese than in the lean subjects (hs-CRP, p <0.001; leptin, p <0.001) and in the morbidly obese subjects than in the lean subjects (p <0.001 for both). Leptin was also higher in the morbidly obese subjects than in the obese subjects (p <0.001). TxB2 negatively correlated with leptin and BMI. hs-CRP correlated with leptin, and both also correlated with waist circumference, BMI, and homeostasis model assessment of insulin-resistance. In conclusion, insulin-sensitive morbidly obese subjects had lower levels of TxB2 than the obese subjects and lean subjects, suggesting that reduced platelet activation could play a role in the paradoxical protection of morbidly obese subjects from atherosclerosis, despite the greater levels of

Ethnic Variations in Severe Maternal Morbidity in the UK– A Case Control Study

PubMed Central

Nair, Manisha; Kurinczuk, Jennifer J.; Knight, Marian

2014-01-01

Background Previous studies showed a higher risk of maternal morbidity amongst black and other minority ethnic (BME) groups, but were unable to investigate whether this excess risk was concentrated within specific BME groups in the UK. Our aim was to analyse the specific risks and to investigate reasons for any disparity. Methods Unmatched case-control analysis using data from the United Kingdom Obstetric Surveillance System (UKOSS), February 2005-January 2013. Cases were 1,753 women who experienced severe morbidity during the peripartum period. Controls were 3,310 women who delivered immediately before the cases in the same hospital. Multivariable logistic regression modelling was used to adjust for known confounders and to understand their effects. Results Compared with white European women, the odds of severe maternal morbidity were 83% higher among black African women (adjusted odds ratio (aOR) = 1.83; 95% Confidence Interval (CI) = 1.39–2.40), 80% higher among black Caribbean (aOR = 1.80; 95% CI = 1.14–2.82), 74% higher in Bangladeshi (aOR = 1.74; 95% CI = 1.05–2.88), 56% higher in other non-whites (non-Asian) (aOR = 1.56; 95% CI = 1.05–2.33) and 43% higher among Pakistani women (aOR = 1.43; 95% CI = 1.07–1.92). There was no evidence of substantial confounding. Anaemia in current pregnancy, previous pregnancy problems, inadequate utilisation of antenatal care, pre-existing medical conditions, parity>3, and being younger and older were independent risk factors but, the odds of severe maternal morbidity did not differ by socioeconomic status, between smokers and non-smokers or by BMI. Discussion This national study demonstrates an increased risk of severe maternal morbidity among women of ethnic minority backgrounds which could not be explained by known risk factors for severe maternal morbidity. PMID:24743879

Factors that influence women's health in Tanzania.

PubMed

Lugina, H I

1994-01-01

A descriptive account of factors that influence women's health in Tanzania is given. The social and cultural processes that enhance or undermine women's health are emphasized. Recommendations for changes to improve women's health are made.

Psychosocial factors for influencing healthy aging in adults in Korea.

PubMed

Han, KyungHun; Lee, YunJung; Gu, JaSung; Oh, Hee; Han, JongHee; Kim, KwuyBun

2015-03-07

Healthy aging includes physical, psychological, social, and spiritual well-being in later years. The purpose of this study is to identify the psychosocial factors influencing healthy aging and examining their socio-demographic characteristics. Perceived health status, depression, self-esteem, self-achievement, ego-integrity, participation in leisure activities, and loneliness were identified as influential factors in healthy aging. 171 Korean adults aged between 45 and 77 years-old participated in the study. Self-reporting questionnaires were used, followed by descriptive statistics and multiple regressions as inferential statistical analyses. There were significant differences between participants' general characteristics: age, education, religion, housing, hobby, and economic status. The factors related to healthy aging had positive correlation with perceived health status, self-esteem, self-achievements, and leisure activities, and negative correlation with depression and loneliness. The factors influencing healthy aging were depression, leisure activities, perceived health status, ego integrity, and self-achievements. These factors were able to explain 51.9%. According to the results, depression is the factor with the greatest influence on healthy aging. Perceived health status, ego integrity, self-achievement, self-esteem, participation of leisure activities were also influential on healthy aging as beneficial factors.

A brief review of salient factors influencing adult eating behaviour.

PubMed

Emilien, Christine; Hollis, James H

2017-12-01

A better understanding of the factors that influence eating behaviour is of importance as our food choices are associated with the risk of developing chronic diseases such as obesity, CVD, type 2 diabetes or some forms of cancer. In addition, accumulating evidence suggests that the industrial food production system is a major contributor to greenhouse gas emission and may be unsustainable. Therefore, our food choices may also contribute to climate change. By identifying the factors that influence eating behaviour new interventions may be developed, at the individual or population level, to modify eating behaviour and contribute to society's health and environmental goals. Research indicates that eating behaviour is dictated by a complex interaction between physiology, environment, psychology, culture, socio-economics and genetics that is not fully understood. While a growing body of research has identified how several single factors influence eating behaviour, a better understanding of how these factors interact is required to facilitate the developing new models of eating behaviour. Due to the diversity of influences on eating behaviour this would probably necessitate a greater focus on multi-disciplinary research. In the present review, the influence of several salient physiological and environmental factors (largely related to food characteristics) on meal initiation, satiation (meal size) and satiety (inter-meal interval) are briefly discussed. Due to the large literature this review is not exhaustive but illustrates the complexity of eating behaviour. The present review will also highlight several limitations that apply to eating behaviour research.

Alternative Administrative Certification: Socializing Factors Influencing Program Choice

ERIC Educational Resources Information Center

Bickmore, Dana L.; Bickmore, Steven T.; Raines, Sarah

2013-01-01

This study used an organizational socialization lens to examine factors influencing participants' decision to pursue the principalship and choice to engage in an alternate administration certification program. Through an analysis of participant focus groups and interviews, factors emerged from the codes that were compared with dimensions of…

Factors Influencing the Fatigue Strength of Materials

NASA Technical Reports Server (NTRS)

Bollenrath, F

1941-01-01

A number of factors are considered which influence the static and fatigue strength of materials under practical operating conditions as contrasted with the relations obtaining under conditions of the usual testing procedure. Such factors are interruptions in operation, periodically fluctuating stress limits and mean stresses with periodic succession of several groups and stress states, statistical changes and succession of stress limits and mean stresses, frictional corrosion at junctures, and notch effects.

Impact of Malaria at the End of Pregnancy on Infant Mortality and Morbidity

PubMed Central

Sigauque, Betuel; Sanz, Sergi; Maixenchs, María; Ordi, Jaume; Aponte, John J; Mabunda, Samuel; Alonso, Pedro L; Menéndez, Clara

2011-01-01

Background. There is some consensus that malaria in pregnancy may negatively affect infant's mortality and malaria morbidity, but there is less evidence concerning the factors involved. Methods. A total of 1030 Mozambican pregnant women were enrolled in a randomized, placebo-controlled trial of intermittent preventive treatment with sulfadoxine-pyrimethamine, and their infants were followed up throughout infancy. Overall mortality and malaria morbidity rates were recorded. The association of maternal and fetal risk factors with infant mortality and malaria morbidity was assessed. Results. There were 58 infant deaths among 997 live-born infants. The risk of dying during infancy was increased among infants born to women with acute placental infection (odds ratio [OR], 5.08 [95% confidence interval (CI), 1.77–14.53)], parasitemia in cord blood (OR, 19.31 [95% CI, 4.44–84.02]), low birth weight (OR, 2.82 [95% CI, 1.27–6.28]) or prematurity (OR, 3.19 [95% CI, 1.14–8.95]). Infants born to women who had clinical malaria during pregnancy (OR, 1.96 [95% CI, 1.13–3.41]) or acute placental infection (OR, 4.63 [95% CI, 2.10–10.24]) had an increased risk of clinical malaria during infancy. Conclusions. Malaria infection at the end of pregnancy and maternal clinical malaria negatively impact survival and malaria morbidity in infancy. Effective clinical management and prevention of malaria in pregnancy may improve infant's health and survival. PMID:21199881

How modifiable factors influence parental decision-making about organ donation.

PubMed

Luberda, Kamila; Cleaver, Karen

2017-11-07

A global shortage of organs from children and adults available for transplantation is compounded by the failure of next of kin to consent for organs to be donated after death. Non-modifiable and modifiable factors influence decision-making in this area. Modifiable factors are of interest when examining families' decision-making about the donation of organs from their deceased child. A scoping review was undertaken to determine how modifiable factors influence parental decision-making about organ donation. Thematic analysis identified two themes: interactions with healthcare professionals and pre-disposition to organ donation. Satisfaction with experiences of hospital care, the information provided and the way it was communicated, as well as interactions pertaining to emotional support were all found to be modifiable factors that influenced decision making. Likewise, a predisposition to organ donation and knowing the deceased's wishes were associated with the consent decision. Nurses working in critical care environments need to be able to support parents during this difficult time. This article aims to raise awareness of modifiable factors that influence parental decision-making, highlighting their relevance for children's nursing practice. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

The dark side of the moon: impact of moon phases on long-term survival, mortality and morbidity of surgery for lung cancer.

PubMed

Kuehnl, A; Herzog, M; Schmidt, M; Hornung, H-M; Jauch, K-W; Hatz, R A; Graeb, C

2009-04-16

Superstition is common and causes discomfiture or fear, especially in patients who have to undergo surgery for cancer. One superstition is, that moon phases influence surgical outcome. This study was performed to analyse lunar impact on the outcome following lung cancer surgery. 2411 patients underwent pulmonary resection for lung cancer in the past 30 years at our institution. Intra- and postoperative complications as well as long-term follow-up data were entered in our lung-cancer database. Factors influencing mortality, morbidity and survival were analyzed. Rate of intra-operative complications as well as rate of post-operative morbidity and mortality was not significantly affected by moon phases. Furthermore, there was no significant impact of the lunar cycle on long-term survival. In this study there was no evidence that outcome of surgery for lung cancer is affected by the moon. These results may help the physician to quiet the mind of patients who are somewhat afraid of wrong timing of surgery with respect to the moon phases. However, patients who strongly believe in the impact of moon phase should be taken seriously and correct timing of operations should be conceded to them as long as key-date scheduling doesn't constrict evidence based treatment regimens.

Respiratory morbidity among street sweepers working at Hanumannagar Zone of Nagpur Municipal Corporation, Maharashtra.

PubMed

Yogesh, Sabde D; Zodpey, Sanjay P

2008-01-01

Due to the occupational exposure street sweepers are very much vulnerable to develop the chronic diseases of respiratory system. Therefore this study was undertaken to find out the proportion of chronic respiratory morbidity among the street sweepers and the role of various associated risk factors. The study included two groups: study group i.e. street sweepers and comparison group (Class IV workers working in the office buildings). Various risk factors studied were age, sex, socioeconomic status, length of service, smoking habit, type of house, area of residence, cooking fuel and pets. Proportion of chronic respiratory morbidity (chronic bronchitis, asthma and bronchiectasis) was higher (8.1%) among street sweepers compared to comparison group (2.1%), the difference being statistically significant. Unconditional multivariate logistic regression revealed that risk of having chronic respiratory morbidity among street sweepers was 4.24 (95% CI of OR = 1.24 to 14.50) times higher than that in the comparison group and the risk increased significantly with increasing length of service (OR = 1.75, 95 % CI = 1.09 to 2.81).

Determinants of childhood morbidity in Bangladesh: evidence from the Demographic and Health Survey 2011.

PubMed

Kamal, Md Moustafa; Hasan, Md Masud; Davey, Rachel

2015-10-28

The present study aims to estimate the incidence of preventable infectious diseases or associated symptoms among young children in Bangladesh and also determine the factors affecting these conditions. The study hypothesised that various background characteristics of children as well as their parents influence the incidence of morbidity of children aged below 5 years. The study used data from the most recent nationally representative cross-sectional Bangladesh Demographic and Health Survey (BDHS) conducted in 2011. A total of 7550 children aged below 5 years during the survey from mothers aged between 12 and 49 years are the participants of the study. In general, younger children were more likely to suffer from multiple health conditions than their older counterparts. Children belonging to households classified as poor (OR=1.425, 95% CI (1.130 to 1.796)) or middle (OR=1.349, 95% CI (1.113 to 1.636)) faced greater risk of illness than those from well-off households. A combination of source and treatment practices of drinking water showed a significant impact on incidence of childhood morbidity. Children from households using untreated non-piped water were 85.8% (OR=1.860, 95% CI (1.269 to 2.728)) more likely to suffer from comorbidity than those who treat their piped drinking water. However, we observed that water treatment alone has no impact unless the water itself was sourced from a pipe. Accelerated programmes promoting access to safe drinking water along with water treatment practices, and better household environment may prove effective in reducing the incidence of childhood morbidity in Bangladesh. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Compression of morbidity 1980-2011: a focused review of paradigms and progress.

PubMed

Fries, James F; Bruce, Bonnie; Chakravarty, Eliza

2011-01-01

The Compression of Morbidity hypothesis-positing that the age of onset of chronic illness may be postponed more than the age at death and squeezing most of the morbidity in life into a shorter period with less lifetime disability-was introduced by our group in 1980. This paper is focused upon the evolution of the concept, the controversies and responses, the supportive multidisciplinary science, and the evolving lines of evidence that establish proof of concept. We summarize data from 20-year prospective longitudinal studies of lifestyle progression of disability, national population studies of trends in disability, and randomized controlled trials of risk factor reduction with life-style-based "healthy aging" interventions. From the perspective of this influential and broadly cited paradigm, we review its current history, the development of a theoretical structure for healthy aging, and the challenges to develop coherent health policies directed at reduction in morbidity.

[The dynamics of the occupational morbidity rate in the Eastern Siberia].

PubMed

Pankov, V A; Lakhman, O L; Perezhogin, A N; Tyutkina, G A; Kuleshova, M V; Smirnova, O V

The dynamics and structure of the occupational morbidity rate in main branches of the industry in the Eastern Siberia for the 2000-2015 (on the example of the Irkutsk region) is presented in this paper. During the observation period there were noted the significant gain in the number of cases of occupational diseases registered in such different branches of industry as Coal and Lignite Mining, ship and aircraft building, and in some other branches (metallurgical production, air transport, pulp production, electric power distribution industry). In the structure of the occupational morbidity leading positions are occupied by diseases associated with the exposure to physical factors, industrial aerosols, physical overload and overexertion of certain organs and systems. The main reasons and factors contributing to the gain of the occupational morbidity rate are the imperfection of technological processes, working places, personal protective equipment and/or their lack, constructive defects of machines and equipment, the violation of safety regulations, regimen of the work and rest, insufficiently high level of medical and preventive maintenance, delayed making of decisions for the rational employment to the workers with the revealed early forms of occupational diseases. There pointed out priority directions of the prevention the implementation of which will allow to decline the level of the occupational morbidity rate. The main directions are the implementation of economically caused mechanisms of the interest in the preservation of workers ’ health; implementation of the regional aimed programs; the introduction of new processes, equipment and mechanisms meeting modern hygienic requirements; the assessment of occupational risk with the creation and implementation of the system of monitoring for the dynamics of working conditions and the state of the workers ’ health for the making corrective management solutions on the optimization and elevation of the efficacy

Expanding the scope beyond mortality: burden and missed opportunities in maternal morbidity in Indonesia.

PubMed

Widyaningsih, Vitri; Khotijah; Balgis

2017-01-01

factors for maternal morbidity, as well as increasing healthcare coverage for the vulnerable population.

Expanding the scope beyond mortality: burden and missed opportunities in maternal morbidity in Indonesia

PubMed Central

Widyaningsih, Vitri; Khotijah; Balgis

2017-01-01

opportunities in maternal healthcare. Efforts are needed to identify risk factors for maternal morbidity, as well as increasing healthcare coverage for the vulnerable population. PMID:28649930

Prospective morbidity surveillance of Shell refinery and petrochemical employees.

PubMed Central

Tsai, S P; Dowd, C M; Cowles, S R; Ross, C E

1991-01-01

Results for a prospective morbidity study of 14,170 refinery and chemical workers from 1981 through 1988 are presented. Illness/absence data for this study were extracted from the morbidity section of the Shell Health Surveillance System which includes records of all illness/absences in excess of five days. Age adjusted annual morbidity frequency rates and annual durations of absence are presented by age, sex, job, and work status. Generally, rates and durations of absence were highest for older age groups, women, and production workers. Increased risk was associated with the presence of known disease risk factors. Overall, 48% of the employees had at least one illness/absence in excess of five days during the eight year period. Twelve per cent of the employees had four or more absences, which accounted for 54% of the total number of absences and 52% of the total work days lost. Among men, the five most common conditions accounted for 72% of all illness/absences. In descending order they were injuries (25%), respiratory illnesses (17%), musculoskeletal disorders (14%), digestive illnesses (9%), and heart disease (7%). Similar patterns were noted among women. These findings may be useful in setting priorities and directing efforts such as health education programmes and other strategies for the prevention of disease. PMID:2015205

Social and Cultural Contexts of Alcohol Use: Influences in a Social-Ecological Framework.

PubMed

Sudhinaraset, May; Wigglesworth, Christina; Takeuchi, David T

2016-01-01

Alcohol use and misuse account for 3.3 million deaths every year, or 6 percent of all deaths worldwide. The harmful effects of alcohol misuse are far reaching and range from individual health risks, morbidity, and mortality to consequences for family, friends, and the larger society. This article reviews a few of the cultural and social influences on alcohol use and places individual alcohol use within the contexts and environments where people live and interact. It includes a discussion of macrolevel factors, such as advertising and marketing, immigration and discrimination factors, and how neighborhoods, families, and peers influence alcohol use. Specifically, the article describes how social and cultural contexts influence alcohol use/misuse and then explores future directions for alcohol research.

Brief Report: Children with ADHD without Co-Morbid Autism Do Not Have Impaired Motor Proficiency on the Movement Assessment Battery for Children

ERIC Educational Resources Information Center

Papadopoulos, Nicole; Rinehart, Nicole; Bradshaw, John L.; McGinley, Jennifer L.

2013-01-01

Motor proficiency was investigated in a sample of children with Attention Deficit Hyperactivity Disorder-Combined type (ADHD-CT) without autism. Accounting for the influence of co-morbid autistic symptoms in ADHD motor studies is vital given that motor impairment has been linked to social-communication symptoms in children who have co-morbid ADHD…

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

Maternal Smoking During Pregnancy and the Risk of Psychiatric Morbidity in Singleton Sibling Pairs

PubMed Central

Lehtonen, Liisa; Korkeila, Jyrki; Gissler, Mika

2017-01-01

Abstract Introduction: Maternal smoking during pregnancy has been associated with an increased risk for psychiatric morbidity. We further studied this with Finnish siblings to control for genetic/familial factors. Methods: From the Finnish Medical Birth Register, sibling pairs were selected as the first two children born 1987–1995 to the same mother (n = 150 168 pairs), along with information on maternal smoking (no smoking/smoking). Information on the children’s psychiatric diagnoses related to outpatient care visits (1998–2013) and inpatient care (1987–2013), and the mothers’ psychiatric morbidity (1969–2013) was derived from the Finnish Hospital Discharge Register. The first pair analysis compared siblings of mothers who only smoked in the first pregnancy (Quitters, 4.7%) and mothers who smoked in both pregnancies (Smokers, 9.6%); the second analysis included mothers who smoked only in the second pregnancy (Starters, 3.3%) and mothers who did not smoke in either pregnancy (Nonsmokers, 77.5%). Smoking information was missing for 5.0% of pairs. Psychiatric morbidity of the siblings and mother was included in the statistical analyses. Results: The risk of psychiatric diagnoses was significantly lower for the second child of quitters (adjusted OR 0.77, 95% CI 0.72–0.83) compared to the risk among smokers. A higher risk for psychiatric diagnoses was found for the second child of starters (1.39, 1.30–1.49) compared to the risk among nonsmokers. The effect of smoking was more robust for externalizing diagnoses. Conclusions: Maternal smoking was independently associated with a higher risk for psychiatric morbidity in children, even when controlling thoroughly for genetic and familial factors. Implications: Maternal smoking during pregnancy has an independent effect on the risk of psychiatric morbidity in children, even after controlling for non-measurable genetic/familial factors by using a sibling pair design. The effect of maternal smoking was robust

Factors influencing laser cutting of wood

Treesearch

V.G. Barnekov; C.W. McMillin; H.A. Huber

1986-01-01

Factors influencing the ability of lasers to cut wood may be generally classified into these three areas: 1) characteristics of the laser beam; 2) equipment and processing variables; and 3) properties of the workpiece. Effects of beam power, mode, polarization, and stability are discussed as are aspects of optics, location of focal point, feed speed, gas-jet assist...

Review on Factors Influencing Physician Guideline Adherence in Cardiology.

PubMed

Hoorn, C J G M; Crijns, H J G M; Dierick-van Daele, A T M; Dekker, L R C

2018-04-09

Cardiovascular disease is the most common cause of death in Western countries. Physician adherence to guidelines is often suboptimal, resulting in impaired patient outcome and prognosis. Multiple studies have been conducted to evaluate patterns and the influencing factors of patient adherence, but little is known about factors influencing physician guideline adherence. This review aims to identify factors influencing physician guideline adherence relevant to cardiology and to provide insights and suggestions for future improvement. Physician adherence was measured as adherence to standard local medical practice and applicable guidelines. Female gender and older age had a negative effect on physician guideline adherence. In addition, independent of the type of heart disease, physicians without cardiologic specialization were linked to physician noncompliance. Also, guideline adherence in primary care centers was at a lower level compared to secondary or tertiary care centers. The importance of guideline adherence increases as patients age, and complex diseases and comorbidity arise. Appropriate resources and interventions, taking important factors for nonadherence in account, are necessary to improve guideline adoption and adherence in every level of the chain. This in turn should improve patient outcome.

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

Surgery for prosthetic valve endocarditis: associations between morbidity, mortality and costs.

PubMed

Grubitzsch, Herko; Christ, Torsten; Melzer, Christoph; Kastrup, Marc; Treskatsch, Sascha; Konertz, Wolfgang

2016-06-01

Surgery for prosthetic valve endocarditis (PVE) is associated with significant morbidity and mortality as well as with increased resource utilization and costs. For risk and cost reduction, an understanding of contributing factors and interrelations is essential. Out of 1080 heart valve procedures performed between January 2010 and December 2012, 41 patients underwent surgery for PVE. Complete economic data were available for 30 of them (study cohort). The patients' mean age was 64 ± 12 years (range 37-79 years), and 73% were men. The clinical course was reviewed and morbidity, mortality and costs as well as associations between them were analysed. The cost matrix for each individual patient was obtained from the Institute for the Hospital Remuneration System (InEK GmbH, Germany). The median follow-up was 2.6 years [interquartile range (IQR) 3.7 years; 100% complete]. Preoperative status was critical (EuroSCORE II >20%) in 43% of patients. Staphylococci were the most common infecting micro-organisms (27%). The operative mortality rate (≤30 days) was 17%. At 1 year, the overall survival rate was 71 ± 9%. At least one disease- or surgery-related complication affected 21 patients (early morbidity 70%), >1 complication affected 12 patients (40%). There was neither a recurrence of endocarditis, nor was a reoperation required. The mean total hospital costs were 42.6 ± 37.4 Thousand Euro (T€), median 25.7 T€, IQR 28.4 T€ and >100 T€ in 10% of cases. Intensive care unit/intermediate care (ICU/IMC) and operation accounted for 40.4 ± 18.6 and 25.7 ± 12.1% of costs, respectively. There was a significant correlation (Pearson's sample correlation coefficient) between total costs and duration of hospital stay (r = 0.83, P < 0.001) and between ICU/IMC costs and duration of ICU/IMC stay (r = 0.97, P < 0.001). The median daily hospital costs were 1.8 T€/day, but >2.4 T€/day in 25% of patients (upper quartile). The following pattern of associations was identified

Librarians' Perspectives on the Factors Influencing Research Data Management Programs

ERIC Educational Resources Information Center

Faniel, Ixchel M.; Connaway, Lynn Silipigni

2018-01-01

This qualitative research study examines librarians' research data management (RDM) experiences, specifically the factors that influence their ability to support researchers' needs. Findings from interviews with 36 academic library professionals in the United States identify 5 factors of influence: (1) technical resources; (2) human resources; (3)…

Depression and Anxiety as Risk Factors for Morbidity and Mortality after Organ Transplantation: A Systematic Review and Meta-Analysis1

PubMed Central

Dew, Mary Amanda; Rosenberger, Emily M.; Myaskovsky, Larissa; DiMartini, Andrea F.; DeVito Dabbs, Annette J.; Posluszny, Donna M.; Steel, Jennifer; Switzer, Galen E.; Shellmer, Diana A.; Greenhouse, Joel B.

2015-01-01

Background Depression and anxiety are common mental health problems in transplant populations. There is mixed evidence concerning whether they increase morbidity and mortality risks post-transplant. If such associations exist, additional risk reduction strategies may be needed. Methods Four bibliographic databases were searched from 1981 through September, 2014 for studies prospectively examining whether depression or anxiety (determined with diagnostic evaluations or standardized symptom scales) affected risk for post-transplant mortality, graft loss, acute graft rejection, chronic rejection, cancer, infection, and rehospitalization. Results Twenty-seven studies (10 heart, total n=1,738; 6 liver, n=1,063; 5 kidney, n=49,515; 4 lung, n=584; 1 pancreas, n=80; 1 mixed recipient sample, n=205) were identified. In each, depression and/or anxiety were typically measured pre- or early post-transplant. Follow-up for outcomes was a median of 5.8 years (range:0.50–18.0). Depression increased the relative risk (RR) of mortality by 65% (RR=1.65, 95% CI:1.34,2.05; 20 studies). Meta-regression indicated that risk was stronger in studies that did (v. did not) control for potential confounders(p=.032). Risk was unaffected by type of transplant or other study characteristics. Depression increased death-censored graft loss risk (RR=1.65, CI:1.21,2.26, 3 studies). Depression was not associated with other morbidities (each morbidity assessed in 1–4 studies). Anxiety did not significantly increase mortality risk (RR=1.39, CI:0.85,2.27, 6 studies) or morbidity risks (assessed in single studies). Conclusions Depression increases risk for post-transplant mortality. Few studies considered morbidities; the depression-graft loss association suggests that linkages with morbidities deserve greater attention. Depression screening and treatment may be warranted, although whether these activities would reduce post-transplant mortality requires study. PMID:26492128

Factors influencing societal response of nanotechnology: an expert stakeholder analysis

NASA Astrophysics Data System (ADS)

Gupta, Nidhi; Fischer, Arnout R. H.; van der Lans, Ivo A.; Frewer, Lynn J.

2012-05-01

Nanotechnology can be described as an emerging technology and, as has been the case with other emerging technologies such as genetic modification, different socio-psychological factors will potentially influence societal responses to its development and application. These factors will play an important role in how nanotechnology is developed and commercialised. This article aims to identify expert opinion on factors influencing societal response to applications of nanotechnology. Structured interviews with experts on nanotechnology from North West Europe were conducted using repertory grid methodology in conjunction with generalized Procrustes analysis to examine the psychological constructs underlying societal uptake of 15 key applications of nanotechnology drawn from different areas (e.g. medicine, agriculture and environment, chemical, food, military, sports, and cosmetics). Based on expert judgement, the main factors influencing societal response to different applications of nanotechnology will be the extent to which applications are perceived to be beneficial, useful, and necessary, and how 'real' and physically close to the end-user these applications are perceived to be by the public.

[Influencing factors in preparation of brucine liposomes by ammonium sulfate transmembrane gradients].

PubMed

Wang, Wei; Chen, Jun; Cai, Bao-Chang; Fang, Yun

2008-09-01

To study the influencing factors in preparation of brucine liposomes by ammonium sulfate transmembrane gradients. The brucine liposomes were separated by Sephadex G-50, and the influence of various factors on the entrapment efficiencies were investigated. The entrapment efficiency was enhanced by increased ammonium sulfate concentration, ethanol volume and PC concentration. Burcine liposomes prepared by ammonium sulfate transmembrance gradients can get a high entrapment efficiency, the main influencing factors were ammonium sulfate concentration, ethanol volume and PC concentration.

Influencing factors associated with the mode of birth among childbearing women in Hunan Province: a cross-sectional study in China.

PubMed

Shi, Yuhui; Jiang, Ying; Zeng, Qingqi; Yuan, Yanfei; Yin, Hui; Chang, Chun; Pang, Ruyan

2016-05-16

An unnecessary Caesarean section (CS) can cause increased maternal and perinatal morbidity and other adverse short- and long-term outcomes. However, countries worldwide have witnessed an increasing trend toward the use of CS. Our objectives were to explore the influencing factors associated with the mode of birth among childbearing women in Hunan Province and to provide evidence and suggestions for the improvement and further understanding of vaginal birth (VB) in China. A total of 977 childbearing women (375 pregnant women and 602 mothers of infants) were enrolled in this study using a two-stage cluster sampling method, and a self-administered questionnaire was used to collect data relating to the mode of birth. A t-test and χ (2)-test were used to analyse the differences between groups, and logistic regression analysis was used to explore the factors that influenced the mode of birth. The VB ratio was 46.2 %, while the CS ratio was 53.8 % in Hunan Province. Among women whose preference was VB, only 69.4 % gave birth by VB. Among women whose preference was CS, 98.1 % gave birth by CS. The top four reasons for preferring CS were a lack of confidence in VB (37.3 %), an abnormality in the prenatal examination (36.6 %), the notion that the baby would suffer fewer risks (34.8 %) and the fear of pain from VB (32.7 %). Age, prenatal examination, and doctors' suggestion were significantly associated with women's mode of birth preference, while place of household registration, husband's preference, prenatal examination and doctors' suggestion had a significant influence on women who changed their choice from VB to CS. The percentage of CS in Hunan was extremely high. Medical factors, such as abnormalities in prenatal examinations, and non-medical factors, such as a lack of confidence in VB, the fear of pain during VB, the desire to select the time of birth and healthy birth systems, should be seriously considered. Targeted health promotion interventions should be

Factors influencing return to work after illness in France.

PubMed

Pélissier, C; Fontana, L; Chauvin, F

2014-01-01

Few studies have been published about the factors influencing return to work after sickness absence. To identify medical and occupational factors influencing the type of fitness certificate given by occupational physicians before employees return to work after sickness absence. A cross-sectional study was undertaken over 3 months in several health services in France. Workers undergoing a medical examination before returning to work after a period of sickness absence of at least 3 weeks were included. Medical and occupational factors were collected using a questionnaire. The relationship between different factors and certification of fitness was assessed by univariate and multivariate analyses. Among the 402 workers included, 64% were considered fit to return to work. Being older, strenuous work, prolonged sick leave and fear of returning to work appeared to be negative factors influencing the return to a previous job. In contrast, having an education level higher than secondary school, being satisfied at work, perception of very good health and benefitting from satisfactory professional relationships appeared to favour return to work. We developed a predictive score of not being fit to return to work after illness. Our study highlighted the relationship between medical and occupational factors with problems returning to work. The predictive score may be used by occupational physicians as a screening tool to identify those who are likely to have difficulties returning to work after illness, so that their working conditions can be modified to take this into consideration.

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

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

PubMed

Furuta, Marie; Sandall, Jane; Bick, Debra

2012-11-10

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. 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. 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 symptoms, an association possibly

Stakeholder Perceptions of Governance: Factors Influencing Presidential Perceptions of Board Effectiveness

ERIC Educational Resources Information Center

Proper, Eve; Willmer, Wesley K.; Hartley, Harold V., III; Caboni, Timothy C.

2009-01-01

This article examines the factors that influence presidents' perceptions of board effectiveness in relation to their boards' fundraising role. Data from a survey of small college presidents are used to see what factors influence each of four areas of satisfaction: deciding policy, making financial contributions, referring donor prospects and…

[Morbidity with temporary disability in railway tunnel workers].

PubMed

Kudrin, V A; Prokhorov, A A

2003-01-01

The paper presents data on the health status of a large professional group of transport building workers--those who build BAM railway tunnels and those who build Moscow and Saint Petersburg underground stations. Major factors that are associated with underground work and that form the level of morbidity with temporary disability are identified. Respiratory, osteomuscular, digestive diseases, accidents, intoxications, and injuries are predominant in the structure of temporary disability. Lines of better organization of therapeutical-and-prophylactic aid to this contingent are defined.

Factors influencing the food choices of Irish children and adolescents: a qualitative investigation.

PubMed

Fitzgerald, Amanda; Heary, Caroline; Nixon, Elizabeth; Kelly, Colette

2010-09-01

Food choices established during childhood and adolescence tend to persist into adulthood with consequences for long-term health. Yet, to date, relatively little research has examined factors that influence the food choices of children and adolescents from their perspectives. In this article, previous research is extended by examining developmental differences between children's and adolescents' perceptions of factors influencing their food choices. Focus group discussions were conducted with 29 young people from three age groups (9-10, 13-14 and 16-18 years). An inductive thematic analysis identified three key factors as influencing food choices. These factors included intra-individual factors: the link between food preferences and awareness of healthy eating; intra-familial factors: the role of the home food environment; and extra-familial factors: eating away from the home. Findings indicate that there were developmental differences between children's and adolescents' perceptions of factors influencing food choice. Among adolescents, parental control began to diminish and adolescents exercised increased autonomy over their food choices compared with children. To develop effective nutrition interventions, it is important to gather child and adolescent input regarding factors perceived as influencing their food choices.

Pretransplant cachexia and morbid obesity are predictors of increased mortality after heart transplantation.

PubMed

Lietz, K; John, R; Burke, E A; Ankersmit, J H; McCue, J D; Naka, Y; Oz, M C; Mancini, D M; Edwards, N M

2001-07-27

Extremes in body weight are a relative contraindication to cardiac transplantation. We retrospectively reviewed 474 consecutive adult patients (377 male, 97 female, mean age 50.3+/-12.2 years), who received 444 primary and 30 heart retransplants between January of 1992 and January of 1999. Of these, 68 cachectic (body mass index [BMI]<20 kg/m2), 113 overweight (BMI=>27-30 kg/m2), and 55 morbidly obese (BMI>30 kg/m2) patients were compared with 238 normal-weight recipients (BMI=20-27 kg/m2). We evaluated the influence of pretransplant BMI on morbidity and mortality after cardiac transplantation. Kaplan-Meier survival distribution and Cox proportional hazards model were used for statistical analyses. Morbidly obese as well as cachectic recipients demonstrated nearly twice the 5-year mortality of normal-weight or overweight recipients (53% vs. 27%, respectively, P=0.001). An increase in mortality was seen at 30 days for morbidly obese and cachectic recipients (12.7% and 17.7%, respectively) versus a 30-day mortality rate of 7.6% in normal-weight recipients. Morbidly obese recipients experienced a shorter time to high-grade acute rejection (P=0.004) as well as an increased annual high-grade rejection frequency when compared with normal-weight recipients (P=0.001). By multivariable analysis, the incidence of transplant-related coronary artery disease (TCAD) was not increased in morbidly obese patients but cachectic patients had a significantly lower incidence of TCAD (P=0.05). Cachectic patients receiving oversized donor hearts had a significantly higher postoperative mortality (P=0.02). The risks of cardiac transplantation are increased in both morbidly obese and cachectic patients compared with normal-weight recipients. However, the results of cardiac transplantation in overweight patients is comparable to that in normal-weight patients. Recipient size should be kept in mind while selecting patients and the use of oversized donors in cachectic recipients should be

Intrinsic factors influencing help-seeking behaviour in an acute stroke situation.

PubMed

Zock, Elles; Kerkhoff, Henk; Kleyweg, Ruud Peter; van de Beek, Diederik

2016-09-01

The proportion of stroke patients eligible for intravenous or intra-arterial treatment is still limited because many patients do not seek medical help immediately after stroke onset. The aim of our study was to explore which intrinsic factors and considerations influence help-seeking behaviour of relatively healthy participants, confronted with stroke situations. Semi-structured interviews were conducted with 25 non-stroke participants aged 50 years or older. We presented 5 clinical stroke situations as if experienced by the participants themselves. Recognition and interpretation of symptoms were evaluated and various factors influencing help-seeking behaviour were explored in-depth. We used the thematic synthesis method for data analysis. Five themes influencing help-seeking behaviour in a stroke situation were identified: influence of knowledge, views about seriousness, ideas about illness and health, attitudes towards others and beliefs about the emergency medical system. A correct recognition of stroke symptoms or a correct interpretation of the stroke situations did not automatically result in seeking medical help. Interestingly, similar factors could lead to different types of actions between participants. Many intrinsic, as well as social and environmental factors are of influence on help-seeking behaviour in an acute stroke situation. All these factors seem to play a complex role in help-seeking behaviour with considerable inter-individual variations. Accomplishing more patients eligible for acute stroke treatment, future research should focus on better understanding of all factors at various levels grounded in a theory of help-seeking behaviour.

From Hospital to Nursing Facility: Factors Influencing Decisions

ERIC Educational Resources Information Center

Mason, Susan E.; Auerbach, Charles; LaPorte, Heidi Heft

2009-01-01

This study addresses the factors influencing decisions to send medicine-surgical (med-surg) patients home or to nursing facilities (NFs). The sample (n = 7,852) was taken from a large, urban, teaching, med-surg unit where discharges were documented and data collected over a two-and-a-half-year period. Using logistical regression, the factors found…

Professional Identity Development in Higher Education: Influencing Factors

ERIC Educational Resources Information Center

Barbarà-i-Molinero, Alba; Cascón-Pereira, Rosalía; Hernández-Lara, Ana beatriz

2017-01-01

Purpose: In the last few years, the interest on professional identity development (PID) and the factors that influence PID has become central in higher education (HE) literature. However, the knowledge developed in this domain has focussed on a factor at a time and on a degree or discipline, thus being difficult to have a general picture of all…

Differences in resuscitation in morbidly obese burn patients may contribute to high mortality

PubMed Central

Rae, Lisa; Pham, Tam N.; Carrougher, Gretchen; Honari, Shari; Gibran, Nicole S.; Arnoldo, Brett D.; Gamelli, Richard L.; Tompkins, Ronald G.; Herndon, David N.

2013-01-01

examination of organ failure scores indicated more severe organ dysfunction in the morbidly obese group. Compared to normal weight patients, being morbidly obese was an independent risk factor for death (OR = 10.1; CI 1.94-52.5, p= 0.006). Conclusions Morbidly obese patients with severe burns tend to receive closer to predicted fluid resuscitation volumes for their actual weight. However, this patient group has persistent metabolic acidosis during the resuscitation phase and is at-risk of developing more severe multiple organ failure. These factors may contribute to higher mortality risk in the morbidly obese burn patient. PMID:23966116

Computer Self-Efficacy and Factors Influencing E-Learning Effectiveness

ERIC Educational Resources Information Center

Chien, Tien-Chen

2012-01-01

Purpose: The purpose of this study is to investigate the influences of system and instructor factors on e-learning effectiveness under the interactions of computer self-efficacy. In this study, the factors of the e-learning system are functionality, interaction, and response. The factors of the e-learning instructor are attitude, technical skills,…

Factors Influencing Intrinsic Motivation towards Physical Activity.

ERIC Educational Resources Information Center

Rutherford, William J.; And Others

1992-01-01

Study examined factors that influenced intrinsic motivation toward physical activity in 60 adult males who completed questionnaires and physical fitness tests. Results showed that performance information given immediately after task performance increased perceived competence and intrinsic motivation levels toward exercise of individuals with…

Factors influencing woodlands of southwestern North Dakota

Treesearch

Michele M. Girard; Harold Goetz; Ardell J. Bjugstad

1987-01-01

Literature pertaining to woodlands of southwestern North Dakota is reviewed. Woodland species composition and distribution, and factors influencing woodland ecosystems such as climate, logging, fire, and grazing are described. Potential management and improvement techniques using vegetation and livestock manipulation have been suggested.

What Motivational Factors Influence African American Males to Enter a Doctorial Program

ERIC Educational Resources Information Center

Humphreys, Phillip

2010-01-01

Purpose: The purpose of this study was to determine the motivational factors that influence African American men to enter a doctoral program by identifying the motivational factors that influenced them to enter a doctorial program. The findings were compared to Dr. Gloria J. Hill's dissertation study (2005), "What Motivational Factors Influence…

Prenatal exposure to gestational diabetes mellitus as an independent risk factor for long-term neuropsychiatric morbidity of the offspring.

PubMed

Nahum Sacks, Kira; Friger, Michael; Shoham-Vardi, Ilana; Abokaf, Hanaa; Spiegel, Efrat; Sergienko, Ruslan; Landau, Daniella; Sheiner, Eyal

2016-09-01

obesity, maternal preeclampsia and fertility treatments, maternal gestational diabetes mellitus was found to be an independent risk factor for long-term neuropsychiatric disease of the offspring (gestational diabetes mellitus A1 [adjusted odds ratio, 1.83; 95% confidence interval, 1.53-2.19] and gestational diabetes mellitus A2 [adjusted odds ratio, 1.64; 95% confidence interval, 1.18-2.27]). Within the limits of our database, our findings also point to a possible association between in utero exposure to gestational diabetes mellitus and autistic spectrum disorder of the offspring (adjusted odds ratio, 4.44; 95% confidence interval, 1.55-12.69), which was found significant also after controlling for time-to-event, maternal age, gestational age at delivery, and offspring weight at birth. Exposure to maternal gestational diabetes mellitus is an independent risk factor for long-term neuropsychiatric morbidity in the offspring. Copyright © 2016 Elsevier Inc. All rights reserved.

Factors influencing the intention to watch online video advertising.

PubMed

Lee, Joonghwa; Lee, Mira

2011-10-01

This study examines the factors influencing consumer intention to watch online video ads, by applying the theory of reasoned action. The attitude toward watching online video ads, the subjective norm, and prior frequency of watching online video ads positively influence the intention to watch online video ads. Further, beliefs held about entertainment and information outcomes from watching online video ads and subjective norm influence attitude toward watching these ads.

Gender as a Modifying Factor Influencing Myotonic Dystrophy Type 1 Phenotype Severity and Mortality: A Nationwide Multiple Databases Cross-Sectional Observational Study.

PubMed

Dogan, Celine; De Antonio, Marie; Hamroun, Dalil; Varet, Hugo; Fabbro, Marianne; Rougier, Felix; Amarof, Khadija; Arne Bes, Marie-Christine; Bedat-Millet, Anne-Laure; Behin, Anthony; Bellance, Remi; Bouhour, Françoise; Boutte, Celia; Boyer, François; Campana-Salort, Emmanuelle; Chapon, Françoise; Cintas, Pascal; Desnuelle, Claude; Deschamps, Romain; Drouin-Garraud, Valerie; Ferrer, Xavier; Gervais-Bernard, Helene; Ghorab, Karima; Laforet, Pascal; Magot, Armelle; Magy, Laurent; Menard, Dominique; Minot, Marie-Christine; Nadaj-Pakleza, Aleksandra; Pellieux, Sybille; Pereon, Yann; Preudhomme, Marguerite; Pouget, Jean; Sacconi, Sabrina; Sole, Guilhem; Stojkovich, Tanya; Tiffreau, Vincent; Urtizberea, Andoni; Vial, Christophe; Zagnoli, Fabien; Caranhac, Gilbert; Bourlier, Claude; Riviere, Gerard; Geille, Alain; Gherardi, Romain K; Eymard, Bruno; Puymirat, Jack; Katsahian, Sandrine; Bassez, Guillaume

2016-01-01

Myotonic Dystrophy type 1 (DM1) is one of the most heterogeneous hereditary disease in terms of age of onset, clinical manifestations, and severity, challenging both medical management and clinical trials. The CTG expansion size is the main factor determining the age of onset although no factor can finely predict phenotype and prognosis. Differences between males and females have not been specifically reported. Our aim is to study gender impact on DM1 phenotype and severity. We first performed cross-sectional analysis of main multiorgan clinical parameters in 1409 adult DM1 patients (>18 y) from the DM-Scope nationwide registry and observed different patterns in males and females. Then, we assessed gender impact on social and economic domains using the AFM-Téléthon DM1 survey (n = 970), and morbidity and mortality using the French National Health Service Database (n = 3301). Men more frequently had (1) severe muscular disability with marked myotonia, muscle weakness, cardiac, and respiratory involvement; (2) developmental abnormalities with facial dysmorphism and cognitive impairment inferred from low educational levels and work in specialized environments; and (3) lonely life. Alternatively, women more frequently had cataracts, dysphagia, digestive tract dysfunction, incontinence, thyroid disorder and obesity. Most differences were out of proportion to those observed in the general population. Compared to women, males were more affected in their social and economic life. In addition, they were more frequently hospitalized for cardiac problems, and had a higher mortality rate. Gender is a previously unrecognized factor influencing DM1 clinical profile and severity of the disease, with worse socio-economic consequences of the disease and higher morbidity and mortality in males. Gender should be considered in the design of both stratified medical management and clinical trials.

The first 1000 days of life: prenatal and postnatal risk factors for morbidity and growth in a birth cohort in southern India.

PubMed

Kattula, Deepthi; Sarkar, Rajiv; Sivarathinaswamy, Prabhu; Velusamy, Vasanthakumar; Venugopal, Srinivasan; Naumova, Elena N; Muliyil, Jayaprakash; Ward, Honorine; Kang, Gagandeep

2014-07-23

To estimate the burden and assess prenatal and postnatal determinants of illnesses experienced by children residing in a semiurban slum, during the first 1000 days of life. Community-based birth cohort Southern India Four hundred and ninety-seven children of 561 pregnant women recruited and followed for 2 years with surveillance and anthropometry. Incidence rates of illness; rates of clinic visits and hospitalisations; factors associated with low birth weight, various illnesses and growth. Data on 10 377.7 child-months of follow-up estimated an average rate of 14.8 illnesses/child-year. Gastrointestinal and respiratory illnesses were 20.6% and 47.8% of the total disease burden, respectively. The hospitalisation rate reduced from 46/100 child-years during infancy to 19/100 child-years in the second year. Anaemia during pregnancy (OR=2.3, 95% CI=1.08 to 5.18), less than four antenatal visits (OR=6.8, 95% CI=2.1 to 22.5) and preterm birth (OR=3.3, 95% CI=1.1 to 9.7) were independent prenatal risk factors for low birth weight. Female gender (HR=0.88, 95% CI=0.79 to 0.99) and 6 months of exclusive breast feeding (HR=0.76, 95% CI=0.66 to 0.88) offered protection against all morbidity. Average monthly height and weight gain were lower in female child and children exclusively breast fed for 6 months. The high morbidity in Indian slum children in the first 1000 days of life was mainly due to prenatal factors and gastrointestinal and respiratory illness. Policymakers need disease prevalence and pathways to target high-risk groups with appropriate interventions in the community. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Political and economic factors influencing contraceptive uptake.

PubMed

Sai, F T

1993-01-01

International, national and local level politics influence the uptake of contraception through consensuses, laws, financial and moral support or the creation of an enabling atmosphere. Opposition to contraception generally comes from some churches and groups opposed to particular technologies. Socio-economic factors, particularly education, the health care system and the perceived or actual cost of fertility regulation as compared to benefits expected from children also powerfully influence contraceptive use. For many poor women in developing countries their powerlessness in relation to their male partners is an important obstacle.

Factors Influencing Professional Help-Seeking for Suicidality.

PubMed

Han, Jin; Batterham, Philip J; Calear, Alison L; Randall, Rebecca

2018-05-01

Evidence suggests that the majority of people with suicidality do not seek help. Little systematic evaluation of factors influencing professional help-seeking has been done. To systematically evaluate the factors that influence professional help-seeking for suicidality. Published quantitative and qualitative studies in Medline and PsycInfo databases were reviewed following PRISMA. In all, 55 relevant studies were identified. Of these, 15 studies examined professional help-seeking intentions for perceived suicidal ideation, among people with or without suicidality; 21 studies examined professional help-seeking behavior among people with suicidality; and 19 studies examined suicidal decedents' health services use. Several potential important barriers were identified including high self-reliance, lack of perceived need for treatment, and stigmatizing attitudes toward suicide, toward mental health issues, and toward seeking professional treatment. The presence of suicidality and mental health issues was found to generally decrease help-seeking intentions for perceived suicidal ideation while facilitating actual service use. Social support and informal support from family and friends also played an important role in professional help-seeking. Although the majority of the included studies were of sound quality, some of the factors identified in the review were assessed in relatively few studies, and most of the included studies were conducted in industrialized countries. Further quantitative and qualitative studies examining the potential important factors in broader community samples, especially in developing countries, are needed.

Factors influencing acceptance of technology for aging in place: a systematic review.

PubMed

Peek, Sebastiaan T M; Wouters, Eveline J M; van Hoof, Joost; Luijkx, Katrien G; Boeije, Hennie R; Vrijhoef, Hubertus J M

2014-04-01

To provide an overview of factors influencing the acceptance of electronic technologies that support aging in place by community-dwelling older adults. Since technology acceptance factors fluctuate over time, a distinction was made between factors in the pre-implementation stage and factors in the post-implementation stage. A systematic review of mixed studies. Seven major scientific databases (including MEDLINE, Scopus and CINAHL) were searched. Inclusion criteria were as follows: (1) original and peer-reviewed research, (2) qualitative, quantitative or mixed methods research, (3) research in which participants are community-dwelling older adults aged 60 years or older, and (4) research aimed at investigating factors that influence the intention to use or the actual use of electronic technology for aging in place. Three researchers each read the articles and extracted factors. Sixteen out of 2841 articles were included. Most articles investigated acceptance of technology that enhances safety or provides social interaction. The majority of data was based on qualitative research investigating factors in the pre-implementation stage. Acceptance in this stage is influenced by 27 factors, divided into six themes: concerns regarding technology (e.g., high cost, privacy implications and usability factors); expected benefits of technology (e.g., increased safety and perceived usefulness); need for technology (e.g., perceived need and subjective health status); alternatives to technology (e.g., help by family or spouse), social influence (e.g., influence of family, friends and professional caregivers); and characteristics of older adults (e.g., desire to age in place). When comparing these results to qualitative results on post-implementation acceptance, our analysis showed that some factors are persistent while new factors also emerge. Quantitative results showed that a small number of variables have a significant influence in the pre-implementation stage. Fourteen out of

Gender and age group differences in suicide risk associated with co-morbid physical and psychiatric disorders in older adults.

PubMed

Vasiliadis, Helen-Maria; Lamoureux-Lamarche, Catherine; Gontijo Guerra, Samantha

2017-02-01

It is unclear whether health service use influences the association between psychiatric and physical co-morbidity and suicide risk in older adults. Controls were older adults (n = 2,494) participating in a longitudinal study on the health of the elderly carried out between 2004 and 2007, in Quebec. The cases were all suicide decedents (n = 493) between 2004 and 2007, confirmed by the Quebec Coroner's office. Multivariate analyses were carried out to test the association between suicide and the presence of psychiatric and physical illnesses controlling for health service use and socio-demographic factors by gender and age group. Interaction terms were also tested between suicide and co-morbidity on outpatient service use. The presence of physical illnesses only, was associated with a reduced risk of suicide across all sex and age groups. The presence of a mental disorder only was associated with an increased risk of suicide overall and specifically in females and those aged 70 to 84 years of age. Suicide risk was lower in those with a psychiatric and physical co-morbidity and consulting mental health services. Increased mental health follow-up in older adults with psychiatric illnesses is needed for the detection of suicidal behavior and reducing suicide risk in males. Further research should focus on the mitigating effect of the presence of physical illnesses on stigma and health service use and the presence of social support in the elderly.

Assessment of Oral Conditions and Quality of Life in Morbid Obese and Normal Weight Individuals: A Cross-Sectional Study

PubMed Central

de Freitas, Adriana Rodrigues; Sales-Peres, Arsênio; Ceneviva, Reginaldo

2015-01-01

The aim of this study was to identify the impact of oral disease on the quality of life of morbid obese and normal weight individuals. Cohort was composed of 100 morbid-obese and 50 normal-weight subjects. Dental caries, community periodontal index, gingival bleeding on probing (BOP), calculus, probing pocket depth, clinical attachment level, dental wear, stimulated salivary flow, and salivary pH were used to evaluate oral diseases. Socioeconomic and the oral impacts on daily performances (OIDP) questionnaires showed the quality of life in both groups. Unpaired Student, Fisher’s Exact, Chi-Square, Mann-Whitney, and Multiple Regression tests were used (p<0.05). Obese showed lower socio-economic level than control group, but no differences were found considering OIDP. No significant differences were observed between groups considering the number of absent teeth, bruxism, difficult mastication, calculus, initial caries lesion, and caries. However, saliva flow was low, and the salivary pH was changed in the obese group. Enamel wear was lower and dentine wear was higher in obese. More BOP, insertion loss, and periodontal pocket, especially the deeper ones, were found in obese subjects. The regression model showed gender, smoking, salivary pH, socio-economic level, periodontal pocket, and periodontal insertion loss significantly associated to obesity. However, both OIDP and BOP did not show significant contribution to the model. The quality of life of morbid obese was more negatively influenced by oral disease and socio-economic factors than in normal weight subjects. PMID:26177268

Assessment of Oral Conditions and Quality of Life in Morbid Obese and Normal Weight Individuals: A Cross-Sectional Study.

PubMed

Yamashita, Joselene Martinelli; Moura-Grec, Patrícia Garcia de; Freitas, Adriana Rodrigues de; Sales-Peres, Arsênio; Groppo, Francisco Carlos; Ceneviva, Reginaldo; Sales-Peres, Sílvia Helena de Carvalho

2015-01-01

The aim of this study was to identify the impact of oral disease on the quality of life of morbid obese and normal weight individuals. Cohort was composed of 100 morbid-obese and 50 normal-weight subjects. Dental caries, community periodontal index, gingival bleeding on probing (BOP), calculus, probing pocket depth, clinical attachment level, dental wear, stimulated salivary flow, and salivary pH were used to evaluate oral diseases. Socioeconomic and the oral impacts on daily performances (OIDP) questionnaires showed the quality of life in both groups. Unpaired Student, Fisher's Exact, Chi-Square, Mann-Whitney, and Multiple Regression tests were used (p<0.05). Obese showed lower socio-economic level than control group, but no differences were found considering OIDP. No significant differences were observed between groups considering the number of absent teeth, bruxism, difficult mastication, calculus, initial caries lesion, and caries. However, saliva flow was low, and the salivary pH was changed in the obese group. Enamel wear was lower and dentine wear was higher in obese. More BOP, insertion loss, and periodontal pocket, especially the deeper ones, were found in obese subjects. The regression model showed gender, smoking, salivary pH, socio-economic level, periodontal pocket, and periodontal insertion loss significantly associated to obesity. However, both OIDP and BOP did not show significant contribution to the model. The quality of life of morbid obese was more negatively influenced by oral disease and socio-economic factors than in normal weight subjects.

Factors in Client–Clinician Interaction That Influence Hearing Aid Adoption

PubMed Central

Jennings, Mary Beth; Shaw, Lynn; Meston, Christine N.; Cheesman, Margaret F.

2011-01-01

The influence of client–clinician interactions has not been emphasized in hearing health care, despite the extensive evidence of the impact of the provider–patient interaction on health outcomes. The purpose of this study was to identify factors in the client–clinician interaction that may influence hearing aid adoption. Thirteen adults who had received a hearing aid recommendation within the previous 3 months and 10 audiologists participated in a study to generate, sort, and rate the importance of factors in client–clinician interaction that may influence the hearing aid purchase decision. A concept mapping approach was used to define meaningful clusters of factors. Quantitative analysis and qualitative interpretation of the statements resulted in eight concepts. The concepts in order of their importance are (a) Ensuring client comfort, (b) Understanding and meeting client needs, (c) Client-centered traits and actions, (d) Acknowledging client as an individual, (e) Imposing undue pressure and discomfort, (f) Conveying device information by clinician, (g) Supporting choices and shared decision making, and (h) Factors in client readiness. Two overarching themes of client-centered interaction and client empowerment were identified. Results highlight the influence of the client–clinician interaction in hearing aid adoption and suggest the possibility of improving hearing aid adoption by empowering clients through a client-centered interaction. PMID:22155784

Profiling contextual factors which influence safety in heavy vehicle industries.

PubMed

Edwards, Jason R D; Davey, Jeremy; Armstrong, Kerry A

2014-12-01

A significant proportion of worker fatalities within Australia result from truck-related incidents. Truck drivers face a number of health and safety concerns. Safety culture, viewed here as the beliefs, attitudes and values shared by an organisation's workers, which interact with their surrounding context to influence behaviour, may provide a valuable lens for exploring safety-related behaviours in heavy vehicle operations. To date no major research has examined safety culture within heavy vehicle industries. As safety culture provides a means to interpret experiences and generate behaviour, safety culture research should be conducted with an awareness of the context surrounding safety. The current research sought to examine previous health and safety research regarding heavy vehicle operations to profile contextual factors which influence health and safety. A review of 104 peer-reviewed papers was conducted. Findings of these papers were then thematically analysed. A number of behaviours and scenarios linked with crashes and non-crash injuries were identified, along with a selection of health outcomes. Contextual factors which were found to influence these outcomes were explored. These factors were found to originate from government departments, transport organisations, customers and the road and work environment. The identified factors may provide points of interaction, whereby culture may influence health and safety outcomes. Copyright © 2014. Published by Elsevier Ltd.

Birth Weight, Physical Morbidity, and Mortality: A Population-based Sibling-Comparison Study

PubMed Central

Class, Quetzal A.; Rickert, Martin E.; Lichtenstein, Paul; D'Onofrio, Brian M.

2014-01-01

Associations between low birth weight (≤2,500 g) and increased risk of mortality and morbidity provided the foundation for the “developmental origins of health and disease” hypothesis. Previous between-family studies could not control for unmeasured confounders. Therefore, we compared differentially exposed siblings to estimate the extent to which the associations were due to uncontrolled factors. Our population cohort included 3,291,773 persons born in Sweden from 1973 to 2008. Analyses controlled for gestational age, among other covariates, and considered birth weight as both an ordinal and a continuous variable. Outcomes included mortality after 1 year, cardiac-related death, hypertension, ischemic heart disease, pulmonary circulation problems, stroke, and type 2 diabetes mellitus. We fitted fixed-effects models to compare siblings and conducted sensitivity analyses to test alternative explanations. Across the population, the lower the birth weight, the greater the risk of mortality (e.g., cardiac-related death (low birth weight hazard ratio = 2.69, 95% confidence interval: 2.05, 3.53)) and morbidity (e.g., type 2 diabetes mellitus (low birth weight hazard ratio = 1.79, 95% confidence interval: 1.50, 2.14)) outcomes in comparison with normal birth weight. All associations were independent of shared familial confounders and measured covariates. Results emphasize the importance of birth weight as a risk factor for subsequent mortality and morbidity. PMID:24355331

Analysis of factors influencing organic fruit and vegetable purchasing in Istanbul, Turkey.

PubMed

Oraman, Yasemin; Unakitan, Gökhan

2010-01-01

This article examines the influences on the purchasing decisions of fruit and vegetable consumers and presents findings from a survey conducted with 385 respondents living in urban areas in Istanbul, Turkey. It uses a binary logistic model to estimate factor effects in organic fruit and vegetable purchasing in Turkey. The results indicate that concern for human health and safety is a key factor that influences consumer preferences for organic food. Findings will help organic product suppliers understand the key factors influencing consumer purchasing and consumption behaviors.

Pakistani medical students' specialty preference and the influencing factors.

PubMed

Rehman, Anis; Rehman, Tariq; Shaikh, Muhammad Ateeb; Yasmin, Haleema; Asif, Ammara; Kafil, Hina

2011-07-01

To elucidate the specialty preferences of Pakistani medical students and the factors which influence medical students to make the decision regarding which specialty to pursue. Both basic sciences and clinical students from four medical colleges of Pakistan, i.e., Dow Medical College, Sindh Medical College, Liaquat National Medical College and Muhammad Medical College, were included in the cross-sectional survey during the period of July 2008 to Jan' 2009. After ethical acceptance, data was collected using convenient sampling technique. The questionnaire covered the following demographic details: 13 common specialties and 15 influencing factors. Questionnaires included in the analysis were 771. Most students gave preference to surgery and its associated sub-specialties (50.3%) followed by internal medicine (26.8%), paediatrics (23.2%), dermatology (16.7%), gynaecology and obstetrics (16.7%), psychiatry (13.1%), radiology (10.8%), ENT (8.8%), anaesthesiology (8.7%), administrative medicine (8.6%), orthopaedics (8.2%), ophthalmology (7.5%), and laboratory medicine (6.1%). The highly considered factors (regarding specialties) chosen by 70% of the medical students were: applicable to respective personalities of the individuals, prestige and respect, international opportunities, and time commitment. Surgical-skills, job availability, financial rating, academic performance, and a role model were moderately influencing factors. Hospital environment, parents, general practice, peer-pressure and personal health were the least influential. This trend suggests competition in surgery and its sub-specialties along with internal medicine, paediatrics, dermatology, gynaecology and obstetrics. Specialty suited to personality, time commitment, prestige/respect and international opportunity, influenced more than 70% of the students.

[Health status, use of health services and reported morbidity: application of correspondence analysis].

PubMed

Espinàs, J A; Riba, M D; Borràs, J M; Sánchez, V

1995-01-01

The study of the relationship between self-reported morbidity, health status and health care utilization presents methodological problems due to the variety of illnesses and medical conditions that one individual may report. In this article, correspondence analysis was use to analyse these relationships. Data from the Spanish National Health Survey pertaining to the region of Catalonia was studied. Statistical analysis included multi-way correspondence analysis (MCA) followed by cluster analysis. The first factor extracted is defined by self-assessed health perception; the second, by limitation of activities, and the third is related to self-reported morbidity caused by chronic and acute health problems. Fourth and fifth factors, capture residual variability and missing values. Acute problems are more related to perception of poor health while chronic problems are related to perception of fair health. Also, it may be possible to distinguish self-reported morbidity due to relapses of chronic diseases from true acute health problems. Cluster analysis classified individuals into four groups: 1) healthy people; 2) people who assess their health as being poor and those with acute health problems; 3) people with chronic health problems, limited activity and a perception of fair health; and 4) missing values. Correspondence analysis is a useful tool when analyzing qualitative variables like those in a health survey.

The impact of co-morbidity on health-related quality of life in breast cancer survivors and controls.

PubMed

Schoormans, Dounya; Czene, Kamila; Hall, Per; Brandberg, Yvonne

2015-05-01

The objective of this study was: 1) to compare health-related quality of life (HRQoL) scores of breast cancer survivors to matched controls; and 2) to examine the relative impact (explained variance) of the type and number of co-morbidities on HRQoL. Data from the KARMA project was used in this cross-sectional study. For each woman diagnosed with breast cancer (n = 2552) there were two healthy age- and geographically matched females (n = 5104). Breast cancer survivors were categorized according to time since diagnosis: recently diagnosed (0-1 year), short- (2-5 years), mid- (6-10 years), and long-term survivors (> 10 years). Women completed a questionnaire addressing demographics (age, educational level, and geographical location), lifestyle factors (body mass index (BMI) and smoking), co-morbidities, and HRQoL. The difference in explained variance in six HRQoL-domains between demographics, lifestyle factors, and co-morbidity in women with breast cancer and matched controls was examined by hierarchical regression analyses. Women recently diagnosed (n = 63), reported the worst HRQoL followed by short-term survivors (2-5 years, n = 863). Thereafter, HRQoL scores further improved (6-10 years, n = 726), and were comparable to healthy females after 10 years (n = 893). Co-morbidity has a negative impact on HRQoL, which increased with time after diagnosis. Cardiovascular disease and depression were the strongest associates. Breast cancer survivors report clinically significant improvement in HRQoL scores six years after diagnosis. Co-morbidity has a negative impact on HRQoL, which increases with time after diagnosis, even though the number of co-morbidities remains stable. In long-term survivors there should be increasing awareness of co-morbidity and its impact on HRQoL.

Factors influencing training transfer in nursing profession: a qualitative study.

PubMed

Ma, Fang; Bai, Yangjing; Bai, Yangjuan; Ma, Weiguang; Yang, Xiangyu; Li, Jiping

2018-03-20

There is a growing recognition that training is not translated into performance and the 'transfer problem' exists in organization training today. Although factors contributing to training transfer have been identified in business and industry, the factors influencing training transfer in nursing profession remain less clear. A qualitative descriptive study was undertaken in two tertiary referral hospitals in China from February 2013 to September 2013. Purposeful sampling of 24 nursing staffs were interviewed about the factors influencing training transfer. Seven themes evolved from the analysis, categorized in 4 main domains, which described the factors influencing training transfer in nursing profession in trainee characteristics, training design, work environment and profession domain. The trainee characteristics domain included attitude and ability. The training design domain included training content and instruction method. The work environment domain included supports as facilitators and opposition as hindrance. The theme pertaining to the profession domain was professional development. Health care managers need to understand the factors influencing training transfer for maximizing the benefits of training. The right beliefs and values about training, the rigorous employee selection for training, the relevance of training content, training instructions facilitating learning and transfer, supports from peer, supervisors and the organization, organizational culture such as change, sharing, learning and support, and professional development are key to successful training transfer. Furthermore, managers should be aware of the opposition from co-workers and find ways to prevent it.

Factors influencing antibiotic prescribing in long-term care facilities: a qualitative in-depth study.

PubMed

van Buul, Laura W; van der Steen, Jenny T; Doncker, Sarah M M M; Achterberg, Wilco P; Schellevis, François G; Veenhuizen, Ruth B; Hertogh, Cees M P M

2014-12-16

Insight into factors that influence antibiotic prescribing is crucial when developing interventions aimed at a more rational use of antibiotics. We examined factors that influence antibiotic prescribing in long-term care facilities, and present a conceptual model that integrates these factors. Semi-structured qualitative interviews were conducted with physicians (n = 13) and nursing staff (n = 13) in five nursing homes and two residential care homes in the central-west region of the Netherlands. An iterative analysis was applied to interviews with physicians to identify and categorize factors that influence antibiotic prescribing, and to integrate these into a conceptual model. This conceptual model was triangulated with the perspectives of nursing staff. The analysis resulted in the identification of six categories of factors that can influence the antibiotic prescribing decision: the clinical situation, advance care plans, utilization of diagnostic resources, physicians' perceived risks, influence of others, and influence of the environment. Each category comprises several factors that may influence the decision to prescribe or not prescribe antibiotics directly (e.g. pressure of patients' family leading to antibiotic prescribing) or indirectly via influence on other factors (e.g. unfamiliarity with patients resulting in a higher physician perceived risk of non-treatment, in turn resulting in a higher tendency to prescribe antibiotics). Our interview study shows that several non-rational factors may affect antibiotic prescribing decision making in long-term care facilities, suggesting opportunities to reduce inappropriate antibiotic use. We developed a conceptual model that integrates the identified categories of influencing factors and shows the relationships between those categories. This model may be used as a practical tool in long-term care facilities to identify local factors potentially leading to inappropriate prescribing, and to subsequently

Transradial access for visceral endovascular interventions in morbidly obese patients: safety and feasibility.

PubMed

Biederman, Derek M; Marinelli, Brett; O'Connor, Paul J; Titano, Joseph J; Patel, Rahul S; Kim, Edward; Tabori, Nora E; Nowakowski, Francis S; Lookstein, Robert A; Fischman, Aaron M

2016-05-07

Transradial access (TRA) has been shown to lower morbidity and bleeding complications compared to transfemoral access in percutaneous coronary interventions. Morbid obesity, commonly defined as a body mass index (BMI) ≥40 kg/m2, has been shown to be a risk factor for access site complications irrespective of access site. This study evaluates the safety and feasibility of performing visceral endovascular interventions in morbidly obese patients via TRA. Procedural details, technical success, and 30-day major and minor access site, bleeding, and neurological adverse events were prospectively recorded in a database of 1057 procedures performed via the radial artery. From this database we identified 22 visceral interventions performed with TRA in 17 morbidly obese patients (age: 53 ± 11 years, female: 71%) with a median BMI of 42.7 kg/m2. Interventions included radio-embolization (n = 7, 31.8%), chemo-embolization (n = 6, 27.3%), uterine fibroid embolization (n = 4, 18.2%), renal embolization (n = 2, 9.1%), hepatic embolization (n = 1, 4.5%), lumbar artery embolization (n = 1, 4.5%), and renal angioplasty (n = 1, 4.5%). The technical success was 100%. There were no major or minor adverse access site, bleeding, or neurological complications at 30 days. This study suggests visceral endovascular interventions performed in morbidly obese patients are safe and feasible.

Heat Waves and Morbidity: Current Knowledge and Further Direction-A Comprehensive Literature Review

PubMed Central

Li, Mengmeng; Gu, Shaohua; Bi, Peng; Yang, Jun; Liu, Qiyong

2015-01-01

In the past few decades, several devastating heat wave events have significantly challenged public health. As these events are projected to increase in both severity and frequency in the future, it is important to assess the relationship between heat waves and the health indicators that can be used in the early warning systems to guide the public health response. Yet there is a knowledge gap in the impact of heat waves on morbidity. In this study, a comprehensive review was conducted to assess the relationship between heat waves and different morbidity indicators, and to identify the vulnerable populations. The PubMed and ScienceDirect database were used to retrieve published literature in English from 1985 to 2014 on the relationship between heat waves and morbidity, and the following MeSH terms and keywords were used: heat wave, heat wave, morbidity, hospital admission, hospitalization, emergency call, emergency medical services, and outpatient visit. Thirty-three studies were included in the final analysis. Most studies found a short-term negative health impact of heat waves on morbidity. The elderly, children, and males were more vulnerable during heat waves, and the medical care demand increased for those with existing chronic diseases. Some social factors, such as lower socioeconomic status, can contribute to heat-susceptibility. In terms of study methods and heat wave definitions, there remain inconsistencies and uncertainties. Relevant policies and guidelines need to be developed to protect vulnerable populations. Morbidity indicators should be adopted in heat wave early warning systems in order to guide the effective implementation of public health actions. PMID:25993103

Stress-coping morbidity among family members of addiction patients in Singapore.

PubMed

Lee, Kae Meng Thomas; Manning, Victoria; Teoh, Hui Chin; Winslow, Munidasa; Lee, Arthur; Subramaniam, Mythily; Guo, Song; Wong, Kim Eng

2011-07-01

INTRODUCTIONS AND AIMS: Research from western countries indicates that family members of addiction patients report heightened stress and psychological morbidity. This current study aimed to examine stress, coping behaviours, related morbidity and subsequent resource utilisation among family members of patients attending a national treatment program in Singapore. The study used a matched case-control design. One hundred family members of addiction patients attending treatment and 100 matched controls completed a semi-structured interview with a researcher. This included the Beck Depression Inventory-II, Short-Form Health Survey-36, General Health Questionnaire-28, Perceived Stress Scale, Family Member Impact Scale and Coping Questionnaire, and also assessed service utilisation. T-tests revealed significantly greater depression, stress and psychiatric morbidity and poorer overall well-being (Short-Form Health Survey-36) among family members compared with controls. Despite the apparent negative impact on mental health, their physical morbidity did not differ from controls and services utilisation was low. Tolerant-inactive coping was found to be most strongly correlated with psychological well-being. Multivariate analysis indicated that perceived stress was the strongest predictor of overall strain (General Health Questionnaire), but this was not moderated by coping style. Subjective appraisal of stress and coping responses are essential factors affecting the morbidity of family members. Family members demonstrated a need and willingness to engage in formal treatment/counselling for their own problems that were attributed to living with an addiction patient. This provides an opportunity for stress management and brief interventions to modify coping styles, thereby minimizing the potential negative mental health impact on family members. © 2011 Australasian Professional Society on Alcohol and other Drugs.

Factors that influence women's dispositions toward science

NASA Astrophysics Data System (ADS)

Atria, Catherine Graczyk

Females have been underrepresented in the study of science and science careers for decades although advancements have been made in closing this gender gap, the gap persists particularly in the physical sciences. Variables which influence a woman's desire to pursue and maintain a science course of study and career must be discovered. The United States lags behind other industrialized countries in the fields of science, math, and engineering. Females comprise an estimated half of the population; their potential contributions cannot be ignored or overlooked. This retrospective research study explores the personal experiences of ten women enrolled in science majors, with science related career plans. The goal of this study is to describe the factors that influence the participants' interest in science. The findings, the effect of science coursework, science teachers' personality and manner, other influential educational personnel, role models and mentors, external influences exclusive of school, parental influence, locus of control and positive attitudes toward science confirm what other researchers have found.

Factors influencing post-traumatic stress in Korean forensic science investigators.

PubMed

Yoo, Yang-Sook; Cho, Ok-Hee; Cha, Kyeong-Sook; Boo, Yun-Jeong

2013-09-01

The aim of this study was to understand factors that influence post-traumatic stress (PTS) in Korean forensic science investigators. A total of 111 forensic science investigators were recruited in Korea. PTS was measured using the tool modified by Choi (2001) from the original developed by Foa, Riggs, Dancu, and Rothbaum (1993) based on DSM-IV. Factors influencing PTS included demographic and job-related characteristics, emotional intelligence, and death anxiety. PTS scores were positively correlated with personality type, fatigue from work, and death anxiety. PTS scores were negatively correlated with length of career as a forensic science investigator and emotional intelligence. The factors that had the greatest influence on PTS were death anxiety, years spent as a forensic science investigator, personality type, emotional intelligence, fatigue, and homicide experience. The explanatory power of these six factors was 44.0%. Therefore, it is necessary to regularly evaluate the mental health of those who are vulnerable to PTS. Based on these results, various interventions could be implemented for promoting overall health of the forensic science investigators. Copyright © 2013. Published by Elsevier B.V.

Compression of Morbidity 1980–2011: A Focused Review of Paradigms and Progress

PubMed Central

Fries, James F.; Bruce, Bonnie; Chakravarty, Eliza

2011-01-01

The Compression of Morbidity hypothesis—positing that the age of onset of chronic illness may be postponed more than the age at death and squeezing most of the morbidity in life into a shorter period with less lifetime disability—was introduced by our group in 1980. This paper is focused upon the evolution of the concept, the controversies and responses, the supportive multidisciplinary science, and the evolving lines of evidence that establish proof of concept. We summarize data from 20-year prospective longitudinal studies of lifestyle progression of disability, national population studies of trends in disability, and randomized controlled trials of risk factor reduction with life-style-based “healthy aging” interventions. From the perspective of this influential and broadly cited paradigm, we review its current history, the development of a theoretical structure for healthy aging, and the challenges to develop coherent health policies directed at reduction in morbidity. PMID:21876805

Prevalence and Patterns of Multi-Morbidity in Serbian Adults: A Cross-Sectional Study

PubMed Central

Jovic, Dragana; Vukovic, Dejana; Marinkovic, Jelena

2016-01-01

Introduction Like many developing countries, Serbia is facing a growing burden of chronic diseases. Within such public health issue, multi-morbidity requires a special attention. Aims This study investigated the prevalence of multi-morbidity in the Serbia population and assessed the co-occurrence of chronic diseases by age and gender. Methods We analyzed data from the 2013 National Health Survey, which included 13,103 individuals ≥ 20 years old. Multi-morbidity patterns were identified by exploratory factor analysis of data on self-reported chronic diseases, as well as data on measured body weight and height. The analysis was stratified by age and gender. Results Multi-morbidity was present in nearly one-third of respondents (26.9%) and existed in all age groups, with the highest prevalence among individuals aged 65 years and older (47.2% of men and 65.0% of women). Six patterns of multi-morbidity were identified: non-communicable, cardio-metabolic, respiratory, cardiovascular, aggregate, and mechanical/mental/metabolic. The non-communicable pattern was observed in both genders but only in the 20–44 years age group, while the aggregate pattern occurred only in middle-aged men. Cardio-metabolic and respiratory patterns were present in all age groups. Cardiovascular and mechanical/mental/metabolic patterns showed similar presentation in both men and women. Conclusions Multi-morbidity is a common occurrence among adults in Serbia, especially in the elderly. While several patterns may be explained by underlying pathophysiologies, some require further investigation and follow-up. Recognizing the complexity of multi-morbidity in Serbia is of great importance from both clinical and preventive perspectives given that it affects one-third of the population and may require adjustment of the healthcare system to address the needs of affected individuals. PMID:26871936

Factors Potentially Influencing Student Acceptance of Biological Evolution

NASA Astrophysics Data System (ADS)

Wiles, Jason R.

This investigation explored scientific, religious, and otherwise nonscientific factors that may influence student acceptance of biological evolution and related concepts, how students perceived these factors to have influenced their levels of acceptance of evolution and changes therein, and what patterns arose among students' articulations of how their levels of acceptance of evolution may have changed. This exploration also measured the extent to which students' levels of acceptance changed following a treatment designed to address factors identified as potentially affecting student acceptance of evolution. Acceptance of evolution was measured using the MATE instrument (Rutledge and Warden, 1999; Rutledge and Sadler, 2007) among participants enrolled in a secondary-level academic program during the summer prior to their final year of high school and as they transitioned to the post-secondary level. Student acceptance of evolution was measured to be significantly higher than pre-treatment levels both immediately following and slightly over one year after treatment. Qualitative data from informal questionnaires, from formal course evaluations, and from semi-structured interviews of students engaged in secondary level education and former students at various stages of post-secondary education confirmed that the suspected factors were perceived by participants to have influenced their levels of acceptance of evolution. Furthermore, participant reports provided insight regarding the relative effects they perceived these factors to have had on their evolution acceptance levels. Additionally, many participants reported that their science teachers in public schools had avoided, omitted, or denigrated evolution during instruction, and several of these students expressed frustration regarding what they perceived to have been a lack of education of an important scientific principle. Finally, no students expressed feelings of being offended by having been taught about

Factors influencing worker use of personal protective eyewear.

PubMed

Lombardi, David A; Verma, Santosh K; Brennan, Melanye J; Perry, Melissa J

2009-07-01

To identify and describe the array of factors that influence a workers' decision to wear personal protective eyewear (PPE) and the barriers that exist in preventing their use. A series of focus groups enrolled workers and supervisors primarily from manufacturing, construction, or service/retail industries that had potential exposure to eye injury hazards in their job tasks. Focus group sessions were facilitated to collect qualitative and quantitative data in two categories, "sought information" and "emergent themes", related to the factors influencing use of PPE. We conducted a series of 7 groups with 51 participants, 36 (71%) males and 15 (29%) females ranging in age from 19 to 64 years old, from a variety of occupations including construction (24%), production (22%), installation, repair and maintenance (14%), and healthcare (10%). Most were highly experienced in their occupation (>10 years); males (86%) and females (53%), and had received some safety training in the past (82%). The majority of workers in this study were required to wear PPE on their worksite (78%), however only 55% had a dedicated safety officer. A conceptual model that summarizes the "sought information" and "emergent themes" is presented that depicts the decision making process for the factors influencing use of PPE and consists of three primary branches; perceptions of hazards and risks, "barriers" to PPE usage, and enforcement and reinforcement. Lack of comfort/fit, and fogging and scratching of the eyewear were suggested as the most important barriers to PPE usage. Younger age and lack of safety training were other important factors affecting use of PPE. Several potentially modifiable factors identified would lead to an increase in workers' PPE use and encourage supervisors to provide ongoing positive feedback on the continuous use of PPE by workers at risk for an eye injury.

Why neurology? Factors which influence career choice in neurology.

PubMed

Albert, Dara V; Hoyle, Chad; Yin, Han; McCoyd, Matthew; Lukas, Rimas V

2016-01-01

To evaluate the factors which influence the decision to pursue a career in neurology. An anonymous survey was developed using a Likert scale to rate responses. The survey was sent to adult and child neurology faculty, residents and fellows, as well as medical students applying for neurology. Descriptive statistics were used to analyse the factors of influence. Respondents were subsequently categorized into pre-neurology trainees, neurology trainees, child neurologists and adult neurologists, and differences between the groups were analysed using Pearson's chi-square test. One hundred and thirty-three anonymous responses were received. The respondents were neurologists across all levels of training and practice. Across all respondents, the most common factor of high importance was intellectual content of specialty, challenging diagnostic problems, type of patient encountered and interest in helping people. Responses were similar across the groups; however, the earliest trainees cited interest in helping people as most important, while those in neurology training and beyond cite intellectual content of the specialty as most important. As trainees transition from their earliest levels of clinical experience into working as residents and faculty, there is a shift in the cited important factors. Lifestyle and financial factors seem to be the least motivating across all groups. Encouragement from peers, mentors, faculty and practicing physicians is considered high influences in a smaller number of neurologists. This may present an opportunity for practicing neurologists to make connections with medical students early in their education in an effort to encourage and mentor candidates.

Factors that influence disease-specific quality of life or health status in patients with COPD: a review and meta-analysis of Pearson correlations.

PubMed

Tsiligianni, Ioanna; Kocks, Janwillem; Tzanakis, Nikolaos; Siafakas, Nikolaos; van der Molen, Thys

2011-09-01

A major goal in the management of chronic obstructive pulmonary disease (COPD) is to ensure that the burden of the disease for patients with COPD is limited and that patients will have the best possible quality of life. To explore all the possible factors that could influence disease-specific quality of life and health status in patients with COPD. A systematic review of the literature and a meta-analysis were performed to explore the factors that could have a positive or negative effect on quality of life and/or health status in patients with COPD. Quality of life and health status are determined by certain factors included gender, disease severity indices, lung function parameters, body mass index, smoking, symptoms, co-morbidity, depression, anxiety, and exacerbations. Factors such as dyspnoea, depression, anxiety and exercise tolerance were found to be more correlated with health status than the widely used spirometric values. Forced expiratory volume in one second had a weak to modest Pearson weighted correlation coefficient which ranged from -0.110 to -0.510 depending on the questionnaire used. The broad range of determining factors suggests that, in order to reach the management goals, health status should be measured in addition to lung function in patients with COPD.

Influence of conventional cardiovascular risk factors and lifestyle characteristics on cardiovascular disease after hematopoietic cell transplantation.

PubMed

Chow, Eric J; Baker, K Scott; Lee, Stephanie J; Flowers, Mary E D; Cushing-Haugen, Kara L; Inamoto, Yoshihiro; Khera, Nandita; Leisenring, Wendy M; Syrjala, Karen L; Martin, Paul J

2014-01-20

To determine the influence of modifiable lifestyle factors on the risk of cardiovascular disease after hematopoietic cell transplantation (HCT). HCT survivors of ≥ 1 year treated from 1970 to 2010 (n = 3,833) were surveyed from 2010 to 2011 on current cardiovascular health and related lifestyle factors (smoking, diet, recreational physical activity). Responses (n = 2,362) were compared with those from a matched general population sample (National Health and Nutrition Examination Survey [NHANES]; n = 1,192). Compared with NHANES participants, HCT survivors (median age, 55.9 years; median 10.8 years since HCT; 71.3% allogeneic) had higher rates of cardiomyopathy (4.0% v 2.6%), stroke (4.8% v 3.3%), dyslipidemia (33.9% v 22.3%), and diabetes (14.3% v 11.7%; P < .05 for all comparisons). Prevalence of hypertension was similar (27.9% v 30.0%), and survivors were less likely to have ischemic heart disease (6.1% v 8.9%; P < .01). Among HCT survivors, hypertension, dyslipidemia, and diabetes were independent risk factors for ischemic heart disease and cardiomyopathy, and smoking was associated with ischemic heart disease and diabetes (odds ratios [ORs], 1.8 to 2.1; P = .02). Obesity was a risk factor for post-transplantation hypertension, dyslipidemia, and diabetes (ORs ≥ 2.0; P < .001). In contrast, lower fruit/vegetable intake was associated with greater risk of dyslipidemia and diabetes (ORs, 1.4 to 1.8; P ≤ .01), and lower physical activity level was associated with greater risk of hypertension and diabetes (ORs, 1.4 to 1.5; P < .05). Healthier lifestyle characteristics among HCT survivors attenuated risk of all cardiovascular conditions assessed. Attention of clinicians to conventional cardiovascular risk factors and modifiable lifestyle characteristics offers hope of reducing serious cardiovascular morbidity after HCT.

Trends in bariatric surgery for morbid obesity in Wisconsin: a 6-year follow-up.

PubMed

Henkel, Dana S; Remington, Patrick L; Athens, Jessica K; Gould, Jon C

2010-02-01

The prevalence of morbid obesity is increasing throughout Wisconsin and the United States. In 2004, we published a study, "Trends in Bariatric Surgery for Morbid Obesity in Wisconsin." We determined that surgery rates were increasing but felt the demand exceeded the capacity of the surgeons. This is a 6-year follow-up. Data was gathered from 3 sources: the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, the Wisconsin Hospital Association, and a survey administered to Wisconsin bariatric surgeons. From 2003-2008, an average of 2.8% of Wisconsin adults were morbidly obese. Although the number of bariatric surgeries performed in Wisconsin remained steady (1311 surgeries in 2003 and 1343 in 2008), the types of procedures shifted from open gastric bypass (73% in 2003) to laparoscopic gastric bypass (80% in 2008). The rate of surgery was 1 for every 100 morbidly obese adults. The majority of surgeons surveyed (70%) report that a lack of insurance benefits is the biggest barrier to performing bariatric surgery. The prevalence of morbid obesity continues to increase in Wisconsin compared to our previously published data. Bariatric surgery volumes have remained stable but the type of procedure has changed. Approximately 1% of bariatric surgery candidates have surgery each year.

The Effects of Weather Factors on Hand, Foot and Mouth Disease in Beijing.

PubMed

Dong, Weihua; Li, Xian'en; Yang, Peng; Liao, Hua; Wang, Xiaoli; Wang, Quanyi

2016-01-12

The morbidity and mortality of hand, foot and mouth disease (HFMD) are increasing in Beijing, China. Previous studies have indicated an association between incidents of HFMD and weather factors. However, the seasonal influence of these factors on the disease is not yet understood, and their relationship with the enterovirus 71 (EV71) and Coxsackie virus A16 (CV-A16) viruses are not well documented. We analysed 84,502 HFMD cases from 2008 to 2011 in Beijing to explore the seasonal influence of weather factors (average temperature [AT], average relative humidity [ARH], total precipitation [TP] and average wind speed [AWS]) on incidents of HFMD by using a geographically weighted regression (GWR) model. The results indicated that weather factors differ significantly in their influence on HFMD depending on the season. AT had the greatest effect among the four weather factors, and while the influence of AT and AWS was greater in the summer than in the winter, the influence of TP was positive in the summer and negative in the winter. ARH was negatively correlated with HFMD. Also, we observed more EV71-associated cases than CV-A16 but there is no convincing evidence to show significant differences between the influences of the weather factors on EV71 and CV-A16.

The Effects of Weather Factors on Hand, Foot and Mouth Disease in Beijing

NASA Astrophysics Data System (ADS)

Dong, Weihua; Li, Xian'En; Yang, Peng; Liao, Hua; Wang, Xiaoli; Wang, Quanyi

2016-01-01

The morbidity and mortality of hand, foot and mouth disease (HFMD) are increasing in Beijing, China. Previous studies have indicated an association between incidents of HFMD and weather factors. However, the seasonal influence of these factors on the disease is not yet understood, and their relationship with the enterovirus 71 (EV71) and Coxsackie virus A16 (CV-A16) viruses are not well documented. We analysed 84,502 HFMD cases from 2008 to 2011 in Beijing to explore the seasonal influence of weather factors (average temperature [AT], average relative humidity [ARH], total precipitation [TP] and average wind speed [AWS]) on incidents of HFMD by using a geographically weighted regression (GWR) model. The results indicated that weather factors differ significantly in their influence on HFMD depending on the season. AT had the greatest effect among the four weather factors, and while the influence of AT and AWS was greater in the summer than in the winter, the influence of TP was positive in the summer and negative in the winter. ARH was negatively correlated with HFMD. Also, we observed more EV71-associated cases than CV-A16 but there is no convincing evidence to show significant differences between the influences of the weather factors on EV71 and CV-A16.

The Effects of Weather Factors on Hand, Foot and Mouth Disease in Beijing

PubMed Central

Dong, Weihua; Li, Xian’en; Yang, Peng; Liao, Hua; Wang, Xiaoli; Wang, Quanyi

2016-01-01

The morbidity and mortality of hand, foot and mouth disease (HFMD) are increasing in Beijing, China. Previous studies have indicated an association between incidents of HFMD and weather factors. However, the seasonal influence of these factors on the disease is not yet understood, and their relationship with the enterovirus 71 (EV71) and Coxsackie virus A16 (CV-A16) viruses are not well documented. We analysed 84,502 HFMD cases from 2008 to 2011 in Beijing to explore the seasonal influence of weather factors (average temperature [AT], average relative humidity [ARH], total precipitation [TP] and average wind speed [AWS]) on incidents of HFMD by using a geographically weighted regression (GWR) model. The results indicated that weather factors differ significantly in their influence on HFMD depending on the season. AT had the greatest effect among the four weather factors, and while the influence of AT and AWS was greater in the summer than in the winter, the influence of TP was positive in the summer and negative in the winter. ARH was negatively correlated with HFMD. Also, we observed more EV71-associated cases than CV-A16 but there is no convincing evidence to show significant differences between the influences of the weather factors on EV71 and CV-A16. PMID:26755102

Physical co-morbidity among treatment resistant vs. treatment responsive patients with major depressive disorder.

PubMed

Amital, D; Fostick, L; Silberman, A; Calati, R; Spindelegger, C; Serretti, A; Juven-Wetzler, A; Souery, D; Mendlewicz, J; Montgomery, S; Kasper, S; Zohar, J

2013-08-01

Co-morbid physical illness has been suggested to play an important role among the factors contributing to treatment resistance in patients with major depressive disorder. In the current study we compared the rate of physical co-morbidity, defined by ICD-10, among a large multicenter sample of 702 patients with major depressive disorder. A total of 356 of the participants were defined as treatment resistant depression (TRD) patients-having failed two or more adequate antidepressant trials. No significant difference was found between TRD and non-TRD participants in the prevalence of any ICD-10 category. This finding suggests that although physical conditions such as diabetes, thyroid dysfunction, hypertension, ischemic heart disease, and peptic diseases are often accompanied by co-morbid MDD, they do not necessarily have an impact on the course of MDD or the likelihood to respond to treatment. Marginally higher rates of co-morbid breast cancer, migraine and glaucoma were found among TRD participants. Possible explanations for these findings and their possible relation to TRD are discussed. Copyright © 2012 Elsevier B.V. and ECNP. All rights reserved.

Consumer's Online Shopping Influence Factors and Decision-Making Model

NASA Astrophysics Data System (ADS)

Yan, Xiangbin; Dai, Shiliang

Previous research on online consumer behavior has mostly been confined to the perceived risk which is used to explain those barriers for purchasing online. However, perceived benefit is another important factor which influences consumers’ decision when shopping online. As a result, an integrated consumer online shopping decision-making model is developed which contains three elements—Consumer, Product, and Web Site. This model proposed relative factors which influence the consumers’ intention during the online shopping progress, and divided them into two different dimensions—mentally level and material level. We tested those factors with surveys, from both online volunteers and offline paper surveys with more than 200 samples. With the help of SEM, the experimental results show that the proposed model and method can be used to analyze consumer’s online shopping decision-making process effectively.

[Analysis of influencing factors of snow hyperspectral polarized reflections].

PubMed

Sun, Zhong-Qiu; Zhao, Yun-Sheng; Yan, Guo-Qian; Ning, Yan-Ling; Zhong, Gui-Xin

2010-02-01

Due to the need of snow monitoring and the impact of the global change on the snow, on the basis of the traditional research on snow, starting from the perspective of multi-angle polarized reflectance, we analyzed the influencing factors of snow from the incidence zenith angles, the detection zenith angles, the detection azimuth angles, polarized angles, the density of snow, the degree of pollution, and the background of the undersurface. It was found that these factors affected the spectral reflectance values of the snow, and the effect of some factors on the polarization hyperspectral reflectance observation is more evident than in the vertical observation. Among these influencing factors, the pollution of snow leads to an obvious change in the snow reflectance spectrum curve, while other factors have little effect on the shape of the snow reflectance spectrum curve and mainly impact the reflection ratio of the snow. Snow reflectance polarization information has not only important theoretical significance, but also wide application prospect, and provides new ideas and methods for the quantitative research on snow using the remote sensing technology.

Factors Influencing Renewable Energy Production & Supply - A Global Analysis

NASA Astrophysics Data System (ADS)

Ali, Anika; Saqlawi, Juman Al

2016-04-01

Renewable energy is one of the key technologies through which the energy needs of the future can be met in a sustainable and carbon-neutral manner. Increasing the share of renewable energy in the total energy mix of each country is therefore a critical need. While different countries have approached this in different ways, there are some common aspects which influence the pace and effectiveness of renewable energy incorporation. This presentation looks at data and information from 34 selected countries, analyses the patterns, compares the different parameters and identifies the common factors which positively influence renewable energy incorporation. The most successful countries are analysed for their renewable energy performance against their GDP, policy/regulatory initiatives in the field of renewables, landmass, climatic conditions and population to identify the most influencing factors to bring about positive change in renewable energy share.

The Influence Factors and Mechanism of Societal Risk Perception

NASA Astrophysics Data System (ADS)

Zheng, Rui; Shi, Kan; Li, Shu

Risk perception is one of important subjects in management psychology and cognitive psychology. It is of great value in the theory and practice to investigate the societal hazards that the public cares a lot especially in Socio-economic transition period. A survey including 30 hazards and 6 risk attributes was designed and distributed to about 2, 485 residents of 8 districts, Beijing. The major findings are listed as following: Firstly, a scale of societal risk perception was designed and 2 factors were identified (Dread Risk & Unknown Risk). Secondly, structural equation model was used to analyze the influence factors and mechanism of societal risk perception. Risk preference, government support and social justice could influence societal risk perception directly. Government support fully moderated the relationship between government trust and societal risk perception. Societal risk perception influenced life satisfaction, public policy preferences and social development belief.

Factors influencing the flavour of game meat: A review.

PubMed

Neethling, J; Hoffman, L C; Muller, M

2016-03-01

Flavour is a very important attribute contributing to the sensory quality of meat and meat products. Although the sensory quality of meat includes orthonasal and retronasal aroma, taste, as well as appearance, juiciness and other textural attributes, the focus of this review is primarily on flavour. The influence of species, age, gender, muscle anatomical location, diet, harvesting conditions, ageing of meat, packaging and storage, as well as cooking method on the flavour of game meat are discussed. Very little research is available on the factors influencing the flavour of the meat derived from wild and free-living game species. The aim of this literature review is thus to discuss the key ante- and post-mortem factors that influence the flavour of game meat, with specific focus on wild and free-living South African game species. Copyright © 2015 Elsevier Ltd. All rights reserved.

Factors Influencing Employee Learning in Small Businesses

ERIC Educational Resources Information Center

Coetzer, Alan; Perry, Martin

2008-01-01

Purpose: The purpose of this research is to identify key factors influencing employee learning from the perspective of owners/managers. Design/methodology/research: Data were gathered from owners/managers in a total of 27 small manufacturing and services firms through interviews and analysed using content analytic procedures. Findings: The…

Exploring Factors That Influence Quality Literature Circles

ERIC Educational Resources Information Center

Young, Chase; Mohr, Kathleen A. J.

2018-01-01

Research indicates that literature circles are an authentic means for literacy development that students typically enjoy. To better understand the potential value and to add to the research base regarding literature circles, this study, involving 17 fourth graders, explores factors that may influence the quality of literature discussions,…

A Survey of Factors Influencing High School Start Times

ERIC Educational Resources Information Center

Wolfson, Amy R.; Carskadon, Mary A.

2005-01-01

The present study surveyed high school personnel regarding high school start times, factors influencing school start times, and decision making around school schedules. Surveys were analyzed from 345 secondary schools selected at random from the National Center for Educational Statistics database. Factors affecting reported start times included…

Does Multi-morbidity Mediate the Effect of Socioeconomics on Self-rated Health? Cross-country Differences

PubMed Central

Assari, Shervin; Lankarani, Maryam Moghani

2015-01-01

Background: This study explored cross-country differences in how multi-morbidity explains the effects of socioeconomic characteristics on self-rated health. Methods: The study borrowed data from the Research on Early Life and Aging Trends and Effects. Participants were 44,530 individuals (age > 65 years) who were sampled from 15 countries (i.e. United States, China, India, Russia, Costa Rica, Puerto Rico, Mexico, Argentina, Barbados, Brazil, Chile, Cuba, Uruguay, Ghana and South Africa). Multi-morbidity was measured as number of chronic medical conditions. In Model I, main effects of socioeconomic factors on self-rated health were calculated using country-specific logistic regressions. In Model II, number of chronic conditions were also added to the models to find changes in coefficients for demographic and socioeconomic factors. Results: In the United States, number of chronic medical conditions explained the effect of income on subjective health. In Puerto Rico, number of chronic medical conditions explained the effect of marital status on subjective health. In Costa Rica, Argentina, Barbados, Cuba, and Uruguay, number of chronic medical conditions explained gender disparities in subjective health. In China, Mexico, Brazil, Russia, Chile, India, Ghana and South Africa, number of chronic medical conditions did not explain the effect of demographic or socioeconomic factors on subjective health. Conclusions: Multi-morbidity explains the effect of demographic and socioeconomic factors on subjective health in some but not other countries. Further research is needed. PMID:26445632

Factors influencing global antiretroviral procurement prices.

PubMed

Wirtz, Veronika J; Forsythe, Steven; Valencia-Mendoza, Atanacio; Bautista-Arredondo, Sergio

2009-11-18

Antiretroviral medicines (ARVs) are one of the most costly parts of HIV/AIDS treatment. Many countries are struggling to provide universal access to ARVs for all people living with HIV and AIDS. Although substantial price reductions of ARVs have occurred, especially between 2002 and 2008, achieving sustainable access for the next several decades remains a major challenge for most low- and middle-income countries. The objectives of the present study were twofold: first, to analyze global ARV prices between 2005 and 2008 and associated factors, particularly procurement methods and key donor policies on ARV procurement efficiency; second, to discuss the options of procurement processes and policies that should be considered when implementing or reforming access to ARV programs. An ARV-medicines price-analysis was carried out using the Global Price Reporting Mechanism from the World Health Organization. For a selection of 12 ARVs, global median prices and price variation were calculated. Linear regression models for each ARV were used to identify factors that were associated with lower procurement prices. Logistic regression models were used to identify the characteristics of those countries which procure below the highest and lowest direct manufactured costs. Three key factors appear to have an influence on a country's ARV prices: (a) whether the product is generic or not; (b) the socioeconomic status of the country; (c) whether the country is a member of the Clinton HIV/AIDS Initiative. Factors which did not influence procurement below the highest direct manufactured costs were HIV prevalence, procurement volume, whether the country belongs to the least developed countries or a focus country of the United States President's Emergency Plan For AIDS Relief. One of the principal mechanisms that can help to lower prices for ARV over the next several decades is increasing procurement efficiency. Benchmarking prices could be one useful tool to achieve this.

Factors influencing global antiretroviral procurement prices

PubMed Central

2009-01-01

Background Antiretroviral medicines (ARVs) are one of the most costly parts of HIV/AIDS treatment. Many countries are struggling to provide universal access to ARVs for all people living with HIV and AIDS. Although substantial price reductions of ARVs have occurred, especially between 2002 and 2008, achieving sustainable access for the next several decades remains a major challenge for most low- and middle-income countries. The objectives of the present study were twofold: first, to analyze global ARV prices between 2005 and 2008 and associated factors, particularly procurement methods and key donor policies on ARV procurement efficiency; second, to discuss the options of procurement processes and policies that should be considered when implementing or reforming access to ARV programs. Methods An ARV-medicines price-analysis was carried out using the Global Price Reporting Mechanism from the World Health Organization. For a selection of 12 ARVs, global median prices and price variation were calculated. Linear regression models for each ARV were used to identify factors that were associated with lower procurement prices. Logistic regression models were used to identify the characteristics of those countries which procure below the highest and lowest direct manufactured costs. Results Three key factors appear to have an influence on a country's ARV prices: (a) whether the product is generic or not; (b) the socioeconomic status of the country; (c) whether the country is a member of the Clinton HIV/AIDS Initiative. Factors which did not influence procurement below the highest direct manufactured costs were HIV prevalence, procurement volume, whether the country belongs to the least developed countries or a focus country of the United States President's Emergency Plan For AIDS Relief. Conclusion One of the principal mechanisms that can help to lower prices for ARV over the next several decades is increasing procurement efficiency. Benchmarking prices could be one useful

Influencing factors on the visibility of surface distresses

NASA Astrophysics Data System (ADS)

Smęt, Wojciech; Skakuj, Marek

2018-05-01

A systematic and future-oriented maintenance management requires quality-assured data regarding the condition of the roadway. An important characteristic for assessing the condition of the road surface are cracks [1]. Experience has proven that the road surface temperature and residual humidity can influence the visibility of cracks. To investigate and quantify these influencing factors in more detail, the Federal Ministry of Transport and Digital Infrastructure has implemented a comprehensive research project [2], during which several measurement campaigns were carried out at different seasons and at different temperatures and humidity degrees of the road surface. The visibility of the cracks was assessed using the German approach ZTV ZEB-StB [3]. After evaluating the cracks, the data was synchronized and the network allocation of the geo-referenced raw data was realized. The relevant condition performance indicators were calculated subsequently. For each evaluation section of 100 meters length, the mean road surface temperature was calculated and, if available, the type and year of construction of the surface course was determined. The evaluated data was visualized to establish correlations between the data and the influencing factors. For the statistical analysis of the results, a total of six comparative scenarios were defined in which the influencing factors of road surface temperature and residual humidity were assessed. This paper documents the results of the research project. In order to obtain a uniform and comparable picture of the condition of the road surface over the years and thus to be able to observe the aging process of the road surface, the measurement campaigns are to be carried out under defined conditions. The research project included proposals for defining and further specifying the measurement conditions.

Attitudes, norms and controls influencing lifestyle risk factor management in general practice.

PubMed

Ampt, Amanda J; Amoroso, Cheryl; Harris, Mark F; McKenzie, Suzanne H; Rose, Vanessa K; Taggart, Jane R

2009-08-26

With increasing rates of chronic disease associated with lifestyle behavioural risk factors, there is urgent need for intervention strategies in primary health care. Currently there is a gap in the knowledge of factors that influence the delivery of preventive strategies by General Practitioners (GPs) around interventions for smoking, nutrition, alcohol consumption and physical activity (SNAP). This qualitative study explores the delivery of lifestyle behavioural risk factor screening and management by GPs within a 45-49 year old health check consultation. The aims of this research are to identify the influences affecting GPs' choosing to screen and choosing to manage SNAP lifestyle risk factors, as well as identify influences on screening and management when multiple SNAP factors exist. A total of 29 audio-taped interviews were conducted with 15 GPs and one practice nurse over two stages. Transcripts from the interviews were thematically analysed, and a model of influencing factors on preventive care behaviour was developed using the Theory of Planned Behaviour as a structural framework. GPs felt that assessing smoking status was straightforward, however some found assessing alcohol intake only possible during a formal health check. Diet and physical activity were often inferred from appearance, only being assessed if the patient was overweight. The frequency and thoroughness of assessment were influenced by the GPs' personal interests and perceived congruence with their role, the level of risk to the patient, the capacity of the practice and availability of time. All GPs considered advising and educating patients part of their professional responsibility. However their attempts to motivate patients were influenced by perceptions of their own effectiveness, with smoking causing the most frustration. Active follow-up and referral of patients appeared to depend on the GPs' orientation to preventive care, the patient's motivation, and cost and accessibility of

Motivational factors influencing nurses to undertake postgraduate hospital-based education.

PubMed

Kinsella, Danny; Fry, Margaret; Zecchin, Alison

2018-05-01

Specialist postgraduate education improves patient health outcomes, and assists in meeting the emerging specialisation of nursing practice. The aim of this study was to investigate the motivational factors that influence nurses' engagement with hospital-based postgraduate education. The research design was descriptive and exploratory, using a survey method. The survey consisted of demographic details, the Participation Reasons Scale (PRS) and open-ended questions. Thirty-four participants (100%) completed the survey. Of the PRS extrinsic and intrinsic factors, Professional Improvement and Development (Factor 1) and Professional Service (Factor 2), both intrinsic factors, ranked the highest. Therefore, this study identified that intrinsic motivation factors influenced engagement with postgraduate specialty programs for early career nurses. These results highlight the importance of intrinsic motivation factors for a nursing workforce and how this can potentially drive behaviour and decision making. A better understanding of motivation factors across a nurse's career could lead to educational strategies that optimise postgraduate program engagement to better support healthcare delivery and a culture of lifelong learning. Copyright © 2018. Published by Elsevier Ltd.

Personal factors associated with health-related quality of life in persons with morbid obesity on treatment waiting lists in Norway.

PubMed

Lerdal, Anners; Andenæs, Randi; Bjørnsborg, Eva; Bonsaksen, Tore; Borge, Lisbet; Christiansen, Bjørg; Eide, Hilde; Hvinden, Kari; Fagermoen, May Solveig

2011-10-01

To explore relationships of socio-demographic variables, health behaviours, environmental characteristics and personal factors, with physical and mental health variables in persons with morbid obesity, and to compare their health-related quality of life (HRQoL) scores with scores from the general population. A cross-sectional correlation study design was used. Data were collected by self-reported questionnaire from adult patients within the first 2 days of commencement of a mandatory educational course. Of 185 course attendees, 142 (76.8%) volunteered to participate in the study. Valid responses on all items were recorded for 128 participants. HRQoL was measured with the Short Form 12v2 from which physical (PCS) and mental component summary (MCS) scores were computed. Other standardized instruments measured regular physical activity, social support, self-esteem, sense of coherence, self-efficacy and coping style. Respondents scored lower on all the HRQoL sub-domains compared with norms. Linear regression analyses showed that personal factors that included self-esteem, self-efficacy, sense of coherence and coping style explained 3.6% of the variance in PCS scores and 41.6% in MCS scores. Personal factors such as self-esteem, sense of coherence and a high approaching coping style are strongly related to mental health in obese persons.

Nurturing Sport Expertise: Factors Influencing the Development of Elite Athlete

PubMed Central

Baker, Joseph; Horton, Sean; Robertson-Wilson, Jennifer; Wall, Michael

2003-01-01

The development of expertise in sport is the result of successful interaction of biological, psychological, and sociological constraints. This review examines the training and environmental factors that influence the acquisition of sport expertise. Research examining the quality and quantity of training indicate that these two elements are crucial predictors of attainment. In addition, the possession of resources such as parental support and adequate coaching are essential. Social factors such as cultural influences and the relative age effect are also considered as determinants of sport expertise. Although it is evident that environmental factors are essential to the acquisition of high levels of sport development, further research is clearly required. PMID:24616603

Analysis of the influencing factors of global energy interconnection development

NASA Astrophysics Data System (ADS)

Zhang, Yi; He, Yongxiu; Ge, Sifan; Liu, Lin

2018-04-01

Under the background of building global energy interconnection and achieving green and low-carbon development, this paper grasps a new round of energy restructuring and the trend of energy technology change, based on the present situation of global and China's global energy interconnection development, established the index system of the impact of global energy interconnection development factors. A subjective and objective weight analysis of the factors affecting the development of the global energy interconnection was conducted separately by network level analysis and entropy method, and the weights are summed up by the method of additive integration, which gives the comprehensive weight of the influencing factors and the ranking of their influence.

Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review.

PubMed

Francke, Anneke L; Smit, Marieke C; de Veer, Anke J E; Mistiaen, Patriek

2008-09-12

Nowadays more and more clinical guidelines for health care professionals are being developed. However, this does not automatically mean that these guidelines are actually implemented. The aim of this meta-review is twofold: firstly, to gain a better understanding of which factors affect the implementation of guidelines, and secondly, to provide insight into the "state-of-the-art" regarding research within this field. A search of five literature databases and one website was performed to find relevant existing systematic reviews or meta-reviews. Subsequently, a two-step inclusion process was conducted: (1) screening on the basis of references and abstracts and (2) screening based on full-text papers. After that, relevant data from the included reviews were extracted and the methodological quality of the reviews was assessed by using the Quality Assessment Checklist for Reviews. Twelve systematic reviews met our inclusion criteria. No previous systematic meta-reviews meeting all our inclusion criteria were found. Two of the twelve reviews scored high on the checklist used, indicating only "minimal" or "minor flaws". The other ten reviews scored in the lowest of middle ranges, indicating "extensive" or "major" flaws. A substantial proportion (although not all) of the reviews indicates that effective strategies often have multiple components and that the use of one single strategy, such as reminders only or an educational intervention, is less effective. Besides, characteristics of the guidelines themselves affect actual use. For instance, guidelines that are easy to understand, can easily be tried out, and do not require specific resources, have a greater chance of implementation. In addition, characteristics of professionals - e.g., awareness of the existence of the guideline and familiarity with its content - likewise affect implementation. Furthermore, patient characteristics appear to exert influence: for instance, co-morbidity reduces the chance that guidelines

Factors influencing cancer treatment decision-making by indigenous peoples: a systematic review.

PubMed

Tranberg, Rona; Alexander, Susan; Hatcher, Deborah; Mackey, Sandra; Shahid, Shaouli; Holden, Lynda; Kwok, Cannas

2016-02-01

We aim to systematically review studies that identify factors influencing cancer treatment decision-making among indigenous peoples. Following the outline suggested by the Preferred Reporting Items for Systematic Review and Meta-analysis, a rigorous systematic review and meta-synthesis were conducted of factors that influence cancer treatment decision-making by indigenous peoples. A total of 733 articles were retrieved from eight databases and a manual search. After screening the titles and abstracts, the full text of 26 articles were critically appraised, resulting in five articles that met inclusion criteria for the review. Because the five articles to be reviewed were qualitative studies, the Critical Appraisal Skills Program toolkit was used to evaluate the methodological quality. A thematic synthesis was employed to identify common themes across the studies. Multiple socio-economic and cultural factors were identified that all had the potential to influence cancer treatment decision-making by indigenous people. These factors were distilled into four themes: spiritual beliefs, cultural influences, communication and existing healthcare systems and structures. Although existing research identified multiple factors influencing decision-making, this review identified that quality studies in this domain are scarce. There is scope for further investigation, both into decision-making factors and into the subsequent design of culturally appropriate programmes and services that meet the needs of indigenous peoples. Copyright © 2015 John Wiley & Sons, Ltd.

Factors Influencing Pursuit of Higher Education: Validating a Questionnaire.

ERIC Educational Resources Information Center

Harris, Sandra M.

This paper explains the process used to validate the construct validity of the Factors Influencing Pursuit of Higher Education Questionnaire. This questionnaire is a literature-based, researcher-developed instrument which gathers information on the factors thought to affect a person's decision to pursue higher education. The questionnaire includes…

Concrete pavement mixture design and analysis (MDA) : factors influencing drying shrinkage.

DOT National Transportation Integrated Search

2014-10-01

This literature review focuses on factors influencing drying shrinkage of concrete. Although the factors are normally interrelated, they : can be categorized into three groups: paste quantity, paste quality, and other factors.

Pattern of emergency neurologic morbidities in children.

PubMed Central

Ofovwe, Gabriel E.; Ibadin, Michael O.; Okunola, Peter O.; Ofoegbu, Bibian

2005-01-01

Neurologic morbidities seen in the children's emergency facility of the University of Benin Teaching Hospital, Nigeria, over a five-year period (July 1996-June 2001) was evaluated to determine the pattern and outcome. Notes and ward records of patients with neurologic morbidities were retrieved. Data obtained from these sources include age, sex principal diagnosis, duration of stay and outcome. Six-hundred-four out of 3,868 patients (15.6%) had neurologic morbidity. Children five years of age and under were 466 (77.2%), and modal age group was 1-2 years. Febrile convulsion was the most common neurologic morbidity seen (35.1%) followed by cerebral malaria (28.0%) and then meningitis (27.0%). An increased incidence of cases occurred during the rainy season. Sixty-four out of 406 with complete records (15.8%) died. Forty-seven (67.2%) died within 24 hours of admission. Cerebral malaria and meningitis accounted for all the deaths. Preventable infectious diseases are the major causes of emergency neurologic morbidities and mortality. The majority die within 24 hours largely due to a delay in presentation to the hospital. Effective malaria control and prevention of meningitis would reduce the incidence of neurologic morbidities and, if this is coupled with health education of the populace on the importance of attending health facility early, mortality from these causes would be greatly reduced. PMID:15871144

An Analysis of Factors that Influence Enlistment Decisions in the U.S. Army

DTIC Science & Technology

1998-03-01

NAVAL POSTGRADUATE SCHOOL Monterey, California CM THESIS AN ANALYSIS OF FACTORS THAT INFLUENCE ENLISTMENT DECISIONS IN THE U.S. ARMY by Young...TITLE AND SUBTITLE : AN ANALYSIS OF FACTORS THAT INFLUENCE ENLISTMENT DECISIONS IN THE U.S. ARMY 6. AUTHOR(S) Oh, Young Yeol 7...200 words) The purpose of this thesis is to analyze factors that influence decisions to enlist in the U.S. Army. This thesis uses 1997 New Recruit

Pharmacokinetics in Morbid Obesity: Influence of Two Bariatric Surgery Techniques on Paracetamol and Caffeine Metabolism.

PubMed

Goday Arno, Albert; Farré, Magí; Rodríguez-Morató, Jose; Ramon, Jose M; Pérez-Mañá, Clara; Papaseit, Esther; Civit, Ester; Langohr, Klaus; Lí Carbó, Marcel; Boix, David Benaiges; Nino, Olga Castañer; Le Roux, Juana Antonia Flores; Pera, Manuel; Grande, Luis; de la Torre, Rafael

2017-12-01

The purpose of the study was to study the impact of the two most common bariatric surgery techniques on paracetamol pharmacokinetics (a marker of gastric emptying) and caffeine metabolism (a marker of liver function). In the present prospective study, we studied 24 morbid obese patients before, at 4 weeks, and 6 months after having undergone sleeve gastrectomy (n = 10) or Roux-en-Y gastric bypass (n = 14). For comparative purposes, 28 healthy controls (14 normal weights and 14 overweights) were also included in the study. Paracetamol pharmacokinetics was altered in the obese participants leading to lower bioavailability. Bariatric surgery resulted in faster absorption and normalized pharmacokinetic parameters, prompting an increase in paracetamol bioavailability. No differences were found between surgical procedures. In the case of caffeine, the ratio paraxanthine/caffeine did not differ between morbid obese and healthy individuals. This ratio remained unmodified after surgery, indicating that the liver function (assessed by cytochrome P450 1A2 activity) was unaffected by obesity or bariatric surgery. Paracetamol pharmacokinetics and caffeine plasma levels are altered in severely obese patients. The two studied bariatric surgical techniques normalize paracetamol oral bioavailability without impairing the liver function (measured by cytochrome P450 1A2 activity).

From shared care to disease management: key-influencing factors

PubMed Central

Eijkelberg, Irmgard M.J.G.; Spreeuwenberg, Cor; Mur-Veeman, Ingrid M.; Wolffenbuttel, Bruce H.R.

2001-01-01

Abstract Background In order to improve the quality of care of chronically ill patients the traditional boundaries between primary and secondary care are questioned. To demolish these boundaries so-called ‘shared care’ projects have been initiated in which different ways of substitution of care are applied. When these projects end, disease management may offer a solution to expand the achieved co-operation between primary and secondary care. Objective Answering the question: What key factors influence the development and implementation of shared care projects from a management perspective and how are they linked? Theory The theoretical framework is based on the concept of the learning organisation. Design Reference point is a multiple case study that finally becomes a single case study. Data are collected by means of triangulation. The studied cases concern two interrelated Dutch shared care projects for type 2 diabetic patients, that in the end proceed as one disease management project. Results In these cases the predominant key-influencing factors appear to be the project management, commitment and local context, respectively. The factor project management directly links the latter two, albeit managing both appear prerequisites to its success. In practice this implies managing the factors' interdependency by the application of change strategies and tactics in a committed and skilful way. Conclusion Project management, as the most important and active key factor, is advised to cope with the interrelationships of the influencing factors in a gradually more fundamental way by using strategies and tactics that enable learning processes. Then small-scale shared care projects may change into a disease management network at a large scale, which may yield the future blueprint to proceed. PMID:16896415

From shared care to disease management: key-influencing factors.

PubMed

Eijkelberg, I M; Spreeuwenberg, C; Mur-Veeman, I M; Wolffenbuttel, B H

2001-01-01

In order to improve the quality of care of chronically ill patients the traditional boundaries between primary and secondary care are questioned. To demolish these boundaries so-called 'shared care' projects have been initiated in which different ways of substitution of care are applied. When these projects end, disease management may offer a solution to expand the achieved co-operation between primary and secondary care. Answering the question: What key factors influence the development and implementation of shared care projects from a management perspective and how are they linked? The theoretical framework is based on the concept of the learning organisation. Reference point is a multiple case study that finally becomes a single case study. Data are collected by means of triangulation. The studied cases concern two interrelated Dutch shared care projects for type 2 diabetic patients, that in the end proceed as one disease management project. In these cases the predominant key-influencing factors appear to be the project management, commitment and local context, respectively. The factor project management directly links the latter two, albeit managing both appear prerequisites to its success. In practice this implies managing the factors' interdependency by the application of change strategies and tactics in a committed and skillful way. Project management, as the most important and active key factor, is advised to cope with the interrelationships of the influencing factors in a gradually more fundamental way by using strategies and tactics that enable learning processes. Then small-scale shared care projects may change into a disease management network at a large scale, which may yield the future blueprint to proceed.

Critical factors and paths influencing construction workers' safety risk tolerances.

PubMed

Wang, Jiayuan; Zou, Patrick X W; Li, Penny P

2016-08-01

While workers' safety risk tolerances have been regarded as a main reason for their unsafe behaviors, little is known about why different people have different risk tolerances even when confronting the same situation. The aim of this research is to identify the critical factors and paths that influence workers' safety risk tolerance and to explore how they contribute to accident causal model from a system thinking perceptive. A number of methods were carried out to analyze the data collected through interviews and questionnaire surveys. In the first and second steps of the research, factor identification, factor ranking and factor analysis were carried out, and the results show that workers' safety risk tolerance can be influenced by four groups of factors, namely: (1) personal subjective perception; (2) work knowledge and experiences; (3) work characteristics; and (4) safety management. In the third step of the research, hypothetical influencing path model was developed and tested by using structural equation modeling (SEM). It is found that the effects of external factors (safety management and work characteristics) on risk tolerance are larger than that of internal factors (personal subjective perception and work knowledge & experiences). Specifically, safety management contributes the most to workers' safety risk tolerance through its direct effect and indirect effect; while personal subjective perception comes the second and can act as an intermedia for work characteristics. This research provides an in-depth insight of workers' unsafe behaviors by depicting the contributing factors as shown in the accident causal model developed in this research. Copyright © 2015 Elsevier Ltd. All rights reserved.

[The impact of preoperative biliary drainage on surgical morbidity in hilar cholangiocarcinoma patients].

PubMed

Li, Shao-qiang; Chen, Dong; Liang, Li-jian; Peng, Bao-gang; Yin, Xiao-yu

2009-08-01

To evaluate the impact of preoperative biliary drainage on surgical morbidity in hilar cholangiocarcinoma patients underwent surgery. One hundred and eleven consecutive patients with hilar cholangiocarcinoma whose serum total bilirubin (TBIL) level > 85 micromol/L and underwent surgery in the period from June 1998 to August 2007 were enrolled. There were 67 male and 44 female patients, aged from 26 to 82 years old with a mean of 56 years old. Fifty-five patients underwent preoperative biliary drainage with a mean of 11.4 d of drainage period (drainage group), the other (n = 56) were the non-drainage group. The preoperative TBIL level of drainage group was (154 +/- 69) micromol/L, which was significantly lower than the value of pre-drainage (256 +/- 136) micromol/L (P = 0.000) and the value of non-drainage group (268 +/- 174) micromol/L (P = 0.005). ALT and GGT levels could be lowered by preoperative biliary drainage. The postoperative complications of these two groups were comparable (36.3% vs. 28.6%, P = 0.381). Four patients in drainage group and 5 patients in non-drainage group died of liver failure. Multivariate logistic regression indicated that hepatectomy (OR = 0.284, P = 0.003) was the independent risk factor associated with postoperative morbidity. Bismuth-Corlette classification (OR = 0.211, P = 0.028) was the independent risk factor linked to postoperative mortality. Preoperative biliary drainage could alleviate liver injury due to hyperbilirubin, but it could not decrease the surgical morbidity and postoperative mortality. Concomitant hepatectomy and Bismuth-Corlette classification were independent risk factors linked to surgical risks.

Caregiver burden and correlates among caregivers of children and adolescents with psychiatric morbidity: a descriptive cross sectional study.

PubMed

Molebatsi, Keneilwe; Ndetei, David M; Opondo, Phillip R

2017-09-01

To determine levels and correlates of caregiver burden among caregivers of children and adolescents with psychiatric morbidity. Over a period of four months, a total of 252 caregivers of children and adolescents with psychiatric morbidity were recruited. Data on socio-demographic factors, psychiatric morbidity among caregivers, and level of caregiver burden was collected using a researcher-designed socio-demographic questionnaire, Mini International Neuropsychiatric Interview, and Zarit burden interview, respectively. Data was analysed using statistical package for social sciences (SPSS) version 21. Females (n = 211, 83.7%) and mothers (n = 182, 72.2%) accounted for the majority of the study participants. The majority of caregivers reported moderate to severe caregiver burden; (n = 100, 39.7%). Being single or separated (B = -6.91, p = 0.001, β = -0.18) and presence of psychiatric morbidity (B = 7.44, p = 0.009, β = 0.22) in the caregiver significantly contributed to the high levels of caregiver burden. Caregivers of children and adolescents with psychiatric morbidity suffer high levels of caregiver burden. A multidisciplinary approach to management of children with psychiatric morbidity to address challenges faced by the caregivers may alleviate the burden; thereby improving clinical outcomes of children and adolescents with psychiatric morbidity.

Are self-reports of health and morbidities in developing countries misleading? Evidence from India

PubMed Central

Subramanyam, Malavika A; Selvaraj, Sakthivel; Kawachi, Ichiro

2009-01-01

Self reported measures of poor health and morbidities from developing countries tend to be viewed with considerable skepticism. Examination of the social gradient in self-reported health and morbidity measures provides a useful test of the validity of self-reports of poor-health and morbidities. The prevailing view, in part influenced by Amartya Sen, is that socially disadvantaged individuals will fail to perceive and report the presence of illness or health-deficits because an individual’s assessment of their health is directly contingent on their social experience. In this study, we tested whether the association between self-reported poor-health/morbidities and socioeconomic status (SES) in India follows the expected direction or not. Cross sectional logistic regression analyses were carried out on a nationally representative population based sample from the 1998–99 Indian National Family Health Survey (INFHS); and 1995–96 and 2004 Indian National Sample Survey (INSS). Four binary outcomes were analyzed: any self-reported morbidity; self-reported sickness in the last 15 days; self-reported sickness in the past year; and poor self-rated health. In separate adjusted models, individuals with no education reported higher levels of any self-reported, self-reported sickness in the last 15 days, self-reported sickness in the last year, and poor self-rated health compared to those with most education. Contrary to the prevailing thesis, we find that the use of self-rated ill health has face validity as assessed via its relationship to SES. A less dismissive and pessimistic view of health data obtained through self-reports seems warranted. PMID:19019521

Are self-reports of health and morbidities in developing countries misleading? Evidence from India.

PubMed

Subramanian, S V; Subramanyam, Malavika A; Selvaraj, Sakthivel; Kawachi, Ichiro

2009-01-01

Self-reported measures of poor health and morbidities from developing countries tend to be viewed with considerable skepticism. Examination of the social gradient in self-reported health and morbidity measures provides a useful test of the validity of self-reports of poor health and morbidities. The prevailing view, in part influenced by Amartya Sen, is that socially disadvantaged individuals will fail to perceive and report the presence of illness or health-deficits because an individual's assessment of their health is directly contingent on their social experience. In this study, we tested whether the association between self-reported poor health/morbidities and socioeconomic status (SES) in India follows the expected direction or not. Cross-sectional logistic regression analyses were carried out on a nationally representative population-based sample from the 1998 to 1999 Indian National Family Health Survey (INFHS); and 1995-1996 and 2004 Indian National Sample Survey (INSS). Four binary outcomes were analyzed: any self-reported morbidity; self-reported sickness in the last 15 days; self-reported sickness in the past year; and poor self-rated health. In separate adjusted models, individuals with no education reported higher levels of any self-reported, self-reported sickness in the last 15 days, self-reported sickness in the last year, and poor self-rated health compared to those with most education. Contrary to the prevailing thesis, we find that the use of self-rated ill-health has face validity as assessed via its relationship to SES. A less dismissive and pessimistic view of health data obtained through self-reports seems warranted.

Alcohol-related morbidity and mortality within siblings.

PubMed

Søndergaard, Grethe; Osler, Merete; Andersen, Anne-Marie Nybo; Andersen, Per Kragh; Dalton, Susanne Oksbjerg; Mortensen, Laust H

2015-03-01

To estimate the association between educational status and alcohol-related somatic and non-somatic morbidity and mortality among full siblings in comparison with non-related individuals. Cohort study. Denmark. Approximately 1.4 million full siblings born in Denmark between 1950 and 1979 were followed from age 28-58 years or censoring due to alcohol-related hospitalization and mortality. Cox regression analyses were used to estimate associations of educational status with alcohol-related outcomes. Results from cohort analyses based on non-related individuals and inter-sibling analyses were compared. A lower educational status was associated with a higher rate of alcohol-related outcomes, especially among the youngest (aged 28-37 years) and individuals born 1970-79. Compared with the cohort analyses, the associations attenuated slightly in the inter-sibling analysis. For example, in the cohort analysis, females with a basic school education born 1970-79 had an increased rate of alcohol-related non-somatic morbidity and mortality [hazard rate ratio (HR) = 4.05, 95% confidence interval (CI) = 3.27-5.02] compared to those with a vocational education. In the inter-sibling analysis, the HR attenuated (HR = 2.66, 95% CI = 1.95-3.63). For alcohol-related somatic outcomes the corresponding figures were HR = 3.47 (95% CI = 2.63-4.58) and HR = 3.36 (95% CI = 2.10-5.38), respectively. In general, the associations were stronger among females than males (aged 28-37) in the analyses of alcohol-related non-somatic outcomes. Health conditions earlier in life explained only a minor part of the associations. The association between educational status and alcohol-related somatic and non-somatic morbidity and mortality is only driven by familial factors to a small degree. © 2014 Society for the Study of Addiction.

Factors influencing behavior in the forced swim test

PubMed Central

Bogdanova, Olena V.; Kanekar, Shami; D’Anci, Kristen E.; Renshaw, Perry F.

2017-01-01

The forced swim test (FST) is a behavioral test in rodents which was developed in 1978 by Porsolt and colleagues as a model for predicting the clinical efficacy of antidepressant drugs. A modified version of the FST added the classification of active behaviors into swimming and climbing, in order to facilitate the differentiation between serotonergic and noradrenergic classes of antidepressant drugs. The FST is now widely used in basic research and the pharmaceutical screening of potential antidepressant treatments. It is also one of the most commonly used tests to assess depressive-like behavior in animal models. Despite the simplicity and sensitivity of the FST procedure, important differences even in baseline immobility rates have been reported between different groups, which complicate the comparison of results across studies. In spite of several methodological papers and reviews published on the FST, the need still exists for clarification of factors which can influence the procedure. While most recent reviews have focused on antidepressant effects observed with the FST, this one considers the methodological aspects of the procedure, aiming to summarize issues beyond antidepressant action in the FST. The previously published literature is analyzed for factors which are known to influence animal behavior in the FST. These include biological factors, such as strain, age, body weight, gender and individual differences between animals; influence of preconditioning before the FST: handling, social isolation or enriched environment, food manipulations, various kinds of stress, endocrine manipulations and surgery; schedule and routes of treatment, dosage and type of the drugs as well as experimental design and laboratory environmental effects. Consideration of these factors in planning experiments may result in more consistent FST results. PMID:23685235

Assessment of respiration-related quality of life of Chinese patients with silicosis and its influencing factors using the St. George's Respiratory Questionnaire (SGRQ).

PubMed

Liu, Hongbo; Yan, Bo; Han, Bing; Sun, Jinkai; Yang, Yang; Chen, Jie

2012-06-01

The aims are to assess respiration-related quality of life using the St. George Respiratory Questionnaire and determine its influencing factors among patients with silicosis in China. The incidence of silicosis had an increasing trend in recent years in developing countries. Although the majority of patients with silicosis are in therapy routinely, the patients' quality of life has been impaired because silicosis cannot be cured. The study on quality of life of patients with silicosis is few, and clinical physicians have difficulty in planning to promote quality of life of patients with silicosis according to the current health situation. A cross-sectional design was used for this study. A survey was performed on patients with silicosis by face-to-face interview in the Shenyang No. 9 Hospital in China. The St. George Respiratory Questionnaire was used to assess respiration-related quality of life. In all 208 enrolled patients with silicosis, symptoms, activity and impacts scores were 56·02, 56·46 and 52·33, respectively. Lower impacts scores were found comparing with symptoms and activity ones. Patient age was associated with an expected decrease in respiration-related quality of life. Patients with longer duration of exposure had higher total scores of the St. George Respiratory Questionnaire, indicating worse quality of life. Patients with more co-morbidities reported worse quality of life. Patients with silicosis were found relatively moderate respiration-related quality of life. Shortening dust exposure, decreasing the number of co-morbidity and controlling the occurrence of pulmonary tuberculosis could improve respiration-related quality of life. As indicated by the results of this study, the number of co-morbidity negatively impact the quality of life of patients with silicosis. Clinical physicians and nurses should pay close attention to the co-morbidity to promote quality of life of patients with silicosis according to the current health situation. �

Motivating Factors Influencing College Students' Choice of Academic Major

PubMed Central

Brocavich, Joseph M.; Boone, R. Thomas; Pal, Somnath

2010-01-01

Objectives To assess the factors, motivations, and nonacademic influences that affected the choice of major among pharmacy and nonpharmacy undergraduate students. Methods A survey was administered to 618 pharmacy and nonpharmacy majors to assess background and motivational factors that may have influenced their choice of major. The sample consisted of freshman and sophomore students enrolled in a required speech course. Results African-American and Hispanic students were less likely to choose pharmacy as a major than Caucasians, whereas Asian-Americans were more likely to choose pharmacy as a major. Pharmacy students were more likely to be interested in science and math than nonpharmacy students. Conclusion Students' self-reported racial/ethnic backgrounds influence their decision of whether to choose pharmacy as their academic major. Results of this survey provide further insight into developing effective recruiting strategies and enhancing the marketing efforts of academic institutions. PMID:20498739

Factors influencing tinnitus loudness and annoyance.

PubMed

Hiller, Wolfgang; Goebel, Gerhard

2006-12-01

To evaluate the 2 major components of tinnitus severity, loudness and annoyance, and their degree of dependence on characteristics of tinnitus manifestation, history, and etiology. Cross-sectional survey performed during the first months of 2004. Nonclinical population. A total of 4995 members of the German Tinnitus League. Comprehensive screening questionnaire, including the Klockhoff and Lindblom loudness grading system and the miniversion of the Tinnitus Questionnaire. A moderate correlation of 0.45 was found between tinnitus loudness and annoyance. Both factors were generally higher in men, those older than 50 years, those with binaural and centrally perceived tinnitus, those with increased noise sensitivity, and those who had continuous tinnitus without interruptions. Tinnitus that lasted 12 months or less had a stronger influence on annoyance (odds ratio [OR], 1.96) than on loudness (OR, 0.45), whereas the contrary was found for tinnitus of more than 5 years' duration (ORs, 0.72 and 2.11, respectively). Loudness and annoyance were increased in subjects with coexisting hearing loss, vertigo, and hyperacusis. The impact of hyperacusis on annoyance was clearly stronger than on loudness (ORs, 21.91 vs 9.47). Several clinical factors of tinnitus influence perceived loudness and annoyance. Both are distinguishable components of tinnitus severity.

The influence of risperidone on attentional functions in children and adolescents with attention-deficit/hyperactivity disorder and co-morbid disruptive behavior disorder.

PubMed

Günther, Thomas; Herpertz-Dahlmann, Beate; Jolles, Jellemer; Konrad, Kerstin

2006-12-01

This study aims to examine the influence of risperidone on various attentional functions, including intensity and selectivity aspects of attention plus inhibitory control in children with attention deficit/hyperactivity disorder (ADHD) with co-morbid Disruptive Behavior Disorders (DBD) and normal IQ. Children with ADHD and DBD, aged 8-15 years, were treated with risperidone (mean daily dose: 1.5 mg; n = 23) and examined with three attentional paradigms before and after a 4-week treatment period. Age- and IQ-matched normal controls (n = 23) were also tested without medication on the same two occasions. No influence of the medication could be detected for any neuropsychological variable, neither as a positive enhancement nor as adverse side effects. However, clinical symptoms of ADHD and DBD assessed on the IOWA Conners Scale significantly improved after the 4-week treatment period. Divergent behavioral and cognitive effects of risperidone on ADHD symptoms were observed, with a significant reduction in behavioral symptoms, whereas no positive treatment effects were found on laboratory tasks of impulsivity. Thus, the cognitive effects of risperidone seem to differ from the cognitive effects of stimulant treatments in children with ADHD + DBD. However, no negative impact of risperidone was observed on attentional functions either, i.e., there was no slowing of cognitive speed.

29 CFR 98.860 - What factors may influence the debarring official's decision?

Code of Federal Regulations, 2010 CFR

2010-07-01

... your present responsibility. In making a debarment decision, the debarring official may consider the... 29 Labor 1 2010-07-01 2010-07-01 true What factors may influence the debarring official's decision... (NONPROCUREMENT) Debarment § 98.860 What factors may influence the debarring official's decision? This section...

Estimating prevalence of coronary heart disease for small areas using collateral indicators of morbidity.

PubMed

Congdon, Peter

2010-01-01

Different indicators of morbidity for chronic disease may not necessarily be available at a disaggregated spatial scale (e.g., for small areas with populations under 10 thousand). Instead certain indicators may only be available at a more highly aggregated spatial scale; for example, deaths may be recorded for small areas, but disease prevalence only at a considerably higher spatial scale. Nevertheless prevalence estimates at small area level are important for assessing health need. An instance is provided by England where deaths and hospital admissions for coronary heart disease are available for small areas known as wards, but prevalence is only available for relatively large health authority areas. To estimate CHD prevalence at small area level in such a situation, a shared random effect method is proposed that pools information regarding spatial morbidity contrasts over different indicators (deaths, hospitalizations, prevalence). The shared random effect approach also incorporates differences between small areas in known risk factors (e.g., income, ethnic structure). A Poisson-multinomial equivalence may be used to ensure small area prevalence estimates sum to the known higher area total. An illustration is provided by data for London using hospital admissions and CHD deaths at ward level, together with CHD prevalence totals for considerably larger local health authority areas. The shared random effect involved a spatially correlated common factor, that accounts for clustering in latent risk factors, and also provides a summary measure of small area CHD morbidity.

Estimating Prevalence of Coronary Heart Disease for Small Areas Using Collateral Indicators of Morbidity

PubMed Central

Congdon, Peter

2010-01-01

Different indicators of morbidity for chronic disease may not necessarily be available at a disaggregated spatial scale (e.g., for small areas with populations under 10 thousand). Instead certain indicators may only be available at a more highly aggregated spatial scale; for example, deaths may be recorded for small areas, but disease prevalence only at a considerably higher spatial scale. Nevertheless prevalence estimates at small area level are important for assessing health need. An instance is provided by England where deaths and hospital admissions for coronary heart disease are available for small areas known as wards, but prevalence is only available for relatively large health authority areas. To estimate CHD prevalence at small area level in such a situation, a shared random effect method is proposed that pools information regarding spatial morbidity contrasts over different indicators (deaths, hospitalizations, prevalence). The shared random effect approach also incorporates differences between small areas in known risk factors (e.g., income, ethnic structure). A Poisson-multinomial equivalence may be used to ensure small area prevalence estimates sum to the known higher area total. An illustration is provided by data for London using hospital admissions and CHD deaths at ward level, together with CHD prevalence totals for considerably larger local health authority areas. The shared random effect involved a spatially correlated common factor, that accounts for clustering in latent risk factors, and also provides a summary measure of small area CHD morbidity. PMID:20195439

Factors influencing utilisation of maternal health services by adolescent mothers in Low-and middle-income countries: a systematic review.

PubMed

Banke-Thomas, Oluwasola Eniola; Banke-Thomas, Aduragbemi Oluwabusayo; Ameh, Charles Anawo

2017-02-16

Adolescent mothers aged 15-19 years are known to have greater risks of maternal morbidity and mortality compared with women aged 20-24 years, mostly due to their unique biological, sociological and economic status. Nowhere Is the burden of disease greater than in low-and middle-income countries (LMICs). Understanding factors that influence adolescent utilisation of essential maternal health services (MHS) would be critical in improving their outcomes. We systematically reviewed the literature for articles published until December 2015 to understand how adolescent MHS utilisation has been assessed in LMICs and factors affecting service utilisation by adolescent mothers. Following data extraction, we reported on the geographical distribution and characteristics of the included studies and used thematic summaries to summarise our key findings across three key themes: factors affecting MHS utilisation considered by researcher(s), factors assessed as statistically significant, and other findings on MHS utilisation. Our findings show that there has been minimal research in this study area. 14 studies, adjudged as medium to high quality met our inclusion criteria. Studies have been published in many LMICs, with the first published in 2006. Thirteen studies used secondary data for assessment, data which was more than 5 years old at time of analysis. Ten studies included only married adolescent mothers. While factors such as wealth quintile, media exposure and rural/urban residence were commonly adjudged as significant, education of the adolescent mother and her partner were the commonest significant factors that influenced MHS utilisation. Use of antenatal care also predicted use of skilled birth attendance and use of both predicted use of postnatal care. However, there may be some context-specific factors that need to be considered. Our findings strengthen the need to lay emphasis on improving girl child education and removing financial barriers to their access to MHS

Obstructive Sleep Apnea: Differences between Normal-Weight, Overweight, Obese, and Morbidly Obese Children.

PubMed

Scott, Brian; Johnson, Romaine F; Mitchell Md, Ron B

2016-05-01

The severity of obstructive sleep apnea in children determines perioperative management and is an indication for postoperative polysomnography. The relationship between increasing weight and sleep apnea severity in children remains unclear. To compare demographic, clinical, and polysomnography parameters in normal-weight, overweight, obese, and morbidly obese children, as well as identify demographic factors that predict sleep apnea severity. Case series with chart review. Academic children's hospital. A retrospective chart review of 290 children aged 2 to 18 years who underwent polysomnography at an academic children's hospital was performed. Demographics, clinical findings, and polysomnographic parameters were recorded. Children were categorized as normal weight, overweight, obese, or morbidly obese. Differences were assessed using linear and logistical regression models. Significance was set at P < .05. Morbidly obese were older than normal-weight children (mean, 8.0 ± 0.5 years vs 5.8 ± 0.3 years; P < .001) and less likely to have a normal polysomnogram (16% vs 48%; P = .02). There were no differences in sex, ethnicity, birth status (term or preterm), or tonsil size between normal-weight, overweight, obese, and morbidly obese children. Sleep efficiency and percentage of time in rapid eye movement were decreased in morbidly obese compared with other children (P < .05). The apnea-hypopnea index was positively correlated with increasing body mass index z score only as a function of increasing age (P < .001). Obstructive sleep apnea severity is correlated with a combination of increasing age and weight but not with either variable independently. This study suggests that obese and morbidly obese older children are most likely to have severe obstructive sleep apnea. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

National trends and differences in morbidity among surgical approaches for radical prostatectomy in Germany.

PubMed

Stolzenburg, Jens Uwe; Kyriazis, Iason; Fahlenbrach, Claus; Gilfrich, Christian; Günster, Christian; Jeschke, Elke; Popken, Gralf; Weißbach, Lothar; von Zastrow, Christoph; Leicht, Hanna

2016-11-01

In this study, we document trends in radical prostatectomy (RP) employment in Germany during the period 2005-2012 and compare the morbidity of open (ORP), laparoscopic and robotic-assisted RP based on nationwide administrative data of Allgemeine Ortskrankenkassen (AOK) German local healthcare funds. Administrative claims data of all AOK patients subjected to RP during 2005-2012 (57,156 cases) were used to evaluate the employment of minimally invasive RP (MIRP) procedures, pelvic lymph node dissection (PLND) and nerve-sparing approaches during this period. In addition, data from the most recent three-year period of our dataset (2010-2012) were used to compare the morbidity among the different surgical approaches. Study end points comprised 30-day mortality, 30-day transfusion, 1-year reintervention and 30-day adverse events, as well as 1-year overall complications. A 20 % reduction in RP utilization from 2007 to 2012 was documented. ORP remained the predominant RP approach in Germany. MIRP approaches carried a lower risk of 30-day transfusions, 1-year reinterventions and 1-year overall complications than ORP when adjusting for confounding factors. PLND was associated with an increased risk of complications, while age in the highest quintile and the presence of comorbidities were independent risk factors for morbidity and mortality. Lack of pathological data was the main limitation of the study. RP utilization in Germany is dropping, but the use of MIRP has risen steadily during the years 2005-2012, which is expected to have a positive impact on the morbidity of the operation.

Factors influencing societal response of nanotechnology: an expert stakeholder analysis.

PubMed

Gupta, Nidhi; Fischer, Arnout R H; van der Lans, Ivo A; Frewer, Lynn J

2012-05-01

Nanotechnology can be described as an emerging technology and, as has been the case with other emerging technologies such as genetic modification, different socio-psychological factors will potentially influence societal responses to its development and application. These factors will play an important role in how nanotechnology is developed and commercialised. This article aims to identify expert opinion on factors influencing societal response to applications of nanotechnology. Structured interviews with experts on nanotechnology from North West Europe were conducted using repertory grid methodology in conjunction with generalized Procrustes analysis to examine the psychological constructs underlying societal uptake of 15 key applications of nanotechnology drawn from different areas (e.g. medicine, agriculture and environment, chemical, food, military, sports, and cosmetics). Based on expert judgement, the main factors influencing societal response to different applications of nanotechnology will be the extent to which applications are perceived to be beneficial, useful, and necessary, and how 'real' and physically close to the end-user these applications are perceived to be by the public. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11051-012-0857-x) contains supplementary material, which is available to authorized users.

Waiting for thyroid surgery: a study of psychological morbidity and determinants of health associated with long wait times for thyroid surgery.

PubMed

Eskander, Antoine; Devins, Gerald M; Freeman, Jeremy; Wei, Alice C; Rotstein, Lorne; Chauhan, Nitin; Sawka, Anna M; Brown, Dale; Irish, Jonathan; Gilbert, Ralph; Gullane, Patrick; Higgins, Kevin; Enepekides, Danny; Goldstein, David

2013-02-01

Patients with thyroid pathology tend have longer surgical wait times. Uncertainty during this wait can have negative psychologically impact. This study aims to determine the degree of psychological morbidity in patients waiting for thyroid surgery. Prospectively assessing patients pre- and postoperative psychological morbidity (level 2c). Patients waiting for thyroidectomy were mailed a sociodemographic and four psychological morbidity questionnaires: Impact of Events Scale-Revised (IES-R), Illness Intrusiveness Ratings Scale (IIRS), Perceived Stress Scale (PSS) and Hospital Anxiety and Depression Scale (HADS). We assessed whether anxiety was related to length of wait and a number of clinical/sociodemographic factors. We achieved a 53% response rate over a 3-year period, with 176 patients providing complete preoperative data; and 74 (42%) completed postoperative data. The average age was 53 (± 12) years; 82% were female. Respondents with a suspicious or known malignancy waited an average of 107 days while those with benign neoplastic biopsies waited an average of 218 days for thyroidectomy. Respondents reported substantial psychological morbidity with high IES-R, IIRS, PSS, and HADS scores. There was no significant association between psychological morbidity and wait times, clinical or sociodemographic factors. Postoperative anxiety decreased significantly in all psychological morbidity measures except for the IIRS. Patients waiting for thyroid surgery have mild to moderate psychological morbidity and long wait times for surgery. These appear not to be related. Psychological morbidity decreases after surgery. Reducing wait time can potentially reduce the time that patients have to live with unnecessary stress and anxiety. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

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

Factors influencing the pathways in response to complaints.

PubMed

Hsieh, Sophie Yahui

2010-01-01

The purpose of this paper is to explore hospital staff response to patient complaints and the factors influencing the response pathway. The paper uses an exploratory study in a large Taiwanese hospital purposefully chosen as a case study site. The critical incident technique (CIT) is implemented, using a questionnaire along with non-participant observations in which the results have been triangulated. A total of 59 cases were collected. The study found when facing "humaneness" complaints, hospital staff attempted to investigate the event and then explain the facts to the complainant or empathise with him/her and then refer the problem to the relevant unit. In response to complaints combining "communication" and "care/treatment and humaneness", staff tended to investigate the event's details and then directly explain them to the complainant. When complaints involved "care/treatment", staff tended to empathise with the complainant, investigate the facts and explain them to the complainant. Additionally, the organisational response to complaints was influenced by who made complaints; its type, severity, complaining method and patient status. The literature revealed that the case study is the most common organisational study method. However, this approach is criticised for not offering findings that can be generalised. Complaint nature is the major factor influencing the response pathway. If healthcare managers intend to reduce complaint rates then they need to carefully classify the complaint's nature. Different complaints have different handling procedures and guidelines to help managers resolve complaints in the first place. There are extensive studies focusing on investigating complaints and their resolution. These studies tend not to demonstrate various means of handling patient complaints. Neither do they describe how different complaints might lead to different outcomes. Therefore, this paper explores hospital staff response to patient complaints and the factors

Factors influencing the incidence of maxillofacial fractures.

PubMed

Chrcanovic, Bruno Ramos

2012-03-01

Maxillofacial injuries occur in a significant proportion of trauma patients. Trauma causes considerable economic expense due to procedural costs, the time a patient is off work, and the associated loss of income. For these reasons, it is an important health and economic issue. The aim of this study is to discuss the factors that may influence the incidence of maxillofacial fractures. As it is necessary to determine trends to help guide the development of new methods of injury prevention, preventative measures are also discussed. An electronic search was undertaken in March 2011, including articles published between 1980 and 2011 with the terms "facial fractures" and "maxillofacial fractures" in the title. The texts of epidemiological studies were reviewed in order to identify factors that may influence the incidence of maxillofacial fractures. From the selected articles, ten factors were identified: age, gender, geographic region and cultural aspects, socioeconomic status, temporal and climatic influence, use of alcohol and drugs, compliance with road traffic legislation, domestic violence, osteoporosis, and etiology of the maxillofacial trauma. Care of injured patients should include not only management of the acute phase, but also combine preventive programs and interventional programs aimed at reducing the incidence of maxillofacial fractures. Therefore, there is a need to ensure strict compliance of traffic rules and regulations, implement improvement in automotive safety devices, organize prevention programs to minimize assaults, implement school education in alcohol abuse and handling potentially hostile situations (especially for men), improve protection during sporting activities, and legislate wearing of protective headgear in workers. Preventive strategies remain the cheapest way to reduce direct and indirect costs of the sequelae of trauma. Societal attitudes and behaviors must be modified before a significant reduction in the incidence of maxillofacial

Morbidity and process of care in urban Malaysian general practice: the impact of payment system.

PubMed

Teng, C L; Aljunid, S M; Cheah, Molly; Leong, K C; Kwa, S K

2003-08-01

The majority of primary care consultations in Malaysia occur in the general practice clinics. To date, there is no comprehensive documentation of the morbidity and practice activities in this setting. We reported the reasons for encounter, diagnoses and process of care in urban general practice and the influence of payment system on the morbidity and practice activities. 115 clinics in Kuala Lumpur, Ipoh and Penang participated in this study. General practitioners in these clinics completed a 2-page questionnaire for each of the 30 consecutive patients. The questionnaire requested for the following information: demographic data, reasons for encounter, important physical findings, diagnoses, investigations ordered, outpatient procedures performed, medical certificate given, medication prescribed and referral made. The morbidity (reasons for encounter and diagnoses) was coded using ICPC-2 and the medication data was coded using MIMS Classification Index. During 3481 encounters, 5300 RFEs (152 RFEs per 100 encounters) and 3342 diagnoses (96 diagnoses per 100 encounters) were recorded. The majority of the RFEs and diagnoses are in the following ICPC Chapters: Respiratory, General and unspecified, Digestive, Neurological, Musculoskeletal and Skin. The frequencies of selected aspects of the process of care (rate per 100 encounters) were: laboratory investigations 14.7, outpatient procedures 2.4, sick certification 26.9, referral 2.4, and medication prescription 244. Consultation for chronic diseases and acute infections were influenced more by demographic variables (age, employment) rather than payment system. Cash-paying patients were more likely to receive laboratory investigations and injections. This study demonstrated the breadth of clinical care in the general practice. Relatively fewer patients consulted specifically for preventive care and treatment of chronic diseases. The frequencies of outpatient procedures and referrals appeared to be low. Payment system

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. Copyright © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Organizational factors influencing successful primary care and public health collaboration.

PubMed

Valaitis, Ruta; Meagher-Stewart, Donna; Martin-Misener, Ruth; Wong, Sabrina T; MacDonald, Marjorie; O'Mara, Linda

2018-06-07

Public health and primary care are distinct sectors within western health care systems. Within each sector, work is carried out in the context of organizations, for example, public health units and primary care clinics. Building on a scoping literature review, our study aimed to identify the influencing factors within these organizations that affect the ability of these health care sectors to collaborate with one another in the Canadian context. Relationships between these factors were also explored. We conducted an interpretive descriptive qualitative study involving in-depth interviews with 74 key informants from three provinces, one each in western, central and eastern Canada, and others representing national organizations, government, or associations. The sample included policy makers, managers, and direct service providers in public health and primary care. Seven major organizational influencing factors on collaboration were identified: 1) Clear Mandates, Vision, and Goals; 2) Strategic Coordination and Communication Mechanisms between Partners; 3) Formal Organizational Leaders as Collaborative Champions; 4) Collaborative Organizational Culture; 5) Optimal Use of Resources; 6) Optimal Use of Human Resources; and 7) Collaborative Approaches to Programs and Services Delivery. While each influencing factor was distinct, the many interactions among these influences are indicative of the complex nature of public health and primary care collaboration. These results can be useful for those working to set up new or maintain existing collaborations with public health and primary care which may or may not include other organizations.

Research on Influencing Factors of Salespeople's Empowerment Readiness in Green Energy Enterprise